Saturday, June 25, 2011

Food supplements for Osteoarthritis


For this post, I decided to do away with the emotional tone.  Instead, just plain orthopedic information in the meantime.   (Is that good or bad?) Anyway, I will be discussing one issue pertaining to osteoarthritis, my field of specialization. Just as a reminder to my readers, though, that the contents of this post are all still based on my personal experience and point of view, and I don’t work or am NOT connected with any pharmaceutical company.  

So, you may have probably seen a lot of commercial advertisements that promote glucosamine and chondroitin.  (Aling Dionisia is in one of these advertisements). 

Recently, this question from a patient has again cropped up. “ Doc, do food supplements like glucosamine and chondroitin sulfate really help people with osteoarthritis?”  Patients of mine who have relatives in the US have asked me this question several times since their supplements are apparently given by their relatives for free.  

My honest answer?  

Some will pretend to know.

But me? I don’t know.  And I say that with a smile on my face.

Let me tell you a little bit more about these food supplements.  First, osteoarthritis, the most common form of arthritis which is mainly due to “wear and tear” as we age, can be in the form of mild, moderate or severe.  The severe form is very crippling and painful. Surgery in the form of joint replacement is the treatment of choice for the severe type.  The mild and moderate forms have several treatment options, one of them is the use of these food supplements, mainly in the form glucosamine and chondroitin sulfate. 

In the US, glucosamine and chondroitin, either alone or in combination, are probably two of the most common food supplements used by adults. 

Chondroitin and glucosamine have been found in the normal cartilage (the material in between bones that act as “shock absorbers”) of joints.  So, it makes sense that if you take them as food supplements, they can “replenish” the worn out cartilage.  But one question is, how do they get to the joints when you take them orally?  Cartilage doesn’t have blood vessels where these substances can be delivered to the intended tissues.

As with any vitamins, there are different ways that you can take it, depending on the brand. Most branded forms are large tablets but here in the Philippines, there is a powder form of glucosamine which is mixed with water.  This may be especially suited for you if you don’t take pills well.

But are there studies that support the use of these food supplements?  

Yes, there are. And you know what, there are also studies that do not recommend it.  One of my colleagues in the profession told me that you can always find a study that supports what you want to hear.  And you can always find a study that will not support what you want to hear.  Confusing, huh.  

The American Academy of Orthopedic Surgeons (AAOS) came out with a guideline released in 2009 for knee osteoarthritis.  As a consequence of inconclusive evidence, the guideline does not recommend the use of these food supplements.  I am not aware of any local study that dwells on the topic.  But there have been several reports that showed that the results of studies in Caucasians are very different from Asians like us.  And so further studies, I think, are needed, especially on Filipinos.

In my practice, I personally see patients who claim they improve with the intake of these food supplements.  And you cannot take that away from them.  Placebo effect? Maybe yes. Maybe not. My mentor, who is a world-renowned Filipino-American orthopedic surgeon, takes them every day. And is still very strong, at 80 years old. There are others who are big fans of food supplements.

So, when a patient asks me if they can take these food supplements, I tell them that they can take them if they want, as long as they don’t experience any side effect (There have been no major side effects that have been reported anyway).   But they have to realize also that osteoarthritis is a degenerative process that comes with age. It cannot be totally prevented, but at least we can delay the process. 

Until valid and definitive clinical trials have been undertaken in a Filipino population regarding the effectiveness of taking food supplements like glucosamine and chondroitin, I cannot recommend for or against the use of them. The problem is, no company in the Philippines will spend millions of pesos/dollars to conduct such clinical trials.

So, do you still want to take those food supplements?  The decision is yours.

If you have taken or know someone who have taken these food supplements before, do tell us about your experience!

More non-surgical treatment of osteoarthritis on the next blog…


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Doc Ralds said...

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