Dr. Margaret Slater, a veterinarian and epidemiologist at Texas A & M University, gives the stuff to all her loved ones, two-footed and four-footed, who suffer from arthritis.
“My dog, my horse, my mother and her dog are all benefitting from it,” she says with a chuckle.
Dr. David Hungerford, chief of orthopedics at the Good Samaritan Hospital in Baltimore, is waiting to see – and perhaps even conduct – a clinical study on the substance.
But meanwhile, this Johns Hopkins surgeon whose arthritic hands perform 300 joint replacement operations a year, many on people with arthritic knees, has begun taking the stuff himself.
“I’ve had significant improvement,” he says.
In Toronto, Dr. Joseph B. Houpt, director of rheumatology at Mt. Sinai Hospital, is already doing a study, prompted by enthusiastic reports from patients who buy the remedy in health food stores. And by watching his dog.
“I have two yellow Labs,” he says. “One was creaking and groaning, unable to jump over stumps, unable to jump up on the couch.” She’s been “like a pup” since she’s been on the drug.
Oops. We are not supposed to call this stuff a drug, no matter how much it sounds – or acts – like one. Officially, it’s a dietary supplement, actually two supplements called glucosamine and chondroitin sulfate, which are made naturally in the body and are found, in tiny quantities, in food.
The supplements have been selling briskly, thanks to high profile reports in the media and a best-selling book with a vastly over-hyped title.
Taken separately, the supplements appear safe, based on studies in Europe, and to protect against the cartilage destruction that is the hallmark of osteoarthritis, which affects 16 million Americans. Rheumatoid arthritis affects another 2 million.
Because they are sold as supplements, these products are available in health food stores, pharmacies or by mail order. They are not approved by the Food and Drug Administration which means, of course, that you don’t have the government’s assurance that the products really work and are safe.
Still, these alternative remedies are clearly setting America’s arthritic toes a-tappin’ and hands a-clappin’ – as they have in Europe for years in both oral and injectable versions. (The injectable form is not available here.)
At the Bread and Circus store in Cambridge, one combination product, Joint Fuel by Twin Laboratories, is selling “extremely well,” says acting assistant nutrition manager Catherine Devine. And another, marketed as Glucosamine Chondroitin Complex by the Solgar Vitamin and Herb Company, is sold out.
Glucosamine or chondroitin are selling well separately, too.
The only patented combination product is Cosamin, made by Nutramax Laboratories, Inc. in Baltimore, which also makes a nearly identical product, Cosequin, for animals. Like the health food products, Cosamin, which Nutramax may someday try to market as a drug, is a hot seller in pharmacies and doctors’ offices – $ 100 for a 60-day supply for a person under 200 pounds.
So far, there is not a single published study on the combination of glucosamine and chondroitin in humans, although several on Cosamin are in the works, says Dr. Todd Henderson, a veterinarian and vice president of Nutramax. Several studies of the combination product show promising results in animals.
But there are a number of European studies in people that suggest that, taken separately, glucosamine or chondroitin can help substantially. Glucosamine probably works by stimulating the cells that make cartilage, and chondroitin, by inhibiting cartilage breakdown.
Much of the fascination with these supplements has been triggered by the best-selling, if misleadingly-titled book, “The Arthritis Cure,” by Dr. Jason Theodosakis, a Tucson physician. Theodosakis says the osteoarthritis in his knees and one elbow was so bad he was on crutches and “couldn’t even brush my teeth.”
Despite surgery, he was convinced he would never live without pain and stiffness, despite high doses of anti-inflammatory drugs. But within two weeks of taking the dietary supplements, he says, he began experiencing a “dramatic recovery.”
Since then, he says he’s treated hundreds of people, though he sounds slightly chagrined at having used the word “cure” in his title, which the American College of Rheumatology calls “irresponsible” and the Arthritis Foundation, “deceptive.”
In an interview and in the book, Theodosakis is more cautious, saying he needed ” a catchy title” and that he’s talking about curing symptoms, not the disease itself.
Others studying glucosamine and chondroitin are also trying to temper the growing public enthusiasm.
Dr. David Eisenberg, a self-described “open minded skeptic” and director of the center for alternative medicine research at Beth Israel Deaconess Medical Center, is intrigued but cautious, because people with arthritis are so eager to try anything that might help. Eisenberg is considering whether to conduct a study of sea cucumbers, a Chinese remedy for arthritis.
Dr. Amal Das, an orthopedic surgeon in Hendersonville, N.C. who does knee and hip replacement surgery, is already conducting a double-blind, placebo-controlled trial of Cosamin in 100 arthritis patients.
At regular intervals, patients complete a questionnaire assessing their pain, says Das, who has previously studied other medications to help patients avoid joint replacement surgery.
In Toronto, rheumatologist Houpt is also doing a double-blind study on 100 patients, though he is testing glucosamine alone, not the combination product. He’s heard the promising anecdotes, but warns, “You have to have a balanced approach to this. That’s why it’s important to look at large populations.”
Hungerford, the Johns Hopkins surgeon, agrees, adding it is “theoretically possible” that the supplements, if taken before cartilage is destroyed, could reduce the need for some of the 200,000 knee replacements and more than 200,000 hip replacements done every year.
“But in order for me and thousands of other physicians to become convinced that this is the recognized and preferred first line of treatment, double-blind, placebo-controlled, multi-centered trials need to be done,” he says.
And unless these studies are done and the FDA gives its blessing, there’s no way to be sure that what you buy will work and be safe, or even that the labels on the bottles will tell the truth. In fact, one study of nearly 30 glucosamine or chondroitin products found that several did not contain the doses specified.
“I can’t imagine there are real big safety problems,” says Dr. David Felson, a rheumatologist at Boston Medical Center. And the FDA says it has received no complaints about either dietary supplement.
But Felson warns, “You don’t know what else might be in the stuff that you buy in the health food store.”
If you do decide to treat yourself, the dose Theodosakis suggests is 1,500 milligrams of glucosamine and 1,200 milligrams of chondroitin sulfate per day for a person who weighs between 120 and 200 pounds.
Three tablets of Cosamin provides that dosage. Each tablet also contains 66 milligrams of ascorbate and 10 milligrams of manganese to enhance absorption. But other combination products may not meet this suggested dose. Each table of Joint Fuel, for instance, contains only half as much glucosamine and only a tiny bit, 17 milligrams, of chondroitin.
If you want to try the supplements, you should definitely talk it over with your doctor, among other things, to confirm that you really do have arthritis and not some other problem.
But the bottom line, says Das of North Carolina, is that it’s “probably okay” to try the supplements, especially since “there are no known side effects.”
The risks, in other words, are all yours. But the benefits may be, too.