Chondroitin -ChondroPure
Chondroitin sulfate belongs to a family of heteropolysaccharides called glycosaminoglycans or GAGs. Glycosaminoglycans were formerly known as mucopolysaccharides. GAGs in the form of proteoglycans comprise the ground substance in the extracellular matrix of connective tissue. Chondroitin sulfate is found in humans in cartilage, bones, cornea, skin and the arterial wall. This type of chondroitin sulfate is sometimes referred to as chondroitin sulfate A or galactosaminoglucuronoglycan sulfate.
About the Quality of Chondroitin in Dietary Supplements
Chondroitin is a widely used ingredient that occurs naturally in the body of warm-blooded animals, and forms an important building block of joint cartilage. Glucosamine may help build tissue that holds water providing cartilage thickness and giving it a cushioning effect.
Dozens of scientific studies with animals and humans have clearly demonstrated that dietary supplementation of glucosamine in combination with chondroitin, another building block of cartilage, benefits connective tissues. The best-known clinical study is the 4-year one known as the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), conducted at 16 sites across the United States. This double-blind, placebo-controlled study was sponsored by the government funded National Institute of Health (NIH), and was published in 2005 in the New England Journal of Medicine. This study, which enrolled nearly 1,600 patients, showed that when Glucosamine and Chondroitin were used in combination, they resulted in relief of knee pain in nearly 79% of patients with moderate to severe osteoarthritis; significantly more than either the placebo control group, or patients that were treated with a common NSAID drug.
The chondroitin sulfate offered to manufacturers of dietary supplements varies widely in quality, species of origin, and country of origin. Only through reliable testing by a qualified analytical laboratory can the manufacturer of chondroitin-containing products be certain of its potency. Unfortunately, this expensive ingredient is widely available in adulterated form, and may vary in potency more than perhaps any other ingredient in the largely unregulated health food industry, ranging from less than 10% to greater than 90% purity.
Origin
Chondroitin sulfate is typically produced from cartilage obtained from cattle, pig, or poultry slaughterhouses, or as a byproduct of the shark fisheries industry. Shark cartilage is most widely used in Europe and Japan, while bovine chondroitin is more popular in the US. The worldwide availability of shark cartilage is rather limited, and much of the presumable marketed shark chondroitin on the market today is actually derived from bovine trachea. This true origin of the chondroitin can only be detected by rather expensive and detailed chemical analyses. Bovine trachea are widely available, and produce chondroitin molecules of smaller size, which can be more easily absorbed by the body. A disadvantage of bovine chondroitin is the common misconception that BSE, the source of mad cow disease, may be present. However, this fear is unfounded, as BSE prions can only occur in proteins, which are absent in good quality chondroitin, due to the complicated extraction processes.
Chondroitin sulfate varies widely in price. Cheap chondroitin, commonly referred to as “food grade” chondroitin, is commonly used for animal supplements, as well as in some low cost human supplements. This chondroitin consists mostly of molecules which have similar chemical characteristics to true chondroitin molecules, but are in fact different and not biologically active. While a product may claim, for example, to contain 200 mg per tablet, the actual beneficial chondroitin content could be less than 20 mg. Pharmaceutical grade chondroitin is typically five to ten times as expensive as food grade chondroitin, but should contain 90 - 98% pure chondroitin.
In response to a growing concern about the quality of chondroitin in today’s supplement products, Dr. David Ji developed a new analytical method which takes advantage of the ability of certain specialized enzymes to break down chondroitin molecules into smaller parts, which can then be analyzed. Since only true chondroitin molecules are attacked by these enzymes, it is highly specific, and unaffected by the presence of chondroitin-like molecules. An added advantage is that the concentrations of the breakdown products, so-called Type A and Type C molecules, can yield an indication of the origin of the chondroitin, land-based or marine, and based on the known A/C ratio.
CHONDROPURE® is chondroitin at farmaceutical grade
The Role of Chondroitin in Our Body
Chondroitin sulfate and hyaluronic acid are vital for the structure and function of articular cartilage. Chondroitin sulfate and hyaluronic acid are fundamental components of aggrecan found in articular cartilage. Aggrecan confers upon articular cartilage shock-absorbing properties. It does this by providing cartilage with a swelling pressure that is restrained by the tensile force of collagen fibers. This balance confers upon articular cartilage the deformable resiliency vital to its function. Hyaluronic acid, which is also found in synovial fluid, has lubricating properties for the joint.
