Personal health

Jane Brody
I have been asked repeatedly in the last two months about my knees and whether the arthritis remedy I mentioned in a column on alternative medicine was actually working. It is a combination of glucosamine and chondroitin sulfate, natural substances that are centrally involved in the formation of the cartilage that caps the ends of bones.
Deterioration of this articulator cartilage and resulting abnormalities in the surrounding bone cause the stiffness, pain crackling sounds and sometimes swelling of joints that are the hallmarks of osteoarthritis, the wear and tear form of arthritis that afflicts 16 million Americans.
The product had seemed to be so effective in countering the arthritic lameness of my 11-year-old spaniel that I decided to try it myself. After two months on this remedy, I am about 30 percent better, I am not pain-free and I still tend to get a little stiff after prolonged sitting, but I have stopped limping, I am playing tennis and ice skating with less pain and my knees have stopped swelling after strenuous activity.
But please understand that I am only an anecdote of one, not a study that proves anything. Without a careful scientific study, any personal account of benefit leaves open to question what actually caused the improvement.
The starting dose of three capsules a day costs about $1.67. Since it is sold as a nutritional supplement rather than a drug, it is not covered by health insurance.
The usual treatments for osteoarthritis are anti-inflammatory drugs, combined with muscle strengthening activities and judicious exercise. This approach may relieve discomfort and slow deterioration of the joint, but it does not restore the health of damaged cartilage and can cause serious drug reactions.
Rebuilding damaged cartilage has long been the holy grail of orthopedics and rheumatology; and supporters of the glucosamine and chondroitin combination hope it will be the first remedy to achieve this. The individual ingredients have already been shown to improve arthritic symptoms in more than a dozen studies in Europe, some of which were well designed.
European researchers have shown, using radioactively labeled substances, that glucosamine and chondroitin taken by mouth do indeed find their way to articular cartilage, and biopsies of some treated patients have shown structural improvements in damaged cartilage.
Dr. Marc Hochberg, chief of rheumatology at the University of Maryland School of Medicine, said that early studies of glucosamine and chondroitin sulfate when taken orally for osteoarthritis "appear to demonstrate that they are effective and warrant examination in a placebo controlled, randomized trial."
The American College of Rheumatology also noted the promise of early studies but cautioned that "what looks promising at first doesn't always pan out to be effective or safe." The Arthritis Foundation also cited European reports indicating that the two nutrients are safe and "may be helpful in controlling pain and improving function", but added that "good controlled long-term studies are needed to see if the products are indeed helpful and safe".
The combination of glucosamine and chondroitin is now being tested in well-designed human trials by a few clinical researchers in the United States. Dr Amal Das, an orthopedic surgeon in Hendersonville, NC, is assessing its effectiveness in 100 patients with mild to moderate osteoarthritis of the knee.
Das, who specializes in hip and knee replacement, said he had been searching for a 'biological alternative to joint replacement" when he stumbled upon the European data on glucosamine and chondroitin. Glucosamine was described as reducing the pain and disability associated with osteoarthritis and chondroitin appeared to slow progression of the disease.
He said he started using the treatment in patients who could not tolerate anti-inflammatory drugs. The compounds are not toxic and, in safety studies at Cornell University's College of Veterinary Medicine, the combination product lacked side effects beyond occasional loose stools in dogs.
"If the compounds are proved to be as effective as the European studies say they are, they should replace the anti-inflammatory medications." Das said.
A preventive medicine specialist in Arizona who is himself using this remedy and has prescribed it for about 600 patients, including his mother and grandmother, has decided not to await results of these studies and instead summarized the European findings in a book that promotes the combination as part of a nine-point program combating osteoarthritis. The book, despite its injudicious title, "The Arthritis Cure," By Dr. Jason Theodosakis with Brenda Adderly and Barry Fox (St. Martin's Press, $22.95), makes no wild claims. Theodosakis emphasizes that not every patient responds to the remedy and not everyone who does respond ends up free of - or unrestricted movement. But cites a number of placebo-controlled studies of the individual ingredients that showed improvements in significantly more patients given either glucosamine or chondroitin than those who received a look-alike inactive capsule. And he recounts the histories of patients who experienced significant improvement after taking the substances, some of whom began feeling better within a week or two.
Although glucosamine with or without chondroitin has been used for years by veterinarians, mainly in horses and dogs, most American doctors, who tend not to act on the basis of European studies, have kept their distance. The substances cannot be patented, which is why drug companies have not supported research. Neither have rheumatologists, who have seen scores of quack remedies for arthritis, pushed for government sponsored studies. Glucosamine and chondroitin are marketed as nutritional supplements and therefore, by federal law, are not regulated by the Food and Drug Administration.
Each capsule supplies 500 milligrams of glucosamine, 400 milligrams of chondroitin sulfate, 66 milligrams of ascorbate to enhance absorption and 10 milligrams of manganese, which plays a key role in the synthesis of a component of cartilage. No other combination product currently on the market supplies anywhere near these dosages, although health food stores do sell products containing large dosages of the individual ingredients.
Costs about $100 for a bottle of 180 capsules, can be obtained only from a licensed health professional physician, osteopath, chiropractor, nurse/practitioner, pharmacist, dentist or physical therapist. (Jane Brody writes for The New York Times News Service.)

These Web Pages where constructed from various health and other publications on Nutrition. The sole purpose is to provide information and is not considered to be medical advice. No medical claims are being made by Dr.H. Edward Elrod, or The Elrod Clinic.

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