Glucosamine Sulfate and Chondroitin Sulfate
by Roberta Lee, MD (topic expert: health)

I spent the first ten years of my professional life running between five and ten miles five times a week. For me, this physical activity provided a much needed intellectual respite from the frenetic pace of medicine. As a morning person, my running set the pace of my day giving me "calm" in the midst of whatever medical "storm" I would encounter. Occasionally an ache or pain would plague me, but I was young and my body was resilient. Somewhere in my late forties, however, things changed. I began to experience aches and pains from physical exertion more frequently - and I was in great physical shape!

As a consequence I began to investigate novel and safe alternatives for every day discomforts. I knew there were over-the-counter products that I could take for achiness, such as nonsteroidal anti-inflammatory medications like ibuprophen, but I didn't want to take them regularly. This desire to stay away from quasi "prescriptive" medications led me to the discovery of glucosamine sulfate and chondroitin sulfate.

Glucosamine sulfate, a salt form of the amino sugar glucosamine, is a constituent of cartilage known as proteoglycans. The source for the supplements comes either from marine exoskeletons or synthetic production. The thinking goes that glucosamine is required to stimulate the metabolism of chondrocytes (cartilage-building cells) which are necessary to build healthy tendons, ligaments, cartilage and other body elements.

Some trials have looked at glucosamine's effectiveness for osteoarthritis (DJD) or degenerative arthritis. Preliminary data suggests that for mild forms of DJD, glucosamine sulfate plus chondroitin sulfate may be useful in relieving pain and stiffness.

The most common adverse reactions are gastrointestinal such as an upset stomach. There are few reports of mild elevation of blood sugar in those with diabetes and some concern that glucosamine can interact negatively with a commonly used blood thinner warfarin (Coumadin). People with severe allergies to shellfish should also be cautious, but glucosamine sulfate has been used safely in most known to have allergies to shellfish.

The recommended dose is 500 mg three times daily and can be taken in pill or liquid form. Alternatively, you can use a topical application as well. None require a doctor's prescription. Discussing the pros and cons of this supplement with your health care provider can shed light on whether this supplement is safe for you.

Chondroitin sulfate is another natural compound critical to healthy connective tissue and joint cartilage. Chondroitin sulfate absorbs water adding to cartilage thickness. But the source and usefulness of the oral supplements are under some debate.

The sources for supplements include shark and bovine cartilage which have been tied to spongiform encephalopathy, otherwise known as BSE and mad cow disease. Furthermore, the usefulness of chondroitin in its oral form is under debate. Chondroitin is a large molecule and is not absorbed orally; therefore supplements taken by mouth may not be useful although it is well tolerated. The reported dose is 200-400 mg two to three times a day. Another option is use of chondroitin by cream (topical use). The topical dose is 50 mg/gram of chondroitin sulfate/30 mg/gram of glucosamine sulfate.

These days, I still make sure I have daily aerobic exercise. Time has taught me that stretching - especially after exercise is very useful in fending off pain and stiffness. Also varying your aerobic forms of exercise and availing yourself to the treadmill, stair stepper, elliptical trainer and brisk walking keep your body nimble and fit. As spring emerges I wish you fun on your walks and runs!