Glucosamine Dosage...

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Re: Glucosamine Dosage...

Postby Doc E » Thu Dec 04, 2014 8:59 am

Misskiwi67 wrote:1. So you are a human nutritionist?

2. Damn, I was going to have you explain some posts on VIN that stated Glucosamine hydrochloride was more potent and better absorbed in the acidic canine stomach pH and see if your info was newer.


Clinical nutrition in humans as well as other mammals (remember comparative anatomy? - Try comparative nutrition).

Posts on VIN or peer reviewed scholarly articles ? How old is the information they are using ? I haven't seen a VIN ARTICLE about HCL vs Sulfate for a number of years.

Initial research on Glucosamine was only in the HCl form....... Thus the variable findings as to effectiveness. All Glucosamine is in the HCl form when initially made. The better companies go to the additional steps and expense to convert the HCl form into Sulfate (did you ever wonder why?).

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Re: Glucosamine Dosage...

Postby Misskiwi67 » Thu Dec 04, 2014 9:31 am

Doc E wrote:
Misskiwi67 wrote:1. So you are a human nutritionist?

2. Damn, I was going to have you explain some posts on VIN that stated Glucosamine hydrochloride was more potent and better absorbed in the acidic canine stomach pH and see if your info was newer.


Clinical nutrition in humans as well as other mammals (remember comparative anatomy? - Try comparative nutrition).

Posts on VIN or peer reviewed scholarly articles ? How old is the information they are using ? I haven't seen a VIN ARTICLE about HCL vs Sulfate for a number of years.

Initial research on Glucosamine was only in the HCl form....... Thus the variable findings as to effectiveness. All Glucosamine is in the HCl form when initially made. The better companies go to the additional steps and expense to convert the HCl form into Sulfate (did you ever wonder why?).

.


Veterinarians know better than anyone that dogs are not cats, cats are not human (many human drugs kill cats!), and comparative means knowing differences as well as similarities. I would NEVER attempt to make recommendations on human nutrition based on my veterinary knowledge, I am not trained, nor would I risk my livlihood doing so. Sad that it doesn't work both ways, I see human MD's prescribing for their pets all the time without penalty, and I know of two cases recently with severe consequences.

I have an empty ICU today, I will go back and see what I can dig up, scholarly articles were difficult to find because the search always came back with chondroitin SULFATE making the search function useless.
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Re: Glucosamine Dosage...

Postby Misskiwi67 » Thu Dec 04, 2014 9:49 am

From the compendium of Continuing Education of Practicing Veterinarians:
Oral Joint Health Supplements: Chemistry, Pharmacology, and Administration Guidelines - 2009:

Glucosamine is commercially available in three main forms: glucosamine hydrochloride, glucosamine sulfate, and N-acetyl-d-glucosamine (FIGURE 4). The hydrochloride and sulfate forms are both salts that stabilize glucosamine following its large-scale production.9 The pKa of glucosamine is 6.91 at 98.6°F (37°C), which means that in the acidic stomach environment, dissolution of the salts generates glucosamine free base5,6 (FIGURE 4). The free-base form is thought to be absorbed and ultimately incorporated into various biosynthetic pathways, including the synthesis of cartilage glycosaminoglycans as described in FIGURE 1 .

While all glucosamine salts are believed to generate glucosamine free base in the stomach, not all glucosamine salts deliver comparable amounts of glucosamine free base. Ninety-nine percent-pure glucosamine hydrochloride delivers approximately 80% glucosamine free base, whereas glucosamine sulfate delivers 50% to 60%.9-11 Thus, if an oral joint health supplement contains 12 g of glucosamine hydrochloride, the horse is actually being fed 9.6 g of glucosamine free base. Likewise, if 12 g of glucosamine sulfate per serving is administered, the horse is receiving 6 to 7.2 g of glucosamine free base.


It is an equine article, I haven't found anything specific to canines yet. I considered calling Nutramax for their canine research, but I have a feeling they will likely have similar results since all their products use Glucosamine hydrochloride.
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Re: Glucosamine Dosage...

Postby huntnvet » Thu Dec 04, 2014 10:09 am

Instead of discussing the proper form, how about asking if glucosamine actually works. The human clinical trials do not lend much support to the use of glucosamine for OA. There are a number of books written about CAM therapies, and they just don't support it! Try reading "snake oil science: the truth about CAM therapies", written by the former director of the NIHs Alternative therapy division.......this guys job was to fund studies and review them. He documents every clinical trial inside and outside the U.S., and the summary is they are not much different than a placebo!

