Disc NutritionOverview of Intervertebral Spinal Disc Nutrition Overview of the Healing Properties for Degenerated or Damaged Discs and Cartilage Glucosamine SulfatePerna Canaliculus [pure chondroitin sulfate — the green lipped mussel source of GAG] Glucosamine sulfate and chondroitin sulfate [a form of glycosaminoglycan – GAG] are naturally occurring substances that are essential for cartilage maintenance, as well as necessary for cartilage regeneration.Together, they help chondrocytes within cartilage form new cartilage. Healing Properties for Degenerated DiscsGlucosamine SulfateChondroitin Sulfate (Perna Canaliculus)Chondroitin Sulfate: Injection or OralDrugs Harmful to Disc CartilageChiropractic and Glucosamine for OsteoarthritisLoss of Glycosaminoglycan Leads to Disc Degeneration The amount of proteoglycans formed depends upon the amount of glucosamine present. The more glucosamine available, the more proteoglycans can be made. (11) Glucosamine forms proteoglycans that are found within the joints while chondroitin sulfates act like “magnets” that attract fluid into the proteoglycan molecules. This is important because the fluid acts as a shock absorber and sweeps nutrients into the cartilage. (8) They are both tied to the sulfate compound. In a dog study, it was found that sulfate and glycosaminoglycan act as chondroprotective agents. (30) Sulfur is an essential nutrient for joint tissue as it stabilizes the connective tissue matrix of cartilage, tendons, and ligaments. It inhibits the enzymes that lead to cartilage destruction in osteoarthritis. Healthy people have low serum sulfate levels; osteoarthritic people have even lower levels. Arthritic persons are commonly deficient in sulfur. (29) In the posterior anulus and nucleus in degenerative disc disease, chondroitin is undersulfated. (31) Perna Canaliculus [*from green lipped mussel (shellfish); those allergic to shellfish should be cautious] is pure chondroitin sulfate which is one form of glycosaminoglycan. It is reportedly the “single most effective” item for relief of joint pain and inflammation as occurs with disc herniations, osteoarthritis, and rheumatoid arthritis. may decrease (or eliminate) pain of rheumatiod and osteoarthritismay help restore mobility to degenerated joints/cartilagemay decrease joint distortion from degeneration of joint tissue Perna canaliculus extract has proven to be the single most effective preparation ever encountered for the treatment of osteo- and rheumatoid arthritis. Perna canaliculus extract did have genuine anti-inflammatory effects. (17) Further, one of the most popular and effective substances used by doctors in Europe for arthritis is chondroitin sulfate A (CSA). CSA is naturally found in bones, cartilage, tendons, ligaments, vertebral discs as well as in many plants. (17) In one study, 77% of those taking CSA reported reduced inflammation — over 42% higher than those receiving NSAIDs. It repairs degraded bones,increases the absorption and replacement of calcium,diminishes the disease andbegins rebuilding the damaged area with none of the health risks of NSAIDs. SPECIFICALLY... GLUCOSAMINE SULFATE may prevent degeneration & promote regeneration of cartilage. improves mobility and relieves pain with significantly less side effects than NSAIDshas good tolerabilitymaintains its good benefits even if there is an interruption in taking them compared with drug therapy which relieves pain only while taking the drug Glucosamine sulfate (GS) is a naturally occurring part of joint cartilage and forerunner for and stimulant of proteoglycan synthesis and the making of GAG which is necessary for development of the white fibrocartilage of the disc. Unlike NSAIDs which relieve symptoms of and, over time, accelerate the destruction of, degenerative joint and disc disease, glucosamine has been shown in experiments to slow the progression of the degenerative disease and promote repair of affected cartilage: Two similar yet separate experiments (6,7) were conducted and gained similar results: patients receiving glucosamine sulfate improved by 71% compared to a placebo group. (6) A comparison (8) of 2 groups —one receiving ibuprofen and one GS three times per day (total of 1500 mg) for 30 days—showed that the GS group reported less pain on rest, standing, and exercise. The GS group’s improvement was more pronounced, lasting for a period of 6 to 12 weeks after the treatment ended. In a double-blind study (9) of people suffering from osteoarthritis of the knees compared a placebo group to a GS group. The GS group showed significant reduction in pain, joint tenderness, and swelling treated with 1500 mg GS daily. Findings by electron micrographs of cartilage of persons receiving GS compared to a placebo (10) show: Placebo results - typical of osteoarthritis; GS results - more similar to healthy cartilage. GS is able to stimulate proteoglycan synthesis by chondrocytes and has mild anti-inflammatory properties. In a clinical trial, GS was tested against ibuprofen. 