This article is from WeChat public account:Back to Park (ID: fanpu2019) author: Shi Jun, from the title figure: Oriental IC
Double 11 is approaching, many people have already piled up health care products in the shopping cart in advance, only to wait for the zero point discount to start shooting. Among them, one of the most popular and most publicized products is probably imported joint health products. However, recent research has proven that the key ingredients in joint health products are probably not as useful as placebo. At the same time, due to the random changes in its formulation, it is difficult to monitor the toxicity and toxicity.
Maybe you exercise regularly, maybe you need to sit still for a long time because of working relationship, maybe you are old, no matter what the situation, the concept of protecting the joints is no stranger.
The best health care product for joints, the most popular brand nowadays is Move Free, which is a brand of Schiff, a famous American health care company. The common models are as follows:
Image from Schiff’s official website
The famous American supermarket Costco also has several types that people often buy.
Image from CVS official website
The main ingredients of these are glucosamine (glucosamine) and chondroitin sulfate. Some added vitamin D or an organic sulfur compound: dimethyl sulfone (MSM, essential for human collagen synthesis).
Glucosamine is known as “can strengthen, protect and rebuild joints”, while chondroitin sulfate “can help lubricate and cushion joints”, ultimately relieving joint pain, joint stiffness and arthritis.
I believe that everyone has seen a lot of web articles recommend this health care product (screening here).
However, is glucosamine and chondroitin sulfate really good for joints?
A study published one after another in authoritative journals showed that glucosamine and chondroitin sulfate health supplements have no effect on joints. Even in the United States, there are several class actions that prosecute manufacturers of these health products to make false advertisements, misleading and deceiving ordinary consumers[1, 2].
Figure: In June 2019, the consumer collective v. Schiff Move Free advertising false propaganda, officially filed. [2]
series of studies, the answer is getting clearer
The most famous study is called GAIT (Glucosamine/Chondroitin Arthritis Intervention Trial), conducted at 16 rheumatology research centers in the United States. In 4 years, it cost US$12.5 million and was funded by two departments under the National Institutes of Health (NIH), which are national supplements and substitutions. Medical Center (NCCAM), National Institute of Arthritis/Musculoskeletal/Skin Disease(NIAMS).
The purpose of the study was to determine whether glucosamine and chondroitin sulfate are effective in treating osteoarthritis.
The following studies are taken out for analysis and analysis.
1
This study was published in the authoritative medical journal New England Journal of Medicine in 2006 [3].
A total of 1583 patients with osteoarthritis were enrolled and randomized to receive:
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Placebo (The same as the shape of the drug, but there is no drug ingredient, can be simply understood as a sugar ball)
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1500 mg glucosamine per day
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1200 mg of chondroitin sulfate per day
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1500 mg glucosamine + 1200 mg chondroitin sulfate per day
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200 mg of prescription drug Celebrex (an analgesic for pain relief for other conditions such as arthritis)
It is worth noting that this dose was the dose of glucosamine and chondroitin sulfate in the popular health supplements at the time. It is emphasized here that there is a reason for the dose in the health supplement at that time, which will be further explained later.
If the patient feels that the joint pain is still uncontrollable, take up to 4000 mg of acetaminophen (the main component of Tylenol).
The main purpose of the study was to see if the knee pain was reduced by 20% compared to before taking it after 24 weeks.
The result is as follows:
It can be seen that taking glucosamine and chondroitin sulfateThere was no significant difference between the group and the placebo group.
But it’s worth noting that at 24 weeks, 60.1% (more than half) people who took a placebo also felt the symptoms Improved. This extraordinary placebo effect is often seen in clinical trials of arthritis. Understanding what you are eating, patients think they are taking useful medicines, and strong psychological cues will make the pain less intense.
Source: The-Science-Site.com
This trial is a good example of why clinical trials are only rigorous for randomized, double-blind trials. In the randomized double-blind trial, the pills in the placebo group and the real pills were basically the same in appearance. The person who eated could not guess what it was, and the person who collected the data did not know what each patient ate. What is it, in order to ensure that there is no bias in the data collection process.