I can only assume doc you see value in this bc you have a world view that supports things like chiropractic.

Mustard, you will find better uses for your money than buying glucosamine! Hopefully you are skeptical, I would encourage you to do your own study with the glucosamine, have a friend administer it or not, see if you can document the difference, clinical trials say you can't.
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Re: Glucosamine Dosage...

Postby Doc E » Thu Dec 04, 2014 10:55 am

huntnvet wrote: 1. The human clinical trials do not lend much support to the use of glucosamine for OA.

2. I can only assume doc you see value in this bc you have a world view that supports things like chiropractic.

3. administer it or not, see if you can document the difference, clinical trials say you can't.


1. Nor did I or anyone else say anything about OA.
2. I have a world view that supports things like both traditional as well as complimentary health care.
3. SOME clinical trials 'say you can't' but many say you can.

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Re: Glucosamine Dosage...

Postby Misskiwi67 » Thu Dec 04, 2014 1:09 pm

The studies are certainly mixed, but the evidence is decent for a synergistic effect with other remedies, so the recommended approach to osteoarthritis treatment is multi-modal. I personally dish out the big bucks for the old lab, she gets Dasuquin and Previcox daily. I should probably switch her to j/d too, but haven't yet.

Here's some (peer reviewed but easily interpreted by the lay-person) articles for any who might be interested:

http://www.cliniciansbrief.com/sites/de ... hritis.pdf

http://scoutshouse.com/wp-content/uploa ... nfo_CB.pdf
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Re: Glucosamine Dosage...

Postby Doc E » Fri Dec 05, 2014 9:00 am

Although some of these studies were done a number of years ago, here are some of what most nutritionists consider some of the best studies done.

[Gonarthrosis--current aspects of therapy with glucosamine sulfate (dona200-S)]. Fortschr Med Suppl 1998;183:1-12.
D'Ambrosio E, Casa B, Bompani R, Scali G, Scali M. Glucosamine sulphate: a controlled clinical investigation in arthrosis. Pharmatherapeutica 1981;2:504-8.
Giordano N, Nardi P, Senesi M, Palumbo F, Battisti E, Gonnelli S, Franci B, Campagna MS, Gennari C. [The efficacy and safety of glucosamine sulfate in the treatment of gonarthritis]. Clin Ter 1996;147:99-105.
Gottlieb MS. Conservative management of spinal osteoarthritis with glucosamine sulfate and chiropractic treatment. J Manipulative Physiol Ther 1997;20:400-14.
Kelly GS. The role of glucosamine sulfate and chondroitin sulfates in the treatment of degenerative joint disease. Altern Med Rev 1998;3:27-39.
Leffler CT, Philippi AF, Leffler SG, Mosure JC, Kim PD. Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study. Mil Med 1999;164:85-91.

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Re: Glucosamine Dosage...

Postby mustad » Mon Dec 08, 2014 10:11 am

huntnvet wrote: Mustard, you will find better uses for your money than buying glucosamine! Hopefully you are skeptical, I would encourage you to do your own study with the glucosamine, have a friend administer it or not, see if you can document the difference, clinical trials say you can't.


My initial thought of potentially using Glucosamine for my dog comes from the success I have had with it. After many years of abusing my knees with jumping off cliffs on my skis, playing hockey, running, etc... I could tell when the moisture of the rain was coming in. This caused me summers of agony here in New England with the level of humidity we have. After talking about this with my doctor, he suggested trying Glucosamine/MSM as a potential remedy. Said it would take some time, but that he had seen success with it over time. While skeptical, I decided to try it. After about 4 months, I was pain free and have been pain free since. I haven't taken any for about two years, but it definitely helped me.

I am more skeptical to what the medical community messages as a whole vs my personal doctor who is compensated based on the results he provides me.

So far so good with my dog. I'm starting to see a difference now in how much he limps.
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Re: Glucosamine Dosage...

Postby Doc E » Mon Dec 08, 2014 11:18 am

huntnvet wrote:Instead of discussing the proper form, how about asking if glucosamine actually works. .


How about Adequan (polysulfated glycosaminoglycan) ?
Do you use that in your practice ?

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Re: Glucosamine Dosage...

