The last several years have seen a revolution in the treatment of
arthritis with the discovery that cell communication takes place
through carbohydrates (sugars) attached to amino acids in the proteins
located on the surface of every cell in your body.
is among the eight sugars required to make these ‘glycoproteins’.
Researchers have theorised that arthritis is the result of abnormal
glucosamine metabolism, a malformation in their glycoforms.
a chief component of proteoglycans (which make cartilage), glucosamine
seems able to stop proteoglycan breakdown, rebuild damaged cartilage
(Orthop Praxis, 1970; 9: 225) and stimulate the production of
glycosaminoglycans such as chondroitin, another building block of
For years, we’ve known that sulphur is vital for
preventing joint degeneration (J Bone Joint Surg, 1934; 16: 119-25).
For this reason, glucosamine is usually given with sulphate to
strengthen its effects on connective tissue. In a large Portuguese
study, glucosamine sulphate improved pain and symptoms in 95 per cent
after two months, and markedly so in 59 per cent (Int J Tissue React,
1992; 14: 243-51). A microscopy study of cartilage from patients
treated with glucosamine sulphate found evidence of new growth (Clin
Ther, 1980; 3: 260-72).
With one in three of us suffering from
arthritis of some variety, supplement manufacturers were quick to spot
an opportunity in a potentially enormous market, particularly as
arthritis sufferers have to take supplements more or less for life.
ever since the publication of Dr Jason Theodosakis’s The Arthritis Care
Book, which recommends glucosamine and chondroitin for arthritis, such
preparations have become the number one bestselling supplement in
Glucosamine sulphate is often paired with chondroitin
sulphate, shown to modify the structure of joints and not just
alleviate symptoms (Osteoarth Cartilage, 1998; 6 [Suppl A]: 39-46).
Injected chondroitin sulphate results in visible improvements in the
joints on X-rays (Semin Arth Rheum, 1987; 17: 2 [Suppl 1]: 35-53).
and chondroitin appear to work synergistically. Chondroitin inhibits
enzymes that destroy cartilage and reduces arterial clogging, improving
the supply of nutrients to cartilage (Townsend Lett Docs, January
1994). This allows glucosamine to make more glycosaminoglycans.
test the leading brands of these products, PROOF! sent a cross-section
of the most popular ones to Somerset Scientific Services Laboratory in
Taunton, Somerset, one of the EC’s official laboratories for food law
enforcement as well as a testing laboratory for standards and quality
for the government and private industry.
Of our chosen eight
products, purchased as usual through The Nutri Centre in London, four
were glucosamine alone, three were glucosamine/chondroitin and one was
chondroitin alone. Thus, to be fair, we had two winners: the best
combination product and the best single product. We were mainly looking
for the product that delivered the best dosage of glucosamine or
chondroitin at the best price.
However, Somerset’s repeated
efforts to test for chondroitin proved unsuccessful at the time of
press. This was disappointing, given the relative instability of
chondroitin. (If they do manage to produce results, we will report them
in our next issue.)
To determine value for money, we compared:
* the price per tablet, which varied from 12 p to more than five times that - 67 p
the total glucosamine or chondroitin per £, which also varied more than
fourfold - from 1200 mg per £ to more than 5000 mg per £
* the amount of active ingredients present compared with the amounts stated on the label.
We were pleasantly surprised to find that most manufacturers included more than was stated.
of the combination products shared a single fault. As glucosamine works
best at 500 mg three times a day, and chondroitin works best with a
single 800-mg serving once a day, no combination product was able to
give the optimal dose of both.
Some of the products include
other micronutrients - usually manganese and vitamin C, which aid
glucosamine/chondroitin absorption. Others include calcium and
magnesium for their beneficial effects on bones, with the rationale
that glucosamine and chondroitin will work even better on cartilage if
you strengthen bone. Although we acknowledge these good intentions, in
many cases, too little of either nutrient was included to do much good.
