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Glucosamine Sulfate Supplementation After 40


- Dr. James Meschino, DC, MS, ROHP

SUPPLEMENT TO PRESERVE YOUR JOINTS AND BLOOD VESSELS

(excerpt from Dr. Meschino’s book: The Meschino Optimal Living Program 2nd edition)

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Glucosamine, Joint Cartilage, and Osteoarthritis

Another age-related problem that is engineered, to varying degrees, into our genetic blueprints after the age of 40, is the development of osteoarthritis. Osteoarthritis, also known as degenerative arthritis is the most common joint disease in humans and vertebrate animals. Virtually everyone who lives past age 75 will develop it to some degree and nearly 50% of the population suffers from osteoarthritis by age 65. Essentially, osteoarthritis is considered to be an age-related affliction in that it becomes much more prevalent after the age of 45. The development of osteoarthritis has traditionally been associated with a wear and tear effect on the joints of the body, but recent evidence suggests that it is caused by a complex pattern of changes in the repair mechanisms that keep joints functioning normally. A major underlying factor in this disturbance of repair mechanisms involves an age-related decline in the ability of cartilage cells (chondrocytes), within our joints, to manufacture sufficient amounts of a substance called glucosamine sulfate. Under normal conditions our cartilage cells (chondrocytes) continually synthesize glucosamine sulfate, which is required as a raw material from which cartilage cells make an important component of cartilage known as chondroitin sulfate. The cartilage in our joints consists mostly of a tough protein material called collagen, which provides the structural backbone of joint cartilage. Chondroitin sulfate fills in the space between the collagen fibers, just as mortar fills in the spaces between the bricks of a house. Thus, cartilage formation, and its on-going maintenance, requires the continuous synthesis of both collagen and chondroitin sulfate because old collagen fibers and old chondroitin sulfate are broken down by the body and replaced by new collagen fibers and new chondroitin sulfate on a continual basis throughout our lifetime.


The chondroitin sulfate, that is interspersed between the collagen fibers, not only increases the shock absorbing action of joint cartilage, but it also acts like a water magnet to hold moisture within cartilage, further increasing the shock absorbing capabilities of joint cartilage. In fact, healthy cartilage that contains youthful amounts of chondroitin sulfate is 75-80 percent water by weight. However, by age 40 the body starts to slow down its rate of synthesis of glucosamine sulfate and thus, the production of chondroitin sulfate is greatly impaired. This results in the soft, rubbery, shock absorbing joint cartilage at the ends of our bones to become eroded and thinner. When this occurs our bones move closer together (loss of normal joint space), and may rub against each other, producing pain and inflammation. Erosion of the joint cartilage also contributes joints that become stiff, disfigured, less flexible, and show a loss of normal range of motion. All of this adds up to the symptoms and signs of osteoarthritis, which often produces chronic pain, inflammation, morning stiffness, and often restricts afflicted individuals from participating in many different activities that they were once able to enjoy. As such, osteoarthritis doesn’t only cause physical pain and suffering, but it also contributes to compromised quality of life by frequently restricting an individual’s ability to perform work- related tasks and participate in many of life’s fun and joyful activities.

Thus, the age-related decline in glucosamine sulfate synthesis has been shown to contribute to degeneration of joint cartilage, promoting the development of osteoarthritis as we age. This, of course, means that if there were a way to provide the cartilage cells with the glucosamine sulfate they can no longer make for themselves in adequate quantities, it may be possible to prevent cartilage erosion and thinning and preserve the integrity of our joint cartilage by enabling cartilage cells to make more youthful levels of chondroitin sulfate. This would result in the ability to prevent cartilage degeneration and osteoarthritis. And that is exactly what I am suggesting that you do after the age of 40. My advice, which I follow myself, is to ingest a supplement each day of 500 or 1,000 mg of glucosamine sulfate, beginning at age 40. Many studies have demonstrated that glucosamine sulfate supplementation can compensate for the impaired glucosamine synthesis that occurs after age 40, providing cartilage cells with the ability to make more optimal levels of chondroitin sulfate and thereby, slow and/or reverse the aging effect on our joints that leads to osteoarthritis. In fact, many studies have shown that glucosamine sulfate is an effective natural treatment for individuals who already suffer from osteoarthritis and other joint cartilage injuries.