Postby huntnvet » Tue Dec 30, 2014 2:17 pm

Doc/Misskiwi, I think you would agree that not all research is created equal. That is to say, some research meets the basic fundamental requirements for experimental design, and some does not. If research violates the basics of design, this greatly increases the likely hood of a false positive result. Now maybe this stuff, experimental design, makes your eyes glaze over, but I find it very interesting. I also find it extremely important in the current age of information. What I mean is, with all the information available to people now, how is someone suppose to evaluate the validity of the information they find? Unfortunatly, in regards to experimental design and bias, our education system does a terrible job preparing people to use and evaluate the information. I would go further and say that if every graduating senior understood the basics of experimental design, we would see a drastic change in the world of medicine…in both alternative and more traditional. Below are 3 of the most basic requirements for proper experimental design. These are not the only requirements, but I selected these because they can be proven mathematically to be true.

1. Appropriate control group – this is without a doubt the most important aspect of research. Without this, you CANNOT make assumptions as to the validity of the treatment groups because of the placebo effect. If you aren’t familiar with the placebo effect, spend some time studying it and you will understand why this is a must.
2. Each group must have greater than 50 participants – I think you would agree that the larger an appropriate sample size, the less likely hood of a false positive. I’m not a biostatistician, but they generally agree that 50 per group is a minimum.
3. Experimental replication – the reason that we must document all details of an experiment, is so that the experiment can be repeated by different investigators to find out if the result was one purely of chance, or if we actually found a true difference. For example: a p-value of 0.05, does not mean that the chance of a false positive in the experiment is 5%, it’s actually approximately 30%. Thus, we must replicate experiments to see if the result is one of chance alone.
4. There are a number of other fundamentals: blinding, drop-out rate, investigator bias, and journal bias are just a few of them. But in general, the first two listed are arguably the most important.

If we apply these standards to the research papers you list Doc, not one of them meets these requirements! Now to be fair, you can apply this to all trials done with glucosamine. AND, you will find something interesting….the trials that violate rule 1 and 2, almost always show a positive effect of glucosamine, while the trials that meet all basic/fundamentals of experimental design, find that there is no difference between glucosamine and a placebo!

The following 4 examples meet all the requirements of experimental design (thus, are far less likely to produce a false positive than any of the studies you listed), and they all say that glucosamine is no different than a placebo!
1. McAlindon et al. 2004, “Effectiveness of glucosamine”
2. Ciebere et al.2004, “Randomized, double-blind, placebo controlled glucosamine discontinuation”
3. Hughes and Carr. 2002, “A randomized, double-blind, placebo controlled trial of glucosamine sulphate”
4. Rindone et al. 2000, “Randomized, controlled trial of glucosamine”

To go a step further, here is the single largest trial (>300 participants per group) done on the effectiveness of glucosamine, and it meets all the requirements of basic experimental design. This experiment also had 5 groups, one of which was the use of glucosamine and chondroitin sulfate together. Also, it was published in the New England Journal of Medicine, considered one of the top 3 journals in the world.

D.O. Clegg et al., Glucosamine chondroitin dulfate and the two in combination for painful knee osteoarthritis. NEJM 354 (2006): 795-808.

Guess what?.....Ill quote the authors, “Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee.”

Yes, there are mixed results on glucosamine use….there is pseudo junk science with poor experimental design and always seems to be published in obscure journals that says it has some effect, AND there is well designed experiments published in quality journals like NEJM, that repeatedly show it is only a placebo effect!
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Re: Glucosamine Dosage...

Postby Doc E » Tue Dec 30, 2014 9:07 pm

huntnvet wrote:Doc/Misskiwi,

So, you read all of the references that I provided ? I seriously doubt that you did !

The following 4 examples meet all the requirements of experimental design (thus, are far less likely to produce a false positive than any of the studies you listed), and they all say that glucosamine is no different than a placebo!
1. McAlindon et al. 2004, “Effectiveness of glucosamine”
2. Ciebere et al.2004, “Randomized, double-blind, placebo controlled glucosamine discontinuation”
3. Hughes and Carr. 2002, “A randomized, double-blind, placebo controlled trial of glucosamine sulphate”
4. Rindone et al. 2000, “Randomized, controlled trial of glucosamine”

To go a step further, here is the single largest trial (>300 participants per group) done on the effectiveness of glucosamine, and it meets all the requirements of basic experimental design. This experiment also had 5 groups, one of which was the use of glucosamine and chondroitin sulfate together. Also, it was published in the New England Journal of Medicine, considered one of the top 3 journals in the world.
All of these trials use Glucosamine HCl and not Sulfate.... thus the results are null and void

Guess what?.....Ill quote the authors, “Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee.”
All of these trials use Glucosamine HCl and not Sulfate.... thus the results are null and void

Yes, there are mixed results on glucosamine use….there is pseudo junk science with poor experimental design and always seems to be published in obscure journals that says it has some effect, AND there is well designed experiments published in quality journals like NEJM, that repeatedly show it is only a placebo effect!

