Landmark in Osteoarthritis Research Validates Glucosamine Sulfate 

If there’s a way to do it better . . . find it!

- Thomas Edison

o one in history found more ways to "do it better" than Edison - with the possible exception of Leonardo da Vinci. Both men combined soaring inventive genius with a capacity for hard work that would put a bulldozer to shame. Their example inspires us mere mortals to try a little harder, and to never give up.

At Life Enhancement magazine, we are engaged in a never-ending search for ways to "do it better" based on the research of medical scientists. We live by Edison's dictum. Therefore, effective immediately, we are recommending glucosamine sulfate instead of acetylglucosamine - not because the latter isn't good, but because the former appears to be even better, in terms of the weight of hard scientific evidence supporting it. We reached this conclusion based on a new study describing some of the most solid, convincing research we have ever seen on a nutritional supplement.

The study was published in January in the revered British medical journal The Lancet.1 In a separate commentary entitled “Glucosamine for osteoarthritis: dawn of a new era?” in the same issue, Dr. Tim McAlindon of the Arthritis Center at Boston University Medical Center says,2

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the commonest symptomatic treatment for OA [osteoarthritis] but have major adverse effects and might even worsen the osteoarthritic process. Although inestimable resources have been poured into the development of a panoply of NSAIDs, scarce currency has been given to the notion that progression of OA could be retarded pharmacologically, let alone by a nutritional product. The report of the clinical trial in today's Lancet may radically change this situation. . . . The study is a landmark in OA research. . . .

The three-year study was conducted at the Bone and Cartilage Metabolism Research Unit of the University of Liège, Belgium, in collaboration with research laboratories in the United States, the United Kingdom, and Italy. The objective was to evaluate the long-term effects of glucosamine sulfate on the progression of joint-structure changes and joint symptoms in osteoarthritis. This approach is notable for the fact that it focuses on the possibility of long-term structural modification and support of the joint, rather than the more usual short-term symptom control with painkillers or with NSAIDs, such as aspirin and ibuprofen.

In the field of OA drugs, there are two distinct classes: (1) symptom-modifying drugs, such as those just mentioned, and (2) structure-modifying drugs, which alter the joint structure favorably and thus interfere with the progress of the disease. The symptom modifiers are obviously necessary and desirable, but the structure modifiers are even better - or would be, if any existed. At present, there are none, despite unending searches by drug companies for a synthetic compound that will fill the bill.


But wait! Who needs drugs? What about the nutritional supplement glucosamine sulfate? Doesn't it act as a structure modifier, helping to maintain the integrity of our joints and retard their further deterioration? Indeed it does, as many have known from personal experience with glucosamine sulfate - just as they have with its cousin acetylglucosamine - for many years. Now this protective action has finally been proved beyond doubt by the Belgian researchers and their international colleagues - for glucosamine sulfate (they did not test any other compound).

Glucosamine sulfate, a derivative of the natural glucosamine found in the human body, is obtained by synthesis from chitin, the tough, protective substance that is the principal component of the outer shell of arthropods, such as crabs and shellfish. It is believed that glucosamine and various of its derivatives can help repair cartilage, to which they are chemically related, but just how they do this is still unknown.

The Belgian study, conducted on 212 adults over 50 years of age with osteoarthritis of the knee, was a model of scientific excellence. A randomized, double-blind, placebo-controlled clinical trial, it was designed and executed with extraordinary attention to every conceivable detail that could affect the outcome. To evaluate the patients, the researchers used two techniques: one to assess the symptoms of OA objectively and the other to measure joint structure in the knee so as to ascertain the degree of deterioration that occurred during the three-year period.

Symptom assessments were accomplished by means of the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, a validated, disease-specific questionnaire that is accepted by the medical community as the standard in this field. It asks 24 questions pertaining to pain, stiffness, and limitations of physical function.

Structure measurements were made by radiographic (x-ray) examination, under highly reproducible conditions, of the medial compartment of the tibiofemoral joint. In plain English, that's a spot on the inner side of the joint between the shinbone (tibia) and the thighbone (femur). It is subject to the greatest pressure in the knee joint, and thus to the greatest potential loss of cartilage due to OA. In the normal joint, there is a healthy cushion of cartilage, along with a lubricant called synovial fluid, that acts as a shock absorber and insulator, keeping the ends of the bones at a safe distance from each other. In OA, however, the cartilage deteriorates and becomes thinner, eventually allowing the bones to rub against each other, with dire results. By measuring the width of the selected joint space precisely on the x-ray images, the researchers were able to track the progress of the disease throughout the study.

