Glucosamine chondroitin, glucosamine sulfate, glucosamine hydrochloride, glucosamine sulphate

Glucosamine is made from the combination of a sugar - hence the first part of the name glucos(e) - and an amine, which is a derivative of ammonia containing nitrogen (N) and hydrogen (H) atoms.
   Glucosamine is found largely in cartilage and plays an important role in its health and resiliency. As we age, we lose some of the glucosamine and other substances in cartilage. This can lead to thinning of cartilage and the onset and progression of osteoarthritis. It is important to note that there are a variety of important substances within cartilage and glucosamine ingestion, by itself, should not be viewed as the complete answer.

Glucoamine and Osteoarthritis
Glucosamine has hardly been evaluated in conditions other than osteoarthritis. Hence it is not clear whether glucosamine is helpful in those with damage to cartilage or joints due to musculoskeletal injuries. Glucosamine does help rebuild cartilage in osteoarthritis patients, but it is unlikely that it would help joints where the cartilage has been surgically removed. Similarly, glucosamine has not been tested in autoimmune diseases involving joints such as lupus and rheumatoid arthritis. Those with artificial joints are not likely to be helped by glucosamine since they have no cartilage.

Combining Glucosamine with Drugs
Glucosamine Sulfate may be taken together with acetaminophen or NSAIDs such as ibuprofen and naproxen. After glucosamine starts working in a few weeks, hopefully the dose of the drugs can be reduced or eliminated. I am not aware of glucosamine interacting with other medicines.

Glucosamine and allergies
Those who are allergic to sulfates may take glucosamine hydrochloride and not glucosamine sulfate, and they should avoid chondroitin sulfate. Glucosamine is derived from shrimp, oyster and crab shells and chondroitin is derived from cartilage of cows, pigs, and sharks. There is no synthetically made glucosamine on the market.

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Joint Formula contains many nutrients found to have a role in arthritis.

Boswellia serrata
Chondroitin
Glucosamine links gluco
Lipoic acid
MSM
Turmeric root extract, Curcumin

Glucosamine sulfate of hydrochloride?
Glucosamine is available as glucosamine sulfate or glucosamine hydrochloride. A review of the scientific literature shows glucosamine is likely to be helpful for many patients with osteoarthritis. Almost all of the studies done with glucosamine have used the sulfate form since a company in Europe funded the studies, and we know that it works. However, the hydrochloride form has been used by doctors for many years and it seems to work just as well. The hydrochloride form is cheaper. The positive effects of glucosamine reducing joint pain are often noticed within a few weeks.

Long term safety
Based on our current understanding, glucosamine can be taken for extended periods, months and years. Thus far, after being on the market for quite a number of years, there have not been any reports in the medical literature of any significant side effects resulting from the use of glucosamine. However, as with most nutrients and medicines, long term effects are not clearly known. It is best pregnant women not take glucosamine until more is known about this interaction.

Glucosamine and Diabetes
We are not aware of any significant changes to blood sugar resulting from glucosamine ingestion. The dose of glucosamine, one or two grams a day, is minimal as a sugar source compared to the amounts of carbohydrates found in the foods we consume. One study indicates that glucosamine is safe in diabetes.
   In a study published in Archives of Internal Medicine, 38 elderly patients with type 2 diabetes were divided into two groups. The first group took 1500 mg of glucosamine a day combined with 1200 mg of chondroitin sulfate. Chondroitin is another supplement often used in combination with glucosamine to treat osteoarthritis. The other group took placebo pills. Two-thirds of the dose was taken in the morning and one-third in the evening. The study lasted for 90 days. Blood studies were done to evaluate blood sugar levels, and also levels of hemoglobin A1c, a specific blood marker than can tell us average blood sugar levels over long periods of time. There was no statistically significant rise in hemoglobin A1c levels in those who took glucosamine.
   Comments: Patients with diabetes are often at risk from toxic effects from many of the current treatments for osteoarthritis, such as the NSAIDs like ibuprofen or naprosyn. These medicines cause stomach ulcers and kidney damage if used for prolonged periods. Glucosamine provides a safe and natural alternative.

Timing of Glucosamine ingestion
It's difficult to say when the best time or frequency to take glucosamine, whether with or without food, but a good option is to take glucosamine before meals. All 1,500 mg a day can be taken at one time or split in two or three divided doses throughout the day. 

Glucosamine and Chondroitin
If glucosamine itself is not helpful in relieving arthritic symptoms, it may be combined with chondroitin and other nutrients. Alternatively, glucosamine and chondroitin can be started together with several other nutrients.  

Can glucosamine pills be absorbed from the stomach and end up in cartilage?
Yes. After oral administration of glucosamine sulfate (GS), 90% is absorbed. (Sulfate means that the glucosamine is attached to a sulfur and oxygen atoms.)
   In a study done in Italy, two healthy male volunteers were given 250 mg of oral GS, tagged with radioactive carbon 14 as a tracer, in the morning on an empty stomach. The radioactive GS was found an hour later in blood and then later in other tissues. The researchers state, "GS very rapidly diffuses in most tissues and organs and that it has a special tropism (attraction) for articular tissue (cartilage) and for bone." These volunteers were also given GS intravenously (IV) and intramuscularly (IM). The amount of GS in blood after oral administration was only a quarter of the amount available by IV and IM. Therefore oral administration is effective, but not as good as IV or IV. When oral GS is absorbed, it first goes to the liver where a large portion gets broken down into smaller molecules such as carbon dioxide, urea and water.