Until the specific actions of supplemental chondroitin sulfate are determined, the mechanism of action is a matter of speculation. However, possible actions documented thus far include promotion and maintenance of the structure and function of cartilage (referred to as chondroprotection), pain relief of osteoarthritic joints and anti-inflammatory activity.
In the progression of degenerative joint disease or osteoarthritis, aggrecan synthesis is decreased, leading to the loss of cartilage resiliency, pain, and other symptoms that do accompany osteoarthritis.
Intra-articular injections of hyaluronic acid can relieve joint pain and improve mobility. This type of therapy is called viscotherapy and is believed to act by improving joint lubrication. If chondroitin sulfate were delivered into joints, some similar effects would be expected. Some studies have shown that parenterally administered chondroitin sulfate does get into cartilage tissue as does orally administered chondroitin sulfate. There is some indication that orally administered chondroitin sulfate leads to increases in hyaluronic acid and viscosity of synovial fluid, as well as decreases in collagenase in synovial fluid. That is, chondroitin delivered into joints may inhibit enzymes involved in cartilage degradation and enhance the production of hyaluronic acid.
Two recent meta-analyses indicate that chondroitin sulfate may be useful in the treatment of osteoarthritis. One of these meta-analyses included all double-blind, placebo-controlled trials that lasted four weeks or longer. This meta-analysis also included trials that studied the effects of glucosamine on osteoarthritis. In all, there were 13 of these studies (six involving glucosamine and seven involving chondroitin sulfate).
All 13 studies found positive results in hip or knee osteoarthritis. The authors of the meta-analysis judged a trial positive if there was 25% or more improvement in the treatment group compared with placebo. The Levesque Index and global pain scores were used to assess improvement. Very significant improvement was associated with both glucosamine (39.5%) and chondroitin (40.2%), compared with placebo.
A significant synergistic effect has been reported recently using combined glucosamine hydrochloride and chondroitin sulfate in an experimental study. The combination was more effective than either substance alone in inhibiting progression of degenerative cartilage lesions*. Longer term clinical studies are needed to confirm or refute this synergy effect.
In another recent meta-analysis of chondroitin sulfate, this one examining four randomized double-blind, placebo- or NSAID-controlled studies of 227 patients, chondroitin sulfate supplemented subjects showed at least 50% improvement, compared with controls. Various studies have reported significant reduction in NSAID use among osteoarthritis subjects supplemented with chondroitin sulfate.
There is also radiological evidence of chondroitin's possible efficacy in osteoarthritis. Knee joint space decreased significantly in placebo subjects but remained unchanged in those receiving chondroitin sulfate for a year. And, in another study, those receiving chondroitin sulfate showed significantly fewer instances of erosive osteoarthritis (compared with placebo controls) on hand radiographs over a three-year period.
It is believed that chondroitin sulfate's possible efficacy in osteoarthritis derives from the fact that it is one of the two most abundant glycosaminoglycans (GAGs) in articular cartilage. Supplementation with this GAG seems, in part at least, to confer chondroprotection through its inhibitory action on some of the enzymes that damage cartilage. Further, by inhibiting other enzymes that can block transport of nutrients that nourish cartilage, this GAG may promote cartilage replacement.
Some years ago, chondroitin sulfate was investigated for its possible use in atherosclerosis. There was some evidence that it could favorably lower lipid levels and protect against blood clotting. Atheromatous aortic lesions were prevented in animals on high-cholesterol diets.
In a clinical trial, 60 patients suffering from coronary artery disease received 2 grams of oral chondroitin sulfate daily for 900 days. During that period, 16 of 60 unsupplemented control patients suffered acute coronary incidents. Only one of the chondroitin sulfate-treated subjects had an acute coronary incident. The same research group later followed up with similarly positive results.
More research is needed before any conclusions can be drawn with respect to a possible role for chondroitin sulfate in the treatment or prevention of atherosclerosis.
| CHONDROITIN SULFATE |
| Main Actions: |
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| Main Uses: | osteoarthritis, arthritis, rheumatoid arthritis, psoriasic arthritis, cartilage disorders |
| Standard Dosage: | 1200 mg daily |
| Contraindications: | None known. However:
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| Drugs interactions: | None known. |
Glucosamine and Chondroitin Sulfate*
Thus far, it has been 20 years since glucosamine and chondroitin are used in Europe as adjuvants to traditional treatments of osteoarthritis both in humans and animals.