35% of the ibuprofen group complained of adverse effects throughout the treatment, with seven dropping out of the study. Only six of the 100 patients in the GS group experienced adverse effects. Therefore, GS was as effective as ibuprofen. (18) The absorption rate for GS is about 98%. (24,25) GS is extremely non-toxic, and its therapeutic margin is 10-30 times better than NSAIDs (26) When taken orally, it is more effective than placebo and at least as effective as NSAIDs in relieving the symptoms of osteoarthritis. (28) 2% of 1500 patients were unable to tolerate GS: peptic ulcer and diuretic use were associated w/increased risk of side effects, most commonly: gastric upset (3.5%), heartburn (2.7%), diarrhea and nausea (1%). (27) NOTE: GLUCOSAMINE SULFATE IS PREFERRED OVER GLUCOSAMINE HCl. (29)GS is the preferred form of glucosamine (over GS HCl, for example) and the only form of glucosamine subjected to over 300 scientific investigations & 20 double-blind studies. (29) GS HCl lacks the sulfur compound which is an essential nutrient for joint tissue. (29)The sulfur compound restrains the enzymes which lead to cartilage destruction in osteoarthritis. (29)GS has many clinical studies proving its effectiveness; GS HCl lacks such studies. (29) AND SPECIFICALLY...CHONDROITIN SULFATE [glycosaminoglycan (GAG)] may stop destruction of & even enhance the regeneration of cartilage. Supplemented chondroitin sulfates work like naturally occurring chondroitins found in cartilage: stop enzyme starvation of cartilage and build proteoglycans, glycosaminoglycans, and collagen, the building blocks for healthy new cartilage. (13)protect existing cartilage from premature breakdown by inhibiting the action of certain “cartilage chewing” enzymes. (12)work synergistically with glucosamine. (14) Results of loss or low proteoglycan or glycosaminoglycan content: The central event in osteoarthritis and degenerative disc disease is the loss of the proteoglycans from the disc. (32)Low GAG precedes degenerative disc disease; injured and adjacent discs show less GAG and increased collagen. (33)Osteodegenerative arthritis shows increased release of GAG. (34)Arthrosis shows a loss of glycosaminoglycan. (35) Busci reports that OSTEOARTHRITIS CAN BE REVERSED by chondroprotective agents - GAGs - if use of analgesics (aspirin, non-steroidal drugs) is minimal. (1) Further, he states that oral administration of GAGs is better than injection because constant higher levels can be maintained in the bloodstream instead of short periods of elevation by shots. Cole, Ghosh & Taylor wrote that mature beagle dogs, when given GAG over a 26 wk period, showed cartilage improvement. (2) These findings were the first to suggest that GAG administration might be of value in management of degenerative disc disease. A 50% loss of GAG from rabbit articular cartilage when arthritis of the joint was reported in one study. This caused the cartilage matrix to be less capable of restoring the proteoglycan content of the cartilage and resulted in loss of joint stiffness and resistance to the compression. (3) In rabbits with osteoarthritis of the knee, injection of sulfated GAG inhibited enzymes that destroy cartilage and promoted repair of the defects. GAG had been found to increase proliferation of the hyaline cartilage of the hip joint in mice and the femoral condyles, femur and tibia of rabbits. Furthermore, Puhl and Dustmann induced regeneration of damaged cartilage in rabbits. (5) 120 patients suffering from osteoarthritis of the knees and hips were either given oral chondroitin sulfates or a placebo. After three months, the group given the oral chondroitin in the morning and the evening reported a reduction in pain and pain movement. There were no reported side effects. In addition, there was a 60-day carry-over effect when administration was stopped. Results appeared within 2 to 8 weeks. (16) 50 patients suffering from osteoarthritis of the knee were given oral chondroitin sulfate or a pain medication. Cartilage tissue samples were taken after three months of therapy. Results showed that the chondroitin group had repaired the cartilage to a significant degree. (15) Eismont showed circulation into the disc when he reported that antibiotics reach the nucleus