Chondroitin sulphate

Chondroitin is a popular supplement for supporting joint health, used to help naturally rebuild joint cartilage and support tissue regeneration after injury or exercise. As an important structural component of joint cartilage and one of the key substances that allows joints to withstand pressure, chondroitin is used by many people with joint pain, osteoarthritis and other age-related wear and tear. Usually, chondroitin is used in supplements in combination with similarly acting or synergistic compounds such as glucosamine or MSM.

Although not all studies have shown that chondroitin is able to help anyone with joint pain, many studies support its effectiveness and safety. The Natural Medicines Comprehensive Database has classified chondroitin as "possibly effective" for osteoarthritis and many other authorities stand behind its use to combat pain in place of prescription medications (1, 2). In addition to providing relief for people with arthritis, chondroitin (and glucosamine) could help people who suffer from chronic conditions such as knee problems or sacroiliac joint problems that cause pain in the upper leg and lower back.

Chondroitin is a natural substance found in the human body and is a major component of joint cartilage. Drinking meat broth is probably one of the best ways to naturally consume chondroitin and glucosamine together in the form of natural foods. The chondroitin contained in supplements is either extracted naturally from the cartilage of animals such as cows, cattle and sharks, or produced synthetically in a laboratory. The lab-produced form of chondroitin is known as chondroitin sulfate and is a combination of chondroitin with mineral salts that help improve absorption (3).

What do chondroitin supplements do?

Both the naturally derived and synthetically produced forms of chondroitin help to build connective tissue in the body, including the connective tissue that forms joints and the digestive tract. Because it works by retaining water, the benefits of chondroitin include better lubrication and flexibility of stiff or damaged joints and body tissues.

How does chondroitin work

Chondroitin is a major component of the human extracellular matrix (EMC) - a component found in all tissue types and organs of the body that forms a physical scaffold for tissue. The EMC consists of water, proteins and polysaccharides (4). Chondroitin helps bind sugar and protein molecules together and plays an important role in maintaining structural integrity. Its primary benefits and mechanisms of action are to stimulate the regeneration of articular cartilage - the connective tissue that cushions the ends of the bones in the joints. Chondroitin contains tightly packed sulfate groups that form a barrier that can resist compression, impact and even electrostatic charges that could damage tissue. Chondroitin is technically a complex carbohydrate that has shock- and water-absorbing capabilities, which make it critical for joints to move without friction.

This is the reason that loss of chondroitin from joint cartilage is one of the main causes of osteoarthritis, which leads to joint degeneration. Chondroitin is also important for the formation of other tissue types in the body including the skin, digestive tract and brain. In relation to the brain's extracellular matrix, it helps to stabilize the brain's synapses and protect the brain from injury. After trauma to the brain, chondroitin levels increase rapidly to help regenerate new tissue to replace damaged nerve endings.

The main benefits and uses of chondroitin

Chondroitin can help in the treatment of osteoarthritis joint pain

Research shows that in the US alone, 27 million adults suffer from osteoarthritis, which is the most common type of degenerative joint disease and is characterized by a breakdown of joint cartilage and increased joint pain. Chondroitin is commonly used to treat pain associated with osteoarthritis - particularly forms that affect very vulnerable parts of the body such as the knees and hands. Overall, studies show that chondroitin use tends to bring moderate improvements in joint pain over a course of several months, with some people experiencing greater benefits in less time - especially when multiple supplements are combined and other changes, such as an arthritis-friendly diet, are made to manage symptoms.

According to the US Arthritis Foundation, study participants usually experience an improvement in painful symptoms when using chondroitin compared to a placebo. The best results are usually achieved after using a chondroitin product for 3 months or more (5). The University of Utah's School of Medicine recently conducted the largest clinical trial to study the effects of chondroitin and glucosamine, known as the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT).

According to reports from the National Center for Complementary and Integrative Health, this is the first large-scale, multi-institutional clinical trial in the United States to examine the effects of the supplements glucosamine hydrochloride and sodium chondroitin sulfate in the treatment of knee osteoarthritis (6). The GAIT study compared the effects of glucosamine and chondroitin sulfate (used both individually and in combination) with a placebo and a prescription drug. The study, which lasted six months, involved 16 rheumatology research centers in the U.S. and 1,500 patients.