After 24 weeks of taking Celebrex, people who felt a 20% reduction in pain were about 10% higher than the placebo group and achieved statistically significant results. Once again prove that this prescription drug has a certain effect.
Finally, the authors of the study grouped the patients involved according to the severity of the symptoms and found that combination therapy with 1500 mg glucosamine + 1200 mg chondroitin sulfate/day appeared to have a positive effect on patients with severe symptoms. However, it is worth noting that the number of volunteers with severe symptoms in this study is relatively small, and the sample size is too small to be conclusive and further research is needed.
2
So, thisSome authors continue to study. The new results were published in the journal “Arthritis and Rheumatism” in 2008 [4]. We call Research II (previously called Research 1).
The time for Study 2 was extended from 24 weeks to 24 months (two years), and the study focused on patients with more severe symptoms because In a short-term trial, a combination of glucosamine + chondroitin sulfate may be useful for these patients.
The study enrolled 572 patients with moderate or severe knee osteoarthritis and randomly assigned to five groups:
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Placebo
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Glucosamine (500 mg each time, 3 times a day: 1500 mg/day)
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Chondroitin sulfate (400 mg each time, 3 times a day: 1200 mg/day)
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Glucosamine (500 mg each time, 3 times a day)+ Chondroitin sulfate (400 mg each time, 3 times a day)
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西乐葆(Celebrex, 200 mg once daily)
The final effective indicator for this trial is not the subjective pain sensation in the trial (this patient feels the most likely to have errors) , Instead, an X-ray film was used at 24 months to determine the change in joint gap width. The more severe the osteoarthritis, the more cartilage loss, the smaller the joint clearance. If a drug can stop or even reverse the shortening of the joint space, it can structurally improve the joints and relieve symptoms.
Finally, in study 2, osteoarthritis patients in the placebo group had an average reduction in joint spacing of 0.166 mm after two years, implying an increase in osteoarthritis.
Glucosamine, chondroitin sulfate, or a combination of both did not significantly reduce the loss of joint space width compared with placebo(Arthritis did not alleviate ).
The researchers even observed that joint joint shortening (arthritis exacerbation) is more serious than other groups, possibly because Eating two drugs affects the absorption of each drug – and most health products on the market mix these two ingredients together.
3
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The final results of the GAIT study were published in the Journal of Rheumatology in 2010 [5]. We call it Research III.
Study 3 is similar to Study 1, except that the trial was extended from 24 weeks to 24 months.
This time, the researchers recruited 662 volunteers with moderate to severe osteoarthritis and randomly assigned them to the same five groups as the second paper. The main indicator is the same as the first study, see if the knee pain is reduced by 20% compared to before taking the drug.
The results of this long-term trial are similar to those of Study 1. All groups had significant pain and functional improvements over 2 years. However, none of the treatments were significantly better than placebo. There were no statistically significant differences between the treatment groups, again demonstrating a strong placebo effect.
The good news is that no serious side effects were observed in all treatment groups – it seems that at least two years of these drugs are safe in this trial.
GAIT research tells us:
1. The efficacy of glucosamine and chondroitin sulfate is largely due to strong psychological implications. Even if you eat “sugar balls”, if you think you are taking drugs that are useful for your joints, more than half of them will feel less joint pain.
2. Taking glucosamine and chondroitin sulfate at the same time may affect the absorption of any single component.
3. Glucosamine and chondroitin sulfate do not improve the joint space shortening after illness.
4
The latest study on glucosamine and chondroitin sulfate completed [6] in 2016. The trial enrolled 164 patients with knee pain due to osteoarthritis, and half of them took glucosamine (1500 mg / day) and chondroitin sulfate (1200 mg / day) ; the other half took Placebo.
However, the study was prematurely terminated for a very unusual reason: the symptoms of patients taking glucosamine and chondroitin sulfate worsened compared to the placebo group.
Beyond the results of the previous three trials, this result suggests a terrible possibility: Being doing nothing, taking glucosamine and chondroitin sulfate may make the joints worse.
Move Free, liver toxicity?