Above all, be patient and maintain a leap of faith as it could
be three months or more of regularly taking supplements before you see
any improvement, since the effects of glucosamine get better over time.
You also shouldn’t put all your eggs in this single basket.
Glucosamine works best as part of an all-embracing treatment programme
that also includes diet, other supplements and exercise.
Glucosamine sulphate 600 mg
Price: £6.95 for 60 tablets
for a quality vitamin manufacturer, Lamberts has managed to slash the
cost of glucosamine to a price none of the other manufacturers can
compete with. This product costs 12 p per tablet, or slightly more than
5 g of glucosamine per £. In fact, our sampling found 400 mg more per £
than declared, making Lamberts an even better deal than it claims.
Although Lamberts calls this a hypoallergenic product, remember that all tablets require binders to stay in one piece.
Each tablet contains glucosamine sulphate as potassium chloride, which is useful if you have high blood pressure.
only ‘fault’ we could find was the choice of making each tablet 600 mg
rather than the optimal 500 mg; if you take three tablets a day, you’d
receive 300 mg above the optimal daily dosage. The result of such
‘overdosing’ is anybody’s guess.
This is a no-frills product
with no other cofactors included, which may be a bonus if you’re
already taking other supplements (multivitamins, say) and don’t want to
duplicate unnecessarily. But if you need to take glucosamine for life
and budgetary considerations loom large, Lamberts’ product is a clear
GlucOsamine & Chondroitin
Manufacturer: Health Perception
Price: £12.99 for 30 tablets
combo offers the best value for money of all the combination products.
At 43 p per tablet and more than 2000 mg of glucosamine/chondroitin per
£, this UK company manages to undercut its US competitors.
Perception claims to have the only product which has 'undergone a
double-blind placebo-controlled clinical trial at a British hospital',
but it’s hard to know whether this is the only product to have had such
a trial or the only such product to have had a trial in the UK.
on their glucosamine is sparse. This glucosamine is sodium-derived but
'salt-free'. As for chondroitin sulphate, all they admit to is a 'fish
source'. For some reason, the product also includes tiny amounts of
bioflavonoids and manganese.
This is as good as a combo
product can be, with 500 mg of glucosamine and 400 mg of chondroitin
per tablet - giving you at least a fighting chance of getting the
correct amount of each. However, the size of the bottle means
replenishment every 10 days.
Manufacturer: Thorne Research
Price: £23.20 for 90 capsules
vitamin manufacturer Thorne has produced a no-frills winner, containing
the optimal amount of glucosamine to alleviate symptoms. Thorne’s is
also competitive in cost and the sole manufacturer to deliver its
product in a capsule rather than tablet, thus avoiding all binders,
coatings or allergens. This is most likely the most hypoallergenic of
all the products in our road test.
Although not the cheapest
at 26 p per capsule, this has a total delivery of 2370 mg of
glucosamine per £ - nearly 400 mg more than the 1940 mg declared.
is also the only manufacturer besides Lamberts to not include
cofactors, which means you may have to take additional supplements - a
good multivitamin and mineral tablet, for instance - to achieve the
One nice touch is the size of the package.
With 90 capsules per bottle and a dosage of three a day, you have a
clear month’s supply.
Price: £38.39 for 60 tablets
the three combination products, quality vitamin manufacturer Solgar
offers a close runner-up. This version contains 500 mg each of
glucosamine and chondroitin per tablet - optimal for the former,
slightly too much of the latter, according to the literature (see box,
The problem with having both in a single tablet is that
you need to take too much chondroitin to get enough glucosamine. The
manufacturer doesn’t specify where the chondroitin comes from, but the
glucosamine derives from shellfish, so vegetarians beware.
Mystifyingly, this combo is slightly cheaper than its single-product
cousin (see below). This also contains calcium ascorbate (buffered
vitamin C) and calcium, vegetable cellulose, vegetable stearic acid,
manganese, silica and vegetable glycerin.
