Chondroitin Sulfate

What does it do? Chondroitin sulfate consists of repeating chains of molecules called glycosaminoglycans (GAGs). Chondroitin sulfate is a major constituent of cartilage, providing structure, holding water and nutrients, and allowing other molecules to move through cartilage—an important property, as there is no blood supply to cartilage.

In degenerative joint disease, such as osteoarthritis, there is a loss of chondroitin sulfate as the cartilage erodes. Animal studies indicate that chondroitin sulfate may promote healing of bone, which is consistent with the fact that the majority of glycosaminoglycans found in bone consist of chondroitin sulfate.1 Chondroitin sulfate has been shown, in numerous double-blind trials,2 3 4 5 6 7 8 9 to relieve symptoms and possibly slow the progression of, or reverse, osteoarthritis.10

Chondroitin and similar compounds are present in the lining of blood vessels and the urinary bladder. They help prevent abnormal movement of blood, urine, or components across the barrier of the vessel or bladder wall. Part of chondroitin’s role in blood vessels is to prevent excessive blood clotting. However, whether supplements of chondroitin are able to favorably affect blood clotting remains unclear. In addition, chondroitin sulfate may lower blood cholesterol levels.11 Older preliminary research showed that chondroitin sulfate may prevent atherosclerosis in animals and humans and may also prevent heart attacks in people who already have atherosclerosis.12 13 14

Chondroitin sulfate can help form a coating on nasal passages. Perhaps as a result, researchers found that when chondroitin sulfate was sprayed into the nasal passages of a small group of people who snore, the amount of time people spent snoring was reduced about one-third in a double-blind trial.15 No further studies have investigated the effects of oral chondroitin sulfate on snoring.

Chondroitin sulfate is rich in sulfur and is related to glucosamine. GAGs affect how the body processes oxalate—a substance linked to kidney stones. In one study of 40 people with a history of kidney stones, 30 mg twice a day of mixed GAGs reduced urinary oxalate excretion in 15 days—a change that could drop the risk of stone formation.16 However, studies on the effect of GAGs on stone formation in humans have produced inconsistent results.17

Where is it found? The only significant food source of chondroitin sulfate is animal cartilage.

Chondroitin sulfate has been used in connection with the following conditions (refer to the individual health concern for complete information):

Rating Health Concerns
3Stars Osteoarthritis
2Stars Wound healing (topical)
1Star Atherosclerosis
Heart attack
High cholesterol
Kidney stones
Sprains and strains
Wound healing (oral)
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

Who is likely to be deficient? Because the body makes chondroitin, the possibility of a dietary deficiency remains uncertain. Nevertheless, chondroitin sulfate may be reduced in joint cartilage affected by osteoarthritis and possibly other forms of arthritis.

How much is usually taken? For atherosclerosis, researchers have sometimes started therapy using very high amounts, such as 5 grams twice per day with meals, lowering the amount to 500 mg three times per day after a few months. Before taking such high amounts, people should consult a doctor. For osteoarthritis, a typical level is 400 mg three times per day. Oral chondroitin sulfate is rapidly absorbed in humans when it is dissolved in water prior to ingestion. Approximately 12% of chondroitin sulfate taken by mouth becomes available to the joint tissues from the blood.18

Are there any side effects or interactions? Nausea may occur at intakes greater than 10 grams per day. No other adverse effects have been reported.

One doctor has raised a concern that chondroitin sulfate should not be used by men with prostate cancer. This concern is based upon two studies. In one, the concentration of chondroitin sulfate was found to be higher in cancerous prostate tissue as compared to normal prostate tissue.19 In the other study, it was shown that higher concentrations of chondroitin sulfate in the tissue surrounding a cancerous prostate tumor predict a higher rate of recurrence of the cancer after surgery.20 However, no studies to date have addressed the question of whether taking chondroitin sulfate supplements could promote the development of prostate cancer. Simply because a substance is present in or around cancerous tissue does not by itself suggest that that substance is causing the cancer. For example, calcium is a component of atherosclerotic plaques that harden the arteries; however, there is no evidence that taking calcium supplements causes atherosclerosis. To provide meaningful information, further studies would need to track the incidence of prostate cancer in men taking chondroitin supplements. Until then, most nutritionally-oriented doctors remain unconcerned about this issue.

It is not known whether taking glucosamine sulfate and chondroitin sulfate in combination is a more effective treatment for osteoarthritis than taking either one by itself.

