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Glucosamine is important for maintaining elasticity, strength, and durability of the cartilage in movable joints.  Glucosamine also appears to have anti-inflammatory properties and could be used to promote the maintenance of joint function and to decrease pain in individuals suffering from osteoarthritis (OA). Glucosamine may act synergistically with chondroitin sulfate. Chondroitin sulfate is a critical compound in connective tissue and joint cartilage.   Supplementation with chondroitin sulfate is claimed to support the maintenance of strong, healthy cartilage and joint function.

The use of glucosamine based products for osteoarthritis and other issues related to joint pain began decades ago and has become a mainstay in many medicine cabinets across the country.  The purported benefits are improvement in joint pain and protection of the joints.  There are dozens and dozens of studies that show a benefit from using glucosamine supplementation and nearly as many demonstrating that it has no more efficacy than a placebo.

As practitioners of Brazilian Jiu-Jitsu we put our joints under strain on a regular basis.  Aches and pains have become an accepted price that we pay for training but there may options available to you that can lessen or eliminate the pain.

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• Do not use these products if you are allergic to shellfish
• Use with caution in diabetics because glucose regulation/insulin sensitivity may be affected. 
• Do not use in patients with active bleeding conditions, history of bleeding, blood disorders or in patients on blood thinners.
• Please consult your physician or healthcare professional prior to beginning any new supplementation.
• Inconsistencies have been found in the amount of active ingredient in commercially available products.
• Do not take these supplements with certain antibiotics as the absorption of the antibiotic may be affected.

Studies & Recommendations:
The American Associate of clinical endocrinologists (AACE) medical guidelines for the clinical use of dietary supplements and nutraceuticals was published most recently in 2003 and gives their opinion on the role of glucosamine and chondroitin in patients.  In there estimation glucosamine may be effective in treating OA and could be recommended to patients that are seeking alternative treatments and/or haven’t responded to traditional therapy.  Their stance on chondroitin is very similar and state that it may help to restore damaged cartilage.

The Osteoarthritis Research Society International (OARSI) published their recommendations and review of the use of glucosamine products in the treatment of patients with OA of the knees and hips in 2006.  What’s interesting about this article is that they went into exhaustive detail and provided strength of results (SOR) for the data, level of evidence (LoE), frequency the subject was recommended in other guidelines and level of consensus amongst the reviewers.  For the products we’re looking this is how it all broke down:

• May provide symptomatic improvement of symptoms in patients with OA of the knee

1. 1. LoE – 1a for both products
   2. 6 of 10 guidelines include the use of glucosamine vs 2 of 7 for chondroitin
   3. There was a 92% consensus with the above statement from the review panel
   4. SOR = 63

• May have structure modifying effects in patients with OA of the hips

1. 1. LoE – 1b for both products
   2. There was a 69% consensus with the above statement from the review panel
   3. SOR = 41

The last major study that we’ll look at is the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT).  The full trial can be downloaded here and a nice synopsis is here.   GAIT is the first large-scale, multicenter trial in the US to test the use of glucosamine/chondroitin for the treatment of OA of the knee.  This is the type of trial that would typically be submitted to the FDA by a drug manufacturer to get approval for a new product.  The trial compared placebo, celecoxib (prescription anti-inflammatory also known as Celebrex) and a combination of glucosamine and chondroitin.  The results showed that for patients with mild pain glucosamine and chondroitin was not statistically superior to placebo in relieving pain.  However, in the sub-set group that reported moderate to severe pain glucosamine and chondroitin supplementation resulted in >20% reduction in pain compared to placebo alone.  This finding was corroborated in the New England Journal of Medicine as well (1).

Trial Run:
A few months ago Q5 supplements, which is owned and operated by Bill Thomas, sent me a bottle of Joint Fuel.  You may be familiar with Bill as one of the original owners of BJJ Weekly.  He’s recently moved into the supplementation business and has a line of products geared specifically to BJJ athletes.  I discovered Q5 after Comprido tweeted to them after competing in Chicago.  Over the next 45 days I took 2 tablets of Joint Fuel every night before I went to bed, I didn’t load the product as suggested.  The pills are a little larger than most multivitamins and there is a definite fishy smell to them.  The smell didn’t bother me but I’m sure there are others that it would.