The Glucosamine Story

In the body, glucosamine is synthesized by the conversion of sugar molecule called fructose-6 phosphate to glucosamine-6 phosphate by the enzyme, fructose-6 phosphate amide transferase, in the hexosamine biosynthetic pathway. In the aging process, it appears that the fructose-6 phosphate amide transferase enzyme concentrations decline or this enzyme becomes less active, resulting in the noted reduction in glucosamine synthesis seen with aging. Since the early 1980’s, researchers have conducted a large number of clinical and experimental investigations to determine if oral glucosamine sulfate supplementation can compensate for the age-related decline in glucosamine synthesis and thereby, block the progression of osteoarthritis and/or reverse or repair any existing joint cartilage damage. In the past twenty years glucosamine sulfate has been the subject of more than 300 scientific investigations and over 20 double-blind clinical studies. In a recent review, which appeared in the journal, Rheumatology Disease Clinics Of North America, researchers indicated that glucosamine supplementation has been shown to be highly effective in the treatment of osteoarthritis in all 13 double-blind clinical trials reviewed by these investigators.

Don’t have time to read the whole book right now?

No worries. Let me send you a copy so you can read it when it’s convenient for you. Just let me know where to send it.

GLUCOSAMINE SULFATE SUPPLEMENTATION AFTER 40

Dr. James Meschino, 

DC, MS, ROHP

Absorption and Metabolism of Oral Glucosamine Sulfate

Glucosamine is a small and simple molecule that is readily absorbed from the gastrointestinal tract. In fact, studies demonstrate that 90-98% of glucosamine sulfate is absorbed intact from the intestinal tract. By contrast, less than 13% of chondroitin sulfate is absorbed from the intestinal tract, making it significantly less effective than glucosamine sulfate as an intervention in the prevention and management of osteoarthritis. Once absorbed from the gut, glucosamine circulates through the bloodstream, where it can be taken up by cartilage cells (chondrocytes) an important component of chondroitin sulfate, fills in the gaps between the collagen fibers of our joint cartilage. As well, glucosamine sulfate is required for the synthesis of hyaluronic acid by the synovial membrane of the joint. Hyaluronic acid increases the viscosity of the synovial fluid and thus, serves to reduce the wear and tear stress on the articular cartilage and related joint structures. Glucosamine supplementation has also been shown to increase the synthesis of collagen by chondrocytes (cartilage cells). Thus, glucosamine supplementation may be helpful in preventing, reversing, or stabilizing the osteoarthritic process by stimulating the synthesis of chondroitin sulfate, collagen, and hyaluronic acid. Essentially all of the research on glucosamine has employed the use of glucosamine sulfate. Only glucosamine sulfate is approved as a treatment for osteoarthritis in more than 70 countries around the world and has been used by millions of people for this purpose for more than 20 years. Glucosamine sulfate also delivers the mineral sulfur (hence the name glucosamine sulfate) to the joint cartilage. It has been recognized for many years that sulfur is a vital nutrient for the maintenance of joint cartilage. Sulfur is required to stabilize the connective tissue matrix of cartilage, tendons, and ligaments. Sulfur hot springs and the recent popularity and use of MSM (methlyl sulfonyl methane) by arthritis patients have provided strong anecdotal evidence that increasing the delivery of sulfur to the joints can help to alleviate arthritic symptoms to an appreciable degree. Experimental evidence indicates that sulfur has an anti-inflammatory effect and directly helps to maintain the structure and the integrity of joint cartilage. The veterinary use of DMSO (dimethylsulfoxide), a rich source of sulfur, has demonstrated effective anti- inflammatory effects in animals when applied topically. Preliminary trials with oral MSM in humans have revealed significant improvement in the symptoms of osteoarthritis. As such, the use of glucosamine sulfate provides the joint structures with the mineral sulfur as well as glucosamine and thus, this form of glucosamine offers a double benefit in the management of osteoarthritis cases.


Other forms of glucosamine are present in the commercial market place such as N-acetyl- glucosamine and glucosamine hydrochloride. There is presently insufficient evidence to support their use and neither one of these forms provides the addition of the mineral sulfur, which has shown to be of value in osteoarthritis cases.