At the time of writing, there were no well-known drug interactions with chondroitin sulfate.

References:

1. Moss M, Kruger GO, Reynolds DC. The effect of chondroitin sulfate on bone healing. Oral Surg Oral Med Oral Pathol 1965;20:795–801.

2. Rovetta G. Galactosaminoglycuronoglycan sulfate (Matrix) in therapy of tibiofibular osteoarthritis of the knee. Drugs Exptl Clin Res 1991;17:53–7.

3. Mazieres B, Loyau G, Menkes CJ, et al. Le chondroitine sulfate dans le traitement de la gonarthrose et de la coxarthrose. Rev Rhum Mal Steoartic 1992;59:466–72 [in French].

4. Uebelhart D, Chantraine A. Efficacité clinique du sulfate de chondroitine dans la gonarthrose: étude randomisée en doublée-insu versus placébo. Rev Rhum 1994;10:692 [in French]

5. Morreale P, Manopulo P, Galati M, et al. Comparison of the anti-inflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis. J Rheumatol 1996;23:1385–91.

6. Bourgeois P, Chales G, Dehais J, et al. Efficacy and tolerability of chondroitin sulfate 1200 mg/day vs chondroitin sulfate 3 x 400 mg/day vs placebo. Osteoarthritis Cartilage 1998;6(Supplement A):25–30.

7. Verbruggen G, Goemaere S, Veys EM. Chondroitin sulfate: S/DMOAD (structure/disease modifying anti-osteoarthritis drug) in the treatment of finder joint OA. Osteoarthritis Cartilage 1998;6(Supplement A):37–8.

8. Bucsi L, Poór G. Efficacy and tolerability of oral chondroitin sulfate as a symptomatic slow-acting drug for osteoarthritis (SYSADOA) in the treatment of knee osteoarthritis. Osteoarthritis Cartilage 1998;6(Supplement A):31–6.

9. Uebelhart D, Thonar EJ-MA, Delmas PD, et al. Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study. Osteoarthritis Cartilage 1998;6(Supplement A):39–46.

10. Kerzberg EM, Roldan EJA, Castelli G, Huberman ED. Combination of glycosaminoglycans and acetylsalicylic acid in knee osteoarthritis. Scand J Rheumatol 1987;16:377–380.

11. Izuka K, Murata K, Nakazawa K, et al. Effects of chondroitin sulfates on serum lipids and hexosamines in atherosclerotic patients: with special reference to thrombus formation time. Jpn Heart J 1968;9:453–60.

12. Morrison LM, Bajwa GS, Alfin-Slater RB, Ershoff BH. Prevention of vascular lesions by chondroitin sulfate A in the coronary artery and aorta of rats induced by a hypervitaminosis D, cholesterol-containing diet. Atherosclerosis 1972;16:105–18.

13. Morrison LM, Branwood AW, Ershoff BH, et al. The prevention of coronary arteriosclerotic heart disease with chondroitin sulfate A: preliminary report. Exp Med Surg 1969;27:278–89.

14. Morrison LM, Enrick NL. Coronary heart disease: Reduction of death rate by chondroitin sulfate A. Angiology 1973;24:269–82.

15. Lenclud C, Chapelle P, van Mylem A, et al. Effects of chondroitin sulfate on snoring characteristics: a pilot study. Curr Ther Res 1998;59:234–43.

16. Baggio B, Gambaro G, Marchini F, et al. Correction of erythrocyte abnormalities in idiopathic calcium-oxalate nephrolithiasis and reduction of urinary oxalate by oral glycosaminoglycans. Lancet 1991;338:403–5.

17. Cao LC, Boevé ER, de Bruihn WC, et al. Glycosaminoglycans and semisynthetic sulfated polysaccharides: an overview of their potential application in treatment of patients with urolithiasis. Urology 1997;50:173–83 [review].

18. Ronca F, Palmieri L, Panicucci P, Ronca G. Anti-inflammatory activity of chondroitin sulfate. Osteoarthritis Cartilage 1998;6(Supplement A):14–21.

19. De Klerk DP, Lee DV, Human HJ. Glycosaminoglycans of human prostatic cancer. J Urol 1984;131:1008–12.

20. Ricciardelli C, Quinn DI, Raymond WA, et al. Elevated levels of peritumoral chondroitin sulfate are predictive of poor prognosis in patients treated by radical prostatectomy for early-stage prostate cancer. Cancer Res 1999;59:2324–8.