pulposus following 8 hours of intramuscular administration. (4) Dogs given GAG (36) showed less osteophyte formation,less disc space narrowing,better disc injury repair, andprevention of experimental disc degeneration. Trentham et al 19 (of Harvard University) report in Science on a new way to help rheumatoid arthritis (RA) sufferers: oral tolerization. This procedure involved a liquid solution of cartilage/collagen and orange juice. Dr. Trentham states that this seems to “teach” the body’s immune system to stop inflaming the tissue around the joints. This appears to arrest the progress of RA. In a three month trial, 28 patients — all of whom were taken off all other drugs — got relief from RA; 4 went into remission. Thirty-one patients on a placebo became worse. Basically, this study finds that the immune system can be helped to relieve joint and disc pain and inflammation with cartilage. “Dr. Arthur Grayzel, senior vice president of medical affairs of the Arthritis Foundation, said he was quite encouraged by the [Trentham] study” that such a solution may have the potential to halt rheumatoid arthritis. (20) 42 patients with osteoarthritis (OA) of the knee were given 800 mg of oral chondroitin sulfate. The chondroitin sulfate patients showed less pain, better mobility, stabilization of joint space narrowing whereas the placebo patients' OA progressed. (37) A 6 month trial compared 800 mg of chondroitin sulfate and a placebo given to 80 patients with OA of the knee. Results showed that the patients had reduced use of pain medications and walked faster. (38) CHONDROITIN SULFATE—A discussion of the oral and injected forms. Pipitone VR: Chondroprotection with chondroitin sulfate. Drugs in Experimental and Clinical Research 1991;17(1):3-7 50 patients with ODA of the knee were given 8-1200 mg of chondroitin sulfate daily or 500 mg of pain medicationIn 3 months, biopsy showed repair of the patients taking chondroitin sulfate. Olivero U et al: Effects of treatment with matrix on elderly people with chronic articular degeneration. Drugs in Experimental and Clinical Research 1991;17(1):45-51 120 ODA of hip and knee patients given chondroitin sulfate or placebo3 months, chondroitin sulfate patients had reduced pain.Take am and pm.Results in 2-8 weeks. Bucsi L, Poor G: Efficacy and tolerability of oral chrondroitin sulfate as a symptomatic slow-acting drug for osteoarthritis in the treatment of knee osteoarthritis. Osteoarthritis and Cartilage 1998;6(A):31-6 6 month trial of 800 mg chondroitin sulfate versus placebo80 patients with osteoarthritis of kneeReduced pain medication and walked faster. Ronca F: Anti-inflammatory activity of chondroitin sulfate. Osteoarthritis and Cartilage 1998;68(A):14-21[Iovu I et al: Anti-inflammatory activitiy of chondroitin sulfate. Osteoarthritis Cartilage 2008; 16(supp3):S14-8] 24 patients with osteoarthritisGiven 800 mg chondroitin sulfate a day for 10 daysJoint aspiration showed decreased phospholipase A2, increased hyaluronic acid concentrationDecreased collagen enzyme breakdownOral chondroitin sulfate reaches target tissues in less than 2 weeks Uebelhart D: Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study. Osteoarthritis and Cartilage.1998;6(A):39-46 42 patients with osteoarthritis of kneeGiven 800 mg oral chondroitin sulfate a dayChondroitin patients showed less pain, better mobility, stabilization of joint space narrowingPlacebo patients progressed Bucci LR: Reversal of osteoarthritis by nutritional intervention. ACA J Chiro 11/90 Glycosaminoglycan is chondroprotective if aspirin and NSAIDS are minimalOral administration is best as serum level is constant with GAG Shostak NA et al: Low back pain in spinal osteochondrosis: experience of treatment with chondroprotective drug. Terapevtichjeskii Arkhiv 2002; 74(8):67-69 30 patients with low back pain (mean age 51)given chondroitin sulfate (drug name: structum) 1g/day for 24 weeks73% of patients showed pain relief and improved spinal functionincluded in treatment of low back pain as chondroprotective drug Mazurov, VI; Belyaeva, IB: Structum in combined treatment of low back pain syndrome. TERAPEVTICHESKII ARKHIV 2004; 76 (8):68-71 Aim. To assess duration of a clinical response and tolerance of structum in patients with low back pain (LBP) and co-morbid cardiovascular disease.Results. To the end of the first treatment months structum significantly relieved pain intensity, spinal motility, increased exercise tolerance. Excellent and good response to structum were observed in 71% patients, noresponse was in 29%. Tolerance of the drug was good in 23 (92%) patients. The effect persisted for 3 