Clinical Studies with Glucosamine Sulfate

Glucosamine sulfate has been the subject of more than 300 scientific investigations and over 20 double –blind clinical studies. In a recent meta-analysis of glucosamine clinical trials in the treatment of osteoarthritis, McAlindon and colleagues indicated that all 13 studies that met the inclusion criteria (double –blind, placebo-controlled trials of greater than 4 weeks’ duration; using global pain score or the Lequesne index joint as the primary outcome measure and considered the trial positive if improvement in the treatment group was equal to or greater than 25% compared with the placebo group), were classified as positive, demonstrating that glucosamine supplementation is highly effective in the treatment of osteoarthritis. This meta- analysis revealed that glucosamine supplementation reduced the symptoms and signs of osteoarthritis by 40.2% on average, compared with the placebo.

Glucosamine sulfate supplementation has also been investigated in head-to-head studies against non- steroidal anti-inflammatory drugs (NSAIDs), in the treatment of osteoarthritis. In a number of these trials glucosamine supplementation was shown to produce better results than ibuprofen and other NSAIDs in relieving the pain and inflammation of osteoarthritis. Unlike many NSAIDs, glucosamine has not been shown to produce any of the adverse side effects that are frequently encountered with the use of NSAIDs (gastritis, peptic ulcer, GI bleeding and erosion of the intestinal lining, liver and kidney toxicity, tinnitis).

In a recent therapeutic investigation (Qiu, G.X., et al. 1998), involving 178 Chinese patients suffering from osteoarthritis of the knee, the group given a daily dose of 1500mg of glucosamine sulfate demonstrated better results than did the group given ibuprofen at 1200 mg per day (NSAID) with respect to reduction in symptoms of osteoarthritis. In this study, glucosamine sulfate was shown to be better tolerated than ibuprofen. Sixteen percent of the ibuprofen group dropped out due to adverse side effects from the drug. A six percent drop out rate occurred in the glucosamine group. The authors of the study conclude that glucosamine sulfate is a selective intervention for osteoarthritis, as effective on the symptoms of the disease as NSAIDs but significantly better tolerated. As such, glucosamine sulfate seems particularly indicated in the long-term treatment needed in osteoarthritis. 

In North America, the medical profession has taken a skeptical view of the original research on glucosamine that has largely been performed in Europe and Asia. Acknowledging that oral glucosamine has been shown to be highly bioavailable (26% bioavailability after first pass through the liver to enter the bloodstream) and demonstrates impressive results in clinical trials with osteoarthritis patients, some researchers have criticized the research methodology of some of these trials, suggesting that North American trials are required before glucosamine can be recommended as a treatment for arthritis. In 1999 and 2001, this request was answered when Reginster et al published their findings in the journals, Arthritis and Rheumatology and Lancet. The three-year randomized study by Dr. Reginster was a large randomized controlled analysis that was placebo-controlled, double-blind, and prospective in nature. It involved 212 patients with knee osteoarthritis. Weight-bearing and antero-posterior radiographs of each knee were done at 1 and 3 years. Joint space width was also measured. Symptom and functional status were scored every 4 months using the Western Ontario and McMaster University Osteoarthritis index (WOMAC). The two groups had comparable baseline status, but after 3 years, there was no further joint space narrowing in the glucosamine group. The placebo group had further joint space narrowing and objective evidence of disease progression. As well, subject symptoms worsened in the placebo group, but the group taking glucosamine realized a marked reduction in symptoms of osteoarthritis over the three-year period. The authors concluded that glucosamine sulfate supplementation significantly reduced progression of knee osteoarthritis. Patients in the glucosamine group did not experience any untoward side effects. In the Lancet editorial, medical practitioners were encouraged to begin embracing certain aspects of the alternative movement, including the use of glucosamine as an effective lifelong intervention for osteoarthritis. As stated in the article, “It is time for (medical doctors) to accommodate the possibility that many nutritional products may have valuable therapeutic effects and to regain the credibility of the public at large”.

Don’t have time to read the whole book right now?

No worries. Let me send you a copy so you can read it when it’s convenient for you. Just let me know where to send it.

