Date post: | 22-Dec-2015 |
Category: |
Documents |
View: | 220 times |
Download: | 0 times |
Learning Objectives Ideantify Health claims of glucosamine Explain brief mechanism of
osteoarthritis Explain metabolic pathway of
glucosamine List side effects related to
glucosamine Describe correlation between
glucosamine and insulin resistance
Claims
Treatment of knee osteoarthritis Repair and maintenance of joint
cartilage Aid glycosaminoglycan (GAGs)
synthesis Reduce joint pain
Osteoarthritis Degenerative joint disease on cartilage Pain, swelling, loss of motion of the joint Loss of normal shape in the long term Different to rheumatoid arthritis (auto
immune disease)
lacks blood vessels, lymphatic vessels, and nerves.
Low level of metabolic activity
osteoarthritis Location: Fingers, neck, back, knees, hips Causes: Overweight, aging, joint injury, sports
activities, muscle imbalance. Injury: stimulate degeneration of proteoglycans
or suppress proteoglycan synthesis Hereditary characteristics approx 1 in 13 or 7.35% or 20 million people in
USA
Common treatment Rest, exercise, medications, surgery, CAM
History of usage The first published study from Germany in 69. Additional studies in Europe and Asia in the 80’s. Comparison of glucosamine to NSAID In 1997,The Arthritis Cure, by Jason Theodasakis, MD.
Not recognized as a treatment by the Arthritis Foundation
A nonpermissible supplement for institutions to provide to their athletes by the NCAA.
Approved as medical drug in some countries in Europe
Glucosamine A building block for articular
cartilage’s extracellular matrix
Used to produce GAGs and proteoglycans
Synthesized by chondrocytes
90% absorption by oral administration
26% available for processing by the body’s tissue
Glucosamine1. Glucosamine sulfate (most common form)2. Glucosamine hydrochrolide3. Glucosamine hydroiodide
Commonly used with; Chondroitin: a glycosaminoglycan derived from articular
cartilage Methylsulfonylmethane (MSM): sulfur compound and high-
temperature solvent
Sulfur is an essential nutrient for the stabilization of the connective tissue matrix.
Glucosamie sulfate stimulates the uptake of sulfate ions -> indicater of GAG synthesis by chondrocytes.
Glucosamine also hinders hyaluronidase (tissue damaging enzyme)
Glucosamine sulfate improves the lubricant properties of synovial fluid.
Source Present in meat, fish, poultry. Synthesized in the body.
Manufactured from chitin, a substance found in shrimp, crab, and lobster shells.
marine exoskeletons. Synthetic glucosamine is also available
Chemically synthesized.
Chemical structure of glucosamine
Aminomonosaccharide synthesized from glucose.
Glucose + amino acid C6H14NO5
Process in the body1. Fructose 6 phsophate+glutamine2. Glucosamine 6 phosphate3. UPD N-acetyl glucosamine
Dosage Adults
500mg per tablets or capsules 1500mg/day 2000mg/day
Children Not enough scientific data MSM (methylsulfonylmethane) and
autism
Safety The clinical studies have consistently reported
that glucosamine appears safe.
No allergic reactions have been reported although glucosamine is derived from shellfish
Allergy to shellfish may wish to avoid glucosamine.
May not have acute oral toxicity in animal
Glucosamine may increase on insulin resistance
Side effects Upset stomach Drowsiness Insomnia Headache Skin reactions Sun sensitivity Nail toughening Abdominal pain Loss of appetite Nausea and vomiting Flatulence Constipation and diarrhea Palpitation (increased BP and HR) May increase risk of bleeding (avoid drug increasing risk of bleeding) Increased amounts of protein in urine: unclear Increased blood level of creatine phosphokinase due to impurities in some
products May exacerbate asthma: Hx of asthma should avoid until it’s clear Not recommended during pregnancy or breastfeeding due to lack of scientific
evidence.
Interactions with Drugs May increase risk of side effects
Diuretics (lasix):
May increase risk of bleeding when taken with drugs that increase the risk of bleeding Aspirin, anticoagulants (blood thinners): warfarin,
(coumadin) or heparin, anti-platelet: clopidogrel, (plavix), non-steroidal anti-inflammatory: ibuprofen
(Motrin, Advil) or naproxen (Naprosyn, Aleve)
Interaction with Herbs and Dietary Supplements
Lower the effectiveness that lower BG level Aloe vera, American ginseng, bilberry, bitter melon, burdock
fenugreek, fish oil, gymnema, horse chestnut seed extract, marshmallow, milk thistle, panax ginseng, rosemary, Siberian ginseng, stinging nettle and white horehound.
