Chondroitin as the key joint health dietary ingredient has been overshadowed by glucosamine (rightly or wrongly) for a long time. That glucosamine appeared in product labels ahead of chondroitin, and therefore consumer awareness, was an historical accident.
The classic formulation introduced decades ago used 1,500 mg glucosamine and 1,200 mg chondroitin because glucosamine was cheaper than chondroitin and this formulation would appear more substantial to consumers with a total of 2,700 mg ingredients per serving. The Federal Trade Commission mandates that labels list ingredients in order of content amount, not in order of importance. Therefore, chondroitin has most often come after glucosamine on a label in a combination formula.
Over the years, consumers have formed an impression that the key ingredient in joint health supplements is glucosamine rather than chondroitin, obscuring chondroitin’s importance despite a preponderance of evidence supporting efficacy of chondroitin for osteoarthritis pain.
Many joint health supplement makers took the cue from the market and gradually moved away from chondroitin, without considering clinical evidence that advised otherwise. In recent years, more joint health supplements of glucosamine only—or combination supplements with mostly glucosamine and little or undisclosed amounts of chondroitin—are on shelves. This is very much a reflection of the industry's need and intention to control cost by limiting or reducing the weight of chondroitin, which remains a more costly ingredient.
In March 2014, Arthritis and Rheumatism published a randomized, placebo-controlled trial led by C. Kent Kwoh, M.D., that showed participants "with mild to moderate osteoarthritis who drank 1,500 mg glucosamine hydrochloride dissolved in lemonade each day for 6 months had just as much pain and knee cartilage deterioration as similar patients who drank lemonade."
Many people were quick to point out that there were numerous other positive clinicals on glucosamine for joint health.
That is true—in a sense.
Many clinical studies, including the large-scale GAIT study of 2005, and the more recent MOVES study published this year, had shown positive aspects of glucosamine for joint health, when used in combination with chondroitin. In fact, studies over the years have continued to show efficacious value and safety of just chondroitin.
This was confirmed by January 2015’s publication of the prestigious Cochrane Collaboration review, "Chondroitin for Osteoarthritis," which examined 43 clinical trials over more than 20 years and involving 9,110 participants.
Glucosamine's possible efficacy is most often indicated in studies when it is used with chondroitin. When used alone, clinical evidence has remained marginally neutral on glucosamine. I am not ready to say glucosamine does not work for joint health: there is not yet enough clinical evidence to disprove perception of its efficacy. But it is becoming clearer that common glucosamine has had the greater share of consumer awareness for joint health more for its economic profile than for its natural attribute as an extract from crustacean shellfish.
Tomorrow I’ll take a look at how the industry can raise chondroitin’s profile.