Great article I found for anyone with joint pain…

Glucosamine/Chondroitin Controversy:
What They’re NOT Telling You

by Dr. Peter Siroka, DPM

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Despite inaccurate reporting from the mainstream media, large study exposes real truth about nutrient combination for those with poor joint health

During the recent running controversy over Glucosamine and Chondroitin, the truly legitimate headlines were the ones you didn’t see. While the media would have been more truthful running headlines such as: “Authoritative Study Finds Celebrex a Failure for Arthritic Pain,” reporters instead chose to side with the pharmaceutical giants and inaccurately suggested that Glucosamine and Chondroitin did not work for people with arthritis.

See, if you take the time to really understand how the GAIT study (Glucosamine-Chondroitin Arthritis Intervention Trial) was conducted—and what it found—you would realize that the opposite is true. In fact, after careful analysis, the study actually reveals that a combination of Glucosamine and Chondroitin is perhaps more impressive than previously thought, and may be an effective first option for those with problematic bone and joint issues.

Strong Statements Baseless?
Conducted at 16 U.S. rheumatology treatment centers and funded by the National Institutes of Health, GAIT was designed as a scientific evaluation of the safety and efficacy of Glucosamine, Chondroitin or a combination of both, versus a placebo or the prescription medication Celebrex in 1,258 people (Clegg et al, 2006). After months of study, the findings were published in the February, 2006 issue of The New England Journal of Medicine.

The GAIT study was published with an editorial expressing doubt about the use of supplements as a viable option for people with poor joint health. “On the basis of the results from GAIT,” the journal opined, “it seems prudent to tell our patients neither glucosamine hydrochloride nor chondroitin sulfate has been shown to be more efficacious than placebo for the treatment of knee pain.” While that may seem a strong and conclusive statement against the supplements, one has to wonder if the editors of the journal considered the data carefully—or if the members of the mainstream media who reported on the study in actuality read it at all. So, here’s what they missed…and what they neglected to tell you.

“Set Up to Fail”
The first thing to notice about the GAIT study is that it only concerns knee pain. Arthritis typically causes discomfort either on the front or in the back of the knee, but bursitis and Baker’s cyst (two non-arthritic conditions) can also cause problems in the same locations. Supplements like Glucosamine and Chondroitin are not typically recommended for bursitis or Baker’s cyst because these nutrients seem to operate on mechanisms in the body not associated with these two types of problems.

But while the researchers in charge of the GAIT study excluded many volunteers with a variety of other health problems from participating in the study, they did not exclude those with bursitis or Baker’s cyst. In addition, even though GAIT was supposed to be a “randomized” study, somehow, more patients with bursitis got placed in the Glucosamine and/or Chondroitin groups compared to those placed in groups treated with Celebrex® or a placebo. Did the researchers—knowing the limits of Glucosamine and Chondroitin on these types of problems—deliberately set up the supplements to fail?

Undermining the Supplements
In addition, study participants were allowed to consume up to 4,000 mg (eight extra-strength tablets) of acetaminophen (Tylenol®) every day during the study, except during the 24-hour period before their knees were evaluated. Previous published research has suggested that taking acetaminophen at the same time as Glucosamine reduces the joint’s ability to absorb Glucosamine from the bloodstream (Hoffer et al, 2001). Were the researchers allowing Glucosamine’s effect to be undermined?

Plus, the use of Celebrex seemed to also undermine the study’s results. Depending on diet and other factors, Celebrex actually can cause damage to the knee. It may prohibit cartilage from growing back when it is pulled away from a joint. This effect is worse in people who have unusual variations in certain detoxifying enzymes in the liver (Fries et al, 2006). Ironically, those who eat cruciferous vegetables (such as cabbage, lettuce and kale) are at risk for a specific reaction that degrades proteins in the knee. But the researchers in charge of GAIT allowed all participants to eat cruciferous vegetables during the study.

