Glucosamine and Chondroitin Can Help Build Cartilage and Fight Osteoarthritis
Return to Youthful Joint Functioning

he cartilage at the ends of your bones is the primary biomaterial that cushions your joints and, along with synovial fluid, minimizes the friction caused by the rubbing together of your bones where they meet. The protective action of your cartilage shock absorbers, however, diminishes with wear, tear, and age. Cartilage degradation may result in stiffness, pain, and many other problems that limit mobility. This may occur in the joints of the hands, neck, feet, knees, elbows, hips, and even the spine. It may occur anywhere in the body where bones rub together, meaning any joint.

Healthy cartilage enables your joints to work properly. As the most common form of arthritis, osteoarthritis causes degradation of cartilage, the result of which is inflammation, pain, loss of movement, and loss of a key element of youthfulness. If not addressed, osteoarthritis can eventually lead to joint deformities and severe loss of mobility. Normally, this condition is age-related and doesn't start until the 40s, but undue stress or injury or a number of other conditions can bring it on earlier.

Unfortunately, new nonsteroidal anti-inflammatory drugs (NSAIDs) such as Celebrex®, or older ones such as aspirin and ibuprofen, do not deal with the causes of arthritis. Instead, these drugs reduce inflammation and pain, which by itself is good, but not without inflicting a variety of side effects, such as stomach pain, ulcers, nausea, cramps, diarrhea, kidney damage, and possibly high blood pressure. These side effects would be less onerous if NSAIDs could stop or repair the damage caused by arthritis. But they don't. In fact, there is some evidence that NSAIDs may make matters worse, i.e., some of these drugs may even exacerbate osteoarthritis.1

Nevertheless, many people have still not heard of the benefits of the natural alternatives to drugs, especially prescription drugs. They have not heard about glucosamine and chondroitin because treating arthritis is a big business, and the cash-register-driven roar of prescription drugs has muffled the squeaks (relatively speaking) of the alternatives. Glucosamine and chondroitin sulfate (usually called chondroitin for short) are nutrients that are not only known and natural to the body, since they are biomolecules that contribute to the making of cartilage, but, unlike many drugs, they are safe, with few to no side effects.

The nutrients glucosamine and chondroitin are required as biomaterials for building and protecting cartilage. The real news is that recent studies have found both of these compounds to be even better than expected, pioneering a whole new domain beyond pain relief, known as chondroprotection (chondro means cartilage-related). It is likely that chondroprotection addresses the core problem of osteoarthritis, which is cartilage degradation. Glucosamine and chondroitin go beyond preserving joint health and maintaining function. More than just being cartilage protectors, they can even restore proper joint function. They are indeed "chondrorestoratives."

An ideal chondroprotective/chondrorestorative would need to accomplish the following goals:2

  1. Enhance the synthesis of chondrocytes (cartilage cells)
  2. Enhance the synthesis of hyaluronic acid (a prime component of synovial fluid, the lubricant of the joint)
  3. Inhibit enzymes that degrade cartilage
  4. Strengthen and enhance vessels that supply the joints with nutrients
  5. Reduce joint pain
  6. Reduce synovitis (inflammation of the synovial membrane, which lines the joint)

Currently there is no one agent that can achieve all of these goals. However, glucosamine and chondroitin together appear to do it all, making them an ideal chondroprotective/chondrorestorative when used in combination.

Glucosamine and its derivatives, such as glucosamine sulfate and acetylglucosamine, have been shown to be effective in restoring proper joint function.3 Yet it is unfortunate that both of the most widely used derivatives of glucosamine, the sulfate form and the hydrochloride form, have relatively short half-lives in the bloodstream, meaning they don't stay there very long. Acetylglucosamine, however, has a longer half-life, ensuring more continuous utilization and  better joint protection. Unlike other derivatives of glucosamine, acetylglucosamine is converted to glucosamine in the body on an as-needed basis, and the levels can more easily be increased and maintained by supplementation.

Acetylglucosamine has other unique benefits and, like chondroitin, it can inhibit the release of the cartilage-degrading enzymes.4 Hyaluronic acid, an all-important component of synovial fluid found in the joint spaces, is readily formed from acetylglucosamine.5 All in all, acetylglucosamine is the best choice as a source of glucosamine.

