Does Glucosamine Work?

A recent study published in the British Medical Journal suggests the popular joint pain supplement glucosamine is ineffective, which brings up the question I’m often asked:  does glucosamine work?

First off, let’s define what we’re talking about.  The reason why people take glucosamine is they’re having joint pain, which can be caused by a lot of different things.  One of the potential causes is something called osteoarthritis or DJD (degenerative joint disease).

WHAT IS DJD?

I prefer the term DJD to osteoarthritis, partly because it’s easier to type, but mostly because it’s a more descriptive term and less likely to confuse people.  “Arthritis” is a general term, and a lot of people simply say they’ve “got arthritis” without knowing what KIND of arthritis they have.  Osteoarthritis is very, very different from Rheumatoid arthritis, but they’re often confused, so let’s define the terms.

DJD or osteoarthritis is, simply put, wear-and-tear arthritis.  It’s the arthritis of overuse.  Think of a marathon runner who doesn’t have any cartilage left in their knees, and you’re getting the picture.  Essentially, you’ve been breaking down the supporting structures of the joint faster than your body can replace those damaged bits, and by slow degrees, you’ve “degenerated”, or worn out, that joint.

Rheumatoid arthritis, on the other hand, is an autoimmune condition in which the body attacks itself.  One way you can tell the difference is that RA affects many joints all over, while DJD only affects one or two joints (the ones you’re over-using).  There’s blood tests that will tell you the difference too.

The point is, DJD is the slow wearing down of the joint.  Specifically, the cartilage that cushions and protects the joint.  And, as that cartilage wears away, you start to get bones grinding on bones.  Ouch.

HOW DOES GLUCOSAMINE WORK?

The basic idea behind glucosamine supplementation is to make it much easier for your body to create cartilage.  Glucosamine is a precursor for glucosaminoglycans (try saying THAT with a mouthful of marbles!), which are a big ingredient in cartilage.

It’s kind of difficult to make cartilage.  Your body tends to do it pretty slowly.  So, the theory goes, if we give the body tons of the building blocks of cartilage, the body will be able to make cartilage more quickly and perhaps keep up with that slow degeneration associated with DJD.  Or, if we’re lucky, even reverse that decline and build up a surplus of cartilage to replace what’s already been lost.

That’s the idea, at least.  But does glucosamine really work?

LATEST STUDY ON GLUCOSAMINE

This British Medical Journal study took a look at the use of glucosamine and another common co-supplement, chondroitin, to see if people were getting any pain relief.  They also took a look at seeing if there was any increase in joint space (from more cartilage being formed, which doesn’t show up on an Xray but will make the space between bones look bigger).

Their findings were not encouraging.  They found very small, clinically insignificant differences in pain from placebo.  They didn’t find much at all for increase in joint space.  Their conclusion?  Glucosamine doesn’t work.  Chuck it out the window.

But is their study any good?

The researchers used what’s called a meta-analysis, which isn’t a term for the Monster Truck of studies. It basically just means you add up other people’s research.  In a regular study, I take a bunch of people and call them “subjects” and do stuff to them I can measure and compare to a control group.  In other words, I generate data.

In a meta-analysis, I take the data from your study, and another guy’s study, and his friend’s study, and their second cousin’s barber’s study, and any other study I can find, and use that.  Rather than generate data, I borrow it from other people.

The upside is, wow, now I’ve got tons of really, really cheap data.  I don’t have to recruit unsuspecting schulbs to be in my study, or pay for materials, or really do much of anything.  Awesome.

The downside is, my results can very, very easily be skewed in an inaccurate direction.  What if I pick only those research articles that support my position, and leave out the ones that might disagree with me?  That’s hardly accurate.  And it happens a lot more than you think.

Oh, it’s not always due to an evil desire to confuse people just for the sake of getting published. Researchers get attached to their ideas.  Often, they will “discard” studies they feel don’t meet up to their standards, when really, those studies just disagreed with their pre-conceived ideas.

I bring this up because these researchers’ findings conflict somewhat with my clinical experience with glucosamine.  So let me share that with you and why I think a lot of studies are flawed when it comes to this particular supplement.