GLUCOSAMINE SULFATE SUPPLEMENTATION AFTER 40

Dr. James Meschino, 

DC, MS, ROHP

Glucosamine Supplementation Also Strengthens Blood Vessels and Provides Other Anti-aging Benefits

The clinical use of glucosamine supplementation may extend beyond the treatment of osteoarthritis. Glucosamine sulfate is also required for the synthesis of other substances (glycosaminoglycans) that are integral components of the filler material between skin cells in the epidermis and collagen and elastin fibers in the dermal layers of the skin. Glucosamine is also required to make the matrix material that supports the intestinal tract lining and the walls of blood vessels. As reviewed by McCarty, glucosamine supplementation can be used to enhance wound healing (e.g., post-surgical), through its effects on stimulating the synthesis of hyaluronic acid. Experimental studies and human anecdotal evidence supports this application at the present time. There is also evidence to suggest that glucosamine sulfate supplementation may be beneficial as part of a nutritional regime to aid in the management of inflammatory bowel diseases. Experimental studies and human anecdotal evidence suggests that this may be the case. It is proposed that glucosamine supplementation can strengthen the basement membrane of gut blood vessels helping to prevent leakage of blood into the intestinal lumen, which may otherwise trigger an inflammatory immune reaction. Further, glucosamine has been shown to have a healing effect on the mucosal lining of the G-I tract itself. Anecdotal evidence supports the trial of glucosamine in both Crohn’s disease and ulcerative colitis. As well, the use of glucosamine sulfate supplementation may also serve to reduce the chances of blood vessel fragility that is associated with risk of stroke and vein disorders that are seen with increasing frequency with advancing age. Thus, the decline in glucosamine synthesis that occurs with aging has serious implications for our blood vessels as well as our joint cartilage. However, it should be noted that experts in this area conclude that adding chondroitin to glucosamine administration has not been shown to further improve the benefits available from glucosamine alone. Thus, at this time, the addition of chondroitin sulfate is seen to impose additional cost with no added benefit.

Side Effects, Toxicity, and Contra-Indications to the Use of Glucosamine

Reported short-term adverse side effects from the use of glucosamine are generally mild and infrequent. These include mild gastrointestinal upset, drowsiness, skin reactions, and headache. Glucosamine sulfate has been shown to be non-toxic at prescribed doses. Patients allergic or sensitive to sulfa drugs or sulfate-containing food additives can safely take glucosamine sulfate. The word sulfate in this instance indicates the presence of the mineral sulfur, not the sulfa compounds used in sulfa drugs and sulfate-containing food additives. All cells of the body contain the mineral sulfur and thus, it is not possible to be allergic to this mineral. However, glucosamine sulfate is manufactured from the chitin exoskeleton of shellfish, such as lobster crab and shrimp. Therefore, it is conceivable that a person with a severe allergy to shellfish may be sensitive to the use of glucosamine, although the pharmaceutical grade of glucosamine is generally devoid of shellfish contaminants. Nevertheless, caution should be exercised in these cases. Some preliminary animal experiments and human trials on healthy individuals reveals that glucosamine supplementation may increase insulin resistance in some individuals by down- regulating the synthesis of insulin receptors by the nuclear DNA. In large clinical trials, this has not surfaced as a concern and no indication of pronounced glucose intolerance has been demonstrated in the many well-documented glucosamine studies, including the study in Lancet Reported short-term adverse side effects from the use of glucosamine are generally mild and infrequent. These include mild gastrointestinal upset, drowsiness, skin reactions, and headache. Glucosamine sulfate has been shown to be non-toxic at prescribed doses. Patients allergic or sensitive to sulfa drugs or sulfate-containing food additives can safely take glucosamine sulfate. The word sulfate in this instance indicates the presence of the mineral sulfur, not the sulfa compounds used in sulfa drugs and sulfate-containing food additives. All cells of the body contain the mineral sulfur and thus, it is not possible to be allergic to this mineral. However, glucosamine sulfate is manufactured from the chitin exoskeleton of shellfish, such as lobster crab and shrimp. Therefore, it is conceivable that a person with a severe allergy to shellfish may be sensitive to the use of glucosamine, although the pharmaceutical grade of glucosamine is generally devoid of shellfish contaminants. Nevertheless, caution should be exercised in these cases. Some preliminary animal experiments and human trials on healthy individuals reveals that glucosamine supplementation may increase insulin resistance in some individuals by down- regulating the synthesis of insulin receptors by the nuclear DNA. In large clinical trials, this has not surfaced as a concern and no indication of pronounced glucose intolerance has been demonstrated in the many well-documented glucosamine studies, including the study in Lancet and the glucosamine meta-analysis appearing in The Journal of The American Medical Association. Some doctors have told their patients not to take glucosamine if they are a diabetic, but this is unwarranted, as many diabetic patients have benefited from the use of glucosamine without any adverse effects on their blood sugar. In fact, if the pain and disability of osteoarthritis is preventing a diabetic from being able to perform endurance exercise and the use of glucosamine can remedy this problem, as it has been shown to do in many cases, then the use of glucosamine can actually help in the management of diabetes because endurance exercise improves glucose tolerance, stabilizing blood sugar. Thus, it is advisable for diabetic patients and pre-diabetic patients with osteoarthritis to use glucosamine sulfate supplementation to manage their condition, and to simply have their blood glucose monitored during the first few weeks of glucosamine sulfate supplementation to identify any blood sugar irregularities that may occur.


