Monday, May 7, 2007

Joint Supplements: Red Herring?

Current research does not support glucosamine/chondroitin supplements

The past several years, especially after the 1994 Supplement Act loosened product restricitons, the dietary supplement industry has burgeoned into a multi- billion dollar industry. A steady flood of media advertising campaigns promoting products claiming to "support", "prevent", "balance, "detoxify", and "protect" permeate the airways. Often presented along with a well prepared sales pitch of pseudo-scientific babble and a litany of testimonials, these products have inundated the animal wellness arena as well. Not to miss out on a good thing, many new manufacturers have jumped on the bandwagon having discovered the gold mine the pet market can be.

Taking full advantage of loop holes in the law, companies have successfully created a demand by attaching claims that do not require rigorous testing, but that create a false sense of efficacy. Due in part to the loosening of federal requirements, the FDA has no direct jurisdiction over these products as long as they do not directly claim a therapeutic effect. Unfortunately, many consumers assume that these products have indeed been tested and approved by some regulatory agency. The good news is, due to many excesses by the supplement companies over the years there has been increasing pressure to better regulate their product claims.

Recent attempts to reign in some of these often over the top claims have, not surprisingly, met with some friction from the supplement industry. In Canada for example, intense lobbying by the supplement industry and politicians, along with some grass roots petitioning has succeeded in slowing down these efforts. In the US, there is significant political might gathered to impede progress in this area. North America is not the only region affected by these issues.The tired banner of "freedom of choice in medicine" was used in New Zealand to agitate a brew of accusations and assumptions.

In spite of this, in the US, the USDA has succeeded in forming a commission to begin formulating a draft for new guidelines titled; "Complementary and Alternative Medicine Products and Their Regulation by the Food and Drug Administration". The most important topic being addressed is how to regulate these products effectively. Hopefully efforts such as these will put more teeth into monitoring an industry working loose and fast with the facts. We will see what becomes of this.

The most well known supplement products after vitamins, it could be argued , are joint support products. If you walk the pharmacy section of many super markets you will note a plethora of joint supplements containing varying combinations of often exotic ingredients. However, the most common ingredients to be found are the famed glucosamine and chondroitin sulfate supplements followed by a varying litany of vitamins, herbs, minerals, and other ingredients.

Due to their consistent popularity these two ingredients were recently studied under more rigorous conditions in order to clarify just how effective they are. After a continuing series of increasingly improved controlled trials, the news is not looking good if you are a fan. A recent meta-analysis in the Annals of Internal Medicine concluded that chondroitin sulfate does not appear to reduce joint pain in people with osteoarthritis. As for glucosamine, a recent Cochrane review found that overall glucosamine does not improve pain through time as previously thought. Additionally, recent reviews in 2007 and another in 2006, question the efficacy of Glucosamine and Chondoitin supplementation together. Research on animals is scattered and inconclusive. Even so, the "Whats good for me, is good for Fido" approach prevails.

Of course, proponents take on a "God of the gaps" approach claiming the wrong product was used, the focus should be on prevention, it takes time...all good and well. More higher quality trials are a good thing, though research funds are not always infinite. Therefore, plausibility needs to be an important aspect to these trials. How far, and how many trials will it take to move on to some other promising substance?

Increasingly -and like many other supplements- it is beginning to be more difficult to justify the money spent (nearing $1 billion) on these two famous substances in light of such equivocal effectiveness. However, that will not stem the supplement industry sales of these products, nor it seems is it discouraging people from using these products. It is quite apparent that people often don’t seem to care what this or that study says.

They often rely on there owned biased version of experience, and what their friends or family say. This is part of the “placebo effect” I have run into often in my own practice. It seems, at least at some level, people need to be saved from themselves, and some regulation is critical.

In the end , recommending weight control, exercise, and a good diet, along with the occasional efficacious medication, or supplement (yes there are some) is just not as fulfilling and easy as that all purpose "pill".

Alas, the struggle to educate the masses goes on....

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