December 4, 2009

Omega-3 fatty acids boost glucosamine's arthritis benefit

In the September 2009 issue of the journal Advances in Therapy, German researchers report that the addition of omega-3 polyunsaturated fatty acids to the over-the-counter arthritis treatment glucosamine sulfate resulted in improved alleviation of symptoms compared to glucosamine alone. The trial is the first, to the authors' knowledge, to test the combination in patients with osteoarthritis.

In their introduction to the article, Joerg Gruenwald and his coauthors explain that a chronic imbalance between the synthesis and degradation of cartilage matrix leads to the loss of joint tissue that occurs in osteoarthritis. Glucosamine and omega-3 fatty acids appear to be successful in adjusting this imbalance in the direction of new cartilage synthesis.

The researchers enrolled 177 men and women between the ages of 40 and 75 with moderate-to-severe hip or knee osteoarthritis. Participants were randomized to receive three capsules daily of 500 milligrams glucosamine sulfate with or without 200 milligrams of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) for 26 weeks. Questionnaires concerning pain, stiffness and physical function limitations were administered before the treatment period, after 13 weeks, and at the trial's conclusion.

One hundred sixty-five participants showed a response of at least a 20 percent reduction in pain scores, with no significant difference between treatment groups. When an at least 80 percent reduction in pain was evaluated among those who complied with the study protocol, 44 percent of those in the combination group compared to 32 percent of those who received only glucosamine were categorized as responders. Morning stiffness and pain in the hips and knees were reduced by 48.5-55.6 percent in those who received both glucosamine and omega-3 fatty acids and by 41.7-55.3 percent in the glucosamine only group. Additionally, combination therapy was received by twice as many patients who reported a 90 to 100 percent reduction in pain compared to those who received glucosamine alone.

The authors remark that while glucosamine sulfate improves cartilage metabolism, EPA and DHA further reduce degradation by suppressing inflammation, which lowers swelling and pain. These readily available and well tolerated treatments could help contribute to maintaining the independence and well-being of an increasingly aged population.

Osteoarthritis

The value of nutrients is well known when it comes to arthritis. Even conventional textbooks recommend that people with osteoarthritis consume a diet rich in natural anti-inflammatory, antioxidant, and joint-supporting nutrients, and avoid eating pro-inflammatory foods that are high in sugar, saturated fats, and trans fatty acids.

The benefit of omega-3 fatty acids is well known in the treatment of people who have osteoarthritis. Clinical studies over the past two decades have proved again and again the value of omega-3 fatty acids in treating inflammatory conditions ranging from atherosclerosis to osteoarthritis. In people who have osteoarthritis, increased consumption of omega-3 fatty acids and adequate intake of monounsaturated fatty acids such as those found in olive oil (and decreased consumption of omega-6 fatty acids) can improve symptoms and even sometimes allow a reduction in the use of NSAIDs (Miggiano GA et al 2005). These fatty acids have many positive effects, including influencing cellular metabolic functions, supporting cell membrane structure, and directly reducing the expression of pro-inflammatory cytokines (Zak A et al 2005). The most potent of the omega-3 fatty acids containing oils are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are found in abundance in cold-water fish (Mori TA et al 2004).

Glucosamine is a naturally occurring substance. It is synthesized by chondrocytes for the purpose of producing joint cartilage. In osteoarthritis, glucosamine synthesis is defective, and supplementation with glucosamine has proven to be beneficial. The body uses the supplemental glucosamine to synthesize the proteoglycans and the water-binding glycosaminoglycans in the cartilage matrix. In addition to providing raw material, the presence of glucosamine seems to stimulate the chondrocytes to produce more proteoglycans and glycosaminoglycans. Glucosamine also inhibits certain enzymes such as collagenase and phospholipase, which destroy cartilage. By blocking pathogenic mechanisms that lead to articular degeneration, glucosamine delays the progression of the disease and relieves symptoms, even for weeks after termination of the treatment. Among the natural therapies for osteoarthritis, glucosamine sulfate is probably the best known. Commercial sources of glucosamine are from the exoskeleton of certain shellfish and are available as glucosamine sulfate and N-acetylglucosamine.

As with most natural remedies, the therapeutic effect of glucosamine is not immediate. It usually takes from 1 to 8 weeks to appear. Once achieved, it tends to persist for a notable time even after discontinuation of the treatment. The probable reason is that glucosamine is incorporated into rebuilding the cartilage itself.

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