Janet Zand, LAc, OMD, Allan N. Spreed, MD, CNC, James B. LaValle, RPh, ND
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 Take 500 milligrams of glucosamine sulfate or glucosamine hydrochloride (HCI) two or three times daily and 500 milligrams of chondroitin sulfate twice a day.
¦ Genistein is a phytoestrogen derived from soybeans or red clover. Plant estrogens have much milder effects than human estrogens do. However, it has been observed that Japanese women, who eat a lot of soy foods, have relatively high levels of phytoestrogens in their blood, and also have fewer menopausal symptoms than their Western counterparts. |
Gary Null, Ph.D.
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 The joints can be nourished with calcium, magnesium, manganese, copper, and vitamins A and D, as well as glucosamine sulfate, and chondroitin. Other basic nutrients for immune repair are bioflavonoids, gamma linoleic acid, essential fatty acids, zinc, and selenium.
Bio-oxidative Therapies
Bio-oxidative therapies can restore health, even after other methods have failed. Some patients benefit from a very low concentration of intravenous hydrogen peroxide. Others do well on ozone therapy, where a portion of the patient's blood is mixed with ozone and then injected back into the body. |
Schuyler W. Lininger, Jr. DC
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 The hypothesis that glucosamine sulfate and chondroitin sulfate (p. 281) work synergistically in the support of osteoarthritis remains unproven. The fact that they are structurally similar suggests that they may act in similar ways.
Glutamic Acid
Glutamic acid is a nonessential amino acid (p. 265) that the body uses to build proteins. Although glutamine (p. 300) and glutamic acid have similar names, they are structurally different.
The fluid produced by the prostate gland contains significant amounts of glutamic acid, and this amino acid may play a role in normal function of the prostate. |
| The few nutritionally oriented doctors aware of these older studies sometimes tell people with a history of heart disease or elevated cholesterol levels to take approximately 500 mg of chondroitin sulfate 3 times per day.
Octacosanol (p. 318), a substance found in wheat germ oil is sometimes available as a supplement. Small amounts (5-20 mg per day) of policosanol, an experimental supplement from Cuba consisting primarily of octacosanol, has led to large reductions in LDL cholesterol and/or increases in HDL. |
| Other
Betaine (not HCI) chondroitin sulfate
(p. 281) Evening primrose oil
(p. 292) Quercetin (p. 328) Resveratrol (p. 329) Vitamin C (p. 341)
Bilberry (p. 396) Butcher's broom
(p. 405) Fo-ti (p. 425) Ginger (p. 427) Hawthorn (p. 433) Rosemary (p. 455) Turmeric (p. 465)
Garlic (p. 425) and ginkgo (p. 427) also decrease excessive blood coagulation. Both have been shown in double-blind58 or single blind59 studies to decrease the overactive coagulation of blood that may contribute to atherosclerosis.
Guggul (p. |
| Test tube and animal studies have found these substances, and others like them, can promote improved tissue healing.49'50,51'52,53 One controlled human study found that wounds healed with greater strength when they were treated topically with a chondroitin sulfate-con-taining powder. |
| Coronary heart disease: Reduction of death rate by chondroitin sulfate A. Angiology 1973; 24: 269-82.
36. Bertelli AA, Giovanninni L, Bernini W, et al. Antiplatelet activity of cis-resveratrol. Drugs Exp Clin Res 1996; 22(2): 61-63.
37. Chen CK, Pace-Asciak CR. Vasorelaxing activity of resveratrol and quercetin in isolated rat aorta. Gen Pharm 1996; 27(2): 363-66.
38. Pace-Asciak CR, Rounova O, Hahn SE, et al. Wines and grape juices as modulators of platelet aggregation in healthy human subjects. Clin Chim Acta 1996; 246(1-2): 163-82.
39. Batista J, Stusser R, Penichet M, Uguet E. |
Gary Null
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 We need to protect these collagen surfaces from the irritative substances which circulate in the blood and ultimately get into the joint...
