Original: Shi Juan returns to the park
As double 11 approaches, many people have already filled their shopping carts with health care products in advance, just waiting for the zero discount time to start shooting. Among them, one of the hottest and most publicized commodities is probably imported joint health care products. However, the latest research proves that the key ingredients in joint health care products may not be as useful as placebos. At the same time, because its formula changes at will, its medicinal properties and toxicity are also difficult to monitor. Friends who want to buy such health care products at special prices need to think twice before you do.
Today’s two articles bring together some kinds of goods that should be bought carefully or even not. Among them, the e-cigarettes that we strongly warned about were completely removed from Taobao and Tmall on November 6. So far, the online sales platform has completely banned the sale of e-cigarettes.
Writing | Shi Juan
Maybe you exercise a lot, maybe you need to sit still for a long time because of your work, or maybe you are old. In either case, the concept of protecting your joints must be familiar.
Known as a health care product that is good for joints, the most popular brand at present is Move Free, which is a brand of Schiff, a famous American health care company. Common models are as follows:
Image from Schiff official website
Costco, a famous American supermarket, also has several kinds that people often buy.
Image from CVS official website
The main components of these drugs are glucosamine and chondroitin sulfate. Some of them are added with vitamin D or an organic sulfur compound: dimethyl sulfone (MSM, an essential substance for human collagen synthesis).
Glucosamine claims to "strengthen, protect and rebuild joints", while chondroitin sulfate "can help lubricate and cushion joints", thus finally relieving joint pain, joint stiffness and arthritis.
I believe everyone has read many online articles recommending this health care product (the screenshot is omitted here).
However, are glucosamine and chondroitin sulfate really good for joints?
One study after another published in authoritative magazines shows that glucosamine and chondroitin sulfate health care products have no effect on joints. Even in the United States, there are several class actions, accusing the manufacturers of these health care products of making false advertisements, misleading and deceiving ordinary consumers [1, 2].
Photo: In June 2019, consumers collectively sued Schiff Move Free for false advertising and formally filed a case. [2]
A series of studies, the answer is getting clearer and clearer.
The most famous research is called Gait (Glucosamine/Chondroitin Arthritis Intervention Trial), which took four years and cost $12.5 million. It was funded by two departments under the National Institutes of Health (NIH), namely National Center for Complementary and Alternative Medicine (NCCAM) and National Institute of Arthritis/Musculoskeletal/Dermatology (NIAMS).
The purpose of this study is to determine whether glucosamine and chondroitin sulfate are effective in the treatment of osteoarthritis.
Let’s take out these studies and analyze them for everyone.
one
This study was published in the authoritative medical journal New England Medicine in 2006 [3].
A total of 1583 patients with osteoarthritis were recruited and randomly assigned to take:
Placebo (the same shape as medicine, but without the ingredients of medicine, it can be simply understood as sugar ball)
1,500 milligrams of glucosamine per day
1200 mg chondroitin sulfate per day
1500 mg glucosamine +1200 mg chondroitin sulfate per day
200 mg of prescription drug celebrex (an analgesic used to relieve pain for arthritis and other diseases) every day.
It is worth noting that this dose is the dose of glucosamine and chondroitin sulfate in popular health care products at that time. It is emphasized here that there was a reason for the dose in health care products at that time, which will be further explained later.
If the patient feels that the joint pain is still uncontrollable, he can take up to 4000 mg of acetaminophen (the main component of Tylenol) every day.
The main purpose of the study is to see if the pain in the knee joint is reduced by 20% after taking the medicine for 24 weeks.
The result is as follows:
It can be seen that there is no significant difference between the group taking glucosamine and chondroitin sulfate and the placebo group.
However, it is worth noting that at 24 weeks, 60.1% (more than half) people who took placebos also felt that their symptoms had improved. This extraordinary placebo effect is often seen in clinical trials of arthritis. Without knowing what they are eating, patients think they are taking useful drugs, and strong psychological hints will make the pain less intense.
Source: The-Science-Site.com.
This trial is a good example to explain why clinical trials are rigorous only if they are randomized and double-blind. Randomized double-blind trials should make sure that there is basically no difference in appearance between the pills in the placebo group and the real pills. The people who eat them can’t guess what they are eating at all, and the people who collect data don’t know what each patient is eating, so as to ensure that there will be no bias in the data collection process.
After taking celebrex for 24 weeks, those who felt that their pain was reduced by 20% were about 10% higher than those in the placebo group, achieving a statistically significant effect. Once again, it proves that this prescription drug is effective.
