Dear Mark: Glucosamine, Chondroitin, and MSM; Iodine for Thyroid
Mark’s Daily Apple
by Mark Sisson: You
Want to Eat Like a Hunter-Gatherer
edition of Dear
Mark is a relatively focused one, with just two topics. I spend
the bulk of my time discussing the merits of glucosamine, chondroitin,
and methylsulfonylmethane supplementation
when it comes to treating osteoarthritis. This is a tough subject,
because while these joint supplements are some of the most commonly
taken, the evidence for their efficacy is mixed. It seems like people
have one of three reactions to these particular supplements. Either
they find them completely and utterly indispensable, completely
and utterly useless, or kinda sorta helpful in a "but I'm not too
sure" kind of way. Next, I discuss whether or not iodine supplementation
is required on a Primal Blueprint eating plan.
Let's get going,
through the site and surprisingly I'm hitting a wall while trying
to find any information in regards to Glucosamine and Chondroitin,
MSM. I did find a few bone health articles where you suggest using
it, but do not go much further with details. Can you give us the
ins and outs of these supplements? I've heard quite a bit about
the benefits of each, however I've also heard quite a bit in regards
to this being some kind of placebo effect that is doing nothing
to improve joint function. I would love to hear your take on this.
chondroitin, and MSM are all separate compounds, though they are
grouped together in supplements so often that the names kind of
blend together. Let's go over each of them.
is a structural component of bone, exoskeletons, shells, and fungi
is a structural component of cartilage.
(MSM) is an organosulfur compound (remember
those?) found, in limited quantities, in certain plants.
Most of the
studies are either inconclusive or indicate that neither glucosamine,
chondroitin, nor MSM have much, if any, effect on humans with osteoarthritis.
one said as much. That's it, then, right? It doesn't work. And
if it does work, it's a placebo.
Period. Throw away your supplements and start mainlining liquefied
NSAIDs. How could anyone be so stupid as to use a supplement?
Eh, not so
studies suggest that glucosamine, chondroitin,
and MSM might work pretty well. And although animals are smarter
than we often credit them, dogs, horses, and rats don't get placebo
effects. When I give Buddha a pill surrounded by raw ground beef,
he's just happy to eat some meat. He has no clue that I'm secretly
giving him a glucosamine tablet, and even if he saw the tablet,
he wouldn't be affected by a "placebo" effect. For a placebo effect
to occur, the patient must be aware of treatment. Dogs don't really
get the idea of treatment or medicine. They might enjoy and benefit
from your hand rubbing their necks while they take a pill or get
treated by the vet, but it's not the same thing.
about humans, though. The main study cited in meta-analyses that
conclude neither glucosamine nor chondroitin sulfate do anything
for human osteoarthritis is the GAIT trial, a multicenter, placebo-controlled,
double-blind study. Overall, the GAIT
trial found that neither supplement, whether alone or in concert,
performed better than placebo. However, in the "moderate-to-severe
pain subgroup" of patients, a combination of glucosamine and chondroitin
sulfate was far more effective than placebo at reducing osteoarthritis-related
pain. But because the subgroup was relatively small, its
results weren't enough to affect the overall conclusion.
works, how does it work? The popular conception is that it, being
a raw building block of bone, gets directly incorporated into damaged
connective tissue. You eat the stuff and it somehow magically makes
it to the afflicted areas. That's how detractors eager to combat
a strawman put it, but the funny thing is that the "strawman" might
actually have some merit. A study
found that 1500 mg of glucosamine sulfate crystalline powder taken
orally appeared in the synovial fluid (a fluid found in joints that
has a yolk-like consistency; scrambled synovia, anyone?) of osteoarthritic
patients. Since synovial fluid provides lubrication and nutrients
to and removes waste from articular cartilage, having higher levels
of glucosamine (a precursor for the glycosaminoglycans which make
up cartilage) could prove useful and even increase glycosaminoglycan
production. Another interesting piece is that a later
study found that glucosamine sulfate was more effective than
glucosamine hydrochloride at showing up in synovial fluid after
oral dosing. Perhaps if the GAIT trial had used glucosamine
sulfate instead of glucosamine hydrochloride, the effects would
been more pronounced.
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March 1, 2012
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