Glucosamine, mesotherapy, mangosteen juice: Useful or useless?
September 26, 2006 | 12:00am
It’s been some time since we opened our mail, and so in the next two weeks, I chose some very interesting health questions to answer – as sent by our readers from all over the country. I know you’ll enjoy reading this and next week’s columns as they contain some of the most sought-after medical information being asked about today.
Glucosamine and chondroitin are the current, popular tag-team of supplements taken by a sizeable number of people for their "arthritis." In the US alone, consumers spend about $730 million a year on these two supplements, usually hoping to find relief from osteoarthritis (OA), a condition that affects at least 20 million Americans. Many Filipinos are taking these supplements, too – on their own or on the prescription of their physicians.
Glucosamine and chondroitin are both present in normal cartilage. Most supplements of glucosamine are prepared from oyster and crab shells; chondroitin is usually derived from cow or shark cartilage. The products are sold separately or in combination. Manufacturers typically recommend 1,500mg of glucosamine and/or 1,200mg of chondroitin a day, usually divided into three doses.
Results from two recent major clinical trials, one conducted in the US and the other in Europe, have shown that glucosamine can reduce pain in people with knee OA. The US clinical trial, called GAIT (for Glucosamine/Chondroitin Arthritis Intervention Trial) is a $14-million, 16-center study by the National Institutes of Health, which involved 1,600 people over age 40 with moderate to severe knee OA pain. The GAIT trial found that patients with severe knee pain randomized to take 1,500mg of glucosamine hydrochloride had a more than 65-percent reduction in pain, but those taking a combination of glucosamine and 800mg of chondroitin sulfate had an almost 80-percent reduction in pain, compared to a 54-percent response among those taking placebo.
The European trial, called GUIDE (Glucosamine Unum In Die "once a day" Efficiency), which involved 318 patients, showed that 1,500mg a day of another formulation of glucosamine – powdered glucosamine sulfate – may have more ability to control knee OA pain than acetaminophen or a placebo. The differences between these studies may relate to the glucosamine preparation used, as well as the dosing schedule. Some research suggests that if you take it once daily, instead of three times daily, there are higher peak levels and, as a result, the supplements are more effective.
And two studies of glucosamine are even more hopeful. Both a 2001 investigation of 212 patients in Belgium and a 2002 investigation of 202 patients in the Czech Republic found that three years of therapy slowed X-ray progression of OA in the knee while reducing pain by 20 percent to 25 percent. If these results are confirmed by subsequent studies, glucosamine would be the first agent that may actually slow the progression of OA.
Both products appear safe. People who are allergic to shellfish might be at risk for reactions to glucosamine, and diabetics should be sure that it does not elevate their blood sugar. Patients taking chondroitin and anticoagulants should be monitored to be sure the patient does not produce excessive anticoagulant effect. And everyone using these products must remember that since supplements from the US, unlike pharmaceuticals, are exempt from FDA oversight, their actual content, purity, effectiveness and safety cannot be assured. Glucosamine and chondroitin supplements are sold over the counter (OTC) in the US, but glucosamine is a prescription drug in Europe. Other than OA, these substances are not known to be useful for any other condition.
Bottom line: Despite some uncertainties, glucosamine and chondroitin are worth a try, together or separately, especially for OA that does not respond well to standard therapy. These supplements, though, may be costly if you have limited financial resources, so prolonged therapy is probably not warranted if it doesn’t seem to help in two or three months. But consider this: While glucosamine and chondroitin are far from being a cure, they can reduce the pain of OA and, possibly, even slow the progression of the disease.
Developed in France in 1952, and introduced a few years ago in the US, and more recently in the Philippines, "mesotherapy" is promoted as a non-surgical alternative to liposuction for cellulite reduction and body contouring. But it has not been proven effective and is potentially dangerous.
Cellulite is a non-medical term for deposits of fat that give the skin a dimply appearance. In mesotherapy, a doctor injects a mixture of drugs, plant extracts, enzymes, and other compounds into these "problem" areas. Ingredients commonly used are phosphatidylcholine (lecithin) and isoproterenol (an asthma drug that’s been used in obesity research). Proponents say mesotherapy increases blood and lymph flow in the tissues and breaks up fat cells, which are then excreted from the body.
But no one really knows how it might work; or, if there is an effect, how significant it is. That makes many doctors wary of performing the procedure. Moreover, there are no standard formulas or doses; practitioners make their own mixtures. And none of these drugs are BFAD- or FDA-approved for use in mesotherapy for body contouring. It is also unknown if the procedure affects other tissues or organs. Mesotherapy can cost several thousand pesos, and five or more sessions may be recommended.
Though there have been no reports of heart attacks or strokes, as there had been with liposuction, mesotherapy is not risk-free. It can cause extreme swelling, allergic reactions, and skin lesions, and there are reports of infections, which have required drug treatment and even surgery. If done incorrectly, there can be scarring.
Words to the wise: Stay away from mesotherapy. We agree with Dr. Rod Rohrich, chairman of the Department of Plastic and Reconstructive Surgery at the University of Texas Southwestern Medical Center: "It is mind-boggling to think that a physician would inject patients with unknown, unproved substances based on hearsay and unsubstantiated clinical findings."
Our best advice is to exercise and lose weight, if you’re overweight. That may help reduce the appearance of cellulite – and also have proven health benefits.
No. Mangosteen marketers make far-fetched and unsubstantiated claims for their products, which are sold as "dietary supplements" via multi-level (network) marketing. The most promoted brand is XanGo, which comes both as a juice puree and in capsules.
Mangosteen (Garcinia mangostana) is a tropical fruit native to Southeast Asia, including the Philippines, where it is mostly grown in Mindanao. It has a hard purple rind and white pulp inside. Laboratory studies have specifically looked at compounds in the rind, called xanthones, which seem to have some anti-cancer effects in the test tube. Mangosteen is also said to have antiseptic, anti-fungal, anti-inflammatory and anti-oxidant activity.
Marketeers cite long lists of lab studies as "proof" of mangosteen’s health benefits. But there are no clinical trials, and what happens in a test tube or animal may not occur in a human. Any reported benefits in humans have been anecdotal. No one even knows if the processed fruit juice and capsule retain the potentially beneficial compounds. What’s more, the juice is typically a mix of fruit juices – with an undisclosed amount of mangosteen in it.
Bear in mind: Exotic fruits and their juices, such as mangosteen and the many other tropical fruits we grow in the Philippines, are quite nutritious. Current nutritional knowledge advises us to eat fruits daily for good health. But don’t expect mangosteen and other tropical fruits to be miracle cures for any disease. There’s just isn’t any scientific support for such claims at this time.
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