What is the most effective brand of Glucosamine/Chondroitin?

I use Shiff Move Free because it’s a quality product and I can get it at the drug store or grocery rather than having to go to a health food store but there are other good brands out there too. Twin Labs, e.g. also makes good products. I think the important thing is to not go with the cheap, off brands because you can never be sure if the products actually contain quality ingredients at the proper levels/dosage.

Almost every scientific research study that has been conducted shows that glucosamine/chondrioutin do not work – they are no more effective than a placebo. So you can save your money.

I would recomend you buy a product that contains glucosamine sulphate rather than glucosamine hydrochloride as glucosamine sulphate has been shown to have signifacnt clinical benefits while the evidence for glucosamine hydrochloride having any benefit is pretty poor. The GAIT study that @crisw links to used glucosamine hydrochloride which would explain the poor results.

According to thier website, Shiff Move Free contains mainly glucosamine hydrochloride (1500mg) with only a small amount of glucosamine sulphate (200mg) so it would not be a product I would recomend.

How much difference was there in the results of the studies of the two compounds?

@Adirondackwannabe In a quick review of the literature (and by quick I mean really quick) I can’t find a study where glucosamine hydrochloride has been shown to have a statistically significant effect on the symptoms of arthritis. A study on glucosamine sulphate did make a difference. Confusing the issue slightly is the fact that a lot of the research on glucosamine was conducted in 80’s and was funded by a company that held the patent on it. They were generally poorly conducted and all found positive benefits and tend to screw things up a little.

WWW.Shaklee.com

This is not spam, this is merely just another link to an answer.

@Lightlyseared Thanks.

@crisw I’m no expert, but I think the jury actually is still out on this one. This article mentions that the GAIT study was not conclusive and that:

a subset of patients with severe osteoarthritis in the knee experienced a significant pain relief with the two supplements.

Even your own “source,” the article you link to, states that:

Though the study failed to find any benefit in taking glucosamine with chondroitin for arthritis patients, even the study’s lead author says this is not the final word on the popular supplements.
...

“I think we feel like it would have been nice to answer the question definitively, but we really couldn’t do that,” Dr. Sawitzke says.

In part because the study sample size was very small.

I’m certainly not saying that the science is overwhelming in support of the efficacy of glucosamine and/or chondroitin, it’s not even close, I’m just saying it may be premature to be believe that the current state of the science regarding is definitive enough to declare that the supplements are nothing but snake oil.

From the Cochrane Collaborative, which is the primary database for evidenced based medicine sources.

Abstract

Background
Osteoarthritis (OA) is a common form of arthritis and is often associated with significant disability and impaired quality of life. This is an update of a Cochrane review first published in 2001 and previously updated in 2005.

Objectives
To review randomized controlled trials (RCTs) evaluating the effectiveness and toxicity of glucosamine in OA.

Search strategy
We searched CENTRAL and the Cochrane Database of Systematic Reviews (The Cochrane Library), MEDLINE, PREMEDLINE, EMBASE, AMED, ACP Journal Club, DARE (to January 2008); contacted content experts, and handsearched reference lists and pertinent review articles.

Selection criteria
RCTs evaluating the effectiveness and safety of glucosamine in OA.

Data collection and analysis
Data abstraction was performed independently by two review authors and investigators were contacted for missing data.

Main results
This update includes 25 studies with 4963 patients. Analysis restricted to studies with adequate allocation concealment failed to show any benefit of glucosamine for pain (based on a pooled measure of different pain scales) and WOMAC pain, function and stiffness subscales; however, it was found to be better than placebo using the Lequesne index (standardized mean difference (SMD) -0.54; 95% confidence interval (CI) -0.96 to -0.12). Collectively, the 25 RCTs favoured glucosamine with a 22% (change from baseline) improvement in pain (SMD -0.47; 95% CI -0.72 to -0.23) and a 11% (change from baseline) improvement in function using the Lequesne index (SMD -0.47; 95% CI -0.82 to -0.12). However, the results were not uniformly positive and the reasons for this remain unexplained. WOMAC pain, function and stiffness outcomes did not reach statistical significance.

RCTs in which the Rotta preparation of glucosamine was compared to placebo found glucosamine superior for pain (SMD -1.11; 95% CI -1.66 to -0.57) and function (Lequesne index SMD -0.47; 95% CI -0.82 to -0.12). Pooled results for pain (SMD -0.05; 95% CI -0.15 to 0.05) and function using the WOMAC index (SMD -0.01; 95% CI -0.13 to 0.10) in those RCTs using a non-Rotta preparation of glucosamine did not reach statistical significance. Two RCTs using the Rotta preparation showed that glucosamine was able to slow radiological progression of OA of the knee over a three-year period (mean difference (MD) 0.32; 95% CI 0.05 to 0.58).

Glucosamine was as safe as placebo in terms of the number of participants reporting adverse reactions (relative risk ratio 0.99; 95% CI 0.91 to 1.07).

Authors’ conclusions
Pooled results from studies using a non-Rotta preparation or adequate allocation concealment failed to show benefit in pain and WOMAC function while those studies evaluating the Rotta preparation showed that glucosamine was superior to placebo in the treatment of pain and functional impairment resulting from symptomatic OA.

So in answer to the question, all brands are equally effective (meaning not better than placebo).

Here’s a good post from the Science Based Medicine blog
http://www.sciencebasedmedicine.org/?p=6266

Here is the meat of it:
Nevertheless, glucosamine (alone or with chondroitin) is widely used, and there are some supporting studies. But they are trumped by a number of well-designed studies that show it works no better than placebo, as well as a study showing that patients who had allegedly responded to glucosamine couldn’t tell the difference when their pills were replaced with placebos. The GAIT trial was a large, well-designed, multicenter study published in The New England Journal of Medicine that showed no effect in knee osteoarthritis. A subsequent study of hip osteoarthritis also showed it worked no better than placebo.

@Rarebear Thanks! Always happy to have the professionals weigh in. Better than making one’s arguments citing a newspaper science writer’s summary. Mea culpa.

And lest anybody think I’m just intereted in debunking alternative therapies, I also don’t recommend arthroscopic surgery for knee osteoarthritis based upon this study .
I believe what the data tells me.

@Rarebear an orthopedic surgeon once told me that that type of surgery had a 33% chance of improvement 33% chance it would make no difference and a 33% chance it would make it worse. I asked him what happened to the other 1% but he didn’t seem to know.

In glucosamine’s defence there are well conducted research published after the 2005 Chochrane review that found small to moderate benefit to taking glucosamine sulphate and one study published last year that demonstrated a reduction on cartilage damage due to physical training so I’m still keeping an open mind.

@Lightlyseared I used to recommend it until I saw the Cochrane analysis, then I stopped. I tell my patients not to spend their money on therapies that have actually been proven to work. If someone comes in, takes it, and swears by it, though, I won’t take it away from them, as they’re obviously being helped by the placebo effect of the drug.

@Rarebear yeah there are some quack remedies out there but I think there is enough recent evidence for glucosamine sulphate to at least consider it. Before 2005 most studies were using glucosamine hcl (or were funded by Rottapharm and a bit dodgy).

@Lightlyseared My point is that recent evidence now shows that there is NO benefit beyond placebo.