The patients in this study (355 at the outset) were screened to exclude anyone with some other condition that might interfere with the results, such as obesity or any other rheumatic disease; 212 made the cut, and 139 actually completed the trial. The randomly divided patients received either 1500 mg/day of glucosamine sulfate (the standard dose in many European and other countries, where it has long been a prescription medication) or placebo.

No other intervention for the patients' OA was allowed except for pain pills as needed, which turned out to be about once every six days, on average - with no significant differences between the test and control groups in this regard. The researchers took pains, so to speak, to prevent these medications from interfering with their symptom assessments of the patients.


The patients' OA status was evaluated at regular intervals for three years, using the techniques described above. The final results were clear and definitive:

Symptom assessment: The glucosamine sulfate group had WOMAC scores that were 24.3% better than the baseline scores, whereas the control group's scores were 9.8% worse - a very significant difference.

Structure measurement: The glucosamine sulfate group had no significant loss of joint space compared to baseline, whereas the control group suffered a significant loss: 0.31 mm, on average. This rate of loss (about 0.1 mm/year) is typical of those measured in long-term studies of OA patients.

Safety: Almost all the patients in the study reported at least one adverse event, mostly having to do with the gastrointestinal tract, but most were transient and of mild to moderate severity. Significantly, there were no substantial differences between the test group and the control group in the frequency or pattern of events, i.e., glucosamine sulfate was no more likely to trigger an event than placebo. Also, routine laboratory tests did not show any great abnormalities in the organs or metabolic functions of either group of patients during the study.

Understanding The Placebo Effect 
A placebo typically alleviates symptoms (to some degree) and makes people feel better simply because they believe in the curative power of pills. Just thinking that they are taking a biologically active substance that will make them feel better can make them feel better and can affect the actual course of their disease or disorder. It's the classic example of the power of mind over matter - a very real, not imaginary, phenomenon.

That is why it is vitally important to control for the placebo effect in clinical trials of almost every kind. Without such controls, it would be impossible to know how much of the observed effect was caused by the experimental agent and how much was caused by the patient's mindset.

But if the placebo effect tends to alleviate symptoms and make people feel better, then why did the control group in the Belgian osteoarthritis study feel worse, not better? Probably because the progression of their disease was stronger than the power of the placebo effect to resist it. What this means is that without the placebo, their symptom assessments would probably have been even worse than they actually were. 


The authors concluded from these results that ". . . long-term administration of glucosamine sulfate over 3 years can prevent joint structure changes in patients with osteoarthritis of the knee with a significant improvement in symptoms." (We know of no reason why these benefits would not also apply to any other joints affected by OA.)

This is great news for victims of OA, of whom there are at least 20 million in the United States. It convincingly validates the use of glucosamine sulfate as a powerful aid for maintaining good joint structure and function. The pharmaceutical industry must be shocked to see this conspicuous hole in their arsenal now filled by (gasp) a nutritional supplement! Something that they can't monopolize and the FDA can't regulate! What is the world coming to?

A better place, that's what. And it will be better still if the medical establishment heeds the words of Dr. McAlindon:2

Although health-care professionals generally expect to be involved in medical decisions of public-health importance, the reality is that they are not regarded as a repository of objective advice about nutritional products and are generally kept out of the loop. This situation must change. It is time for the profession to accommodate the possibility that many nutritional products may have valuable therapeutic effects and to regain the credibility of the public at large.


If our goal is to achieve and maintain health in the long run, we want the best nutritional supplements possible. The research on glucosamine sulfate makes it certifiably among the best-proven nutritional supplements for its intended purpose available anywhere.

If your joints have been giving you trouble, glucosamine sulfate may be just what you need to make you feel better. And tell your doctor about this!


  1. Reginster JY, Deroisy R, Rovati LC, Lee RL, Lejeune E, Bruyere O,Giacovelli G, Henrotin Y, Dacre JE, Gossett C. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001 Jan 27;357:251-­6. 
  2. McAlindon T. Glucosamine for osteoarthritis: dawn of a new era? Lancet 2001 Jan 27;357:247-­8. 

Featured Product

  • Learn more about Glucosamine benefits and implementation strategies.

FREE Subscription

  • You're just getting started! We have published thousands of scientific health articles. Stay updated and maintain your health.

    It's free to your e-mail inbox and you can unsubscribe at any time.
    Loading Indicator