Glucosamine etc

Re: Glucosamine etc

Christopher Saul — Mon, 01 Nov 2010 19:12:01 GMT

I generally have more faith in w3 PUFAs than I do in other neutracuticals, mainly because there is sound scientific logic behind their use.

The logic is that the inflammatory mediators derrived from Eicosapentanoic Acid (EPA - an w3 acid) - namely the 3- and 5- eicosanoids - are less inflammatory than those derrived from arachadonic acid (w6); namely 2- and 4- eicosanoids.

There is a medium scale (200 odd) study in the current JVIM which seems to suggest that addition of increasing doses of w3 result in improved clinical signs of arthritis over a 3 month period (Dose-titration efects of fish oil in osteoarthritic dogs, Fritsch et al, JVIM 24:1020-1026

There is another study of arthritic cats in the May/June 2010 JVIM issue (though I confess I have not read this article beyond the abstract), although in this study they tested a control diet vs a test diet rich in w3 AND chondroitin/glucosamine.

With regards to cardiac disease, there is a good summary article in the september 2010 JSAP, and another more general article about food supplements in the June 2008 JSAP.

Anyway, I although the studies are small, I think we have reason to recommend w3 fatty acids.. at least there is logic behind their use!

Chris

Re: Glucosamine etc

Martin Atkinson — Mon, 01 Nov 2010 17:26:55 GMT

[quote user="Bob Russell"]

Any other nutraceuticals of any real benefit? Except to the manufacturer and retailer of course!!

[/quote]

How about the one that PUFAs particularly Omega 3s are beneficial in patients with cardiac disease?

Re: Glucosamine etc

Malcolm Ness — Mon, 01 Nov 2010 17:00:36 GMT

[quote user="Martin Atkinson"]Whats your personal opinion Malcolm?[/quote]

My position has been consistent since these nutraceuticals were "invented":

First, the theoretical justification, I never found convincing. There was never anything to suggest that these chemicals are in short supply and subsequently there has been serious doubt cast on whether the chemicals even reach the joints.

My position as a clinician has always been that I want to see evidence of a benefit to my patients. There have now been many hundreds of trials and yet no decent evidence to show benefit. The recent Swiss paper was a meta analysis and the previous comments about low numbers etc are just not true - read the paper. I have never advised the use of these chemicals though equally, I have never suggested stopping them. First, that is not my place to do so and second, the one thing we have learnt from the countless trials is that these chemicals are safe! Also, for many people, (see comments above) the use of nutraceuticals is an act of faith and I would no sooner enter a discussion about nutraceutical use than I would suggest that someone change their religion.

I note your comments about other orthopods. Beware "Eminence based medicine". A little story of my own to finish. Some years ago a major company was launching a new OA treating nutraceutical product via a free food and drink binge at a major SA conference. Three eminent speakers (2 from uni and one private practioner PhD holder) stood on stage and toed the company line beutifully while presenting the results of the "Clinical Trial" that they had been taking part in. This trial consisted of feeding free product to client owned dogs in a completely uncontrolled fashion then completeing a lightweight questionairre - submission of which earned the prominent orthopod £25=00. Some of us had earlier declined to take part in this advertorial unless steps were taken to knock it into a proper clinical trial, the results of which would be submitted for publication no matter how good or bad the product turned out to be. Few, if any, of the audience knew about the £25=00 a pop these "scientists" earned and fewer still knew that they were being paid a generous honorarium (in the range of £500=00 per hour) for "reporting their results"

An interesting side-fact that came out of the Swiss meta analysis - although they screened trials for "integrity" using completely objective criteria, they noted that industry supported trials were, in any case, more likely to produce an industry-sympathetic result.

Re: Glucosamine etc

Mark Holmes — Mon, 01 Nov 2010 15:38:42 GMT

[quote user="Bob Russell"]

Any other nutraceuticals of any real benefit? Except to the manufacturer and retailer of course!!

[/quote]

I find EFA/Viacutan etc very useful, not on its own but as adjuct to immunotherapy/atopica/antihistamine or even enviromental modification for atopic dermatitis.

Re: Glucosamine etc

Bob Russell — Mon, 01 Nov 2010 15:22:25 GMT

The American trial was the GAIT trial (can wiki it!!!!) - multicentre clinical trial funded by the National Institutes for Health.

Re: Glucosamine etc

Bob Russell — Mon, 01 Nov 2010 15:14:49 GMT

Without being able to provide links (sorry) - an American study with Glucosamine supplements showed a statistically significant benefit for humans with severe osteoarthritis (those at the point of imminent knee replacement) but no benefit shown for mild to moderate OA.

A Dutch (I think) study showed no statistically significant benefit for any patients. These were both double-blind trials. I will try to find the links.

I have to say I am not impressed with 'nutraceuticals' in general, probably because of the dubious nature of the claims for glucosamine type suppliments.

I am happy to be corrected if anyone can point me in the direction of genuine high quality trial work!!!

Any other nutraceuticals of any real benefit? Except to the manufacturer and retailer of course!!

Re: Glucosamine etc

Martin Atkinson — Mon, 01 Nov 2010 14:21:46 GMT

Whats your personal opinion Malcolm? I know a couple of othopods who do advice G&C and reckon they see benefit. Personally I would rather be told these supplements don't work because it is just one more barrier of client resistance I have to try to overcome to get them to accept a special diet or expensive supplements and I can clear up a lot of shelf space and indecision over which brand to buy. I haven't read the Swiss trial properly but someone suggested that their numbers were a bit too low to stand scrutiny on their statistics and they didn't have enough patients on G&C combination rather than just G or C.

Re: Glucosamine etc

Malcolm Ness — Mon, 01 Nov 2010 13:39:50 GMT

[quote user="Martin Atkinson"]The recent Swiss trial in humans[/quote]

The latest papers I have seen include a metanalysis from some Swiss authors that far from pouring doubt on the subject actually concluded that there was no benefit to be had. So confident were they in the findings that they stated that the use of such nutraceuticals could no longer be advised and that health budgets should not be used to fund the use of these products.

Re: Glucosamine etc

Hannah Wynne Richards — Mon, 01 Nov 2010 13:21:39 GMT

My 6 year old lab has horrible hips-that's how she landed upwith me in the 1st place. She's been on j/d (I practice what I preach ) since I had her (18 months old ),and runs around with no trace of arthritis

Wynne

Re: Glucosamine etc

Martin Atkinson — Mon, 01 Nov 2010 13:16:10 GMT

How much benefit are glucosamine and chondroitin full stop! (I know that was an exclamation mark but you get the idea). If you believe that they do work there is probably not enough in the diets to be beneficial in a dog with arthritis - maybe they will be protective for those that aren't there yet. The recent Swiss trial in humans has poured doubt on the whole shooting match, that said I take G&C for my dodgy knees but perhaps more in hope than expectation.