Patients received one of 5 treatments over the six-month study period, which included treatments with:

• Glucosamine and Chondroitin,
• Celecoxib - a popular prescription drug used to treat osteoarthritis pain)
• A placebo included

A positive response to treatment was defined as a reduction in pain of 20% or more after six months of treatment compared to baseline. Results of the GAIT study showed that glucosamine in combination with chondroitin significantly reduced pain in subjects with moderate to severe pain compared to placebo - approximately 79% of subjects reported a 20% or greater reduction in pain compared to 54% in the placebo group. Chondroitin and glucosamine worked for more patients than the prescription drug - 70% of patients in the Celecobix experienced pain relief. In subjects with mild pain, glucoamine and chondroitin appeared to do less to reduce pain. On average, these subjects did not experience statistically significant pain relief, as was the case for those with more severe pain.

In addition to the GAIT study, there are a number of other larger clinical trials that have evaluated the safety and efficacy of chondroitin. In 2010, a placebo-controlled follow-up study was conducted in a double-blind design using chondroitin and glucosamine in 662 patients with knee osteoarthritis over a 2-year period. Patients were randomized to receive one of 5 treatments (500 mg glucosamine three times daily, 400 mg chondroitin three times daily, a combination of glucosamine and chondroitin, 200 mg of the analgesic celecoxib, or a placebo) over a 24-month period.

The primary outcome was a 20% reduction in pain as measured by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Side effects were found to be the same in all groups and serious side effects were rare (13). Another randomized, placebo-controlled, double-blind clinical trial published in the journal Arthritis and Rheumatism examined the effects of chondroitin in 162 symptomatic patients with osteoarthritis of the hand. The results of this study showed that patients suffering from chronic hand pain who took 800 mg of chondroitin sulfate per day for a period of 3 to 6 months experienced, on average, a mild reduction in pain, reduced morning stiffness and overall improved function (7).

The researchers also found that the majority of patients experienced no adverse side effects, which cannot be said for pain medications, which can cause stomach ulcers, addiction, stomach problems, blood pressure issues and more. The researchers concluded that chondroitin improved hand pain and function and had a good safety profile in patients with symptomatic osteoarthritis of the hand.

Chondroitin helps with recovery from injury and after exercise

There is evidence that chondroitin in combination with glucosamine can also help people without osteoarthritis to maintain valuable joint cartilage, reduce pain and improve physical function (8). Chondroitin can reduce stress on joints after exercise or injury by helping the body synthesize new articular cartilage, keeping joints flexible and controlling natural inflammatory responses.

Chondroitin can improve wound healing and skin health

Chondroitin and glucosamine are also used in combination to support wound healing, heal skin damage and reduce skin inflammation, as well as in veterinary applications. Chondroitin can help the body produce collagen, which is essential for healthy skin, skin healing and combating the symptoms of skin ageing. Preparations containing chondroitin and glucosamine are often used as wound dressings even for severe injuries and are also applied to scratches, burns and lesions to keep wounds moist and promote faster healing (9). Some studies have even found that using chondroitin in the form of gels on patients with burns requiring skin grafting can speed up healing time and help to significantly reduce inflammation.

Another supplement that chondroitin can be combined with to improve skin health is hyaluronic acid. Hyaluronic acid is found in the skin, eye sockets, all bones, connective tissue, joints, tendons and cartilage structures throughout the body. This includes hyaline cartilage, which covers and cushions the ends of bones. Hyaluronic acid is a lubricating, clear substance that is naturally produced by the body to increase moisture levels and improve elasticity and flexibility.

The primary way hyaluronic acid helps improve the appearance of sun-aged skin is by reducing water loss, which prevents dry skin, flaking, dark circles, sagging skin and loss of volume (10). Hyaluronic acid is found in lotions, creams, serums and supplements sold in drugstores and is also found naturally in bone broth. Because hyaluronic acid helps build synovial fluid and can buffer bones while increasing resistance to wear and tear, it is also useful for reducing pain and stiffness associated with degenerative joint disease.

Chondroitin with glucosamine

Chondroitin and glucosamine are often used together as they have similar mechanisms for reducing inflammation and pain - and what's more, both are considered very safe and have a low risk of side effects. There are also formulas that contain chondroitin, glucosamine and MSM.

What is glucosamine and how is it different from chondroitin?