Finally, the author of this study divided the patients into groups according to the severity of symptoms, and found that the combined therapy of 1500 mg glucosamine and 1200 mg chondroitin sulfate/day seems to have certain 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, which needs further research to confirm.
2
So, these authors continued to study. The new results were published in the journal Arthritis and Rheumatism in 2008 [4]. We call it study 2 (the last one was called study 1).
The time of the second study was extended from 24 weeks to 24 months (two years), and the patients with severe symptoms were studied emphatically, because the last short-term trial found that the combination therapy of glucosamine and chondroitin sulfate might be useful for these patients.
572 patients with moderate or severe knee osteoarthritis were recruited and randomly divided into five groups:
placebo
Glucosamine (500 mg each time, 3 times a day: 1500 mg/day)
Chondroitin sulfate (400 mg each time, 3 times a day: 1200 mg/day)
Glucosamine (500 mg each time, 3 times a day)+chondroitin sulfate (400 mg each time, 3 times a day)
Celebrex (200 mg once a day)
The final effective index of this experiment is not the subjective pain feeling in the first experiment (this kind of patient’s feeling is the most prone to error), but the change of joint space width is determined by X-ray at 24 months. The more severe osteoarthritis is, the more cartilage loss is, and the smaller joint space is. If a drug can stop or even reverse the shortening of joint space, it can improve the joint structure and relieve symptoms.
Finally, in the second study, the average joint spacing of patients with osteoarthritis in the placebo group decreased by 0.166 mm after two years, which meant that osteoarthritis was aggravated.
Compared with placebo, glucosamine, chondroitin sulfate or their combination therapy did not significantly reduce the loss of joint space width (arthritis did not relieve).
The researchers even observed that the joint space shortening (arthritis aggravation) of combined therapy was more serious than that of other groups, probably because taking two drugs at the same time affected the absorption of each drug-and most health care products on the market mixed these two ingredients together.
three
The final result of the GAIT study was published in Rheumatology Annual Report in 2010 [5]. We call it study three.
The third study was similar to the first study, except that the experiment was extended from 24 weeks to 24 months.
This time, the researcher recruited 662 volunteers with moderate to severe osteoarthritis and randomly divided them into five groups as in the second paper. The main index is, as in the first study, to see whether the pain of knee joint is reduced by 20% compared with that before taking medicine.
The results of this long-term experiment are similar to those of study 1. All groups had significant pain and functional improvement within 2 years. However, no treatment is significantly better than placebo. There was no statistically significant difference between the treatment groups, which once again proved the powerful placebo effect.
The good news is that no serious side effects were observed in all the treatment groups-it seems that these drugs are safe to take for at least two years in this experiment.
GAIT research tells us:
1. The curative effect of glucosamine and chondroitin sulfate comes from strong psychological suggestion to a great extent. Even if you eat "sugar balls", if you think you are eating drugs that are useful for joints, more than half of people will feel that joint pain is reduced.
2. Taking glucosamine and chondroitin sulfate at the same time may affect the absorption of any single component.
3. Glucosamine and chondroitin sulfate can not improve the shortening of joint space after illness.
four
The latest study on glucosamine and chondroitin sulfate was completed in 2016 [6]. This experiment recruited 164 patients with knee pain caused by osteoarthritis, and half of them took glucosamine (1500 mg/day) and chondroitin sulfate (1200 mg/day). The other half took a placebo.
However, the study was terminated early for an unusual reason: compared with the placebo group, the symptoms of patients who took glucosamine and chondroitin sulfate worsened.
Further than the previous three experimental results, this result suggests a terrible possibility: taking glucosamine and chondroitin sulfate may make the joint condition worse than doing nothing.
Move Free, hepatotoxicity?
I often hear friends around me say that most people eat health care products without any side effects. What if they eat them? If you don’t eat, don’t you miss that "one thousand" opportunity?
However, have you overlooked the "one thousand" harmful situation?
In fact, there are no published prospective studies on the efficacy, tolerance and safety of most health care products.
Remarks:
Prospective study usually involves observing a group of subjects for a long time, and studying whether some observed results (such as illness) are related to other factors (such as suspicious risks or protective factors) during the trial. The prospective study related to the safety of health products mentioned here is to observe whether a group of people who eat health products will have some adverse reactions related to eating health products.
This is because the ingredients of health care products are not strictly monitored by FDA, and the formula can be changed frequently. This not only makes it difficult to study its security, but also means that its security is even more insecure. Who knows which batch of formula will go wrong?
Take the current Schiff Move Free series products as an example.
If you look closely at the website of Schiff Nutrition International, the manufacturer of Move Free, you will find that there is a small line below:
“Our packaging and/or formulas change from time to time. Please refer to the actual packaging for current product information.”
