Glucosamine and Chondroitin: Accept No Substitutions, At Least Not Yet

Joint health is one of the product categories where consumers either feel results, or they dont. Its also consistently one of the largest-selling product categories, with glucosamine and chondroitin combinations annually leading the pack. Its no wonder, given the wide range in chondroitin quality, that some consumers abandon that supplement, citing a lack of results.

Why? Lets look at the details of chondroitin.

The classical formulation of 1500 mg glucosamine and 1200 mg chondroitin (chondroitin purity 95%) was used in the only large sample, double-blind, placebo-controlled clinical study conducted by NIH to examine efficacy claims of joint health supplements. The study showed statistically meaningful efficacy of chondroitin sulfate used together with glucosamine to provide relief in osteoarthritis patients with moderate to severe knee pain.  

The study findings on other formulations seemed to be inconclusive, while numerous other smaller-scale independent studies state either positive results or no results. In addition to well-researched, evidence-based clinical studies, popular perception and widespread consumer experience continue to support the fundamental belief in the effectiveness of chondroitin sulfate as an essential supplement for joint health.  

The problem is the joint health industry has evolved, and continues to face changes due to market conditions. Chondroitin sulfate sodium is the sodium salt of the sulfated linear glycosaminoglycan obtained from bovine, porcine, or avian cartilages of healthy and domesticated animals used for food by humans. Variations of the dietary ingredient also include one in calcium form derived from the same source cartilages, and one derived from shark cartilage. The nature of the material is such that it is resource-dependent with a finite supply. The popularity of chondroitin sulfate has increased demand, while the limited source of raw materials constricts the supply. Participants in the joint health business therefore are facing a tremendous task of meeting consumer demand with limited supplies.

With tight supply and higher prices of chondroitin ingredients, supplement manufacturers are given three options:

1.) Accepting smaller margins and staying with the classical formulation,

2.) Redefining the joint health concept in consumer perception to move away from classical formulation and traditional ingredients like chondroitin,

3.) Lowering the bar: buy and use substandard ingredients.

Similar choices confront the ingredient market: suppliers can make and provide clean and quality materials at thin margins, sell inferior materials by taking advantage of lower sourcing standards of some manufacturers, or resorting to (or turning a blind eye to) adulteration. This is the reality of the joint health supplement market and the answer to the question of why there are conflicting consumer experiences.

The industry has worked hard to combat adulteration. At Synutra, we have led an effort to institute best practices, to use meaningful and effective testing methodologies to weed out adulterated chondroitin materials from the supply chain. Weve advocated using the complete USP monograph methods, specifically using the combination of CPC titration and electrophoresis for more reliable chondroitin assay and purity, complementary to other specific methods such as enzymatic HPLC. This will help the industry reduce intentional and economic adulteration.

Apart from keeping the ingredients clean, joint health supplement manufacturers can create customer loyalty by putting an adequate amount of higher purity chondroitin in the product. Manufacturers investing in quality can also achieve product differentiation by label and Supplement Facts disclosures conforming to the classical formulation and detailing chondroitin purity data. Due to cost pressures in the market, some in the industry have started looking for substitute ingredients for costly chondroitin sulfate. Many alternative formulations have been marketed; some claim efficacy with little or no chondroitin in the product.  

Without sidetracking earnest efforts to find new and effective joint health ingredients, the Glucosamine/Chondroitin Arthritis Intervention Treatment (GAIT) study sponsored by the National Institutes of Health in 2005 remains the only large sample trial that continues to support efficacy of the classical formulation of glucosamine-chondroitin.

What does this mean for the industry and consumers of joint health supplements?  

It is my view that the industry should provide consumers with high-quality products based upon the classical joint health formulation of glucosamine hydrochloride and chondroitin sulfate with proven efficacy supported by the GAIT study. Worthy endeavors to look for alternative ingredients should be encouraged, but not at the expense of undermining consumer confidence in effectiveness of the widely used joint health supplements with chondroitin.

With a clean and well-managed supply chain of quality chondroitin materials, joint health supplement manufacturers can continue to thrive on the classic formulation with high-quality ingredients, and consumers will continue to find relief in the products the industry has to offer.