Dosage

In regards to the treatment of osteoarthritis, the usual daily dosage of glucosamine sulfate is 1500mg per day, which can be taken all at one time or in divided doses of 500mg per dose. Individuals taking diuretic drugs may require an additional 500mg per day to compensate for the increased excretion rate. Individuals weighing more than 200 pounds may also be advised to up their dosage to 2000mg per day. I generally recommend glucosamine in a combination formula with some other natural anti-inflammatory agents, as I will outline shortly.


Quality Assurance.

In many European countries, glucosamine is available only by prescription from a medical practitioner. In North America, glucosamine is classified as a natural health product and is readily available as an over-the-counter product. As such, glucosamine products are held to much lower standards in regards to purity and potency than are prescription medications. A recent independent study revealed that up to one-third of the glucosamine products tested did not contain the amount of glucosamine stated on the label. For this reason, it is imperative to select only those glucosamine products whereby the manufacturer can issue a certificate of analysis and/or a third party true-to-label claim document that verifies the purity and potency of the product. This should be a standing policy in regards to the use of all nutritional supplements.

Other Considerations for Individuals with Osteoarthritis

If you already suffer from osteoarthritis or joint cartilage problems then you also need to understand how some other natural supplements can work in conjunction with glucosamine sulfate to improve your condition. Clinical studies have proven that glucosamine sulfate supplementation in the range of 1500-2,000 mg per day can improve symptoms in a high percentage of individuals who have osteoarthritis and/or other joint cartilage damage. Glucosamine sulfate primarily exerts it effects by providing the raw material from which cartilage cells make more optimal amounts of chondroitin sulfate, hyaluronic acid and by stimulating the production of collagen, as we have seen. However, glucosamine does not directly target the inflammatory process that is associated with osteoarthritis and joint injury problems. The inflammatory process is an important aspect of joint pain and although the improvement in joint function and integrity that occurs with glucosamine sulfate supplementation helps to reduce inflammation to some degree, I usually advise patients with osteoarthritis or inflammation from cartilage injuries to also supplement with a combination of natural anti-inflammatory herbal agents. A number of companies combine some of these natural anti-inflammatory herbs into their glucosamine formulations, which makes the product work in a faster-acting fashion in regards to pain relief and reduction of joint swelling.

Don’t have time to read the whole book right now?

No worries. Let me send you a copy so you can read it when it’s convenient for you. Just let me know where to send it.