"Chondroitin sulfate appears to be one of the best treatments for both arthritis and vascular disease. When you take it orally, it actually enters into the body through the intestinal tract and will selectively go to the joints and all the areas of damage in the blood vessels. It not only acts preventively but also will help reverse the diseases that are present. This substance is now available in this country in health food stores. |
| Others in Europe are using substances they extracted from the cartilage itself, such as the chondroitin sulfate.
"There is a very large body of literature on the topic, with dozens of human studies and even more with animals. We know how and why these substances work because this is how the body heals itself. So I answer their question about where are the studies with my own question: 'Where's everybody been?' Why have people not read the prodigious literature available? Why don't people just open up their eyes and read?"
AVOIDING CERTAIN FOODS AND CHEMICALS Dr. |
Stanley W. Jacob, M.D., Ronald M. Lawrence, M.D., Ph.D.
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 Patients have frequently asked my opinion abour chondroitin sulfate, another popular nutritional supplement suggested for arthritis. I have not seen patients improve after adding chon-droitin sulfate, however.
MSM often allows patients on medication to reduce the number of pain pills they need and sometimes even eliminate them. If you are on medication, always consult your physician first before modifying or stopping a prescription. Some individuals have been taking cortisone for many years for its anti-inflammatory effect. |
| Scientific research indicates that chondroitin is generally not well absorbed.
Perspective # 3—Ephrain Olszewer, M.D.
In Brazil, Efrain Olszewer, M.D., director of the International Preventive Medicine Clinic in Sao Paulo, has been testing MSM on arthritic patients for more than a year.
"We wanted to see if arthritics could be maintained on MSM alone, without any medication such as nonsteroidal antiinflammatories," says Olszewer. "The results to date are good in 90 percent of the cases. |
Nicola Reavley
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 Shark cartilage also contains chondroitin sulfate, which has antiinflammatory properties.
Therapeutic uses
The ability to inhibit angiogenesis means that shark cartilage may be valuable in inhibiting tumor growth,1 and treating eye disorders such as diabetic retinopathy and macular degeneration. It has also been used to treat AIDS, arthritis, psoriasis, and bowel inflammation.
Cautions
Shark cartilage should not to be used by anyone who is still growing and needs angiogenesis for blood vessel development. |
Elson M. Haas, M.D.
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 These chondroitin sulfate/mucopolysaccharide products have been used in the treatment of various conditions, including headaches, arthritis, bursitis, ulcers, respiratory diseases, angina, and allergies. There is no hard evidence to date that these claims, often commercial, are accurate or that there is great therapeutic success in using the oral supplements (they may break down in the digestive tract), although bovine cartilage injections have been helpful in the treatment of arthritis and psoriasis. |
Mark Stengler, N.D.
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 The daily dosage recommended for chondroitin sulfate is 1,200 milligrams.
Other supplements may be beneficial as well. For some patients I recommend MSM and SAMe in additional to glucosamine sulfate. You may also want to consider taking antioxidants such as vitamins C and E, selenium, and lipoic acid, or natural herbal antiinflammatories such as bromelain, boswellia, and cat's claw. To help relieve pain—and possibly improve the condition of cartilage—you can apply ointments that contain MSM or capsaicin. |
Janet Zand, LAc, OMD, Allan N. Spreed, MD, CNC, James B. LaValle, RPh, ND
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| Take 500 milligrams of glucosamine sulfate or hydrochloride three times daily (four times daily if you weigh over 200 pounds) for three to four months.
¦ chondroitin sulfate enhances the activity of glucosamine. Take 500 milligrams twice daily.
¦ Inositol is required for proper muscle function. This is an important supplement to include if the bursitis is accompanied by neuritis. Take 500 milligrams three times daily for one to two weeks. Inositol works quickly. Relief should be apparent after one week.
