I don’t believe you have talked about glucosamine. I am a 53-year old female, vegan for 6 years, in excellent health. However, I have had various joint problems and just been told to take glucosamine by my doctor (750 mg twice daily). Whole Food Market carries several vegan brands. In your opinion do these really strengthen joints/cartilage and which would be the best one to take?

I performed a full literature review on glucosamine and chondroitin a number of years ago for a print newsletter I had at the time. I have checked in on the literature occasionally since then and thought now would be a good time to do so again.

Background: Cartilage is a substance that exists in many joints, such as the knee, that provides cushion between bones. When cartilage starts to wear away, bones start to grind against each other and osteoarthritis results. Glucosamine and chondroitin are components of cartilage and have been promoted as being able to rebuild or at least prevent the deterioration of cartilage. Glucosamine is generally vegan while chondroitin is not. There are vegan forms of glucosamine, especially glucosamine HCl. Glucosamine sulfate often comes from shellfish, but there are vegetarian forms. To my knowledge, there are no vegan forms of chondroitin. Methylsulfonyl methane (MSM) has also been touted to have similar beneficial effects on joints.

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When I wrote my first review, the conclusion at the time, based on a lot of research, was that 1500 mg per day of glucosamine might help prevent the progression of osteoarthritis if it was in its early stages.

I did a little searching today and found that things had not changed much.

I came across an abstract of a 2005 meta-analysis of studies on glucosamine and the progression of new osteoarthritis. It found that glucosamine reduced the amount of pain and progression of the disease (1).

An abstract from a 2010 meta-analysis of studies on glucosamine and chondroitin found no effect of treatment for the first year, but did find a “small to moderate protective effect” over the course of two to three years (2).

The most recent information I found was a 2011 meta-analysis from the British Medical Journal on glucosamine and chondroitin’s effects on osteoarthritis of the hip or knee. If found no benefit. The authors state:

“Results from randomised trials about the effectiveness of chondroitin and glucosamine are conflicting. Trials that have reported large effects on joint pain were often hampered by poor study quality and small sample sizes, whereas large methodologically sound trials often found only small or no effects.”

They conclude:

“Our findings indicate that glucosamine, chondroitin, and their combination do not result in a relevant reduction of joint pain nor affect joint space narrowing compared with placebo. Some patients, however, are convinced that these preparations are beneficial, which might be because of the natural course of osteoarthritis, regression to the mean, or the placebo effect. We are confident that neither of the preparations is dangerous. Therefore, we see no harm in having patients continue these preparations as long as they perceive a benefit and cover the costs of treatment themselves.”

I personally take glucosamine occasionally. It might not be effective if taken only occasionally, but I only have so much money I want to spend on a therapy that is questionable.

I do not have an opinion on which brand is best. There is some debate about whether glucosamine sulfate or glucosamine hydrochloride is better. I do not know the answer to that.

References

1. Poolsup N, Suthisisang C, Channark P, Kittikulsuth W. Glucosamine long-term treatment and the progression of knee osteoarthritis: systematic review of randomized controlled trials. Ann Pharmacother. 2005 Jun;39(6):1080-7. Epub 2005 Apr 26. Abstract

2. Lee YH, Woo JH, Choi SJ, Ji JD, Song GG. Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis. Rheumatol Int. 2010 Jan;30(3):357-63. Abstract

3. Wandel S, Jüni P, Tendal B, Nüesch E, Villiger PM, Welton NJ, Reichenbach S, Trelle S. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ. 2010 Sep 16;341:c4675. Full Text