I often hear friends around me saying that most people do not have side effects when they eat health supplements. Would it be effective if they were eaten? Do you miss the chance of “just in case” without eating?
However, did you ignore the harmful situation of “just in case”?
Most health care products do not have published prospective studies on their efficacy, tolerability and safety.
Remarks:
Forward-looking research (eg sick), and other factors (eg suspicious risk or protective factor) ) Is there an association? The forward-looking study related to the safety of health supplements here is to observe a group of people who eat health supplements. Is there any adverse reaction related to eating health supplements?
This is because the ingredients of the health supplement are not strictly monitored by the FDA and can be changed frequently. This not only makes it difficult to study its security, it also means that its security is even more insecure. Who knows which batch of recipes will have problems?
Take the current red and purple Schiff Move Free series as an example.
A closer look at the pages of Move Free’s manufacturer, Schiff Nutrition International, will reveal a small line below:
“Our packaging and/or formulas change from time to time. Please refer to the actual packaging for current product information.”
Translated into Chinese is “our packaging and / or recipes will change from time to time. Please refer to the actual packaging for current product information.”
Figure: A description of the ingredients of a Move Free product on the Schiff Nutrition International website.
A number of cases have been reported, claiming that patients taking Move Free have clinically significant liver damage.
In 2010, the first article about taking Move Free causedA case report of liver injury was published in the US [7]. Subsequently, 2012 [8] and 2013 [9] have new case reports. In these published cases, patients developed acute hepatocyte damage within 1-3 weeks after taking a Move Free product. The degree of injury is moderate, and it can be relieved within 1 to 2 months after stopping taking it; there is no immunological allergy and autoimmune response characteristics, and in all cases, it can be completely recovered. However, one patient resumed using the product in the middle of the good half and immediately developed an acute liver injury with similar symptoms. In addition, although there are no more cases published, there are three prospective studies in the United States on drug-induced hepatotoxicity, all of which mention cases of acute liver injury associated with Move Free, which occurred during 2012-2013 [ 10-12].
The specific Move Free products mentioned in these cases, in addition to the main glucosamine and chondroitin sulfate, also contain a patented herbal mixture containing Chinese scutellaria (Scutellaria baicalensis) and Black Tea (Acacia catechu) .
These reports attribute most of the liver damage caused by Move Free to Chinese scutellaria [13], and only one case was attributed to glucosamine[ 11]. However, Chinese jaundice protects the liver in animal models, not the liver [14-16]. Why does it cause human liver damage? The report did not reasonably explain the mechanism of action of the liver. There is also a type of explanation that the Chinese scutellaria in Move Free contains contaminants, or maybe it is not Chinese scutellaria (The manufacturer admits wrong, puts a kind of grow A very similar plant is added to the Chinese scutellaria.)
So, it’s not yet certain what specific ingredients may cause liver damage. The manufacturer will often be moreChange the concentration of ingredients and ingredients of health care products, so it is not certain whether the products currently on the market contain these harmful ingredients. At present, the Move Free series products no longer list “including herbal ingredients such as Chinese scutellaria”, but give a patented ingredient of a new name on some products, called “Uniflex, known as minerals extracted from fruits and vegetables.
More notably, the amount of chondroitin sulfate is greatly reduced in the Move Free series listed on the US official website (see picture below) , the dose dropped from 1200 mg per day to 200 mg per day. The Move Free Ultra series has no glucosamine and chondroitin sulfate at all, one of which contains only calcium and calcium borate, and the other contains a patented cartilage mixture. Most other manufacturers produce similar products, such as the Kirkland brand sold by Costco, at a dose of 1500 mg glucosamine and 1200 mg chondroitin sulfate per day.
Figure: The composition of the existing 4 Move Free series products (from the US official website), the red box is chondroitin sulfate content. Click to enlarge
Figure: The composition of the four existing Move Free Ultra products (from the US official website).
In addition, a small study in 2013 found that taking glucosamine may increase the risk of glaucoma, and if left untreated, it will threaten vision [17] . Chondroitin sulfate acts as a blood anticoagulant, so it may cause internal bleeding.