Glucosmaine Research Update
The effect of glucosamine-chondroitin supplementation on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial.
Scroggie DA, Albright A, Harris MD. Wilford Hall Medical Center, Lackland Air Force Base, Lackland, TX 78236, USA.
Arch Intern Med. 2004 Apr 12;164(7):807.
With increasing use of glucosamine-containing supplements for the treatment of osteoarthritis, there is increasing concern in the medical community about possible toxic effects. The present study was undertaken to determine whether glucosamine supplementation altered hemoglobin A1c concentrations in patients with well-controlled diabetes mellitus. To evaluate possible effects of glucosamine supplementation on glycemic control in a selected population of patients with type 2 diabetes mellitus. Placebo-controlled, double-blinded, randomized clinical trial. Outpatient, diabetes monitoring clinic. Patients were typically elderly patients, evenly divided between men and women. Most of the patients were being treated with 1 or 2 drugs for glycemic control. In daily doses for 90 days, patients received either placebo or a combination of 1500 mg of glucosamine hydrochloride with 1200 mg of chondroitin sulfate (Cosamin DS; Nutramax Laboratories Inc, Edgewood, Md).Main Outcome Measure Hemoglobin A1c levels before and after 90 days of therapy. There were 4 withdrawals from the glucosamine-treated group. Three were related to comorbidities (myocardial infarction, congestive heart failure, and atrial fibrillation) and 1 to a possible adverse reaction (excessive flatus). No other patient reported any adverse effects of glucosamine therapy, and no patient had any change in their diabetes management. Mean hemoglobin A1c concentrations were not significantly different between groups prior to glucosamine therapy. Posttreatment hemoglobin A1c concentrations were not significantly different between groups, nor were there any significant differences within groups before and after treatment. This study demonstrates that oral glucosamine supplementation does not result in clinically significant alterations in glucose metabolism in patients with type 2 diabetes mellitus.

Glucosamine sulfate reduces osteoarthritis progression in postmenopausal women with knee osteoarthritis: evidence from two 3-year studies.
Bruyere O. WHO Collaborating Center for Public Health Aspect of Osteoarticular Disorders, Liege, Belgium.
Menopause. 2004 Mar-Apr;11(2):138-43.
To investigate the effect of glucosamine sulfate on long-term symptoms and structure progression in postmenopausal women with knee osteoarthritis (OA). This study consisted of a preplanned combination of two three-year, randomized, placebo-controlled, prospective, independent studies evaluating the effect of glucosamine sulfate on symptoms and structure modification in OA and post-hoc analysis of the results obtained in postmenopausal women with knee OA. Minimal joint space width was assessed at baseline and after 3 years from standing anteroposterior knee radiographs. Symptoms were scored by the algo-functional WOMAC index at baseline and after 3 years. All primary statistical analyses were performed in intention-to-treat, comparing joint space width and WOMAC changes between groups by ANOVA. Of 414 participants randomized in the two studies, 319 were postmenopausal women. At baseline, glucosamine sulfate and placebo groups were comparable for demographic and disease characteristics, both in the general population and in the postmenopausal women subset. After 3 years, postmenopausal participants in the glucosamine sulfate group showed no joint space narrowing, whereas participants in the placebo group experienced a narrowing of -0.33 mm. Percent changes after 3 years in the WOMAC index showed an improvement in the glucosamine sulfate group and a trend for worsening in the placebo group. This analysis, focusing on a large cohort of postmenopausal women, demonstrated for the first time that a pharmacological intervention with glucosamine for OA has a disease-modifying effect in this particular population, the most frequently affected by knee OA.

The effect of glucosamine supplementation on people experiencing regular knee pain.
Braham R. University of Western Australia, Crawley, Western Australia 6009. Br J Sports Med. 2003 Feb;37(1):45-9; discussion 49.
The purpose of this study was to examine the effects of oral glucosamine supplementation on the functional ability and degree of pain felt by individuals who had regular knee pain, most likely due to previous articular cartilage damage, and possibly osteoarthritis. Subjects were randomly supplemented with either glucosamine (n=24) or placebo (P) (lactose) (n=22) for 12 weeks at a dose of 2,000 mg per day. Over this period, four testing sessions were conducted, with changes in knee pain and function assessed by clinical and functional tests, (joint line palpation, a 3 metre "duck walk" and a repeated, walking stair climb), two questionnaires (the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Knee Pain Scale and participant subjective evaluations. The clinical and functional test scores improved with time but there were no significant differences between the two groups. The questionnaire results also recorded a significant main effect for time, but the glucosamine group was found to have significantly better KOOS quality of life scores at week eight and 12, and lower KPS scores at week eight than the placebo group. On self report evaluations of changes across the 12 week supplementation period, 88% (n=21) of the glucosamine group reported some degree of improvement in their knee pain versus only 17% (n=3) in the placebo group. These results suggest that glucosamine supplementation can provide some degree of pain relief and improved function in persons who experience regular knee pain, which may be caused by prior cartilage injury and/or osteoarthritis. The trends in the results also suggest that, at a dosage of 2,000 mg per day, the majority of improvements are present after eight weeks.

Glucosamine Emails
I am a retired pathologist. My wife and I have been taking the standard dose of glucosamine and chondroitin for 4-5 months ( age 78 years). Both of us have noted that our fingernails seem to grow  faster and be stronger than before. Our son (age 50) has noted the same, and he is a guitar player who uses his nails as a pick.  I have not found this effect in a cursory exam of the net and thought you might be interested.

I am a 37 year old male who has been active all my life. Last year I started having major middle back pains that even wiped me out when I washed dishes in my home. Mowing the yard really did me in. I was an avid runner, worked out 4 to 5 times a week, have 2 jobs. One at a desk, the other waiting tables in an Italian restaurant. I have consistently taken Bayer to relieve the pain yet I knew it didn't repair the problem.

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