At 64 p per tablet,
this isn’t the best value for money of the combinations, and was the
second worst bargain in terms of amount of glucosamine/chondroitin per
£. Solgar is often competitively priced but, clearly, not in this case.
Nevertheless, by adding decent amounts of vitamin C and manganese,
Solgar may, in the end, save you money if you don’t want to supplement
Manufacturer: Health Perception
Price: £9.99 for 30 tablets
UK company has produced an outstanding single-product preparation, but
at a price (33 p per tablet). Each tablet contains the recommended 500
mg of glucosamine sulphate made from potassium salts and also includes
generous amounts of vitamin C (300 mg) and calcium carbonate (300 mg),
plus 5 mg of manganese to aid absorption, so you should factor in these
amounts when supplementing with other micronutrients.
Health Perception gets full marks for a generous well-conceived label,
we were concerned on one point. It implies that this product may be
useful for joints and muscles, but also for those who participate in
sports and fitness training. This might encourage anyone involved in
any sort of fitness training to supplement with glucosamine, to unknown
long-term effect. (Health Perception does distinguish between 'normal
use' - two tablets a day - and 'additional requirement' (read
‘arthritis’) - three tablets a day.
There is no mention of
what else is in the tablets (binders, fillers), but we can’t fault this
company on the active ingredients - what it claims (1500 mg per £) is
just about what you get, although our sample tablets had slightly less
vitamin C (220 mg) than declared. In terms of value for money, this
delivers 1523 mg of glucosamine per £ - the worst of the four
Glucosamine sulfate 1000 mg
Price: £39.95 for 60 tablets
vitamin giant Solgar has gone for high potency with their
single-ingredient offering, which is probably meant to be paired with
their other single product, chondroitin sulphate (see below).
if you intend to do that, you’re in for a large dent in your purse. At
67 p per tablet, this is by far the most expensive of the
single-product offerings. However, you do get as much glucosamine
sulphate for your money (around 1500 mg) as you do with Health
This product may be more expensive because
of its natural source, but the formulation lets it down. Having a 1-g
tablet is awkward. If you want to take 500 mg three times a day, you
have to break a tablet in half for each serving, so the average punter
is likely to end up taking more glucosamine than he ought to.
are also those fillers that you usually find in a tablet: powdered
cellulose, silica and magnesium stearate. There seems to be no
scientific justification for having a higher potency other than
allowing Solgar to charge a good deal more per bottle.
Glucosamine Chondroitin Rx-Joint
Manufacturer: Nature’s Plus
Price: £34.95 for 60 tablets
vitamin company Nature’s Plus calls this an 'extended delivery' product
which dripfeeds the two glycoproteins to your joints, allowing for
gradual ‘natural’ absorption. The means of delivery is not clear, but
the company claims it is a 'special base' which allows a gradual
release of ingredients over an extended period of time.
This product also includes vitamin C and manganese as cofactors for improved absorption.
Plus has roughly got the ratio of glucosamine to chondroitin right,
offering 500 mg at 58 p per tablet. It also offers slightly more
glucosamine/chondroitin per £ (1717 mg) than Solgar’s preparation.
Nevertheless, extended-release capsules have spotty reputations and
could be ineffective. It’s also unnecessary as divided doses of
glucosamine appear to be well absorbed. Nature’s Plus has opted for the
N-acetyl version of chondroitin, which may be better at healing a leaky
gut than the joints.
Chondroitin Sulfate 600 mg
Price: £29.39 for 60 tablets
final product is pure chondroitin sulphate in a 600-mg tablet. Like the
glucosamine, it is expensive - 49 p per tablet - with the least amount
of chondroitin for your £ of any product we’ve seen.
not the optimal dosage. Solgar would have done better to produce 800 mg
tablets, or at least 400 mg, to ensure that patients take the right
number. As Solgar is usually fastidious about formulation, it’s also
odd to see a decided absence of cofactors other than a tiny amount of
magnesium, largely to bind the product.
