A Lube Job in Emerald City 

You know that scene in The Wizard of Oz when Dorothy finds the Tin Man? He's completely rusted and is only able to save himself by saying "oil can." That's how I'm feeling these days. My hips and knees are all squeaky. A friend of mine recommends I take supplements for joint health. So, what's in a joint supplement? Oil? And, how does it know where to go in my body?

—Elizabeth

I think it is safe to say that you and the Tin Man don't share the exact same malady, unless you've been overdoing the iron supplements. Those squeaky joints and stiffness are simply nature's way of reminding you that you're not visiting Munchkinland in a dream, but are still awake in Kansas. As for the oil can, the Tin Man should be grateful he had it with him, since who knows what medications might have been in Dorothy's basket—especially during Judy Garland's later years.

The joint health supplement business can be equally grateful for a book written in 1997 by Dr. Jason Theodosakis called The Arthritis Cure. This book extolled the virtues of the then little known team of glucosamine and chondroitin, two compounds showing emerging usefulness in arthritic conditions. Glucosamine is an amino sugar produced naturally in the body and is a normal part of all connective tissue. Most commonly, this dietary supplement is derived from shrimp or crab shells. Chondroitin is a carbohydrate molecule that helps cartilage stay hydrated and is usually produced from cartilage left over from beef processing. This surf and turf combo had sales in the United States approaching three-quarters of a billion dollars last year, becoming a most unusual recycling success story.

It is by no means certain that the symptoms you describe are the beginnings of arthritic degeneration. Osteoarthritis (OA) is a condition in which the joint cartilage deteriorates as the space between the bones narrow, most often due to wear and tear or injury. This degeneration reduces the natural cushion that allows smooth, painless movement; it commonly affects larger, weight-bearing joints like the knees and hips. Although both are inflammatory conditions, osteoarthritis is different from rheumatoid arthritis, an autoimmune disease in which the body attacks joint tissues from within. Typical medical treatment for OA centers around the use of anti-inflammatory drugs like Celebrex, Vioxx or Bextra—the last two of which were pulled from the market by the FDA (known to Pfizer as the Wicked Witch of the East Coast).

Glucosamine and chondroitin have been researched for efficacy and safety for many years. And, although anecdotal reports of miraculous relief cannot be regarded as typical, some moderate effects have been documented. In 2003, a paper was published in which 500 past studies were reviewed (a meta-analysis) to identify well-designed randomized, controlled trials. Fifteen studies involving more than 1,700 patients met the strict inclusion criteria and were analyzed. The outcome showed a noteworthy effect on the symptoms of osteoarthritis and indicated use of these compounds might slow joint space narrowing. Regrettably, barely 20 percent showed improved joint mobility and that was only after several weeks had passed.

As recently as November 2005, a pothole appeared in the yellow brick road when preliminary results were released from a huge National Institutes of Health study testing these two supplements against Celebrex and a placebo. The conclusions have been mostly disappointing for both patients and the supplement industry. Taken either separately or together, glucosamine and chondroitin didn't relieve mild osteoarthritic pain any better than a sugar pill. However, in a much smaller sub-group with moderate to severe OA, there was a somewhat better result: The power couple narrowly beat both Celebrex and the placebo. Unfortunately, statistically, the group was too small to be valid, but that hasn't stopped on-line supplement sellers from favorably spinning the facts faster than a flying Kansas farmhouse.

Still, unless you're allergic to shellfish or take blood-thinning medication, the conflicting research shouldn't stop you from trying the combination. In pill form, the recommended daily dosage used in most studies is 1500 milligram glucosamine hydrochloride and 1200 milligram chondroitin sulfate. Look for the abbreviation "USP," which indicates product standardization, expect to pay about a one dollar per day and commit to at least three months before giving up. Keep in mind, however, the primarily effect is symptom relief, not halting the progression of degeneration. But, less joint discomfort may encourage more exercise—that, plus the accompanying weight loss are two more firmly established methods for relieving joint pain. Getting in shape is a good idea regardless of the reason, especially when you're trying to outrun those flying monkeys.

Dr. Ed Rabin is a chiropractor practicing at Life Chiropractic Center in Boise. Send your ruby Reeboks and health-related questions to theantidote@edrabin.com (on the Web at www.edrabin.com).

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