Our packaging and/or formula will change from time to time. Please refer to the actual packaging for current product information. "
Figure: Composition description of a Move Free product on Schiff Nutrition International website.
At present, many cases have been reported, saying that patients taking Move Free have obvious liver damage in clinic.
In 2010, the first case report on liver injury caused by taking Move Free was published in the United States [7]. Subsequently, new cases were reported in August 2012 and September 2013. In these published cases, patients developed acute hepatocyte injury within 1-3 weeks after taking a Move Free product. The degree of injury is moderate and can be relieved within 1 to 2 months after stopping taking it; There is no immune allergy and autoimmune reaction, and it can finally recover completely in all cases. However, one patient resumed using the product when he was half well, and immediately developed acute liver injury with similar symptoms. In addition, although no more cases have been published, there are three prospective studies on drug-induced hepatotoxicity in the United States, all of which mentioned acute liver injury cases related to Move Free, all of which occurred in 2012-2013 [October 12].
The specific Move Free products mentioned in these cases at that time, in addition to the main glucosamine and chondroitin sulfate, also contained a patented herbal mixture, including China Scutellaria baicalensis and Acacia catechu.
These reports attributed the liver injury caused by Move Free to Scutellaria baicalensis Georgi in China [13], and only one case was attributed to glucosamine [11]. However, China Scutellaria baicalensis Georgi protects the liver in animal models, but not damages it [14-16]. Why can it cause human liver injury? The report did not reasonably explain its mechanism of liver injury. There is also a kind of explanation that the China Scutellaria baicalensis Georgi in Move Free contains pollutants, or maybe it is not China Scutellaria baicalensis Georgi at all (the manufacturer made a mistake and added a similar plant as China Scutellaria baicalensis Georgi).
Therefore, it is still uncertain what specific components may cause liver injury. Manufacturers often change the composition and concentration of health care products, so it is not certain whether the products currently on the market still contain these harmful ingredients. At present, Move Free series products no longer list "including China Scutellaria baicalensis Georgi and other herbal ingredients", but give a patented ingredient with a new name on some products, which is called "uniflex (fruitex-b calcium fruitoborate)", claiming to be a mineral extracted from vegetables and fruits.
What’s more noteworthy is that the content of chondroitin sulfate in the Move Free series products listed on the official website in the United States has been greatly reduced (see the figure below), and the dosage has been reduced from 1200mg per day to 200mg per day. There is no glucosamine and chondroitin sulfate in the Move Free Ultra series products, one of which only contains calcium and calcium borate, and the other contains a patented cartilage mixture. However, most of them are produced by different manufacturers, such as similar products of Kirkland brand sold by Costco, and the dosage is still 1500 mg of glucosamine and 1200 mg of chondroitin sulfate every day.
Figure: The ingredients of four existing Move Free series products (from official website, USA) are chondroitin sulfate content in the red box. Click to see a bigger picture.
Figure: Components of four existing Move Free Ultra series products (from official website, USA).
In addition, a small study in 2013 found that taking glucosamine may increase the risk of glaucoma, which will threaten vision if it is not treated in time [17]. Chondroitin sulfate can play the role of blood anticoagulant, so it may cause internal bleeding.
Another problem that is often overlooked is drug interaction: any combination of compounds may produce bad interactions. If you are taking other drugs, you must decide carefully whether to take health care products. Because they may not contain the amount indicated on the label, or they may contain pollutants-this will make it more difficult for you to accurately judge whether there will be drug interactions.
Other side effects of glucosamine and chondroitin sulfate include:
Heartburn, heartburn
feel tired and sleepy
headache
Allergic reaction (especially if you are allergic to shellfish)
What drugs/treatments are there for arthritis?
So far, there is no therapy or medicine that can cure arthritis.
There are many drugs that can be used to improve symptoms (mainly to relieve pain) and slow down the deterioration of the disease, but they cannot completely reverse the structural damage.
Because there are more than 100 different kinds of arthritis, each specific type of treatment is not exactly the same. We should prescribe the right medicine after diagnosis.
After the doctor looked around and guessed the type of arthritis he might have, there were two main methods for further diagnosis:
1. Body fluid analysis. Analyzing blood, urine and joint fluid can help determine what type of arthritis you may have. In order to obtain a sample of joint fluid, doctors usually need to put a needle into the joint space to suck some fluid.
2. Imaging analysis. Commonly used imaging methods include 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 one that suits you best.
There are usually three types of therapies: drugs, physical therapy and surgery.