Similar to chondroitin, glucosamine is a natural anti-inflammatory compound found in human joint cartilage and connective tissue. Technically speaking, glucosamine is an amino sugar produced by the body. Glucosamine occurs naturally in large quantities in the fluid surrounding the joints and is marketed in supplement form for the same applications as chondroitin. Studies have found that glucosamine has joint regenerative effects and improves joint strength and mobility. Glucosamine sulphate - a combination of glucosamine and mineral salts that is well absorbed by the body - is often used to treat joint pain and osteoarthritis.

What is the combination of chondroitin and glucosamine used for?

The combination of chondroitin and glucosamine can help alleviate the symptoms associated with loss of collagen and (articular) cartilage in the tendons, joints, ligaments, skin and digestive tract. These conditions include tendonitis, bursitis and others. When joint cartilage is damaged due to overuse, injury or inflammation, new cartilage is formed in healthy people to take its place. Unfortunately, the ability to repair joint cartilage and damaged connective tissue decreases with age. In humans and animals, glucosamine and chondroitin stimulate the production of new joint cartilage and can also help to reduce inflammation during the process.

Are chondroitin and glucosamine effective?

To date, more research has been done on the benefits of glucosamine, with glucosamine and chondroitin often being combined for better results. When both are used together, the benefits include:

• reduced joint pain
• improved functionality in arthritis patients
• improved skin health
• better function of the digestive system
• better bone healing
• faster wound healing

Supplements, sources and dosages

To date, there are no official dosage recommendations for chondroitin or glucosamine. The GAIT study used these supplements in the following dosages:

• Glucosamine when used alone: 1,500 mg, divided into 3 intakes of 500 mg each.
• Chondroitin when taken alone: 1,200 mg, divided into 3 doses of 400 mg each. Other studies have used dosages in the range of 800 mg and still observed results.
• Glucosamine and chondroitin sulphate combined: same dosages - 1500 mg glucosamine and 800 to 1200 mg chondroitin per day.

All participants in the GAIT study also took an over-the-counter pain reliever (acetaminophen) regardless of the group they were in. Over-the-counter painkillers have been shown to be safe in combination with glucosamine and chondroitin. Chondroitin has been found to be most helpful when used long-term and in combination with other lifestyle changes such as an anti-inflammatory diet, exercise, stretching and stress reduction. Although chondroitin (and glucosamine) rarely cause side effects and can help to control pain naturally, they do not work for everyone.

They should not be used as a substitute for other medications without consulting your doctor. For optimal effect, a supplement that combines chondroitin with other substances such as glucosamine and MSM should be taken for at least 3 months in sufficient dosage. The effectiveness of chondroitin ultimately depends on the degree of inflammation at the start of use, the degree of joint damage, medical history and other lifestyle choices.

Who can benefit from chondroitin (and glucosamine)

People who want to avoid prescription or over-the-counter pain medications to treat chronic joint inflammation and pain can try using chondroitin instead. Today, chondroitin - especially in combination with glucosamine - has become a popular alternative to non-steroidal anti-inflammatory drugs. Non-steroidal anti-inflammatory drugs are taken daily, or at least regularly, by millions of people suffering from chronic pain. Many patients suffer from side effects such as stomach problems and cannot take these drugs on a long-term basis.

Although few studies have been conducted that directly compare the effectiveness of chondroitin and non-steroidal anti-inflammatory drugs over a long period of time, both appear to have similar effects when it comes to reducing joint and bone pain and improving functionality, with chondroitin taking slightly longer to take effect. Non-steroidal anti-inflammatory drugs reduce pain faster, but their effects also eventually wear off. At this point, the benefits of chondroitin and glucosamine become apparent, as it takes some time for them to start reducing inflammation and stimulating cartilage production. Chondroitin has been most commonly studied in relation to the treatment of osteoarthritis symptoms, but research shows that it can also be used in the treatment of other conditions such as digestive problems and signs of ageing.

Chondroitin in the history of traditional medicine

Even though chondroitin supplements were not available hundreds of years ago, traditional medicine used healing foods that are natural sources of chondroitin. As mentioned earlier, the best way to get chondroitin from food is to drink bone broth or take a powder made from bone broth. Many different types of bone broth (poultry, beef, fish and more) are consumed around the world. True bone broth is made from various parts of animals including bones, marrow, skin, feet, ligaments and tendons, which are boiled and then simmered for several hours to release all the healing ingredients such as chondroitin, glucosamine, collagen, proline, glycine, glutamine and various minerals.

