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John Malins - 22 Apr 2004 21:23 GMT

For the last month or so,I have been taking a combination of marine
chondroitin 400mgs/ glucosamine 500 mgs for the treatment of arthritis,they
where recommended by a friend who is convinced that they improve his
mobility.they are quite expensive ,about ?15 for x 120 they recommend two a
day,I also take cod liver oil caps,I have not noticed any difference in my
joints.are we wasting our money,what do you think? your advice will be
appreciated ....john.m

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Me - 22 Apr 2004 23:00 GMT

> For the last month or so,I have been taking a combination of marine
> chondroitin 400mgs/ glucosamine 500 mgs for the treatment of
[quoted text clipped - 3 lines]
> any difference in my joints.are we wasting our money,what do you think?
> your advice will be appreciated ....john.m

The dose may be a little on the low side. For most benefit you probably
need to take 3 a day. Certainly in the US, there are advocates of even
higher doses.

Regardless, available data shows improvement usually by 4 weeks. There
is some data that hints at even greater improvement at 8 weeks.

The choice is yours. I have no information regarding your financial status
or any medical information other than that you are taking chondromax and
cod liver oil. I, for one, do believe the stuff helps (glucosamine and
chondroitin that is--not necessarily the Chondromax brand). I would
recommend talking to your doctor or pharmacist and consider continuing for
another month on a higher dose.

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Gregory Poon - 23 Apr 2004 00:00 GMT

You're paying a lot of $ for the chondritin portion of the combination, and
that's really a waste of money. Chondritin is a huge molecule that the body
cannot absorb orally -- this is both basic chemistry and has been shown in
studies. Glucosamine, on the other hand, is worth taking and I suggest you
take a simple glucosamine supplement.

Signature

Gregory M. K. Poon, Ph.D., R.Ph., B.Sc.Phm.
Departments of Pharmaceutical Sciences and Chemical Engineering
University of Toronto

> For the last month or so,I have been taking a combination of marine
> chondroitin 400mgs/ glucosamine 500 mgs for the treatment of arthritis,they
[quoted text clipped - 3 lines]
> joints.are we wasting our money,what do you think? your advice will be
> appreciated ....john.m

Reply to this Message

Me - 23 Apr 2004 02:11 GMT

> You're paying a lot of $ for the chondritin portion of the combination,
> and that's really a waste of money. Chondritin is a huge molecule that
> the body cannot absorb orally -- this is both basic chemistry and has
> been shown in studies. Glucosamine, on the other hand, is worth taking
> and I suggest you take a simple glucosamine supplement.

Just curious, what studies showed that chondroitin is not absorbed?

I found one on PubMed, but can't get the full article and the abstract was
certainly too vague to draw any conclusions from. I did find several
showing that it is absorbed generally around 10 to 20 percent.

While absorption is certainly an issue, just because a compound (or group
of compounds in chondroitin's case) is poorly absorbed, does not mean it
cannot work. Some prescription oral drugs have lower absorption than
chondroitin.

It doesn't really matter to me whether or not the OP decides to use it,
and if glucosamine alone works, then great. If he gives up on both
completely, that's his choice. But flatly stating that chondroitin is not
absorbed, period, seems to fly in the face of the preponderance of
evidence.

Reply to this Message

Gregory Poon - 23 Apr 2004 20:42 GMT

> While absorption is certainly an issue, just because a compound (or group
> of compounds in chondroitin's case) is poorly absorbed, does not mean it
> cannot work. Some prescription oral drugs have lower absorption than
> chondroitin.

True, but one needs a sense of scale here. Insulin has a molecular weight
of 6000, and it is not orally bioavailable, at any level. Condroitin is a
polysaccharide with a MW > 14,000. Think I'm comparing apples and oranges?
Heparin, another polysaccharide, is not orally bioavailable. Even
lactulose, a simple dissacharide, with a MW = 343, is not absorbed neither
(that's why it works as an osmotic laxative). For strongly polar substances
like carbohydrates, if the gut wall doesn't have a transporter for them,
they are not going to be absorbed. And there's certainly no condroitin
transporter out there. The condroitin could be digested (even partially) in
the gut and the fragments may be absorbed, but can these fragments be
therapeutically active? Have a critical reading of these papers that claim
bioavailability for condroitin -- how did they measure intact, putatively
active condroitin?

> Just curious, what studies showed that chondroitin is not absorbed?
>
[quoted text clipped - 7 lines]
> absorbed, period, seems to fly in the face of the preponderance of
> evidence.

Biomedical literature can be a mine field. Case in point: Conte A, Volpi
N, Palmieri L, Bahous I, Ronca G. Biochemical and pharmacokinetic aspects of
oral treatment with chondroitin sulfate. Arzneimittelforschung. 1995
Aug;45(8):918-25. They administer orally radiolabelled chondritin and follow
the radioactivity -- but there is no demonstration that the radioactivity
still belonged to "absorbed condroitin" or whether it came from digested
chrodroitin that has been incorporated into other molecules in the body.

Signature

Gregory M. K. Poon, Ph.D., R.Ph., B.Sc.Phm.
Departments of Pharmaceutical Sciences and Chemical Engineering
University of Toronto

> > You're paying a lot of $ for the chondritin portion of the combination,
> > and that's really a waste of money. Chondritin is a huge molecule that
> > the body cannot absorb orally -- this is both basic chemistry and has
> > been shown in studies. Glucosamine, on the other hand, is worth taking
> > and I suggest you take a simple glucosamine supplement.

Reply to this Message

Me - 24 Apr 2004 19:21 GMT

> True, but one needs a sense of scale here. Insulin has a molecular
> weight of 6000, and it is not orally bioavailable, at any level.