months. CHD characteristics did not change while arterial pressure went down noticibly. DRUGS HARMFUL TO DISCS: Damaging Factors of Cartilage and Glycosaminoglycan Processing ANTIDEPRESSANTS ENDANGER BONE and JOINTS Ray: Cyclic antidepressants may increase hip fracture risk. J of Manipulative Medicine (12/91):46 STEROIDS CAUSE BONE LOSS, INCREASE FRACTURE RISK Bockman RS et al: Steroid induced osteoporosis. Ortho Clin of N Amer 21(1):97Fries: Prednisone greatly increases fracture risk. J of Musculoskeletal Med (6/92):16Mitchell: Steroid use causes osteo-degenerative arthritic hips. Radiology 1987; 62(3):709Fessler: [Chronic steroid use leads to epidural lipomatosis.] Spine 1992; 17(2) NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs) DEPRESS GAG PRODUCTION and SYNTHESIS, DESTROY CARTILAGE Yoo: Suppression of proteoglycan synthesis in chondrocyte cultures derived from canine intervertebral disc. Spine 17(2):221-224Newman: Acetabular bone destruction due to NSAIDs. Lancet 1985; pgs. 11-14VanDerKraan et al: High susceptibility of human articular cartilage glycosaminoglycan synthesis to changes in inorganic sulfate availability. J of Ortho Research 1990; 8(4):565-71Whittaker: Arthritis drugs actually cause cartilage destruction! Health & Healing 3(6):1-4 SALICYLATES (aspirin) DEPLETE GAG SYNTHESIS in DISC, LEAD to OSTEOARTHRITIS, WEAKEN BONE Palmoski: Arthritis and Rheumatism 1985; 28:548;DeVries: Arthritis and Rheumatism 1985; 28:922-9;Laan: Arthritis and sciatica drug weakens vertebrae. Backletter 1994;9(2):22 CHIROPRACTIC & GLUCOSAMINE SULFATE FOR OSTEOARTHRITIS From Gottlieb MC: Conservative Management of Spinal Osteoarthritis with Glucosamine Sulfate and Chiropractic Treatment. JMPT 1997; 20(6):400-14The rationales for using NSAIDs in the treatment of osteoarthritis is controversial and openly contested. Given the detrimental effects of NSAIDs on joints and other organs, their use should be discouraged and their classification as a first choice conservative treatment should be abolished. A truly effective and conservative approach to the treatment of osteoarthritis should include chiropractic manipulation, essential nutrient supplementation, exogenous administration of glucosamine sulfate and rehabilitative stretches and exercises to maintain joint function. Because there is no correlation between pain levels and the extent of degeneration detected by radiographic or physical examination, conservative treatment should be initiated and sustained based on functional, objective findings and not strictly on how the patient feels. The use of NSAIDs should be limited to the treatment of gross inflammation and analgesics should only be used in the short-term when absolutely necessary for pain palliation. The present conservative approach could lead not only to a better quality of life but also to the saving of health care dollars by reducing the iatrogenic morbidity and mortality associated with NSAID use. LOSS OF GLYCOSAMINOGLYCAN FROM THE NUCLEUS PULPOSUS LEADS TO INTERNAL STRESS CHANGES IN THE DISC LEADING TO DEGENERATION Boxberger, JI; Sen, S; Yerramalli, CS; Elliott, DM: Nucleus pulposus glycosaminoglycan content is correlated with axial mechanics in rat lumbar motion segments. JOURNAL OF ORTHOPAEDIC RESEARCH 2006; 24 (9):906-1915 The unique biochemical composition and structure of the intervertebral disc allow it to support load, permit motion, and dissipate energy. With degeneration, both the biochemical composition and mechanical behavior of the disc are drastically altered, yet quantitative relationships between the biochemical changes and overall motion segment mechanics are lacking. This study showed that moderate decreases in nucleus glycosaminoglycan content consistent with early human degeneration affect overall mechanical function of the disc. These decreases may expose the disc to altered internal stress and strain patterns, thus contributing through mechanical or biological mechanisms to the degenerative cascade. Consider a nutritional approach to your spinal condition. Contact Cox Chiropractic Medicine INC to discuss what may be appropriate for your disc condition. References: Busci LR: Reversal of osteoarthritis by nutritional intervention. ACA J of Chiropractic (11/90): 69-72.Cole TC, Ghosh P, Taylor TKF: Arteparon modifies proteoglycan turnover in the intervertebral disc. British J of Bone and Joint Surgery 1988; 70B(1):166 .Lowther DA: The effect of compression and tension on the behavior of connective tissues. Aspects of Manipulative Therapy, Churchill Livinstone 1985:16-21.Eismont FL et al: Antibiotic penetration into rabbit nucleus pulposus. Spine 12(3): 