GLUCOSAMINE SULFATE SUPPLEMENTATION AFTER 40

Dr. James Meschino, 

DC, MS, ROHP

The Problems Associated with Conventional Anti-Inflammatory Drugs

Beyond the use of glucosamine sulfate as an effective intervention to halt joint cartilage destruction and help regenerate new cartilage in osteoarthritis cases, substantial clinical and experimental evidence supports the use of other natural health products which demonstrate proven abilities to block the inflammatory process, reducing the signs and symptoms of arthritis and other joint inflammatory conditions. Studies indicate that many of these natural agents provide similar efficacy as conventional anti-inflammatory drugs, and are safer to use with respect to reported adverse side effects. As of yet, most medical practitioners have failed to embrace these alternative anti-inflammatory agents and tend to rely primarily on synthetic anti- inflammatory drugs as their principle approach to managing these problems. It is well documented that these drugs (non steroidal anti-inflammatory drugs, known as NSAIDS) produce intestinal tract ulcers (with potential internal bleeding) in 10-30% of long term users and erosions of the stomach lining and intestinal tract in 30-50% of cases. As a result of these side effects, NSAIDS use is associated with 10,000 – 20,000 deaths per year in the U.S. Even the new COX-2 inhibitor drugs have only been reported to reduce intestinal tract damage by 50% and their toxicity to the liver and kidneys is still under review. Anti-inflammatory drugs have been shown to accelerate damage and erosion of joint cartilage, advancing the osteoarthritic process. Conventional NSAIDS are also known to cause liver and kidney damage with long term use. These and other statistics have lead certain esteemed investigators to conclude, “the epidemiological data highlight the importance of implementing ASA/NSAID therapy only when strictly necessary.”

Reducing Inflammation Naturally

The discovery that certain natural agents produce marked anti-inflammatory effects in regards to inflammatory joint diseases presents an opportunity for arthritis sufferers to add another effective adjunct to the management of these cases and help eliminate or minimize reliance upon more dangerous NSAIDS and other synthetic anti-inflammatory drugs. Experimental research reveals that the efficacy of many natural anti-inflammatory agents stems from their ability to modulate the activity of enzymes that are involved in the inflammatory process (cyclooxygenase and/or 5-lipoxygenase). Joint inflammatory conditions involve the conversion of arachidonic acid to prostaglandin series –2 (PG-2) by the cyclooxygenase enzyme. PG-2 synthesis is known to produce a pro-inflammatory effect, exacerbating joint inflammatory conditions. Accordingly, the conversion of arachidonic acid to leukotriene B4 (LTB-4), by the 5-lipoxygenase enzyme within white blood cells, is also known to contribute to the inflammatory process. White blood cell count in normal synovial fluid is less than 100ml on average, however, cellular response rises to 800ml or more in osteoarthritis and much higher than this in rheumatoid diseases; implicating white blood cells in the T-cell mediated inflammatory response in inflammatory joint conditions. As is the case with many synthetic anti-inflammatory drugs, the active constituents of anti-inflammatory herbs have been shown to block the activity of the cyclooxygenase and lipoxygenase enzymes, inhibiting the synthesis of pro-inflammatory chemicals, primarily PG-2 and LTB-4 series. As such, these natural substances have been shown to reduce inflammation and pain associated with various types of arthritis and traumatic joint injuries. Unlike their synthetic counter parts, they have not been shown to cause erosion injury to the intestinal tract, accelerate cartilage destruction, or produce liver and kidney toxicity. For these reasons, the following herbal agents can be considered viable alternatives to the use of conventional anti- inflammatory drugs in a large percentage of arthritic patients and those suffering from other muscle and joint inflammatory conditions.

Effective Anti-inflammatory Herbs and Supplements

Curcumin is the active anti-inflammatory agent found in the spice turmeric. It has been shown to inhibit the activity of the 5-lipoxygenase and cyclooxygenase enzymes, blocking the synthesis of pro-inflammatory chemicals (PG-2, LTB-4). A large double-blind study demonstrated that curcumin was as effective as the powerful anti-inflammatory drug, phenylbutazone in reducing pain, swelling and stiffness in rheumatoid arthritis patients. It has also been shown to be effective in the treatment of post-surgical inflammation. Other studies indicate that curcumin can lower histamine levels and is a potent antioxidant. These factors may also contribute to its anti- inflammatory capabilities. For best results, you should only use a 95% standardized extract of curcumin derived from turmeric. As a singular agent the daily dosage to consider is 400-600mg, taken one to three times per day. (Lower doses can be used if part of a combination formula containing other anti-inflammatory agents). Side effects are rare, and primarily include heartburn and esophageal reflux. Curcumin has a mild anti-coagulant effect and therefore, caution should be used if combined with powerful anti-coagulant drugs like coumadin, warfarin or plavix, although no drug-nutrient interactions leading to a bleeding disorder have been reported.


