Have you mentioned arthritis in your knee and multiple people have mentioned trying glucosamine?
Many people are given prescription medications to decrease knee pain due to arthritis and are looking for alternatives with fewer side effects. Let’s take a deeper dive into what cartilage is, and how glucosamine can affect cartilage health.
Where Is Cartilage Found In The Body?
Cartilage is found on the ends of bones in joints, at the end of the ribs, and in other areas of the body like the ears and nose. The type of cartilage we are concerned about today is the ones at the end of the bones in your joints like the knees, hips, and elbows. The main function of cartilage is to minimize friction between two surfaces during movement and to help transmit loads from one joint to another.
It contains no blood or lymphatic vessels and has no nerves. Because there are no vessels in the area, there is the minimal capacity for natural healing after injury, so it is important to maintain what we have.
What Is Cartilage?
First, we need to learn the makeup of cartilage. Cartilage has 2 major parts:
- Extracellular matrix (ECM) and,
Think of the ECM as baking ingredients. There are 2 parts to the ECM, the liquids (wet ingredients) and the solids (dry ingredients). To make the ECM, you mix the “wet” ingredient, being the water, and the dry ingredients, being cells like proteoglycans and collagen together. When you mix the ingredients, you can use more water to make a softer ‘dough’ or in this case ECM, or less water to make it stiffer. The ‘dough’ is what you see as the white parts of the cartilage at the ends of the bone.
The 2nd ingredient of cartilage is the chondrocyte. Chondrocytes are cells found dispersed within the ECM. This cell is responsible for producing more dry ingredients for the ECM or breaking down the dry ingredients. So the chondrocyte maintains the ECM to make sure there are enough solids in its environment to keep the cartilage stiff.
With osteoarthritis, the breakdown of cartilage can be caused by excessive loading, ageing, hormones, and inflammation. When the cartilage is injured or weakened, chondrocytes will start producing more ‘dry ingredients’ to help repair the damage. As well it will also produce enzymes that break down the damaged pieces in the area.
If the repair cannot keep up with the damage of the dry ingredients, the ‘dough’ or ECM will be too wet causing the cartilage to be weak and unable to tolerate compression and other forces. This further weakens the cartilage and causes more breakdown when loads are placed on the joint.
Let's Get Back To The Main Question: How Does Glucosamine Help?
Glucosamine is naturally made in the body using glucose. It is used to help make proteoglycans which are in the ‘dry ingredients’ of cartilage. By supplementing the body with glucosamine, the body can use it to immediately make proteoglycans to help stiffen the ECM when chondrocytes cannot keep up with production. As well, it can decrease inflammation in the joint leading to less pain.
What Does The Research Say About The Effectiveness Of Glucosamine?
Based on 2 recent systematic reviews done in 2018, it is shown that glucosamine is beneficial in decreasing pain for those with knee OA. It is still debated whether taking glucosamine can preserve joint space, more studies need to be done to determine if long-term effects of glucosamine can help maintain that space.
There have been no major negative effects noted from taking glucosamine, so it is generally a safe supplement to take. Some minor side effects include:
Nausea, heartburn, diarrhea, constipation, drowsiness, skin reactions, and headaches.
As well, glucosamine is made from the shells of shellfish, so there is a concern that it may cause an allergic reaction in those with shellfish allergies.
For those taking Acetominophen like Tylenol, taking glucosamine supplements at the same time may decrease the effectiveness of acetaminophen and glucosamine. As well, if you are taking warfarin, it may increase the effect of warfarin making the blood thinner and harder to clot.
The recommended dosage for glucosamine is 1500mg/day. You may see some glucosamine supplements combined with chondroitin. There is conflicting evidence regarding which one is better. Some studies show a larger positive effect with glucosamine with chondroitin, others show no added benefits with consuming the combination.
What Is The Takeaway Message?
Give it a try, it can be a good alternative to medications and is supported by current research. If glucosamine doesn’t work for you, try chondroitin or a combination of glucosamine and chondroitin.
What Else Can I Do To Manage My Oa?
But hey, don’t just rely on medications and supplements to manage your OA, exercise is a great way as well!
Try to stretch and strengthen the muscles around the knee and hip. Stronger muscles decrease the shock and compressive forces to the joint. Doing some weight-bearing exercises will also help maintain the health of cartilage.
Articular cartilage gets its nutrients through diffusion from the synovial fluid in the joint space. Fluid is moved through the layers by compression. This is why weight-bearing exercise is important for those with arthritis as it allows more flow of fluid, and therefore nutrients through the layers of cartilage.
If you are unsure of how to manage your OA, or need some guidance and help with your condition, contact one of our Burnaby Physiotherapists. We have experience working with people with OA and have been able to help manage pain through other modalities such as acupuncture, electrotherapy, and exercise.