¦ Proteolytic enzymes work to decrease inflammation and help relieve pain. |
Sheldon Saul Hendler and David Rorvik
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 Glucosamine derivatives are found in hyaluronic acid, keratan sulfate and heparan sulfate. chondroitin sulfate contains derivatives of galactosamine.
The glucosamine-containing glycosaminoglycan hyaluronic acid is vital for the function of articular cartilage. GAG chains 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 forces of collagen fibers. |
| PHARMACOKINETICS
The pharmacokinetics of collagen in bovine cartilage should be similar to those of dietary proteins. See chondroitin Sulfate for pharmacokinetics of that substance.
INDICATIONS AND USAGE
As with shark cartilage, claims for bovine cartilage include anticancer, anti-inflammatory and anti-arthritic effects. Accelerated wound-healing effects are also claimed for oral bovine cartilage. There is little support for these claims. Topical bovine cartilage does appear to aid in wound healing. |
| For example, it is found in products for bone and joint health that often combine such nutrients as vitamin D, calcium, magnesium, soy isoflavones, chondroitin sulfate, glucosamine, curcumin, boswellia, gelatin, ipriflavone, SAMe and others (see monographs on these substances). There's no evidence yet available that the therapeutic effects of boron are increased by such combinations.
HOW SUPPLIED
Capsules — 3 mg Tablets — 3 mg, 6 mg
LITERATURE
Chapin RE, Ku WW, Kenny MA, Mc Coy H, Gladen B, Wine RN, Wilson R, Elwell MR. The effects of dietary boron on bone strength in rats. |
| The main glycosaminoglycan in bovine cartilage is chondroitin sulfate.
In 1976, Judah Folkman and his colleagues reported on the isolation of a factor from the scapular cartilage of calves that inhibited the growth of new blood vessels supporting implanted tumors in rabbits. It also stopped the growth of the tumors.
Subsequently, it was found that factors in shark cartilage had similar effects (see Shark Cartilage). Bovine cartilage, marketed as a nutritional supplement and for other indications, is primarily derived from bovine trachea. |
Nicola Reavley
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| It is often combined with chondroitin, a substance which has anti-inflammatory properties and protects the cartilage against breakdown. It has also been used to promote wound-healing3 and to treat psoriasis.4
Chitosan is a natural product derived from chitin, a carbohydrate found in the shells of shellfish. It is chemically similar to the plant fiber, cellulose.
Therapeutic uses of supplements
Preliminary research suggests that chitosan can bind to fat in the digestive system and stop it from being absorbed. |
Sheldon Saul Hendler and David Rorvik
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| It contains chondroitin sulfate, which has been shown to be helpful in some with osteoarthritis, but studies showing similar activity with the use of bovine cartilage are lacking. Some anti-inflammatory and antitumor effects have been shown in animal and in vitro studies.
CONTRAINDICATIONS, PRECAUTIONS, ADVERSE REACTIONS
CONTRAINDICATIONS
Bovine cartilage supplements are contraindicated in those who are hypersensitive to any component of a bovine cartilage-containing product.
PRECAUTIONS
Pregnant women and nursing mothers should avoid using bovine cartilage supplements. |
Ruth Winter, M.S.
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 SODIUM chondroitin SULFATE • Present in soft connective tissue, it is abundant in skin arterial walls and heart valves. It is used to reduce fats and as a flexible connector between protein molecules. No known toxicity. SODIUM CITRATE • White, odorless crystals, granules, or powder with a cool salty taste. Stable in air. Used as a sequestering ingredient (see) to remove trace metals in solutions and as an alkalizer in cosmetic products. No known skin toxicity.
SODIUM COCETH SULFATE • See Coconut Oil. SODIUM COCOAMINOPROPIONATE • See Coconut Oil. SODIUM COCOAMPHOACETATE • See Surfactants. |
Dr. Mary Dan Eades
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 Anyone over 200 pounds should take 2000 mg glucosamine and 1600 mg chondroitin sulfates. Everyone's needs vary, so be sure to have a thorough consultation with a physician and make clear your intent to follow this treatment.
