Health & beauty

Glucosamine supplements

Updated: 04 Apr 2008
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Introduction

If you suffer from osteoarthritis it may be worth considering glucosamine supplements. But you want to be sure the brand you buy contains an effective dose.

There's no cure for osteoarthritis - but clinical studies have shown that 1500mg of glucosamine sulphate or glucosamine hydrochloride taken each day can be an effective treatment.

We tested 12 brands of glucosamine-only and glucosamine-chondroitin (combination) supplements to find out whether the glucosamine levels stacked up to their label claims.

What we found

Three products weren't up to scratch:

  • Nutralife High Potency Joint Care Arthritis Formula with Glucosamine and Chondroitin
  • Good Health Joint Zone Glucosamine
  • Chondroitin; and Bioorganics Joint Formula Glucosamine 750 + Chondroitin 400

These had only 86 to 90 percent of the amount of glucosamine stated on the label.

No products had more than 100 percent of the label claim.

Our test reinforces the argument that dietary supplements need to be regulated to ensure consumers are getting high-quality products that meet their claims.

Test criteria

Glucosamine and other dietary supplements are covered by the Dietary Supplements Regulations. The regulations require proper labelling, but there's no auditing of a manufacturer's processes.

Across the Tasman, there are more stringent regulations. According to the Therapeutic Goods Administration's manufacturing regulations, products must have between 92.5 percent and 107.5 percent of the active ingredient claimed on the label. We used these criteria for our test.

For details of all the products we tested, see the Test results.

Price and dose

Depending on the amount of glucosamine in each tablet you need to take one or two tablets each day to get the recommended effective dose.

There's a big range of prices. Blackmores Glucosamine 1500 was the cheapest in our survey - it costs 46c per day. Bioorganics Joint Formula Glucosamine 750 + Chondroitin 400 cost more than double that - $1.22 per day. It's an even bigger rip-off because the Bioorganics product contained only 87 percent of the glucosamine claimed on the label.

Confusing labels

The labels on these supplements can be very confusing because glucosamine comes in different chemical forms that contain different amounts of "actual" glucosamine. It can make a big difference to how much of the active ingredient you're taking.

1000mg of glucosamine hydrochloride is equivalent to 830mg of glucosamine. 1000mg of glucosamine sulphate is equivalent to 785mg. 1000mg of glucosamine sulphate potassium chloride complex delivers only 590mg of glucosamine.

Some brands leave you to decipher the small print to find out which chemical form, and how much glucosamine, you're getting.

Test results

Note that our test and price survey was carried out in April 2008, and prices are likely to have changed. 

Guide to the table

Our test was conducted by an independent laboratory in Australia.

  • Products are listed by price: cheapest at top, within groups. Label claims were tested against Australian Therapeutic Goods Administration's requirements (products must have between 92.5% and 107.5% of the amount claimed on the label).
  • Price is based on what we paid for products purchased in New Zealand and an online price survey for products purchased in Australia.
  • Tablets/capsules per day is based on consuming the recommended effective dose.

We recommend

These products all met their label claims (they contained between 94 percent and 96 percent of the amount stated on the label). And all cost less than 60c per day. 

Note that the price survey was carried out in April 2008 - any of the products in our table that met their label claims are worth a try if you find them at a good price.

Pictured left to right:

Blackmores Glucosamine 1500

Microgenics Glucosamine 1500 Chondroitin Complex

Red Seal Pro-Joint Glucosamine Sulphate

NFS Glucosamine Sulphate Complex 1900

Bioorganics Glucosamine Sulfate Complex 1000

Glucosamine - the hype

Glucosamine is naturally found in the body. It's involved in the formation and repair of cartilage and is a major part of bones, ligaments, tendons, and the synovial fluid that lubricates your joints.

It's been used for more than 20 years and during this time 16 randomised controlled trials have shown that it's both effective and safe in the short term.

Mixed results

According to a Cochrane Review of 20 studies, glucosamine improved pain more than a placebo and seems to be safe. But when the review was restricted to eight high-quality studies, the pain improved about the same whether people took glucosamine or the placebo.

Other trials have produced mixed results. A large US study of nearly 1600 people with knee osteoarthritis (which was funded by the National Institute of Health) examined the benefits of glucosamine alone, chondroitin alone, glucosamine and chondroitin together, Celebrex (a pain reliever), and a placebo.

For the group as a whole, no supplement had any effect in terms of pain, stiffness, or swelling, although Celebrex did afford some pain relief. However, in 22 percent of patients with moderate to severe pain glucosamine or chondroitin provided more relief than a placebo did.

The Australian government has funded a major research project to look at the cost-benefits of glucosamine. This could lead to glucosamine being considered for the Pharmaceutical Benefits Scheme - and, if it was accepted, it'd be subsidised for Australian consumers.

