Study: Glucosamine and Chondroitin Sulfate Fail to Relieve Arthritis Pain

The media was all abuzz last week over the new study suggesting that glucosamine and chondroitin sulfate do not relieve arthritis pain. It makes a great news story, but the study was deeply flawed.

First the obvious problems that even the media reported:

In a journal editorial, Dr. Marc Hochberg of the University of Maryland noted the study's limitations: a high dropout rate (20 percent) and a whopping 60 percent who said the dummy pills made them feel better — double the usual placebo effect. Hochberg has received consulting fees from Pfizer Inc., which makes Celebrex, and Merck & Co., which made Vioxx.

Clegg and 10 other researchers in the study reported receiving fees or grant support from Pfizer or McNeil Consumer & Specialty Pharmaceuticals, which makes Tylenol.

So, biggest issue: possible ulterior motives for those that receive funding from pharmaceutical companies who would have a financial interest in the study's failure to confirm positive benefits for supplements. Second biggest issue: self-reporting that allows 60 percent of respondents to experience the placebo effect--soemthing is very wrong here. Third issue: 20 percent drop-out rate is very high.

However, the number one, throw-this-study-out-the-window problem: it is not clear that they used glucosamine sulfate rather than the cheaper and more widely available glucosamine hcl. Only the sulfate form of glucosamine has ever been shown to be effective.

This is from an article available on this site about supplements for joing health (emphasis added):

GLUCOSAMINE is an amino-sugar that is a key component of mucopolysaccharides (a complex polysaccharide group [sugar] with an amino acid group attached, occurring primarily in joints) that diminishes as we age. Some studies show new connective tissue in as little as 30 days after taking the supplement. Only the sulfate form of glucosamine has been shown to increase the rate of cartilage repair and the reduction of tissue loss in joint diseases. Glucosamine hydrochloride, by itself, has not produced sustained benefits in multiple studies. Until more is known, the sulfate variation is the best choice.

There has been some concern that glucosamine impairs blood sugar metabolism, but according to a review of two three-year studies, glucosamine does not reduce insulin sensitivity or produce any other abnormalities in glucose metabolism. There is also no evidence that glucosamine increases cholesterol levels. However, acetaminophen use seems to inhibit the benefits of glucoasmine sulfate.

1. Current Opinion in Rheumatology. 2003 Sep; 15(5): 651-5.
2. Journal of Family Practice. 2003 Aug: 52(8); 645-7.
3. Archives of Internal Medicine. 2003 Jul 14; 163(13): 1514-22.
4. Journal of Arthroplasty. 2003 Apr; 18(3 Suppl 1): 5-9.
5. Metabolism. 2001 Jul; 50(7): 767-70.

There is no reason to stop taking a glucosamine sulfate/chondroitin sulfate supplement at this point. This study has too many flaws to be taken seriously.

UPDATE: Here is a doctor's take on the arthritis study. More reason to ignore it and move on with our lives as though it never happened.

As If You NEED Another Reason to Stay in Shape

From Reuters:

Health-care spending is outpacing the growth of the American economy and will consume 20 percent of U.S. gross domestic product by 2015, the U.S. Centers for Medicare and Medicaid Services (CMS) said on Wednesday.

By comparison, health-care spending accounted for about 16 percent of U.S. GDP in 2004, the latest year for which data are available, according to a study by CMS economists published in the journal Health Affairs.

National health care spending will grow by an average 7.2 percent annually over the coming decade, the study said. That would be slower than in recent years but still 2.1 percent faster than GDP growth, it said.

All this money spent on health care could be avoided with a healthy diet, adequate exercise, and a little willpower. There is no reason to spend all our money curing illnesses that can be avoided in most instances.

McDonald's Faces Lawsuits Over French Fries

From The Guardian (UK):

McDonald's faces at least three lawsuits claiming it misled the public after it acknowledged last week that milk and wheat ingredients are used to flavour its fries.