Another often overlooked issue is drug interactions: Any combination of compounds can have poor interactions. If you are taking other medicines, be careful to decide whether or not to take health supplements. Because they may not contain the amount indicated on the label, or may contain contaminants – this will make it more difficult to accurately determine if there is a drug interaction.
Other side effects of glucosamine and chondroitin sulfate include:
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Heartburn, heartburn, drowsiness, headache, allergic reaction (especially if you are Shellfish allergy).
What are the drugs/therapies for arthritis?
So far, there is no cure or medicine to cure arthritis.
There are many drugs that can be used to improve symptoms (most importantly pain relief) and slow down the progression of the disease, but not completely reverse the structure Damage.
Because there are more than 100 different types of arthritis, each particular type of therapy is not exactly the same. The right medicine should be diagnosed after diagnosis.
The doctors are eager to hear about the type of arthritis that may be suspected. There are two main ways to further diagnose the diagnosis:
1. Human fluid analysis. Analysis of blood, urine and joint fluid can help determine what type of arthritis you might be. In order to obtain a sample of the joint fluid, the doctor usually needs to insert a needle into the joint space to pump some liquid.
2. Image analysis. Common imaging methods are X-ray, CT, magnetic resonance imaging (MRI) and ultrasound.
After confirming the type of arthritis, you may need to try several different treatments or combinations of treatments to find the treatment that works best for you.
There are three general types of therapy: drugs, physiotherapy, and surgery.
01 Drugs
The type of arthritis is different, and the drugs that should be used are different. Commonly used arthritis drugs include:
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Analgesics. These drugs help to relieve pain, but they are not anti-inflammatory. For example, acetaminophen (the main component of Tylenol), tramadol (Ultram, Ultrashet) , and some well-regulated painkillers (such as OxyContin oxycodone).
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Non-steroidal anti-inflammatory drugs (NSAIDs). These drugs can simultaneously relieve analgesia and inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). Certain types of NSAIDs must be obtained through prescription. Oral NSAID may cause stomach upset and some may increase the risk of heart attack or stroke. Some NSAIDs can also rub on joints as a cream or gel.
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Anti-irritants. Some varieties of ointments contain menthol or capsaicin. Rubbing these ointments on the skin of painful joints may interfere with pain signal transmission and thus achieve analgesic effects.
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Anti-rheumatic drugs. Usually used to treat rheumatoid arthritis, it can slow or prevent the immune system from attacking the joints. For example, methotrexate (Trexall) and hydroxychloroquine (Plaquenil).
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Specific immune response modifiers. Usually used with anti-rheumatic drugs, such drugs target certain specific protein molecules involved in the immune response. For example, etanercept (Enbrel) and infliximab (Remicade ).
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Corticosteroids. These drugs, including prednisone and cortisone, reduce inflammation and suppress the immune system. Corticosteroids can be injected orally or directly into the joints.
02 Physiotherapy
Physiotherapy is helpful for certain types of arthritis. Moderate exercise can improve and strengthen the muscles around the joints.
03 surgery
If you don’t care what you do, you have to have surgery. Includes joint repair or joint replacement.
04 Acupuncture, Yoga, Tai Chi and Massage
There is little data to support these non-traditional therapies, but there is no hard evidence to say that it is invalid. You can see if you want to try it yourself.
General Summary
Although there is no convincing data to prove that health supplements containing glucosamine and chondroitin sulfate are beneficial to the joints, many people will buy it. Some people think that even if there is no effect from the overall data of the crowd, it may be useful for individuals because of certain factors; others believe that even if most of the effects come from the placebo effect, the benefits of the placebo effect are real, very Hard to give up.
However, the latest clinical results and several side-effect cases indicate that these health supplements may also be harmful to health. Manufacturers often change the formula, and the ingredients and dosages actually eaten may be far from what you expected.
Most types of arthritis are chronic, life-threatening conditions. Learn about the various risk factors (including obesity, sedentary lifestyle, eating habits, joint injuries, smoking, etc.) Span>, changing lifestyles and reducing the chance of getting sick is the best preventive measure. It is absolutely unacceptable to put all hopes on health products, but not from the fundamentals of living habits.