All the different varieties of glucosamine and chondroitin may leave people confused about what is best. One thing seems quite clear: there are different and complementary roles for the two forms of chondroitin sulfate, called the 4-sulfate and the 6-sulfate.6 Studies have shown that the biological activity of chondroitin sulfate depends on its structure. For example, chondroitin 6-sulfate has been found to be more effective than chondroitin 4-sulfate for inhibiting certain enzymatic degradations of cartilage. By contrast, chondroitin 4-sulfate is more effective for the synthesis of cartilage.

Studies strongly suggest that the ratio of the two forms of chondroitin sulfate in synovial fluid reflects the degree of joint health. When the 6-sulfate is too prevalent, it can interfere with the metabolism of joint tissue. As humans age, the ratio between the two forms of chondroitin eventually shifts almost entirely toward the 6-sulfate.7 As with DHEA and other hormones or nutrients, the goal with chondroitin is to maintain youthful levels (and ratios) through supplementation.

Recent studies have shown that a 60%-40% blend of the 4-sulfate and the 6-sulfate - the same ratio that prevailed in our youth - is superior in providing long-range joint benefits when compared to other chondroitin formulations (see Chondroitin & Glucosamine: New Forms Stand Up to Arthritis - May 99).

Until now, commercially available products containing chondroitin have consisted largely of either chondroitin 4-sulfate or chondroitin 6-sulfate, or of various mixtures of chondroitin, determined not by human physiology, but by price. The good news is that now ratios drawn from the recent literature are available.

When you consider the importance of your joints, a formulation combining acetylglucosamine and appropriately balanced chondroitin 4-sulfate and 6-sulfate is worthy of your attention and an ongoing effort to read and examine the evidence. Detailed information and references can be found in Chondroitin & Glucosamine: New Forms Stand Up to Arthritis - May 99. When you try a nutritional supplement based on the latest discoveries, you will notice that it optimizes both short- and long-term results. You get the more immediate impact of the glucosamine as well as the building benefits of the chondroitins, as the two improve upon your age-bestowed dysfunctions and offer what you have been yearning for - more youthful joint functioning.

In addition, calcium and vitamin D are recommended to help protect bone structure and function. Other nutrients are also known to help with calcium uptake: vitamin A (as the conversion-controlled beta-carotene), vitamin C, and the mineral boron. Because calcium and vitamin D deficiencies are facts of life, taking 1000 mg/day, every day, is a great insurance policy.


  1. Rashad S, Revell P, Hemingway A, Low F, Rainsford K, Walker F. Effect of non-steroidal anti-inflammatory drugs on the course of osteoarthritis. Lancet 1989 Sep 2;2(8662):519-22.
  2. Ghosh P, Smith M, Wells C. Second-line agents in osteoarthritis, Chapter 15 in Second-Line Agents in the Treatment of Rheumatic Diseases, JS Dixon, DE Furst, eds., Marcel Dekker, New York, 1992, pp. 363-427.
  3. Talent JM, Gracy RW. Pilot study of oral polymeric N-acetyl-D-glucosamine as a potential treatment for patients with osteoarthritis. Clin Ther 1996;18/6:1184-90.
  4. Kamel M, Hanafi M, Bassiouni M. Inhibition of elastase enzyme release from human polymorphonuclear leukocytes by N-acetyl-galactosamine and N-acetyl-glucosamine. Clin Exp Rheumatol 1991 Jan-Feb;9(1):17-21.
  5. Laurent TC. Biochemistry of hyaluronan. Acta Oto-Laryngol 1987;104(SUPPL. 442):7-24.
  6. Kostoulas G, Horler D, Naggi A, Casu B, Baici A. Electrostatic interactions between human leukocyte elastase and sulfated glycosaminoglycans: physiological implications. Biol Chem 1997; 378(12):1481-9.
  7. Mourao PA, Michelacci YM, Toledo OM. Glycosaminoglycans and proteoglycans of normal and tumoral cartilages of humans and rats. Cancer Res 1979 Jul;39(7 Pt 1):2802-6.

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