Bone broth is an ancient remedy that has been used in Ayurvedic medicine for thousands of years, especially for people who need additional nutrients, such as pregnant women, the elderly, injured people, etc. In Ayurvedic medicine, bone broth is said to help heal arthritic conditions, have anti-inflammatory effects, boost overall energy and digestion, and improve immune function.

In traditional medicine, bone broth is said to strengthen and nourish 'qi' - the essential energy/vital life force - help heal the kidneys, liver, lungs and spleen, balance yan energy and promote hematopoiesis (12). According to traditional Chinese medicine, consuming bone broth helps to repair tissues and bones and allows the kidneys (considered the powerhouse of the body) to provide energy to the body's damaged tissues that are running out of 'qi'. In some European countries, chondroitin is approved as a symptomatic slow-acting drug for the treatment of osteoarthritis.

Safety and side effects

Chondroitin is probably safe and harmless for most people. It may cause mild stomach pain and nausea. Other side effects that have been reported include diarrhea, constipation, swollen eyelids, swollen legs, hair loss and irregular heartbeat. The risk of side effects increases when very high dosages are used, so one should adhere to the dosage recommendations. There are concerns about the safety of chondroitin because it comes from animal sources.

Some people are concerned that unsafe manufacturing methods could lead to contamination of chondroitin products with tissue from diseased animals including BSE. However, to date there have been no reports of chondroitin-induced illness in humans and the risk is thought to be low. Some chondroitin products contain excessive amounts of manganese.

Precautions and warnings

Pregnancy and lactation: Not enough is known about the safety of chondroitin during pregnancy and lactation. For this reason, pregnant and breastfeeding women should avoid chondroitin to be on the safe side.

Asthma: There are concerns that chondroitin may aggravate asthma. For this reason, chondroitin should be used with caution if you suffer from asthma.

Prostate cancer: Preliminary research suggests that chondroitin may cause the spread or recurrence of prostate cancer. This effect has not been shown with chondroitin sulfate supplements. Until more is known, chondroitin should not be used if you suffer from prostate cancer or have an increased familial risk of prostate cancer.

Conclusion

Chondroitin is a natural substance that helps to build up the joint cartilage that covers the ends of bones, allowing them to glide and move smoothly. The benefits of chondroitin include supporting joint mobility and lubrication, which aids recovery after exercise and helps to combat inflammation, stiffness and pain. Chondroitin can be used in place of non-steroidal anti-inflammatory drugs by patients who require long-term treatment and help with pain management in arthritis, osteoarthritis and chronic injuries.

Glucosamine, chondroitin and MSM are often used together to support joint health. Chondroitin and glucosamine are both considered a very safe and effective way to relieve joint pain and in addition, they are associated with far fewer side effects than most painkillers. Most people experience no side effects with chondroitin, although some do not experience significant improvements with chondroitin.

References

1. http://naturaldatabase.therapeuticresearch.com/(X(1)S(y2posz55lyhsk2agwkfz2yi4))/home.aspx?cs=&s=ND&AspxAutoDetectCookieSupport=1
2. http://www.webmd.com/arthritis/osteoarthritis-women-12/arthritis-supplements
3. http://www.webmd.com/arthritis/tc/glucosamine-and-chondroitin-topic-overview
4. http://jcs.biologists.org/content/123/24/4195
5. http://www.arthritis.org/living-with-arthritis/treatments/natural/supplements-herbs/glucosamine-chondroitin-osteoarthritis.php
6. https://nccih.nih.gov/research/results/gait
7. http://onlinelibrary.wiley.com/doi/10.1002/art.30574/abstract;jsessionid=96ACBF9110B7C55B113C425145DEDC56.d02t03
8. http://www.mayoclinic.org/drugs-supplements/glucosamine/evidence/hrb-20059572
9. http://www.ncbi.nlm.nih.gov/pubmed/16908060
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583886/
11. https://svasthaayurveda.com/a-healing-ayurvedic-bone-broth-recipe/
12. https://www.tcmworld.org/recipes/beef-bone-broth/
13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086604/