Glucosamine / chondroitin

Re: Glucosamine / chondroitin

Michael Woodhouse — Mon, 20 Sep 2010 17:34:59 GMT

[quote user="Martin Jones"]which incidentally has a lovely chapter on disposing of unwanted homoeopaths and other assorted quacks[/quote]

Wouldn't it be ironic it it involved shaking them in water........

Re: Glucosamine / chondroitin

Martin Jones — Mon, 20 Sep 2010 07:37:05 GMT

[quote user="Niall Taylor"]

"Allopathy" has no meaning or relevance in real medicine despite what definitions might be found in (non-medical) dictionaries.

[/quote]

Gah. Taken in again by disreputable sources of information. Why must I persist in my unfounded beliefs? I actually got it out of my Big Bumper Book of Vetting for Boys, which incidentally has a lovely chapter on disposing of unwanted homoeopaths and other assorted quacks.

Re: Glucosamine / chondroitin

Maya J — Sun, 19 Sep 2010 20:05:44 GMT

We tend to recommend Green Lipped Mussel extract. Also recommend chondroitin and glucosamine but not overly convinced of benefits.

We tend to just ask clients to get some from holland and barrett or boots. The green lipped mussel extract at the adult dosage ( about 500mg bd) for a 30kg dog seems to do the trick. Green lipped mussel have glycosaminoglycans that help with tissue repair and studies have also found that Perna canaliculus (green lipped mussel) inhibits the 5-lipoxygenase pathway, which leads to the formation of leukotrienes. Many of the products of these pathways have inflammation-supporting properties.

We have seen good responses in dogs already suffering with arthritis that appear to gain some pain relief and mobility from the stuff.

I am no expert but can only share our experience and recommendations! i think that the royal canin mobility support tabs and mobility diets contain some GLM.

Re: Glucosamine / chondroitin

bob lehner — Sat, 18 Sep 2010 11:06:18 GMT

[quote user="Julian Earl"]Why do owners have such difficulty understanding that arthritis can be extremely painful? Perhaps they need a case in themselves[/quote]

Too true - I can certainly vouch for that.

[quote user="Julian Earl"]A rheumatologist that I know (medic, not vet) told me that there is some evidence that they are beneficial to people with knee or hip arthritis, but not for affected hands or arms.[/quote]

It doesn't help my knackered wrists...!

Re: Glucosamine / chondroitin

Sian33 — Sat, 18 Sep 2010 09:39:56 GMT

A lot of my elderly clients are already on glucosamine/chondroitin and are very happy to find they can share them with the dog, I don't find they skimp on NSAIDs as a result. However I only really ever mention them in passing, never try to "sell" them (sorry boss)

Re: Glucosamine / chondroitin

Niall Taylor — Sat, 18 Sep 2010 08:36:32 GMT

[quote user="Martin Jones"]Allopathy: orthodox medical practice.... as distinguished from homoeopathy. Curse these pointless dictionaries with their made-up definitions.[/quote]

"Allopathy" is a word entirely made up by homeopaths as a strawman against which to pit themselves by suggesting that modern medicine has not progressed from the age of "Heroic Medicine" 200 years ago. In the looking glass world of the homeopath it means either treating a disease with the "opposite" (eg bleeding patients if they appear red and flushed) or simply anything that isn't homeopathy and doesn't comply with its laws of infinitessimals and similars. By that definition chondroitin/glucosamine is certainly "allopathic".

The other homeopaths' definition of "allopathic" is "stuff they don't approve of" in which case chondroitin/glucosamine is obviously not allopathic.

"Allopathy" has no meaning or relevance in real medicine despite what definitions might be found in (non-medical) dictionaries.

Niall

Re: Glucosamine / chondroitin

Niall Taylor — Sat, 18 Sep 2010 08:24:07 GMT

[quote user="Julian Earl"]Strangely enough, it seems to depend upon which company's rep is visiting![/quote]

Now there's a surprise!

[quote user="Julian Earl"]Actually, we do sell the stuff if owners really want it, but point out that there is no real evidence that they help, and I would far, far rather owners spent their hard-earned money on NSAIDs in order to give the pet immediate relief rather than an expensive nutraceutical that may help several weeks later.[/quote]

Yeah, me too. Not a very convincing stance, considering I would rather chew my own arm off than sell homeopathy, but we've had chondroitin/glucosamine products on the shelves for years from back when it looked like there might be some evidence in favour of their use and clients and vets have got used to having the products around. I usually settle for the 'well, you can give it a go but the evidence isn't good' line myself. Does make me smirk though when people say they prefer a certain brand over another!

Niall

Re: Glucosamine / chondroitin

Julian Earl — Fri, 17 Sep 2010 21:22:05 GMT

[quote user="Martin Atkinson"]

[quote user="Martin Jones"]

[/quote]

I thought it was hydochloride that was supposedly more efficacious than sulphate. If its vice versa then I've been mislead by VetPlus and fouled up as I've replaced all my supplies of glucosamine sulphate with hydrochloride!!

[/quote]

Strangely enough, it seems to depend upon which company's rep is visiting! They - Vetplus, Boehringer, Schering-Plough - all seem to have the most evidence for efficacy of their own products, dismissing the evidence of the rival companies. Amazing - they're all the best!

A rheumatologist that I know (medic, not vet) told me that there is some evidence that they are beneficial to people with knee or hip arthritis, but not for affected hands or arms. So there we have it. Conclusive non-peer-reviewed opinion from someone who ought to know - otherwise known as proof - that there may or may not be some benefit for a particular mammalian species in some limbs, and that we actually have no idea whether there is any benefit in different limbs of several other mammals for which the research might not have been done yet.