References:
[1] https://topclassactions.com/lawsuit-settlements/consumer-products/supplements/900914-move-free-supplement-buyers-get-class-cert- False-ad-lawsuit/
[2] https://topclassactions.com/lawsuit-settlements/lawsuit-news/791647-schiff-move-free-class-action-says-joint-health- Supplements-dont-work/
[3] D. O. Clegg et al., Glucosamine, chondroitin sulfate, and the two in combination for painful neck osteoarthritis. N Engl J Med 354, 795-808 (2006).
[4] AD Sawitzke et al., The effect of glucosamine and/or chondroitin sulfate on the progression of bone osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial. Arthritis Rheum 58, 3183-3191 (2008).
[5] AD Sawitzke et al., Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results From GAIT. Ann Rheum Dis 69, 1459-1464 (2010).
[6] JA Roman-Blas et al., Combined Treatment With Chondroitin Sulfate and Glucosamine Sulfate Shows No Superiority Over Placebo for Reduction of Joint Pain and Functional Impairment in Patients With Knee Osteoarthritis : A Six-Month Multicenter, Randomized, Double-Blind,Placebo-Controlled Clinical Trial. Arthritis & Rheumatology 69, 77-85 (2017).
[7] SA Linnebur, OC Rapacchietta, M. Vejar, Hepatotoxicity associated with chinese skullcap contained in Move Free Advanced dietary supplement: two case reports and review of the literature. Pharmacotherapy 30 , 750, 258e-262e (2010).
[8] L. Yang, A. Aronsohn, J. Hart, D. Jensen, Herbal hepatoxicity from Chinese skullcap: A case report. World J Hepatol 4, 231-233 (2012).
[9]. R. Dhanasekaran, V. Owens, W. Sanchez, Chinese skullcap in move free arthritis supplement causes drug induced liver injury and pulmonary infiltrates. Case Reports Hepatol 2013, 965092-965092 (2013).
[10] VJ Navarro et al., Liver injury from herbals and dietary supplements in the US Drug-Induced Liver Injury Network. Hepatology (Baltimore, Md.) 60, 1399- 1408 (2014).
[11] S. Rossi, VJ Navarro, Herbs and Liver Injury: A Clinical Perspective. Clinical Gastroenterology and Hepatology 12, 1069-1076 (2014).< /p>
[12] N. Chalasani et al., Features and Outcomes of 899 Patients With Drug-Induced Liver Injury: The DILIN Prospective Study. Gastroenterology 148, 1340-1352.e1347 ( 2015).
[13] VJ Navarro, LB Seeff, Liver Injury Induced by Herbal Complementary and Alternative Medicine. Clinics in Liver Disease 17, 715-735 (2013).< /p>
[14] Q. Dong et al., Scutellaria baicalensis Georgi extract protects against alcohol-induced acute liver injury in mice and affects the mechanism of ER stress. Mol Med Rep 13, 3052-3062 (2016).
[15] J. Boer et al., Protection against aflatoxin-B-1-induced liver mutagenesis by Scutellaria baicalensis. Mutation research 578, 15-22(2005).
[16] HN Thanh et al., Ethanol extracts of Scutellaria baicalensis protect against lipopolysaccharide-induced acute liver injury in mice. Asian Pacific Journal of Tropical Biomedicine 5, 761-767 ( 2015).
[17] RK Murphy et al., Oral Glucosamine Supplements as a Possible Ocular Hypertensive Agent. JAMA Ophthalmology 131, 955-957 (2013).
About the author:
Historical, the pen name “Cats as you like”, now lives in Boston, USA. He graduated from the Department of Biological Science and Technology of Tsinghua University. After receiving his Ph.D. in the United States, he joined a multinational well-known pharmaceutical company for drug research and development. For more than ten years, he has led the team in combating diabetes and muscular dystrophy. In recent years, he has focused on the research and development of anti-aging drugs. Personal WeChat public number “Yiran free”, talk to you about health care.
This article is from WeChat public account:< Span class="text-remarks">Back to Park (ID: fanpu2019), Author: Shi Jun