Glucosamine and Chondroitin

Kava originates from the root of the Piper methysticum (kava) plant that grows predominately in the South Pacific islands. This drug has been used for centuries by various local cultures because of its sedative and antianxiety effects. Kava has likewise gained popularity in western societies, and studies suggest that kava extracts can be used as an alternative to traditional sedative-hypnotic and anxiolytic drugs, such as benzodiazepines (see Chapter 6).21,39 Kava may also produce 

Melatonin is an endogenous neurohormone that is produced primarily by the pineal gland. In humans, melatonin is normally released at night, with plasma levels tending to peak between 2 and 4 AM.47 Melatonin is associated with the ability to regulate sleep-wake cycles, and perhaps other circadian rhythms.3,31 Because of this effect, synthetic melatonin supplements have been used primarily to treat insomnia, especially in individuals with disturbed sleep cycles or persons who are blind and cannot regulate melatonin release because they are unable to respond visually to normal light-dark cycles.3 

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Celecoxib, however, was effective. In the subgroup of patients with moderate to severe OA pain, the combination of glucosamine and chondroitin appeared to have a moderate effect, although this subgroup analysis must be interpreted with caution. On the other hand, a European study (the GUIDE trial) that compared a prescription glucosamine product with acetaminophen and placebo in patients with knee OA reported that glucosamine performed better versus placebo than did acetaminophen.27... 

Richy F, Bruyere O, Ethgen O, et al. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis A comprehensive meta-analysis. Arch Intern Med 2003 163 1514-1522. 

It has been suggested that dietary supplements such as glucosamine and chondroitin sulfate may help protect articular cartilage and halt or reverse joint degeneration in osteoarthritis. These two compounds are key ingredients needed for the production of several... 

Consequently, it appears that glucosamine and chondroitin supplements are certainly worth a trial for many patients with osteoarthritis. Some gastrointestinal problems may occur, but these supplements are usually well tolerated. Although these supplements are available over-the-counter in the United States, people with osteoarthritis should consult their physician and pharmacist before self-administration. Likewise, patients should be educated on the proper dosage, and should be reminded that these products may need to be consumed for several weeks or months before beneficial effects become apparent. Long-term studies on the effects of these supplements are currently being conducted, and clinicians should try to stay abreast of any new information about the potential benefits of glucosamine and chondroitin. 

McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis a systematic quality assessment and meta-analysis. JAMA. 2000 283 1469-1475. 

Owens S, Wagner P, Vangsness CT, Jr. Recent advances in glucosamine and chondroitin supplementation. JKnee Surg. 2004 17 185-193. 

Glucosamine and chondroitin are chondroprotective agents which are used in the treatment of osteoarthritis. There is conflicting evidence regarding their efficacy and their place in the management of osteoarthritis is unclear. They are not recommended by NICE for osteoarthritis (NICE, 2008). 

In addition to single entity glucosamine, chondroitin, and MSM products, there are also a number of combination products with glucosamine. Trials with combinations of glucosamine and chondroitin showed improvement of symptoms in one group of patients, but in another group, only those with mild to moderate OA showed improvement. Methylsulfonylmethane is also used in combination with glucosamine and... 

Table 6 shows the range of values determined for levels of active constituents in samples of formulated combination glucosamine and chondroitin products. Two of the four products tested passed, and three out of the 12 tested by Consumer Reports passed on levels of both components, chondroitin levels being most frequently below 95% of the stated level. " ... 

Table 6 Levels of active constituents in combination glucosamine and chondroitin products...

Because glucosamine and chondroitin are marketed in the United States as dietary supplements, neither the products nor their purity is adequately regulated by the FDA. Some reliable products include Cosamin DS, Condrosulf, and Dona. ... 

Reginster JY, Bruyere O, Lecart MP, Henrotin Y. Naturocetic (glucosamine and chondroitin sulfate) compounds as structure-modifying drugs in the treatment of osteoarthritis. Curr Opin Rheumatol 2003 15 651-655. 

Studies continue on the effect that D-glucosamine and chondroitin sulfate have on degenerative joint disease. To date the studies are inconclusive because a large placebo effect is observed with sufferers of osteoarthritis. Many people in the control groups of these studies also experience relief of symptoms when they receive treatment with a placebo, such as a sugar pill. 

Capsules containing D-glucosamine and chondroitin sulfate are available over the cormter, and many sufferers of osteoarthritis prefer to take this nutritional supplement as an alternative to any nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen. Although NSAID can reduce inflammation and pain, long-term use of NSAID can result in stomach ulcers, damage to auditory nerves, and kidney damage. 

Novel foods include those providing protein (soy and dairy), and those that are intended to improve cardiovascular health (stanol esters, P-glucan, bioactive peptides, and n-3 fatty acids), bone and joint health (calcium, glucosamine, and chondroitin), eye health (lutein), the immune system (milkmicronutrients, lactoferrin, lactoperoxidase, and colostrum), gut health (probiotics and prebiotics), body fitness (conjugated linoleic acid, amino acids, and glyco-macropeptide), energy level, and for beauty. 

Inflammatoty disturbances Sulfur-containing compounds such as the sulfates of glucosamine and chondroitin, and also methylsulfonylmethane, are effective in the treatment of inflammatoty disorders - especially in joints and bones - and also reduces the deleterious effects of overtraining and athletic injuries (Parcell 2002). 

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