Boswellia In clinical studies, the gum resin of the boswellia tree (yielding 70% boswellic acids) has been shown to improve symptoms in patients with osteoarthritis, and rheumatoid arthritis. Research indicates that boswellic acids inhibit the 5-lipoxygenase enzyme in white blood cells. As a singular agent the usual dosage is 150mg, taken one to three times per day. (Lower doses are effective when combined with other natural anti-inflammatory agents). Boswellia appears to have no important side effects or drug-nutrient interactions of concern. (15,16)

White Willow Bark Extract provides anti-inflammatory phenolic glycosides, such as salicin, which have been shown to be effective in the treatment of arthritis, back pain, and other joint inflammatory conditions. These phenolic glycosides are known to inhibit cyclooxygenase, blocking the production of PG-2 and exert a mild analgesic (pain-killing) effect. Unlike ASA (synthetic acetylsalicylic acid), naturally occurring salicin (salicylic acid) does not increase risk of bleeding disorders. White willow extract has been shown to be slower acting than ASA, but of longer duration in effectiveness. The usual dosage is 20- 40 mg of salicin, one to three times per day (note that 100mg of white willow extract at a 15% standardized extract of salicin content, yields 15mg of salicin per dosage). (A lower dosage can be used if part of a combination formula containing other anti-inflammatory agents). Side effects are rare, but primarily include nausea, headache and digestive upset. Contraindications may include conditions where ASA is contraindicated, including gout, diabetes, haemophilia, kidney disease, active peptic ulcer, glucose-6-phosphate dehydrogenase deficiency, and possibly asthma. However, the salicin content in a single dosage of white willow extract is very low compared to the acetylsalicylic acid content of ASA (e.g. 15mg vs. 320mg); thus, these conditions may not be absolute contraindications for the use of white willow bark extract. It is important to realize that besides salicin, white willow extract contains other phenolic glycosides, which are also known to possess anti-inflammatory properties.


Ginger Root Extract contains oleo-resins that have shown clinical benefit in the management of various arthritic and muscle inflammation problems, including rheumatoid arthritis, osteoarthritis, and myalgias. The active constituents in this regard have been shown to be gingerols (oleo-resins), which inhibit the cyclooxygenase and lipoxygenase enzymes. The usual dosage is 500mg, one to three times daily, standardized to 5% gingerol content. (A lower dosage can be used if part of a combination formula containing other anti-inflammatory agents). Side effects are rare, but include heartburn and digestive upset. It should not be given to patients with gallstones. It may also induce a mild anticoagulant effect (by inhibiting cyclooxygenase enzyme in platelets), therefore it should not be taken concurrently with warfarin of coumadin. However, there are no reports of bleeding disorders with ginger supplementation and no adverse drug –nutrient interactions have been reported in the scientific literature to date.


Bromelain contains anti-inflammatory enzymes that have proven ability to suppress the inflammation and pain of rheumatoid and osteoarthritis, sports injuries, and other joint inflammatory conditions. Bromelain has been shown to inhibit the cyclooxygenase enzyme, inhibiting the synthesis of PG-2. Bromelain also helps to break down fibrin (fibrinolytic), thereby minimizing local swelling. The usual dosage is 400mg, one to three times per day (a lower dosage can be used as part of a combination anti-inflammatory formulation). Bromelain may inhibit platelet clotting and is a known for its fibrinolytic properties. Therefore, it may boost or potentiate the effects of anticoagulant drugs such as warfarin and coumadin and should not be recommended in these cases.


Quercetin is a bioflavonoid compound that blocks the release of histamine and other anti- inflammatory enzymes at supplemented doses (minimum 100-1500 mg per day). Although human studies with arthritic patients are lacking at this time, anecdotal evidence is strong for this application as is experimental research investigation. There are no well-known side effects or drug-nutrient interactions for Quercetin. I personally have used and recommended quercetin, in a combination formula with glucosamine, MSM and bromelain enzymes and have been very impressed with the ability of this combination to more quickly relieve arthritic pain and better manage osteoarthritic problems compared to glucosamine sulfate used alone.

Don’t have time to read the whole book right now?

No worries. Let me send you a copy so you can read it when it’s convenient for you. Just let me know where to send it.

