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Michael
Murray, ND, is a leading authority on natural medicine. He is co-author
of A Textbook of Natural Medicine, a definitive work on naturopathic
medicine for physicians, and The Encyclopedia of Natural Medicine. He
has also authored The Healing Power of Herbs, The Complete Book of
Juicing, and soon to be released, The Healing Power of Foods.
The most
common form of arthritis is osteoarthritis, also known as degenerative
joint disease. Osteoarthritis is seen primarily, but not exclusively, in
the elderly. Surveys have indicated that over 40 million Americans have
osteoarthritis, including 80 percent of persons over the age of 50.
It is
believed that the cumulative effects of decades of joint use leads to
degenerative changes. This damage is compounded by a decreased ability
to repair joint structures. As we age, there is a decreased ability to
restore and manufacture normal joint structures such as cartilage.
The
weight-bearing joints, like the knees and hips and joints of the hands,
are the joints most often affected with osteoarthritis. In affected
joints, there is much cartilage destruction followed by hardening and
the formation of large bone spurs in the joint margins. Pain, deformity,
and limitation of motion in the joint results.
The onset of
osteoarthritis can be very subtle, morning joint stiffness is often the
first symptom. As the disease progresses, there is pain on motion of the
involved joint that is made worse by prolonged activity and relieved by
rest.
Current
Medical Treatment: More Harm than Good?
Research is
indicating that current drugs being used in osteoarthritis may be
producing short-term benefit, but actually accelerating the progression
of the joint destruction. Based on data collected from the earliest
signs of osteoarthritis to the most advanced stages suggest that
cellular and tissue response is purposeful and is aimed at repair of the
damaged joint structure. The process contributing to osteoarthritis
appears to be able to be stopped and sometimes reversed1. Therefore, the
major goal of therapy appears to be enhancing repair processes by
various connective tissue cells. Unfortunately, the current medications
being used actually inhibit repair processes.
Several
studies have attempted to determine the "nature course" of
osteoarthritis.1,2 That is the course of the disease if no treatment is
given. In one study of the natural course of osteoarthritis of the hip
over a 10 year period, all subjects had changes suggestive of advanced
osteoarthritis, yet the researchers reported remarkable clinical
improvement and x-rays confirmed recovery of the joint space in 14 of 31
hips.2 The authors of the study purposely applied no therapy and
regarded their results as reflecting the natural course of the disease.
Nearly half of the patients had confirmed recovery without any therapy.
These
results, as well as others, raise some interesting questions. Does
medical intervention in some way promote disease progression? Can
nutrition and various natural therapies enhance the body's own response
towards health? The answer to both of these questions appears to be yes.
Aspirin and
Other Non-Steroidal Anti-Inflammatory Drugs
The
first drug generally used in the treatment of osteoarthritis is aspirin.
It is often quite effective in relieving both the pain and inflammation,
and is relatively inexpensive. However, since the therapeutic dose
required is relatively high (two to four grams per day), toxicity often
occurs. Tinnitus (ringing in the ears) and gastric irritation are early
manifestations of toxicity.
Other
non-steroidal anti-inflammatory drugs (NSAIDs) are often used as well,
especially when aspirin is ineffective or intolerable. The following are
representative of this class of drugs: ibuprofen (Motrin, Advil, Nuprin),
fenoprofen (Nalfon), indomethacin (Indocin), naproxen (Naprosyn),
tolmetin (Tolectin), and sulindac (Clinoril). These drugs are also
associated with side effects including gastrointestinal upset,
headaches, and dizziness, and are therefore recommended for only short
periods of time.
One side
effect of aspirin and other NSAIDs that is often not mentioned is their
inhibition of cartilage repair and acceleration of cartilage
destruction. Since osteoarthritis is caused by a degeneration of
cartilage it appears that while NSAIDs are fairly effective in
suppressing the symptoms, they possibly worsen the condition by
inhibiting cartilage formation and accelerating cartilage destruction.
This has been upheld in studies which have shown that NSAIDs use is
associated with acceleration of osteoarthritis and increased joint
destruction.3-6 Simply stated, aspirin and other NSAIDs appear to
suppress the symptoms by accelerate the progression of osteoarthritis.
Their use should be avoided.