One claimant, Debra Moffatt, is seeking unspecified damages in a lawsuit filed in Chicago. Her lawyer, Thomas Pakenas, said his client has celiac disease, which causes gastrointestinal symptoms set off by eating gluten, a protein found in wheat.

Jack Daly, a McDonald's senior vice president, said in a statement the company had not yet reviewed the case and is testing its fries for gluten through a food allergy research programme.

Just another reason to stay away from McDonald's. The food is not healthy, and they have not disclosed the actual ingredients in their products.

As Yahoo reports, this is another in a long line of incidents where McDonald's has misled customers:

The company has felt the heat over its fries before. McDonald's paid $10 million in 2002 to settle a lawsuit by vegetarian groups after it was disclosed that its fries were being cooked in beef-flavored oil more than a decade after insisting that it was starting to use pure vegetable oil.

It paid another $8.5 million in February 2005 to settle a suit by a nonprofit advocacy group that accused the company of misleading consumers by announcing that it was changing its cooking oil, then delaying the switch.

McDonald's was also forced to admit recently that their fries have more artery-clogging, diabetes-inducing, cancer-causing trans fats than disclosed previosuly:

McDonald's french fries just got fatter — by nutritional measurement. The world's largest restaurant chain said Wednesday its fries contain a third more trans fats than it previously knew, citing results of a new testing method it began using in December.

That means the level of potentially artery-clogging trans fat in a portion of large fries is eight grams, up from six, with total fat increasing to 30 grams from 25.

Bottom line: Don't eat at McDonald's.

Keep Taking Your Calcium

News reports last week suggested that new findings from the Women's Health Initiative (to be published in the New England Journal of Medicine) show little benefit from taking calcium supplements. The findings are based on a longitudinal study of women's diet and hormone therapy.

The seven-year study of 36,282 women ages 50 to 79 gave half the participants 1,000 milligrams of calcium and 400 units of vitamin D, while the other half took dummy pills.

However, many were also taking their own supplements before the research began, and they were allowed to keep doing so, whether they were assigned to the test group or the comparison group. These extra supplements may have helped the women stay healthy but ironically diluted the findings, since any benefit is harder to show against a backdrop of fewer fractures. Also, women in the study were taking hormone pills, likely further cutting the number of fractures.

The study showed better hip bone density in the group given supplements, but they ranked no better statistically in avoiding fractures of all kinds.

However, some benefit seemed apparent. Women over age 60 reduced their chances of hip fracture by 21 percent with the supplements. And those who took their supplements most regularly lowered their risk by 29 percent.

As stated, there is some benefit to taking the supplements, especially for women over sixty. But the lack of concrete numbers is not an indication of the efficacy of calcium supplementation.

Because the study is longitudinal, the researchers relied on self-reporting, which is notoriously inaccurate. In addition, there is no mention of controlling for other lifestyle factors, such as diet, exercise, smoking, drinking, and so on. All of these factors might influence the positive effects of taking additional calcium.

So here is the bottom line: Keep taking your calcium. Until there is a double-bind, placebo-controlled study that refutes older information about the benefits of calcium supplementation, there is no reason to stop taking it.

Weight Set-Point May be Genetic

A study of primates lasting more than two-decades--conducted by Barbara Hansen of the University of South Florida, Tampa--found that genetic differences might play a role in allowing some primates to be thin and others to get fat, even when fed an identical diet.

Other monkeys, when forced to slim down by as much as 25 percent, regained the weight they'd lost once caloric restrictions were lifted — regardless of whether they'd been on a diet for two months or two years, Hansen said.

"The price of leanness is eternal vigilance," said Hansen, who presented her research Friday at the annual meeting of the American Association for the Advancement of Science.

Hansen has long studied the effects of calorie restriction in roughly 300 rhesus monkeys.

Cutting calories can pay off when it comes to longevity: Monkeys fed 30 percent less over the long term extended their lifetimes to 30 years from an average of 23 years, Hansen said.