Still Performed Admirably
Despite the fact that the odds seemed to be stacked against Glucosamine and Chondroitin, the supplements performed better than expected. For a subset of participants with moderate-to-severe problems, Glucosamine combined with Chondroitin provided statistically significant relief compared to placebo—about 79% experienced a 20% or greater reduction in discomfort. In comparison, only about 70% of those taking Celebrex experienced the same results. In fact, Celebrex did no better than placebo in relieving knee pain in 12 out of 14 outcome measures in the GAIT study. When Celebrex did seem successful, nearly 68% of its effect likely occurred due to “the placebo effect.” In other words, it seemed as if the GAIT researchers checked on study participants so frequently that volunteers often reported less pain simply because they felt they were supposed to be getting better.

In addition, the GAIT trial completely ignored the need for knee replacement surgery. In a previous 36-month study of Glucosamine and Chondrotin, during which patients were followed for eight years after they stopped taking the products, the need for joint replacement was cut by 75%. Even better, these natural products have not been linked to a single death in 15 years, according to Jason Theodosakis, an arthritis and sports medicine specialist and author of the book, The Arthritis Cure. As you may know, Celebrex and some of its related drugs (like Vioxx, which was pulled from the market in 2005) can cause an increased risk of heart attack.

What You Didn’t Hear
But if you listened to the mainstream press, you likely did not hear any of this information. Instead of accurately reporting the truth—that Glucosamine and Chondroitin do help ease moderate to severe discomfort in the knee and that Celebrex does not work as well as previously thought—news reporters instead chose to focus on some of the nominal effects that the nutrients had on minor knee problems.

Perhaps the second half of the GAIT trial—set to launch later this year—will confirm that the use of Glucosamine and Chondroitin prevents or reduces the need for surgery. While it may be speculation to assume that the researchers will measure this possibility, one thing is for sure: Had the researchers used a standard statistical measure, they would have found Glucosamine and Chondroitin to be nearly as effective as Celebrex. Moreover, to prove that Celebrex relieves pain at all, the researchers oddly chose to apply an “unusual standard of proof,” a 98.3% confidence interval, rather than the standard 99%.

Despite its misinterpretations in the press, here are two results that you should know about the GAIT study:

1. The more severe the problem, the greater the effect. While participants with moderate problems seem to respond well to a Glucosamine/Chondroitin combination, those with moderate to severe knee problems reported 25% more improvement.
2. Glucosamine and Chondroitin should be taken together, not separately. The GAIT study noted the most significant effect when the supplements were used in combination. While each nutrient seems to have a positive effect on joint health on its own, the GAIT researchers did find that a combination was much more effective.

Time for the Truth
Fortunately, some experts have not become duped by the inaccurate reporting that seemed to flood the airwaves in the wake of the GAIT study. In fact, many have taken action themselves, speaking out in strong support of Glucosamine and Chondroitin. For example, Dr. Kevin R. Stone, Chairman of the Stone Foundation for Sports Medicine and Arthritis Research in San Francisco, recently made this comment about the GAIT study: “The supplements Glucosamine and Chondroitin together, which are inexpensive and have zero negative side effects, performed as well as the very expensive and somewhat risky Celebrex. I believe the standard of care in medicine will now be to prescribe the supplements first and, if they are not enough, then to add additional medications.”

Hopefully, as health experts become aware of the whole story and more educated, they can help dispel some of the misinformation about Glucosamine and Chondroitin. That in turn may help everyday citizens to realize the healing potential of these natural compounds. In the meantime, you now have an insider’s view of the GAIT study and can now make an informed decision about all the options available to you. This may help you and your loved ones move closer to days of joint comfort, mobility and flexibility that you deserve.

References
Clegg, D.O., et al.(2006). Glucosamine, chondroitin sulfate and the two in combination for painful knee osteoarthritis. New England Journal of Medicine, 354(8), 795–808.

Fries, S., et al. (2006). Marked interindividual variability in the response to selective inhibitors of cyclooxygenase-2. Gastroenterology, 130(1), 55–64.

Hoffer, L.J., et al. (2001). Sulfate could mediate the therapeutic effect of glucosamine sulfate. Metabolism, 50(7), 767–770.