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By 2030, one in four Singaporeans will be 65 and above. According to the United Nations, that number will increase to nearly one in two by 2050. With age comes changes to the body. One of that is being susceptible to osteoarthritis (OA). Worldwide, OA is the leading cause of disability. In 2015, the World Health Organization estimated that a total of 8,000 years had been lost to disability from OA in Singapore. The situation is so worrisome that over 10 year ago, Ministry of Health released clinical practice guidelines on managing knee OA.
To help people with OA, glucosamine is prescribed in many countries although its efficacy remains inconclusive. Singapore has the same practice and its people love it. In 2017, the population spent nearly S$500 million on vitamins and supplements, and glucosamine was what the seniors’ favoured as part of their joint care regiment. In fact, glucosamine enjoys a current value growth of 9%.
But what is glucosamine and what is it expected to do for us?
One of the reasons we are able to move with dexterity and ease is because we have joints. These bones are protected by cartilage, a resilient and elastic padding at the ends of the bones; and lubricated by fluid around them.
Within our cartilage and in the thick fluids surrounding our joints is an amino sugar called glucosamine which also occurs naturally in animal bones, bone marrow, shellfish and fungi. Glucosamine plays a vital role in building cartilage, making glycosaminoglycans and glycoproteins which are the essential building blocks of many parts of our joints including ligaments, tendons, cartilage and synovial fluid.
It is believed that the way our joints are built contributes to the development of OA. This form of arthritis occurs when the protective cartilage that cushions the ends of our joint bones becomes less flexible, and eventually wears down and becomes thin over time. This results in joint friction, pain and stiffness. Glucosamine is, therefore, needed to strengthen the cartilage and increase the fluids in the joints.
Some researchers think the "sulfate" part of glucosamine sulfate is also important. Sulfate is needed by the body to produce cartilage. This is one reason why researchers believe that glucosamine sulfate might work better than other forms of glucosamine such as glucosamine hydrochloride or N-acetyl glucosamine which do not contain sulfate.
Ask most doctors and they will say that it has yet to be conclusively proven that glucosamine supplements can help OA. However, some animal studies have found that glucosamine can both delay the breakdown of and repair damage to cartilage. Laboratory tests also show that glucosamine has anti-inflammatory and even cartilage regenerative properties. These, and the fact that glucosamine supplements have few ill effects, lend to its popularity among ageing populations hoping to stave off or reverse joint problems by increasing or preventing the breakdown of cartilage and the fluid around joints, or both.
Glucosamine supplements can be made in the laboratory or from the shells of shellfish, and are usually available in several forms: glucosamine sulphate, glucosamine hydrochloride and N-acetyl-glucosamine. Each of these have different effects.
Dietary supplements that contain glucosamine often also contain other ingredients such as chondroitin sulfate, methylsulfonylmethane (MSM) and even shark cartilage. Most research on glucosamine involves glucosamine sulfate. There is no clinical evidence to support the use of N-acetyl glucosamine in treating arthritis.
Studies on the benefits of glucosamine remain few with small sample sizes and the results are mixed. The way glucosamine works in disease treatment is still not well understood.
Oral glucosamine sulfate seems to relieve pain for people with OA of the knee, hip or spine. However, unlike over-the-counter pain relief medicines that work quickly, glucosamine sulfate may take up to eight weeks to take effect.
What it does do that pain medication does not is to slow down the breakdown of joints and prevent the condition from deteriorating if used over a long period. Some research has even shown that people who take glucosamine sulfate might be less likely to need total knee replacement surgery. What glucosamine cannot do is prevent OA.
Glucosamine sulfate seems to work better on its own. The Glucosamine and Chondroitin Arthritis Intervention Trial (GAIT) surveyed 1,600 participants in 16 locations across the US. It found that glucosamine with chondroitin sulfate did not give significant relief from OA.
Preliminary research shows that oral glucosamine hydrochloride alleviates pain for those with rheumatoid arthritis although it does not reduce the number of painful or swollen joints.
Glucosamine may reduce inflammation. In a test-tube study, there was significant anti-inflammatory impact when glucosamine was applied to cells involved in bone formation. In studies involving people, glucosamine’s ability to reduce inflammation has been inconclusive.
Some studies indicate that glucosamine supplements may protect joint tissue by preventing the breakdown of cartilage. One small study involving 41 cyclists found that supplements with up to 3 grams of glucosamine daily reduced collagen degradation in the knees by 27% compared to 8% in the group that took placebos.
The typical dosage of glucosamine supplement is 1,500 mg a day although you can you break this up into several smaller doses. When buying glucosamine supplements, read the label carefully to check what types of glucosamine is included and how much of it is included in each pill or capsule.
Glucosamine supplements are largely safe although some report experiencing nausea, heartburn, diarrhea, constipation, drowsiness, skin reactions or headache. Those who are allergic to shellfish need to be careful because glucosamine products might be derived from the shells of shellfish. This is possibly why glucosamine supplements might worsen asthma. Glucosamine sulfate might affect blood sugar levels so avoid it before any surgery. The fact that it might increase the effects of warfarin which is used to help thin blood and increase the risk of bleeding is another reason why it should be avoided before surgery. For most people, though, glucosamine supplements are harmless.