254-6.Wilhelmi, Maier: Experimental studies on the effects of drugs on cartilage. Ciba Geigy Documenta Geigy, Basle, Switzerland, 1982.D’Ambrosio E et al: Glucosamine sulfate: a controlled clinical investigation in arthrosis. Pharmatherapeutica 1981;2:504-8Crolle G, D’Este E: Glucosamine sulphate for the management of arthrosis: a controlled clinical investigation. Curr Med Res Opin 1980;7:104-9Vaz: Double-blind clinical evaluation of relative efficacy of glucosamine sulphate in the management of osteoarthritis of knee in out-patients. Curr Med Res Opin ‘82;8:145-9.Pujalte JM et al: Double-blind clinical evaluation of oral glucosamine sulphate in the basic treatment of osteoarthritis.” Curr Med Res Opin 1980;7:110-14Drovanti A et al: Therapeutic activity of oral glucosamine sulfate in osteoarthritis: a placebo-controlled, double-blind investigation. Clin Ther 1980;3:260-72Benedikt H: Glycosaminoglycans and derivatives for treatment of arthritis. Chiropractic Products 1997; May: 92-95Soldani G, Romangnoli J: Experiment and clinical pharmacology of glycosaminoglycan (GAGS). Drugs in Experimental and Clinical Research 1991; 18(1):81-85.Rovetta G: Galactosaminoglycuronglycan sulphate (matrix) in therapy of tibiofibular osteoarthrosis of the knee. Drugs in Experimental and Clin Research 1991; 18(1):53-57.Pruden JF, Balassa LL: The biological activity of bovine cartilage preparations. Seminars in Arthritis and Rheumatism 1974; 3(4):287+.Pipitone VR: Chondroprotection with chondroitin sulfate. Drugs in Experimental and Clinical Research 1991; 17(1):3-7.Olivero U et al: Effects of treatment with matrix on elderly people with chronic articular degeneration. Drugs in Experimental and Clincal Research 1991; 17(1):45-51.Wellburn M: Shotgun approach may quell arthritis, rheumatism, and back pain! J of Arthritis Research 1994; Sept:15-22.Muller-Fassender HM et al: Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis and Cartilage 1994; 2(1):61-69.Trentham DE et al: Effects of oral administration of Type II collagen on rheumatoid arthritis. Science 1993; 261: .“Chicken bone protein aids arthritis sufferers, scientist says.” Dallas Morning News 24 September 1993:sec. A, p. 6.Theodosakis J, Adderly B, Fox B: The Arthritis Cure. New York: St. Martin’s Press, 1997: 55.Sullivan MX, Hess WC: Cystine content of finger nails in arthritis. JBJS 1935; 16:185-8.Senturia BD: Results of treatment of chronic arthritis and rheumatoid conditions with colloidal sulphur. JBJS 1934; 16:119-25.Setnikar I et al: Pharmacokinetics of glucosamine in man. Arzneim Forsch 1993; 43(1):1109-13.Setnikar I et al: Pharmacokinetics of glucosamine in the dog and man. Arzneim Forsch 1986; 36(4):729-35.Arzneim Forsch 1991; 41:542-5Pharmatherapeutica 1982; 3:157-68Reicht A, Forster KK, FIscher M et al: Efficacy and safety of intramuscular glucosamine sulfate in osteoarthritis of the knee. Arzneimittle-Foschung 1994; 44(1):75-80Murray MT: Irrefutable evidence: glucosamine sulfate proven superior over other forms of glucosamine and chondroitin sulfate. Vital Communications, Inc.Aitman: Arthritis and Rheumatism 1991; 31(1)Hutton et al: Analysis of chondroitin sulfate in lumbar intervertebral discs at two different stages of degneration as assessed by discogram. J of Spinal Disorders 1997; 10(1)Bishop PB, Bray RC: Abnormal joint mechanics and the proteoglycan composition of normal and healing rabbit medial collateral ligament. JMPT 1994; 16(5):300-5Melrose, Ghosh, Taylor, Osti, Vernon-Roberts: A longitudinal study of the matrix changes induced in the intervertebral disc by surgical damage to the anulus fibrosus. Journal of Orthopedic Research, vol. 10Ratliffe:Increased release of matrix componenets from articular cartilage in experimental canine osteoarthritis. J of Orthopedic Research, vol. 10Olsen: Glycosaminoglycans in patellar cartilage. Acta Orthop Scand 1989; 60(1):23-25International Society for the Study of the Lumbar Spine. Proceedings published by Saunders. 1990:13.Uebelhart D: Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study. Osteoarthritis and Cartilage 1998; 68(A):39-46Busci L, Poor, G:Efficacy and tolerability of oral chondroitin sulfate as symptomatic slow-acting drug for osteoarthritis in the treatment of knee osteoarthritis. Osteoarthritis and Cartilage 1998; 68(A):14-21 "This information and website content is not intended to diagnose, guarantee results, or recommend specific treatment or activity. It is designed to educate and inform only. Please consult your physician for a thorough examination leading to a diagnosis and well-planned treatment strategy. See more details on the DISCLAIMER page."