May raise BG level Arginine, cocoa, and ephedra
Increased side effects of glucosamine when used with diuretic herbs or supplements
Artichoke, celery, corn silk, dandelion, kava, couchgrass, elder flower, horsetail, yarrow, uva ursi, shepherd’s purse
Increased risk of bleeding Ginkgo biloba, garlic, alfalfa, ginseng, black cohosh, celery, devil’s
claw, EPA, fish oil, ginger, grapefruit juice, green tea, melatonin, omega-3 FA, onion, parsley, vitamin E, wild willow, wild carrot, wild lettuce,
Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritisby Clegg, D. O., et al., the New England Journal of Medicine. Feb23, 2006
Objective Efficacy and safety as a treatment for knee pain from
osteoarthritis
Study design Multicenter, double blind, placebo-, and celecoxib-controlled GAIT
Subjects 1583 patients with symptomatic knee osteoarthritis(x-rays
documented) 1500mg of glucosamine, 1200 mg of Chondroitin sulfate, both G
& C, 200mg of celecoxib (NSAID: blocks the COX-2 enzyme), or placebo
24 weeks >40 years old, Mean age 59 years old, 64 % women Subgroups: Mild n=1229, moderate to severe n=354 Evaluation at 4, 8, 16, 24 weeks Up to 4000mg of acetaminophen daily as option, except for
the24hours before pain was assessed.
Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritisby Clegg, D. O., et al., the New England Journal of Medicine. Feb23, 2006
Locations 16 study centers including University of Utah, etc
Outcome Measures 20%reduction in pain in the summed score for the
WOMAC pain subscale Global assessment of disease status Soft tissue swelling, effusion, or both in the index knee Medical OutcomeStudy36-item Short-Form General
Health Survery (SF-36): Reflect the health related quality of life.
Health Assessment questionnaire: reflect physical function
Acetaminophen use
Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritisby Clegg, D. O., et al., the New England Journal of Medicine. Feb23, 2006
Results Participants used acetaminophen fewer than two
500mg tablets per day Celecoxib: >20% reduction in 70%, 60% in
placebo No significant differences between placebo and
others. Moderate-to-severe pain with G&C: 79% in G&C,
54% in placebo Mild pain with G&C: 62.9% in G&C, 61.7% in
placebo 77 reports of mild side effects Additional 18 months for half of the participants.
Long-term effects of glucosamine sulfate on osteoarthritis progression: a randomised, placebo-controlled crinical trial by Reginster, J.Y; et al. The Lancet; Jan27,2001;357
Objective Effect of long-term use of glucosamine to change joint
structure and symptoms
Study design Randomized, double blind, placebo-controlled
Subjects 212 patients w/ mild-moderate osteoarthritis (106
subjects each) 1500mg glucosamine sulfate 3 years Consumption of the pure analgesic or a NSAIS, average
one of every 6 days
Long-term effects of glucosamine sulfate on osteoarthritis progression: a randomised, placebo-controlled clinical trial by Reginster, J.Y; et al. The Lancet; Jan27,2001;357
Outcome measures The Western Ontario and McMaster Universities
(WOMAC) osteoarthritis index
Results GS (68subjects)
No average joint-space narrowing improvement of symptoms in WOMAC score
(34%difference)
Placebo(71subjects) A progressive joint-space narrowing Symptoms slightly worsened
Most patient reported at least 1 mild adverse event.
The effect of oral glucosamine sulfate on insulin sensitivy in human subjects. Yu, JG., Boies, SM., Olefsky, JM. Diabetes Care. Jun2003.
Objective Effect of recommended dosage of glucosamine
on insulin resistance.
Study design Not specified
Subjects 7 obese (BMI>27) and 7 lean (BMI<27) IGT in 3 of obese and 2 of lean subjects Glucosamine 1500mg for 4weeks
The effect of oral glucosamine sulfate on insulin sensitivy in human subjects. Yu, JG., Boies, SM., Olefsky, JM. Diabetes Care. Jun2003.
Outcome measures Comparison of fasting plasma glucose and
insulin levels at baseline 4-h plasma glucose curve 4-h meal tolerance test (MTT) plasma insulin
curve
Results No changes in fasting plasma glucose, insulin,
or lipoprotein levels Recommended dosage of glucosamine was not
detrimental to glucose metabolism in humans.
conclusion Glucosamine appears to be more
effective than placebo Glucosamine appears to be more
effective in long term use Combination with chondroitin seems to
be more effective. Short term use of glucosamine may not
affect insulin resistance Used it under supervision of physician