MY RESULTS WITH GLUCOSAMINE

Put most simply, about fifty-fifty.  About half of people who try out glucosamine end up seeing some results.  It doesn’t seem to matter whether it’s the sulfate version, chondroitin, or if they add in MSM (a common co-supplement for joint pain).

What DOES matter is that they take the stuff religiously for six to eight weeks at LEAST to find out if it’s going to work.  And, they need to spread the dose out during the day.  Glucosamine usually comes in 500 mg tablets, and you need 1500 mg a day as a typical therapeutic dose, so you take a tablet with breakfast, lunch and dinner.

And when I say take it religiously, I mean it.  Don’t miss one dose.  And after about two months, you’ll have a fifty-fifty shot at whether or not it works.

So the first question is, did these British researchers pick studies for their meta-analysis that followed those guidelines?  All I can see in their abstract (study summary) is that they chose studies with a large sample size (over 200 subjects).  Nothing about length of time, dosage used, or any of the other details that can derail any sort of clinical regimen.

If something works, but you don’t use it right… it doesn’t work!

INCREASE YOUR ODDS

Here’s a little something extra from your buddy Healthy Andy.  You can increase your odds of making glucosamine effective by making sure you add in light to moderate exercise while you take that supplement.

Wait, what? Didn’t I say earlier that DJD came from overuse?  And now I’m telling you to use the very joint that’s been broken down by overuse?

That’s right.  Because you didn’t break it down with use.  You broke it down with OVERUSE.

Here’s the secret to building up any area of the body you want to.  There are three basic components that interact to create growth: the signal to grow, the material needed to grow, and the opportunity to use that material to grow.

The signal to grow is called stress.  Exercise is a really just stressing the body to signal it that it needs to grow.  That’s all.  It’s the body’s reaction to that stress that leads to the actual growth of tissue.

So first you signal the body.  Then, of course, the body needs the physical building blocks to make it happen.  This is different for various tissues (muscle, bone, tendon, whatever), but in the case of DJD, we’re talking cartilage so we’re also talking glucosamine.

Lastly, you have to give the body a freakin’ chance to actually do its work.  We call this “rest”, and it’s an often-ignored part of physical training, because it sounds lazy and you can’t sell books or DVDs called “Get Ripped And Huge With Rest!”.

HOW TO MAKE CARTILAGE GROW

Therefore, if we want cartilage to grow, not only do we need to provide the materials (like glucosamine), but also we must SIGNAL the body that it needs to actually USE those materials for something.

It doesn’t do me a damn bit of good to suck down gobs and gobs of protein powder if I never bother to work out.  So why should just popping glucosamine pills help me if I never signal the body to build up that joint?  Again, we signal the body to build up a joint with stress (exercise).

The tricky part is, we don’t want to put so much stress on the joint that we continue to break it down.  So the dance is, find the right amount of stress to signal the body for growth while not overwhelming an already weak area.

A good rule of thumb is, let discomfort be your guide.  Light to moderate is the buzzword, and the other key phrase is “to tolerance”.  That means, don’t go until it hurts.  If you put discomfort on a scale from one to ten, one being “I notice it, but I only barely notice it” and ten being “Oh Dear God, I feel like I am burning alive, please shoot me!”, then don’t let your discomfort go past a one.

Walking and light swimming are good choices.  Anything that’s low-impact.  But make sure you’re using the affected joint- walking isn’t going to help your elbow.  For resistance training, use light weights and slow movement.  Explosive, sudden moves are out, as is heavy lifting.

And then you simply slowly, gradually add more stress over time, just like you would if you were recovering from a muscle strain.  Except that cartilage recovers at a much slower rate than muscle, so account for that in your progression of training.

That, my friends, is where I think most of glucosamine research is flawed.  Everybody just shoves pills down peoples’ throats and nobody bothers to actually have those people send the signal to their bodies to actually USE those pills.

So does glucosamine work? Like I said, in my experience, it’s about fifty-fifty whether this stuff will help you.  If you follow my recommendations on exercise, you might boost those odds a little bit.  But either way, glucosamine isn’t going to hurt you, so I usually tell people to give it a shot.

Please feel free to share you experiences with glucosamine in the comments section below, and if you have friends or family with DJD-related joint pain, be sure to pass this article on to them!

Stay healthy!

P.S.  Here’s the link to that study:  http://www.bmj.com/content/341/bmj.c4675