These substances are cited as nutrients contained in most of the food and listed in the same family of vitamins.
Glucosamine and chondroitin are natural occurring substances in humans and animals, especially in cartilages.
An healthy body synthetizes glucose from which it gets the needed glucosamine for maintaining cartilages functioning. About the 90% of intaken glucosamine is absorbed; the 8-12% of this is distribuited into tissues, while the rest is cleared out as urinary execration and carbon dioxide. Only the 10% of intaken chondroitin sulfate is absorbed by the body though. So that in elderly people and/or if joint cartilage is injuried, the body cannot afford to synthetize enough glucosamine for its physiological necessities. Therefore, it's needed an external supplementation making up to this metabolic imbalance.
It's believed that glucosamine and chondroitin sulfate act by inhibiting enzymes that destroy cartilage and stimulating proteoglycans synthesis.
There are several studies that document the effects of glucosamine and chondroitin on more than 4000 individuals. In comparison to traditional NSAIDs they have the same effectiveness but lower toxicity. In addition, many studies have suggested that glucosamine and chondroitin sulfate effects hold over 4 weeks after having discontinued the treatment.
Bibliography
Baici A, Horler D, Moser B, et al. Analysis of glycosaminoglycans in human serum after oral administration of chondroitin sulfate. Rheum Int. 1992; 12:81-88.
Bartolucci C, Cellai L, Cordani D, et al. Chondroprotective action of chondroitin sulfate. Competitive action of chondroitin sulfate on the digestion of hyaluronan by bovine testicular hyaluronidase. Int J Tiss Res. 1991; 13:311-317.
Bourgeois P, Chales G, Dehais J, et al. Efficacy and tolerability of chondroitin sulfate 1,200 mg/day vs. chondroitin 400 mg/day vs placebo. Osteoarthritis Cartilage. 1998; 6 SupplA:25-30.
Busci L, Poor G. Efficacy and tolerability of oral chondroitin sulfate as a symptomatic slow-acting drug. for osteoarthritis (SYSADOA) in the treatment of knee osteoarthrosis. Osteoarthritis Cartilage. 1998; 6 SupplA:31-36.
Conte A, Volpi N, Palmiera L, et al. Biochemical and pharmacokinetic aspects of oral treatment with chondroitin sulfate. Drug Res. 1995; 45:918-925.
Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clin North Am. 1999; 25:379-395.
Leffler CT, Phillipi AF, Leffler SG, et al. Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study. Mil Med. 1999; 164:85-91.
McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis. A systematic quality assessment and meta-analysis. JAMA. 2000; 283:1469-1475.
Morrison LM, Enrick L. Coronary heart disease: reduction of death rate by chondroitin sulfate A. Angiology. 1973; 24:269-287.
Morrison LM, Bajwa GS, Alfin-Slater RB, Ershoff BH. Prevention of vascular lesions by chondroitin sulfate A in the coronary artery and aorta of rats induced by a hypervitaminosis D, cholesterol-containing diet. Atherosclerosis. 1972; 16:105-118
Pipitone VR. Chondroprotection with chondroitin sulfate. Drugs Exp Clin Res. 1991; 17:3-7.
Ronca F, Palmieri L, Panicucci P. Ronca G. Anti-inflammatory activity of chondroitin sulfate. Osteoarthritis Cartilage. 1998; 6 SupplA:14-21.
Towheed TE, Anastassiades TP. Glucosamine and chondroitin for treating symptoms of osteoarthritis. Evidence is widely touted but incomplete. JAMA. 2000; 283:1483-1484.
Uebelhart D, Thonar EJ, Delmas PD, et al. Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study. Osteoarthritis Cartilage. 1998; 6 SupplA:39-46.
Yamanashi S, Toyoda H, Furuya N, et al. Metabolic study on chondroitin sulfate in rabbits. Yakugaku Zasshi. 1991; 111:73-76.
WARNINGS: The statements given in these pages have an informative aim and are drawned on international publications. The natural properties of the botanicals are only referred to their common uses among folk and herbal traditions. Our products are not intended to diagnose, cure, or prevent any disease as well. It's not meant to give any suggestion of diagnosis or disesase treatment. Please see a doctor when needed.