The slimmer monkeys staved off the diabetes, high cholesterol, hypertension and other weight-related ailments that typically shortened the lives of their heavier peers, she added.

Okay, before you start blaming your genetics for the spare tire around your waist, we need to take account of the fact that biology is not destiny. We cannot simply treat the body as a mechanical object. We have interiors, too, and that gives us some choice. We have free will--we can monitor calories, get exercise, eat healthier foods, replace stress eating with meditation, and so on.

So what if you need to keep a food log for the rest of your life? Once you've done it for a few weeks, it simply becomes a part of your day. Would you rather spend a few minues each day recording everything you eat, or would you rather die of a heart attack at 54?

If you have issues with weight, you might need to be diligent about monitoring your diet, but that is a small price to pay for health and well-being.

Heart and Cancer Risk Not Reduced by Lowfat Diet in Older Women

I've been preaching the health benefits of fat for years, and now it seems the science is starting to catch up with what many of us have known for years. It's not the amount of fat that one consumes in the diet--it's the quality.

Ross Prentice and colleagues at the Fred Hutchinson Cancer Research Center in Seattle, Washington, tracked 50,000 post-menopausal women over eight years. Half the women ate low-fat diets high in fruits, vegetables and grains. The other half ate their usual diets. The researchers found no significant difference in disease risk. "Our study," Prentice says, "even though it has yet to yield the dramatic results that some might have hoped for, does include some trends toward positive health benefits."

The study finds that some women who ate high fat diets before the study - but switched to low fat during the study - showed a reduction in risk of breast cancer. Prentice says with heart disease, the type of fat consumed made a difference. "Among the women who make larger reductions in saturated and trans-fat, we saw trends toward reduction in heart disease," he notes.

Emphasis added. The study will be published in the Journal of the American Medical Association.

Here is an article with some information on healthy fats. In the coming weeks, I will post a three-part article with everything you need to know about fat.

Study: Drinking Coffee Reduces Type-II Diabetes Risk

If drinking coffee will reduce type-II diabetes risk, my risk should be in negative numbers.

The study, by Dr. Rob M. van Dam and colleagues at the Harvard School of Public Health in Boston, Massachusetts, is part of a new Nurses Health Study II--a prospective cohort study. The study will be published in the February issue of Diabetes Care, a journal of the American Diabetes Association.

Researchers followed 88,259 U.S. women ages 26 to 46 without diagnosed diabetes and monitored their consumption of coffee and other caffeine-containing foods and drinks in 1991, 1995, and 1999. Over the first ten years of the study, 1,263 cases of type-II diabetes were recorded.

Drinking coffee was associated in a dose-response fashion with a decreased risk of type 2 diabetes. One cup of coffee a day was linked with a 13 percent reduction of type 2 diabetes risk compared with 42 percent reduction for two to three cups a day, and 47 percent reduction for four or more cups a day.

Associations were similar for caffeinated (13 percent reduction) for a one-cup increment per day and decaffeinated (19 percent) coffee and for filtered (14 percent) and instant (17 percent) coffee.

However, tea consumption was linked only with a 12 percent lower risk in those who drank four or more cups risk of type 2 diabetes, indicating that caffeine is not the major constituent that affects the risk.

Not all types of coffee have the same effect. The reduction of type 2 diabetes risk was found with drinking filtered coffee and instant coffee, but not with consumption of espresso or percolator coffee.

Researchers conclude that" moderate consumption of both caffeinated and decaffeinated coffee may lower risk of type 2 diabetes in younger and middle-aged women. Coffee constituents other than caffeine may affect the development of type 2 diabetes."

An earlier study, published in 2004 in the Annals of Internal Medicine, had shown a 30 percent reduction of diabetes risk in women who drank more than six cups of coffee a day.

For men, drinking six or more cups of caffeinated coffee was also linked with a 30 percent lower risk.