GLUCOSAMINE SULFATE SUPPLEMENTATION AFTER 40

Dr. James Meschino, 

DC, MS, ROHP

MSM (Methyl Sulfonyl Methane)

MSM is a natural sulfur-containing compound that is produced by the human body and is found in limited quantities in certain foods, such as fruits, vegetables, and meats. MSM ingested in higher doses as a supplement has been shown to produce anti-inflammatory effects and to help support the integrity of joint cartilage, which has a high requirement for the mineral sulfur. It also has pain relieving properties and has been used to treat a wide variety of muscle and joint inflammatory conditions. Studies suggest that it may also inhibit the formation of scar tissue around joints and slow the degeneration of cartilage in cases of osteoarthritis. When used on its own the usual dosage is 1500-3,000 mg per day, however a daily dosage of 200-400 mg per day can be beneficial if taken in conjunction with glucosamine sulfate and other natural anti- inflammatory agents. MSM is a very safe substance and is not associated with any drug-nutrient interactions, and rarely produces mild side effects such as stomach upset, headache or more frequent bowel movements.


Devil’s Claw contains the anti-inflammatory agent harpogoside. Devil’s claw has demonstrated efficacy in the management of low back pain and is used traditionally as an anti- inflammatory by numerous southern African tribes. The usual dosage is 100-400 mg, one to three times per day (a lower dosage can be used if part of a combination anti-inflammatory formula). The only consistently reported side effect is mild digestive upset on rare occasions. It is contraindicated in patients with active gastric ulcers (may increase gastric acid secretion) and in patients taking warfarin or coumadin (due to its anticoagulant effects).

Using Natural Anti-inflammatory Agents to Manage Arthritis and Other Joint and Muscle Conditions

The clinical and experimental evidence supports the use of natural anti-inflammatory agents mentioned above, as viable alternatives to synthetic NSAIDs drugs or as a means to help individuals with inflammatory joint or muscle conditions lower their requirements for conventional anti-inflammatory pharmaceutical agents. A number of quality-oriented companies manufacture single and combination natural anti-inflammatory supplement products that meet the above dosage and standardized grade criteria that I have outlined in this section. In conjunction with the use of glucosamine, these anti-inflammatory agents are a natural, safe, and effective means to help reduce the inflammation and pain associated with osteoarthritis, and other joint inflammatory conditions.


For patients with low-grade osteoarthritic symptoms I recommend the use of a supplement that contains Glucosamine Sulfate, MSM, Quercetin, and Bromelain enzymes (see resource section)


For patients with more advanced osteoarthritic conditions, I suggest that they also take a supplement that contains a combination of Turmeric (curcumin), Boswellia, White Willow Bark, and Ginger. (see resource section)


For patients with rheumatoid arthritis, lupus, other autoimmune inflammatory conditions, tendonitis, bursitis and joint or muscle inflammation, I recommend that they take only use the combination of Turmeric (curcumin), Boswellia, White Willow Bark, and Ginger, as there appears to be no benefit to the addition of glucosamine in these cases as they are primarily inflammatory conditions (see resource section).

GLUCOSAMINE REFERENCES

Baici A, et al. Analysis of glycosaminoglycans in human sera after oral administration of chondroitin sulfate. Rheumatol Int 1992;12:81-8


Baici A, Wagenhauser F.J. Bioavailability of oral chondroitin sulfate. Rheumatology Int 1993;13:41-43


Barclay TS, Tsourounis C, McCart G.M. Glucosamine. Ann Pharmacother 1998 May; 32 (5): 574-9 (ISSN: 1060-0280)

 

Bland JH, Cooper SM. Osteoarthritis: A review of the cell biology involved and evidence for
reversibility. Management rationally related to known genesis and pathophysiology. Sem Arthr
Rheum 1984;14:106-33


Challem J. Sulfur Power. Natural Way For Better Health (magazine). 1999 (02/28): 34-35 Conte A, et al. Biochemical and pharmacokinetic aspects of oral treatment with chondroitin sulfate. Arzneim Forsch 1995;45:918-25


Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of
glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clin North Am 2000
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Global Integrative Medicine Academy

The Global Integrative Medicine Academy was created to satisfy a need, expressed by many health professionals, to establish credentials as experts in Nutritional Medicine. But, health professionals also needed to be able to complete the programme with a minimum impact on their career, family, and lifestyle. That is why the Advanced Nutritional Medicine and Sports Nutrition Certification Program was created.

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