Within a month or so of started BJJ my fingers began hurting to the point where I was taping several fingers before every gi class.  While taking Joint Fuel the pain gradually began to disappear and I stopped taping my fingers all together.  It wasn’t a sudden change but one day I realized that I hadn’t taped my fingers in a while and they weren’t hurting any more.  I’ve also begun to use my grips much more aggressively with open guard and what would have normally hurt my fingers no longer does.

Joint Fuel has a few additional ingredients: manganese, MSM, DMG and Perna Canalculus.  Manganese is a mineral cofactor that may be of benefit to patients with OA (4).  It is used in the formation of collagen and other components of articular cartilage.  MSM is used as a source of sulfur which is an essential mineral in collagen.  Sulfur concentration is reduced through aging and stress.  DMG is a derivative of glycine and it thought to reduce lactic acid buid-up during stress and also to enhance oxygen use.  DMG was considered novel enough to be used in two trials for children with autism (5,6) in both cases it was not found to be effective.  In this setting DMG is intended to reduce lactic-acid build-up, increase oxygen utilization in tissues and act as an anti-oxidant.  The final ingredient Perna Canaliculus is a little more interesting.  It supplies chondroitin and several other ingredients that are thought to be affective in helping with joint pain.  It was also the subject of this article. 

Summary
There is a lot of data out there that both supports these products and also data that suggests that they’re little more than placebos.  A contributory factor to this is the relatively low quality of data in most of the older studies and also inconsistencies in the ingredients that were purported to be glucosamine and chondroitin supplement.  As many of you know the FDA does not regulate the supplement industry in any significant way and that it is possible for there to be just about anything in those bottles.  To safeguard yourself I’d highly recommend only buying from sources that you trust.  That doesn’t necessarily mean going to a supplement store where you trust the workers but being aware of who is actually creating the product that you’re ingesting.

Joint Fuel is available for $34.00 (shipping included) for a bottle of 90 tabs which lasted me 45 days.  I couldn’t find a single source product that had all of the same ingredients in it.  Bottles of glucosamine/chondroitin can be found inexpensively from your neighborhood mega-store and there are a handful of Perna products out there as well from supplements companies.  The Perna products range in price from ~$25-$99 for a 30 days supply and generally does not include shipping.

If you’re experiencing joint pain from training I’d recommend looking into products such as those mentioned above.  Joint Fuel represents a well-priced Perna product that has a full complement of ingredients that are all intended to ease your joints and allow you to train pain free.  Q5 is also active in our community sponsoring athletes, blogs, tournaments, etc…  If you can afford $34.00 every 45 days I’d definitely recommend giving this supplement a try.  If that’s out of price range take a trip to Walgreens, Target or Wal-Mart and get a bottle of their store brand glucosamine/chondroitin for a test run.  For information on Q5 can be found at their website, Facebook and Twitter.

Disclaimer:
The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan.

1. Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med 2006;354:795-808.
2. Ruane R, Griffiths P.  Glucosamine therapy compared to ibuprofen for joint pain.  BR J Community Nurs.  2002 Mar;7(3):148-52
3. Sawitzke AD, Shi H, Finco MF, et al, “Clinical Efficacy and Safety of Glucosamine, Chondroitin Sulphate, Their Combination, Celecoxib or Placebo Taken to Treat Osteoarthritis of the Knee: 2-Year Results From GAIT,” Ann Rheum Dis, 2010, 69(8):1459-64. [PubMed 20525840]
4. Saltman PD and Strause LG, “The Role of Trace Minerals in Osteoporosis,” J Am Coll Nutr, 1993, 12(4):384-9. [PubMed 8409100]
5. Kern JK, Miller VS, Cauller PL, et al.  Effectiveness of N,N-dimethylglycine in autism and pervasive development disorder.  J Child Neurol. 2001; 16(3):169
6. Bolman WM, Richmond JA.  A double-blind, placebo-controlled, crossover pilot trial of low dose Dimethylglycine in patients with autistic disorder.  J Authism Dev Disord.  1999;29(3):191