Glucosamine Saves Your Joints

By Dr. Michael Colgan

I have used glucosamine sulphate with my horses for years. It definitely reduces the inflammation of lameness and is sometimes spectacularly helpful in joint injuries. But I never recommended it to athletes until I got a joint injury myself.

In 1993, we were doing a few deadlifts in the gym; a lift we usually stay away from. It was ego stuff, kidding around. "I can lift more than you, ha-ha". When we got near the weights that won a local powerlifting meet, things started to get serious. Then I was successful in lifting 10 lbs. above the winning weight at my age and bodyweight (420 lbs.) and things got real serious. Another 10 lbs. on the bar and it was going up nicely when my left foot began to slip. I was wearing sneakers, not lifting shoes, and the sneaker sole began to curl around the foot. So, naturally, I did what we tell our clients never to do. I tried to adjust my position with the weight in the air. With a sort of quiet pouf, my left knee exploded.

Six hours and an MRI later, I was in a wheelchair in excruciating pain, being told I’d torn the anterior cruciate ligament, the lateral collateral ligament and both cartilages (meniscae). "Surgery right away", said the very superior surgeon. "You've burst the knee capsule as well, and there's fluid leaking down the inside of your leg".

I was in too much agony to protest, and emergency surgery was scheduled for next morning at Scripps Hospital, San Diego. But after 1 got home and took some ancient and friendly opiates, common sense returned. Studies show that athletes, who have surgery for cartilage and ligament tears in the knee, fare worse than those who refuse surgery and are treated solely with anti-inflammatories and rehab exercise.

The latest study did a long-term follow-up of 52 athletes aged 40-60 who refused surgery for anterior cruciate ligament tears, and compared them with a similar group who submitted to the atheroscope. Leader of the study Dr. Michael Cicotta of the Rothman Institute in Philadelphia concluded, "The non-operative patients had greater satisfaction with the outcome. There was less evidence of arthritic changes and they had a lower incidence of (re)injury".

Glucosamine to the Rescue

Back to my knee... If glucosamine sulphate could heal injuries in the fragile legs of horses, perhaps it might heal mine. I cancelled the surgery and took 10 grams of glucosamine sulphate and a large handful of multiple antioxidants.

Next morning, my elephant-sized leg required significant opiates to quiet it down to a dull roar, and my resolve began to waver. But three days of 5 grams of glucosamine sulphate and multi-grams of antioxidants and I could put my toe to the ground and hobble about on crutches.

I didn't use OTC anti-inflammatories such as aspirin or ibuprofen, because of the mounting evidence that they inhibit the body's ability to produce cartilage. In fact, the common anti-inflammatories used by many physicians to treat knee pain are now suspected to be a major cause of ligament and cartilage destruction. In any case, after six days the inflammation and constant pain abated.

Within 10 days, to the surgeon's amazement, I could walk with one crutch and a hinged knee brace, and began light quadriceps, hamstring, adductor and abductor exercises to strengthen the knee. After six weeks of glucosamine - now at 2 grams a day - plus antioxidants, I discarded the brace and crutch and could walk without pain. Rehab exercises were still painful, but it soon faded. Three months after the injury, I could run and lift with only occasional twinges. Now, almost a year after the injury, my knee functions perfectly and without a trace of pain.

Research on Glucosamine

O.K. I know my single case doesn't mean squat in scientific terms. But before I even started out, I reviewed the human studies with the stuff. Let's look at a few examples...

One good study with arthritic knees was done at St. John's Hospital in Oporto, Portugal. Much arthritis of the knee occurs because of damage to the cartilage cushion, which leaves the leg bones grinding on each other. Dr. Antonio Vaz randomly divided a group of 68 patients with arthritis of the knee into two groups. One group got a daily dose of 1.5 grams of glucosamine sulphate, the other 1.2 grams of ibuprofen (Motrin). The study was done double-blind. Results showed that, by the end of the study, the glucosamine group had significantly less pain than the ibuprofen group.