Actually, we do sell the stuff if owners really want it, but point out that there is no real evidence that they help, and I would far, far rather owners spent their hard-earned money on NSAIDs in order to give the pet immediate relief rather than an expensive nutraceutical that may help several weeks later.

Why do owners have such difficulty understanding that arthritis can be extremely painful? Perhaps they need a case in themselves. There was pain symposium at Harrogate a few years ago where it was commented that the commonest drug-induced cause of death in the elderly is, or was, due to NSAIDs. The immediate suggestion is that this shows how dangerous NSAIDs are but this suggestion misses the point. The reason for these deaths is that the patients are in such unrelenting pain that they continue to give themselves more and more analgesics above and beyond the recommended maximum dose, until they kill themselves with ulcers and kidney failure. The problem is less the drug, more the failure to appreciate how painful arthritis can be. Consequently, surely glucosamine should be reserved for those patients that are already on NSAIDs but the owners can then afford to try other medications as well?

Re: Glucosamine / chondroitin

Martin Atkinson — Fri, 17 Sep 2010 19:04:18 GMT

[quote user="Martin Jones"]

[/quote]

I do recommend these products for my patients but I'm far from convinced that they work, its all so confusing that I would almost be glad to find they were snake oil then I could tell the 101 reps who turn up peddling their version where to get off. That said I do take it myself along with Omega 6 supplements and I am fairly convinced it helps reduce the pain in my knees which has arisen from years of sporting abuse and injuries. But even if it doesn't help to treat OA I cling to the notion that it may prevent or delay the onset so I can keep on bashing out the miles on the lonely road and the snowy pistes.

Re: Glucosamine / chondroitin

Rob Reid — Fri, 17 Sep 2010 18:25:34 GMT

[quote user="alex gough"]On another list I am on, one poster has a bugbear about glucosamine/chondroitin and regularly posts papers showing a lack of efficacy in humans. [/quote]

One of the reasons I put up this post! (BTW it isn't me who posts those papers on another list.) Do you have any links to these papers Alex? I would be interested to read them.

I have used glucosamine/chondroitin supplements fairly regularly for a few years now and although I do get some clients coming in who report that it helps, I have never been completely convinced that it has been down to the supplement - there have generally been other factors involved as well(NSAID usage, weight loss regime, exercise management.)

I think in light of the evidence (and asccoiated press coverage with it) I now have a hard job convincing people (and myself) to use glucosamine/chondroitin.

Re: Glucosamine / chondroitin

Martin Jones — Fri, 17 Sep 2010 17:55:13 GMT

[quote user="alex gough"]

Allopathic? Are you using homeopathic doses of glucosamine/chondroitin then Martin ;)?

[/quote]

Allopathy: orthodox medical practice.... as distinguished from homoeopathy. Curse these pointless dictionaries with their made-up definitions.

Re: Glucosamine / chondroitin

Alex Gough — Fri, 17 Sep 2010 13:50:19 GMT

[quote user="Martin Jones"] than allopathic, licensed drugs[/quote]

Allopathic? Are you using homeopathic doses of glucosamine/chondroitin then Martin ;)?

There are a lot of treatments that empower owners, but do nothing for the animals.

On another list I am on, one poster has a bugbear about glucosamine/chondroitin and regularly posts papers showing a lack of efficacy in humans.

Alex

Re: Glucosamine / chondroitin

Ruta — Fri, 17 Sep 2010 13:09:21 GMT

Hi, Rob,

Not long time ago I had read from T.W.Fossum "Small animal surgery" that glucosamine/chondrotin does not makes a lot good for small animals with OA. But there is nice effect after omega-3 supplement: it is reduce inflamation, pain and requirement of NVNU.

Regards,

Ruta

Re: Glucosamine / chondroitin

Bob Russell — Fri, 17 Sep 2010 11:44:37 GMT

A US study showed some benefit for patients with severe OA (leading up to hip replacement) but little benefit for mild to moderate OA. A Dutch study showed no significant difference between the placebo and medicated groups.

There seem to be so many variables - which glucosamine? Chondroitin as well.

Not convinced that most of the products have genuine benefits compared with placebo in daily practice. I would like to be convinced but so far one up from homeopathy IMHO.

Re: Glucosamine / chondroitin

Martin Jones — Fri, 17 Sep 2010 09:33:30 GMT

Hmm. Not quite as exhaustive a study as they like to make out - only a sixth of the patients received a combination of glucosamine AND chondroitin and NONE of them received glucosamine sulphate, which we'd probably consider to be more efficacious than hydrochloride (or would we - is it just me?). They also admit that the heterogeneity of patient severity led to problems with, at one end, detecting reductions in pain sensation against a mild underlying level of pain, and at the other, ineffectiveness in the face of pretty horrible pain.

I believe that:

- the combo is useful for all stages of arthritis, but probably most for early onset where owners are starting to see stiffness in the mornings and a bit of exercise intolerance, and we're starting to think about analgesia as part of control

- the combo is good for DELAYING (rather than preventing) progression of OA

- that it's a treatment modaility which empowers owners, gives them some autonomy and responsibility in the treatment process and also has the benefit of being sold by people other than vets - so it can be cheap, and we can recommend it without financial agenda. Owners do like this clear demonstration that we're on the patient's side, not (just) the bank managers, and that's an important builder of trust. I've always found that owner compliance with the drugs that we're probably going to end up on is improved as a result.

- at the worst, and as the study said, these substances are not harmful and are less likely to cause serious adverse side effects than allopathic, licensed drugs.

But I have a small brain.