If you’re thinking of
taking glucosamine and chondroitin separately from Solgar, you’re in
for an unnecessarily expensive deal. If you’d rather take a single
product, all the latest studies point to chondroitin as the more
effective of the two. For this reason, we have to give Solgar points
for providing you with the choice.
Until the publication of Dr Jason Theodosakis’s book, taking
chondroitin and glucosamine was controversial. A number of researchers
concluded that chondroitin, taken orally, cannot be absorbed (Rheumatol
Int, 1992; 12: 81-8). Nevertheless, according to Dr Theodosakis, in the
only head-to-head study published so far, a combination of glucosamine
and chondroitin in a ratio of five to four, respectively, was
significantly more effective than either substance alone. Furthermore,
only the combination, rather than either single ingredient, prevented
the most severe cartilage damage. The study also confirmed that the two
substances work synergistically by stimulating cartilage cells to
produce the proteoglycans that build further cartilage (J Clin Orthop
Rel Res, 2000; 381: 229-40).
The major problem with this study is that it involved animals, so the results may not apply to humans.
in a review of 37 major studies (including 15 in humans) of glucosamine
and chondroitin, the researchers concluded that chondroitin’s 'high'
effect was almost twice that of glucosamine (JAMA, 2000; 283: 1469-75).
Some early research contended that the amount of chondroitin
absorbed from supplements is extraordinarily low - between 0 and 8 per
cent - but these results were from rabbits which, as vegetarians, are
incapable of absorbing animal-derived products (Townsend Lett Docs,
Numerous studies have shown that 500 mg of
glucosamine sulphate three times a day is an optimum daily dosage (Clin
Ther, 1980; 3: 260-72; Lancet, 1989; i; 1275) with no side-effects.
chondroitin, in one study, daily doses of 800 mg or 400 mg twice a day
increased blood levels, but the one-a-day dose of 800 mg was more
effective (Arzneim Forsch, 1995; 45: 918-25). Most other studies since
then have confirmed this as the optimal daily dosage.
dosage, the type of salt used as a stabiliser may also be a
consideration. Most supplements contain glucosamine as glucosamine NCl
(sodium chloride) or KCl (potassium chloride), so even though the
products may be listed as 'pure', they contain table salt or potassium
chloride. The sodium chloride variety could be especially dangerous to
hypertensive patients who have been medically advised to limit their
Another variety is N-acetyl glucosamine which,
according to Stephen Terrass, a senior researcher at Solgar, when
digested, immediately goes towards replenishing the gut wall so that
less is available for repair work on joints.
glucosamine sulphate has always been marketed as the superior product,
this is largely, says glucosamine expert Dr Luke R. Bucci of Houston,
Texas, because they were patented first. Nevertheless, research has
shown glucosamine hydrochloride (HCl) and hydroiodide to be equally
effective. Indeed, a comparative study showed a greater production of
proteoglycans with the HCl form than the sulphate (Pharmacology, 1971;
Supplements of chondroitin are usually derived
from an animal source, usually green-lipped mussels or bovine, whale
and shark cartilage, so you may wish to forego this supplement if you
Another problem with chondroitin is its
apparent instability. Products containing the supplement degrade
readily so that the amount stated on the label often bears no
resemblance to what is inside. Dr Bucci found that the amount of
chondroitin in different batches from different manufacturers ranged
from 100 per cent to 0 (Townsend Lett Docs, January 1994).
although there is no toxicity or interactions yet reported with
glucosamine salts, there is evidence that glucosamine can cause severe
toxicity when given intramuscularly (Lancet, 1989; i: 1275). Other
evidence of toxicity is generally thought to be related to unpurified
forms of chondroitin, and nausea at higher doses has also been
reported. If you do experience nausea, it may be a good idea to lower
the dose or get yourself checked for any signs of toxicity, and come
off chondroitin completely if it doesn’t agree with you.