So, you read all of the references that I provided ? I seriously doubt that you did !
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Re: Glucosamine Dosage...

Postby huntnvet » Wed Dec 31, 2014 1:52 am

Yes, I examined your citations......the question is, did you? You said, “here are some of what most nutritionists consider some of the best studies done.” I hope that statement is false.....

1. this study had no placebo control group, the one they called the control, used piperazine/chlorbutanol. Number of patients per group 15, and several of them dropped out before the study was finished! They saw no significant difference between groups improvement, instead they had to report that the rate of change was different....but not significantly.
2. no placebo control group, thus you can’t draw a conclusion
3. This one doesn’t even make sense Doc! This is a an opinion written by a chiropractor on why he thinks that glucosamine and chiropractic are better than NSAIDs. This is not a study at all, so Im at a loss for why you included it. The best i can tell, he tries to make this look like a review of the literature, but he is the only author! Nobody does a literature review without multiple authors from multiple disciplines to help cancel out any individual bias.
4. Again, did you mean to include this one? This is not a study, just an opinion written by Kelly.
5. Not sure why this one was listed last....it is actually the best one you gave. Their placebo control is not a good one but will work. They only have 17 people per group. But you must have missed their conclusion section, this is a quote “A larger data set is needed to determine the value of this therapy for spinal DJD.” I hardly think this qualifies as “good” evidence, if the authors state this!

You have resorted to the typical nonsense often spouted from practitioners of “alternative” therapies......that is, instead of addressing the real question as to why you can’t prove your therapy with a well designed experiment, you give some other reason. In this case, you claim that glucosamine HCL and glucosamine sulfate are so drastically different, that if they are subjected to identical well designed and controlled studies, they would yield completely opposite results. You really believe this???

Well OK, let’s suppose for a moment that the following things don’t matter: 1. both variants of glucosamine would be broken down by our liver to an identical “salt” upon the first pass affect, or 2. to believe this, we must assume that once these byproducts enter our blood stream, they are delivered immediately to our joints and not broken down further in the same way every other product in our blood is, which we define as half-life. 3. your own chiropractors disagree as to which form works best and each one refers to their own studies.....which by the way, the studies they used failed to have controls either.

Now if we completely ignore digestive physiology as mentioned above......can you give me studies that meet the 2 fundamental requirements I gave previously (appropriate control, at least 50 per tx group) and use glucosamine sulfate? I would be more impressed if you have one that is also published in a well respected journal, but I wont hold you to that one. Also, what study or studies suggest that sulfate is so much better than HCL?

I do have one other question for you, how do you explain the following phenomenon: in the studies you listed above, and almost every other clinical trial, why does the control group (that is the group getting a sugar pill) almost always show a decrease in pain? How is this possible that a sugar pill causes someone to have less pain? Im sure you noticed this phenomenon in the research you read. Have you ever been curious as to why?
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Re: Glucosamine Dosage...

Postby Misskiwi67 » Wed Dec 31, 2014 10:03 am

I was less concerned with the studies and more concerned that Doc E sells the only glucosamine sulfate product I've ever seen. Conflict of interest much?
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Re: Glucosamine Dosage...

Postby Doc E » Wed Dec 31, 2014 10:58 am

Misskiwi67 wrote:I was less concerned with the studies and more concerned that Doc E sells the only glucosamine sulfate product I've ever seen. Conflict of interest much?


Cough - Cough --
Do you know how to use Google ?
Give it a try and use "Glucosamine Sulfate" as your search words. Or if you don't know how to use Google, click the link below.
https://www.google.com/search?q=glucosa ... gws_rd=ssl

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Re: Glucosamine Dosage...

Postby Misskiwi67 » Fri Jan 02, 2015 8:43 am

All 4 veterinary appropriate products on my shelf are HCL. Why would I use google when I have orthopedic and rehab specialists directing the products we carry
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