Another double-blind study divided 30 patients with chronic arthritis into two groups. One group received 500mg of glucosamine sulphate per day for 14 days. The other group received a placebo. Total symptom scores, including pain, swelling, tenderness and loss of function, improved by 71 % in the glucosamine group, but were little changed in the placebo group. Another similar but independent study confirmed these spectacular results.

There are no studies yet on athletes using glucosamine sulphate, but its mechanisms of action indicate it could be a big advance in treatment of ligament and cartilage injuries. Let's look briefly at how it works...

How Glucosamine Works

To understand the mechanism of glucosamine action, we have to take a brief dip into the biochemistry of the connective tissue that makes up our ligaments, cartilages, tendons and spinal discs. The main component of these tissues is collagen, strings of proteins that actually connect the cells to each other. The second component is long chains made mainly of sugars, called glycosaminoglycans (GAGs). These GAGs are the tissue component that collagen models onto. Collagen and GAGs together continuously construct and reconstruct your tendons and ligaments.

That's where glucosamine comes in. It is the major precursor of GAGs. But even more important, the making of glucosamine from glucose and glutamine is your body's rate-limiting step in GAG production, and hence the rate-limiting step in re-modelling your connective tissues.

Following connective tissue injury, such as a cartilage tear, this limit does not allow the body to make sufficient glucosamine for optimal healing. And, as we age, the body's ability to convert glucose and glutamine to glucosamine also declines, because of reduction in the level of the converting enzyme glucosamine synthetase. So your body's ability to repair connective tissues declines also.

With all the athletes knocking themselves leg-less today, and all the older folks who want to run, and lift, and stay active, this defect in our body design has spawned lucrative surgical business, hacking away at knees, ankles, elbows, shoulders and backs. Because ligament and cartilage repair is only fair in the young, and gets progressively worse with age, surgery often seemed the only option.

Then along comes man-made glucosamine, which bypasses the rate limit in your body's GAG production system, increases GAG levels by up to 170%, and increases connective tissue synthesis big time. My own experience with the stuff was almost miraculous, and 1 look forward to controlled studies with athletes to bear me out.

Glucosamine Supplements

Since I first wrote about glucosamine over a year ago, numerous supplement companies have brought out weird and wonderful concoctions incorporating this compound. Many of them indicate their makers don't know the biochemistry I sketched above, so I want to steer you away from the silly combinations and towards the ones that should do the work.

First, avoid the many supplements that contain chondroitin sulphate. Some manufacturers claim that it breaks down to glucosamine in the gut. Some does, but no-one knows how much.

Others claim that chondroitin sulphate passes into the body and is there converted into glucosamine. That's a straight lie.

The molecule of chondroitin sulphate is too big. Its molecular weight is about 50,000. It would take a steam shovel to push a molecule that large through your intestinal wall. In contrast, glucosamine sulphate has a molecular weight of 211. About 95 % of ingested glucosamine sulphate is absorbed. A good proportion of this goes to connective tissues, where it is preferentially used to make GAGs.

What about N-acetyl glucosamine (NAG) now being touted about the marketplace? By itself, NAG is next to useless, because it is only one of the sugars in GAGs, and does not stimulate GAG synthesis without glucosamine sulphate to bypass the rate-limiting step and trigger production. NAG is useful only if taken in conjunction with glucosamine sulphate.

Finally, when you do try the stuff, buy glucosamine sulphate rather than straight glucosamine. Research indicates that sulphur is an essential part of the molecule during tissue re-modelling.

Dosage is unknown, but I successfully used 5 grams per day for a few days, then 3 grams per day for two weeks, followed by 2 grams per day for eight weeks. Glucosamine sulphate is virtually non-toxic to animals, even at 8 grams per kilogram bodyweight per day. The human studies discussed above reported no side-effects at all.

Like I did with chromium picolinate when it was still unknown in 1984, 1 will go out on a limb and predict that glucosamine sulphate will prove to be a winner for athletes.

Note: This page is an exact copy of an article in Muscular Development, Fitness and Health except that the spelling has been altered to the British style from the original spelling. The references are not included.