01
medicine
Different types of arthritis, should use different drugs. Commonly used arthritis drugs include:
Analgesics These drugs help to relieve pain, but they can’t diminish inflammation. For example, acetaminophen (the main component of Tylenol), Ultram (Ultracet), and some strictly regulated painkillers (such as oxycodone).
Non-steroidal anti-inflammatory drugs (NSAIDs). These drugs can relieve pain and diminish inflammation at the same time. Over-the-counter NSAID include ibuprofen (Motrin) and naproxen sodium (Aleve). Some types of NSAID must be obtained by prescription. Oral NSAID may cause stomach upset, and some may increase the risk of heart attack or stroke. Some NSAID can also be rubbed on joints as creams or gels. I have talked about the points for attention in the use of Tylenol and Ibuprofen before. If you are interested, you can go and see it (→ How to use Tylenol and Ibuprofen correctly? | 117 threesome).
Anti-irritant Some kinds of ointment contain menthol or capsaicin. Rubbing these ointments on the skin of painful joints may interfere with the transmission of pain signals, thus achieving the effect of relieving pain.
Antirheumatic drugs. Usually used to treat rheumatoid arthritis, it can slow down or prevent the immune system from attacking joints. Such as methotrexate (Trexall) and hydroxychloroquine.
Specific immune response modulators. It is usually used with anti-rheumatic drugs, which target certain protein molecules involved in immune response. Such as etanercept (Enbrel) and infliximab (Remicade).
Corticosteroids. These drugs, including prednisone and cortisone, can reduce inflammation and suppress the immune system. Corticosteroids can be administered orally or directly into joints.
02
physiotherapy
Physical therapy is helpful for some types of arthritis. Moderate exercise can improve and strengthen the muscles around the joints.
03
operation
If nothing works, it will be operated. Include joint repair or joint replacement.
04
Acupuncture, yoga, Tai Ji Chuan and massage.
There is little data to support these unconventional treatments, but there is no conclusive evidence that they are ineffective. You can look at your own reaction to see if you try.
Total knot
Although there is no convincing data to prove that health products containing glucosamine and chondroitin sulfate are beneficial to joints, many people will buy and take them. Some people think that even if there is no effect from the overall data of the population, it may be useful for individuals because of some factors; Others believe that even if most of the effects come from the placebo effect, the benefits of the placebo effect are real and hard to give up.
However, the latest clinical results and several cases of side effects show that these health care products may also be harmful to health. Manufacturers often change the formula, and the actual ingredients and dosage may be far from what you expected.
Most types of arthritis are chronic and will affect life-long diseases. Knowing all kinds of risk factors (including obesity, sedentary lifestyle, eating habits, joint injuries, smoking, etc.), changing lifestyle and reducing the chance of getting sick are the best preventive measures. It is absolutely unacceptable to put all your hopes on health care products without fundamentally changing your 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 knee osteoarthritis. N Engl J Med 354, 795-808 (2006).
[4] A. D. Sawitzke et al., The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/ chondroitin arthritis intervention trial. Arthritis Rheum 58, 3183-3191 (2008).
[5] A. D. 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] J. A. Roman-Blas et al., Combined Treatment With Chondroitin Sulfate and Glucosamine Sulfate Shows No Superiority Over Placebo for Reduction of Joint Pain and Functional Impai rment in Patients With Knee Osteoarthritis: A Six-Month Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Arthritis & Rheumatology 69, 77-85 (2017).
[7] S. A. Linnebur, O. C. 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] V. J. Navarro et al., Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. Hepatology (Baltimore, Md.) 60, 1399-1408 (2014).
[11] S. Rossi, V. J. Navarro, Herbs and Liver Injury: A Clinical Perspective. Clinical Gastroenterology and Hepatology 12, 1069-1076 (2014).
[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] V. J. Navarro, L. B. Seeff, Liver Injury Induced by Herbal Complementary and Alternative Medicine. Clinics in Liver Disease 17, 715-735 (2013).
[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] H. N. 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] R. K. Murphy et al., Oral Glucosamine Supplements as a Possible Ocular Hypertensive Agent. JAMA Ophthalmology 131, 955-957 (2013).
The pen name is "Cats at My Will" and now lives in Boston, USA. I graduated from the Department of Biological Sciences and Technology in Tsinghua University with a bachelor’s degree, and joined a multinational well-known pharmaceutical company to engage in drug research and development after obtaining a doctorate in the United States. For more than ten years, he led the team to fight diabetes and muscular dystrophy. In recent years, he focused on the research and development of anti-aging drugs. Personal WeChat WeChat official account "Feel Free" to talk to you about medical care.
Shi Juan
END
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Original title: "double 11 carefully buys joint health products: the formula is changed at will, and the effect is not as good as placebo | 117 threesome"
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