Glucosamine
Sulfate: A Natural Alternative to Arthritis Medications
If
current arthritis medications should be avoided, what is an arthritis
sufferer to do? A naturally occurring substance found in high
concentrations in joint structures appears to be nature's best remedy
for osteoarthritis. This compound is glucosamine.
In the body,
the main action of flucosamine on joints is to stimulate the manufacture
of cartilage components. In other words, glucosamine is responsible for
stimulating the manufacture of substances necessary for joint repair.
This action alone suggests a therapeutic role in osteoarthritis. But,
there is much more. Glucosamine has also been shown to exert a
protective effect against joint destruction and, when given orally as
glucosamine sulfate, it is selectively taken up by joint tissues to
exert a powerful therapeutic effect in osteoarthritis.2
Numerous
double-blind studies have shown glucosamine sulfate to yield as good as
or even better results compared to NSAIDs in relieving the pain and
inflammation of osteoarthritis.8-11 What is amazing about these results
is that glucosamine sulfate exhibits no pain relieving effects. While
NSAIDs offer purely symptomatic relief and may actually promote the
disease process, glucosamine sulfate addresses the cause of
osteoarthritis. By getting at the root of the problem, glucosamine
sulfate not only improves the symptoms including pain, it also helps the
body repair damaged joints. This is outstanding, but what is even more
outstanding is the safety and the lack of side effects associated with
oral glucosamine sulfate. In contrast, the side effects and risks
associated with NSAIDs currently used in the treatment of osteoarthritis
are significant. The therapeutic margin, a measure of safety, is 10-30
times more favorable for glucosamine sulfate than for commonly used
NSAIDs and no adverse side effects have been reported.7
The
beneficial results with glucosamine are more obvious the longer it is
used. Because glucosamine sulfate is not a pain relieving substance per
se, it takes a while longer to produce results. But, once it starts
working, it will produce much better results compared to NSAIDs. For
example, in one study that compared glucosamine sulfate to ibuprofen
(Motrin), pain scores decreased faster in the first two weeks in the
ibuprofen group, however by week four, the group receiving the
glucosamine sulfate was doing significantly better than the ibuprofen
group.
Glucosamine
Sulfate vs. Chondroitin Sulfate
Glucosamine
sulfate is a simple molecule. As its name indicates it is composed of
glucose, an amine (nitrogen and two molecules of hydrogen), and sulfur.
It serves as the backbone structure to many glycosaminoglycans including
chondroitin sulfate.
In contrast
to glucosamine, chondroitin sulfate is a very large, complex molecule.
Glucosamine sulfate has a molecular weight of 211. Chondroitin sulfate
has a molecular weight of over 30,000. Chondroitin sulfate is so large
it is virtually impossible for the body to absorb it intact. It must be
broken down into smaller units. Chondroitin sulfate is 250 times larger
than glucosamine. To put this perspective, for the body it would be the
difference between trying to swallow a whole sesame seed versus a whole
watermelon. It is simply impossible. Just like the watermelon,
chondroitin sulfate must be broken down into smaller pieces to be
absorbed. While 98 percent of orally administered glucosamine sulfate is
absorbed intact, the absorption rate for chondroitin sulfate is
estimated to be between zero and eight percent.12
From a
clinical perspective, glucosamine is extremely effective if given
orally. In contrast, the effectiveness of oral chondroitin sulfate is a
subject of considerable debate. Most of the studies have utilized
injectable forms. If chondroitin sulfate is effective orally, it is most
likely due to the body breaking down chemical bonds and freeing up
glucosamine.
Another
analogy would be the difference between crude ore (chondroitin sulfate)
and pure gold (glocosamine). While there is gold in crude ore, if you
are trying to make jewelry, it is better to use the pure gold. If you
are trying to restore joint structures, it is best to use glucosamine
sulfate rather than chondroitin sulfate. Once absorbed, glucosamine is
preferentially taken up by cartilage and other joint structures where it
simulates the manufacture of mucopolysaccharides like chondroitin
sulfate.12
Summary
The case of osteoarthritis is a classic example
where current medical treatment simply suppresses symptoms, and since it
doesn't address the underlying cause, the treatment actually promotes
the disease process. The use of glucosamine is a classic example of how
a natural substance improves a condition by addressing the underlying
cause and supporting the body's ability to heal itself.
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