• Niacin appears to decrease pain and increase mobility of painful joints after as little as 2 to 6 weeks of supplementation. Case reports show the effect to be especially beneficial for osteoarthritis of the knees. Recommendation: Begin with 500 mg of niacin (as niacinamide) and 100 mg B-complex twice a day for a week. |
John Boik
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 GAGs exist in four main forms: heparan sulfate and heparin, chondroitin sulfate and dermatan sulfate, hyaluronic acid, and keratan sulfate. Of these, only hyaluronic acid is not bound to a protein and is not sulfated in its natural form. chains, which appears to facilitate matrix repair by chondrocytes (Hardingham and Fosang, 1992).
Oral administration of polysaccharides may inhibit neoplasia by directly affecting CAMs. |
James A. Duke, Ph.D.
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 The recommended dose of glucosamine is 500 milligrams three times a day; for chondroitin, 400 milligrams three times a day. I take both for my arthritic aches. I think they help. sam-e (S-adenosylmethionine). Pronounced "sammy," this new supplement, imported from Europe, is supposed to help both osteoarthritis and depression. The Germans have approved SAM-e for joint
Exercise Keeps You One Step Ahead of Pain sM£l Years ago, if you had osteoarthritis, your doctor would have advised you to go easy on the physical activity. Not anymore. |
| You may want to try chondroitin as well. The recommended dosage is 400 milligrams three times a day. ginger (zingiber officinale). Ginger is an age-old treatment for inflammation, particularly in Ayurvedic medicine. No wonder: The herb contains 24 distinct anti-inflammatory compounds. One study that I've reviewed shows that large doses of ginger (on the order of 4,000 milligrams a day) help treat both osteoarthritis and rheumatoid arthritis, with no side effects. I see no reason why the herb wouldn't help prevent these conditions as well.
Personally, I love ginger. |
Schuyler W. Lininger, Jr. DC
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| One study found 60 mg per day of such supplements significantly lowered urinary oxalate levels in stone formers.77 Such a decrease should reduce the risk of stone formation. Are There Any Side Effects or Interactions? Refer to the individual supplement for information about any side effects or interactions.
Herbs That May Be Helpful
Highly trained practitioners of botanical medicine use several herbs to help facilitate passage of small kidney stones and to help prevent their formation.
The efficacy of these herbs has not been documented scientifically for people with kidney stones. |
Ralph Golan, M.D.
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 Find a multiple or a back/disc formula that provides most of these nutrients.
• Proteolytic (protein-digesting) enzymes can be used acutely for their anti-inflammatory effect (one or two capsules three or four times a day between meals and at bedtime).
• Try intramuscular injections of vitamin B-12 (1,000 micrograms a day for one to two weeks), with folic acid (2 or 3 milligrams) added in the syringe at least three times a week. After the initial two weeks, lessen the frequency of the injections to two or three injections a week for a month, then one to four injections a month as needed. |
Sheldon Saul Hendler and David Rorvik
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| In another recent meta-analysis of nine randomized, controlled trials of glucosamine, glucosamine was significantly superior to placebo in seven of the studies and was superior to ibuprofen and equal to ibuprofen in the other two studies.
Recently, a long-term, randomized placebo-controlled trial of glucosamine sulfate's effects on osteoarthritis ended with the conclusion that the supplement halts progression of structural joint damage and reduces symptoms of those with osteoarthritis of the knee. |
Jean Carper
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 He determined to do a study of his own, using the highest scientific standards. Two years ago, on the basis of the European evidence, he started a pilot study using the agents on some of his osteoarthritic patients, particularly those who had serious side effects from anti-inflammatory drugs.
Although he stresses that the evidence is anecdotal, it was extremely impressive. Many of his patients, like those in the European studies, improved dramatically. "I've had several patients whose pain has been alleviated. |
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