Not for everyone

  • Glucosamine is usually extracted from crab, lobster or shrimp shells. So people with shellfish allergies shouldn't use it. You can also buy "vegetarian" glucosamine that's made from maize starch.

  • If you have diabetes, check with your GP before taking glucosamine. While it appears safe in the short-term, there's evidence that in the long-term it could make your diabetes worse.

  • Glucosamine hasn't been tested on pregnant or breastfeeding women and it may not be suitable for children.


Case study - worth a try

Lee Pomeroy

Lee Pomeroy (right) is doing her own trial to see if glucosamine is helping her soreness and stiffness. Lee took glucosamine for two months - two tablets per day as recommended on the bottle.

After one month she did notice an improvement but she had also started a new gym programme, which may have accounted for the improvement.

Lee has now stopped taking glucosamine for a couple of months to see if it was the gym or the glucosamine. If her aches and pains get worse she'll start taking the supplements again.

Osteoarthritis

One in every three of us over the age of 45 will have arthritis in their lifetime. Arthritis is the leading cause of pain and disability among older people. Usually the cause is osteoarthritis, aka "wear and tear".

What causes the pain?

The pain from osteoarthritis is caused by the breakdown of the bone-protecting cartilage pad in the joints, leaving the ends of the bone unprotected. Your joints become painful and difficult to move.

Osteoarthritis usually affects the weight-bearing joints - hips, knees and spine - as well as the hands. Symptoms may include pain and stiffness, swelling, and bony growths.

Treatment programmes

There's no cure, but it can be treated. Most treatment programmes include lifestyle changes like weight loss and physiotherapy, along with the use of non-steroidal anti-inflammatory drugs (NSAIDs) to manage the pain. However, the safety of these drugs is a concern. In 2004, Vioxx was withdrawn from the market after a link was found between its use and increased risk of heart attack and stroke.

Even milder NSAIDs like ibuprofen can cause damage to the small intestine if used for more than three months.

There's also been some strange experimentation to help treat osteoarthritis. Several years ago, German researchers reported that applying leeches to an osteoarthritic knee relieved symptoms. Apparently the leech saliva had some painkilling properties.

Not surprisingly, arthritis sufferers have been looking for alternatives.

Alternatives to glucosamine

  • Analgesics are pain relievers that don't have an anti-inflammatory effect. They may contain paracetamol, codeine, aspirin, or a combination of these. There are very few side effects if taken as prescribed.

  • Non-steroidal anti-inflammatory drugs (NSAIDs) help relieve inflammation, swelling, stiffness and joint pain. The major side effects are stomach upsets (such as irritation and ulcers), so NSAIDs should always be taken with food.

  • Cox II Specific Inhibitors assist in the reduction of pain, without the side effects of NSAIDs. But these medicines aren't subsidised in New Zealand.

  • Corticosteroids such as prednisone help reduce inflammation of the joints, blood vessels, and organs. There's a risk of harmful side effects over time, however: your skin may bruise and your bones may develop osteoporosis. Doctors usually only prescribe them during flare-ups.

  • Chondroitin sulphate is naturally found in the body as a component of cartilage. There's some evidence it can reduce pain and improve joint function in people with osteoarthritis.

    Chondroitin sulphate is often sold in combination with glucosamine. Some studies suggest this combination is more effective than either of them taken alone, but the evidence isn't strong.

    If you avoid animal products, be aware that chondroitin is usually extracted from animal or shark cartilage.

  • Capsaicin cream may help a little. Capsaicin's the substance in chillis that make them hot to eat. The theory is that the strong irritating sensations of capsaicin compete with pain signals from the arthritic knee, and so the pain signals can't get through.

  • New Zealand green-lipped mussel extract is available freeze-dried, concentrated or ground in capsules. Evidence for its efficacy has been mixed but some studies suggest it may reduce inflammation, lubricate joints, and reduce pain.

  • Knee replacements and other major surgery are usually a last resort.

  • Exercise is important but you need to be careful as it may make knee osteoarthritis worse. Strengthening exercises should be gradual and not provoke greater knee pain. Pool workouts are ideal. Your exercise regime should be custom-made under a doctor's supervision.

  • Eating a balanced diet is important for maintaining a healthy weight. Excess weight places stress on arthritic joints.

Our advice

  • If you want to give glucosamine a try, keep a daily diary of your pain and physical limitations. If you see no improvement after three months, it's unlikely you'll benefit from glucosamine. 
  • Always check with your doctor before taking glucosamine or any other "alternative" product. It may interact with other medication you're taking.
     
  • Glucosamine supplements are usually derived from seafood. People with a seafood allergy need to steer clear of them. 
     
  • Don't forget the importance of regular exercise and maintaining a healthy weight.
     
  • The Dietary Supplements Regulations are inadequate for ensuring products meet "quality" standards. We want to see more comprehensive regulation that will tell consumers whether a product is safe, meets its claims, and is consistent in quality.

     

More information

 

Report by Belinda Allan.