Does size have anything to do with it, or is it because insulin is a
peptide and may be more fragile in regards to pH and targeted by enzymes?

> Condroitin is a
> polysaccharide with a MW > 14,000. Think I'm comparing apples and
[quoted text clipped - 4 lines]
> transporter for them, they are not going to be absorbed. And there's
> certainly no condroitin transporter out there.

So the studies showing increased levels following oral administration are
simply false?

> The condroitin could be
> digested (even partially) in the gut and the fragments may be absorbed,
> but can these fragments be therapeutically active?

How can you be so sure they aren't?

> Have a critical
> reading of these papers that claim bioavailability for condroitin -- how
> did they measure intact, putatively active condroitin?

Is anyone claiming that chondroitin is only effective if the large
chondroitin chains with a mol wt > 14,000 are absorbed intact? Can you say
for certain that even a chondroitin-derived dissacharide is of absolutely
no benefit?

> Biomedical literature can be a mine field.

Absolutely. Wouldn't it be wonderful if there were no bias or ulterior
motives in science?

> Case in point: Conte A,
> Volpi N, Palmieri L, Bahous I, Ronca G. Biochemical and pharmacokinetic
[quoted text clipped - 4 lines]
> condroitin" or whether it came from digested chrodroitin that has been
> incorporated into other molecules in the body.

Volpi,for one, also found chondroitin plasma levels to be increased
following po administration as determined by electrophoresis rather than
radiolabelling. (Osteoarthritis Cartilage. 2002 Oct;10(10):768-77 and
Osteoarthritis Cartilage. 2003 Jun;11(6):433-41.).

Maybe, just maybe, the NIH's GAIT results will be published sometime in
'05 and provide more evidence of chondroitin's efficacy or lack thereof.

Until then (or other, more definitive results are published), I intend to
continue to recommend it as potentially beneficial.

Reply to this Message

Gregory Poon - 24 Apr 2004 19:48 GMT

> Does size have anything to do with it, or is it because insulin is a
> peptide and may be more fragile in regards to pH and targeted by enzymes?

Size certainly has a lot to do with absorption. Crossing the GI lumenal
membrane presents the same challenges as crossing other membranes in the
body. If cell membranes were leaky to proteins, then our cells would be in
real trouble! If it were not for amino acid and peptide transporters in the
gut, we'd have a tough time absorbing even proteins in our diet. (To turn
the argument around, if we could absorb proteins as is, we wouldn't have
evolved the digestive enzymes.) Polysaccharides have it even worse then
proteins because they are generally much more polar than proteins.

> > The condroitin could be
> > digested (even partially) in the gut and the fragments may be absorbed,
[quoted text clipped - 10 lines]
> for certain that even a chondroitin-derived dissacharide is of absolutely
> no benefit?

You're right, it's not certain, but if the digested fragments of chondroitin
are therapeutic, then why not take it a step further and say that
chondroitin is nothing but a source of glucosamine (sulfated
glucosamine/galactosamine is a component of the chondroitin). If this was
the case, then it'd be silly to take (and spend the $$ on) chondroitin in
the first place.

> > Biomedical literature can be a mine field.
>
> Absolutely. Wouldn't it be wonderful if there were no bias or ulterior
> motives in science?

Agreed. That's where a lot of these "nutraceutical" studies are suspect --
they're either sponsored by the companies themselves or administer specific
brands of the product (wonder why ...)

> Maybe, just maybe, the NIH's GAIT results will be published sometime in
> '05 and provide more evidence of chondroitin's efficacy or lack thereof.
>
> Until then (or other, more definitive results are published), I intend to
> continue to recommend it as potentially beneficial.

Or at least nontoxic.

Signature

Gregory M. K. Poon, Ph.D., R.Ph., B.Sc.Phm.
Departments of Pharmaceutical Sciences and Chemical Engineering
University of Toronto

> > True, but one needs a sense of scale here. Insulin has a molecular
> > weight of 6000, and it is not orally bioavailable, at any level.
[quoted text clipped - 24 lines]
> radiolabelling. (Osteoarthritis Cartilage. 2002 Oct;10(10):768-77 and
> Osteoarthritis Cartilage. 2003 Jun;11(6):433-41.).

Reply to this Message

Me - 25 Apr 2004 01:56 GMT

On Sat, 24 Apr 2004 18:48:00 +0000, Gregory Poon wrote: <snip>

> ...but if the digested fragments of
> chondroitin are therapeutic, then why not take it a step further and say
> that chondroitin is nothing but a source of glucosamine (sulfated
> glucosamine/galactosamine is a component of the chondroitin). If this
> was the case, then it'd be silly to take (and spend the $$ on)
> chondroitin in the first place.

If that is ever shown to be the case, yes it would be silly.

>> > Biomedical literature can be a mine field.
>>
[quoted text clipped - 4 lines]
> -- they're either sponsored by the companies themselves or administer
> specific brands of the product (wonder why ...)

True, but you can't limit that skepticism to "nutraceuticals." (I'm not
accusing you of doing that, BTW.) The same issues can apply to studies of
"drugs" as well. Furthermore, the big pharmaceutical companies have enough
$ to hire people who are better able to disguise bias and manipulate
statistics to make the product look as good as possible.

Ah, the human condition--where integrity is too often inversely
proportional to $$.

>> Maybe, just maybe, the NIH's GAIT results will be published sometime in
>> '05 and provide more evidence of chondroitin's efficacy or lack
[quoted text clipped - 4 lines]
>
> Or at least nontoxic.

Which is more than can be said for other OTC and Rx treatments for OA. I
know, I know... you're probably thinking "well, at least the
OTC and Rx drugs work."

We'll just have to agree to disagree on this one for now, no matter how
wrong I am.

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