That study, by Frank Hu and colleagues from the Department of Nutrition and Epidemiology at the Harvard School of public Health, tracked some 41,934 men from 1986 to 1998 and 84,276 women from 1980 to 1998 for their intake of regular and decaffeinated coffee via food frequency questionnaires every two to four years. Subjects entered the study without known type 2 diabetes. The study did not consider other risk factors.

Caffeine has been shown to have negative effects on glucose metabolism, so there must be some other factor involved, which would explain why decaf coffee produces almost as much risk reduction. So if you are sensitive to caffeine, go with the decaf and enjoy protection from diabetes without the jitters.

Research Update

News you can use from FitBits.

FitBits
January 15, 2006
Exercise ETC’s Review of Exercise Related Research
Compiled by Jeannie Patton, MS, CSCS

Small increases in rest can result in large increases in performance

The ability to achieve and maintain maximal power is required in many sports such as basketball, hockey, soccer, tennis, and squash. The goal of this study was to examine the influence of recovery periods on subsequent performance.

Twenty-five young males served as subjects. The men completed 2 maximal cycling tests that consisted of 5 seconds of all out cycling followed by either a 10 or 30-second rest period. They did this for 20 repetitions.

The longer (30-second) recovery period resulted in significantly higher measures of maximal power output and significantly lower measures of fatigue, blood lactate, heart rate, respiratory exchange ratio and oxygen uptake.

The results of this study indicate that even relatively small changes in recovery duration can have a significant impact on performance and must be considered when training clients involved in sprint sports. An analysis of the demands of the sport, including power demands and recovery time, should be considered when designing sprint/interval activities.

Glaister, Mark. et al. The influence of recovery duration on multiple sprint cycling performance. Journal of Strength & Conditioning Research. 2005, 19(4).831-837.


Flexibility gains not improved during resistance training activity

Adequate levels of flexibility and muscle strength are necessary for activities of daily living (ADL) and optimal performance in sports. The purpose of this study was to determine if strength training, done by itself, can improve flexibility, and vice versa. The researchers sought to determine if separate training programs necessary to develop muscle strength and flexibility.

Subjects were 43 healthy, young adults; they were assigned either to a flexibility training only, a resistance-training group, a mixed training group (resistance and flexibility training,) or a control group.

The researchers found that muscle strength increased with resistance training alone, and when strength training was combined with flexibility training, but did not increase in the flexibility only group. The flexibility increased when only flexibility training was done, and when flexibility was done in combination with resistance training . Flexibility did not increase for the group that did resistance training only. The control group experienced no gains in strength or flexibility.

The results of this study indicate that in young, healthy subjects, while resistance training, by itself, does not increase flexibility, it also does not interfere with increases in range of motion when combined with flexibility training. These results indicate that separate training protocols need to be employed when working with young healthy adults in order to increase muscle strength and flexibility. It would be interesting to have this study repeated using older adults whose flexibility is often
compromised to see if the results are different.

Nobrega, Antonio, C. L. et al. Interaction between resistance training and flexibility training in healthy young adults. Journal of Strength & Conditioning Research. 2005, 19(4).842-846.

TC's Magic 13 Power Foods

TC Luoma has been in the health business for a while. He was the original editor of Muscle Media 2000 back when it was hardcore (now defunct). He founded Testosterone Magazine and Biotest (supplements) back in the late 1990s.

TC has assembled his list of the magic 13 power foods for general health, but especially for athletes.

1. Broccoli
2. Wild Salmon
3. Grass-Fed Beef
4. Walnuts
5. Olive Oil
6. Blueberries
7. Flaxseed
8. Pumpkin
9. Spinach
10. Tomatoes
11. Turkey Breast
12. Yogurt
13. Shiitake Mushrooms

For the reasoning on each choice, read the whole article.

I agree with all of his choices and have been advocating a lot of the same foods for years. I often substitute yams for pumpkin (easier to get year-round) and seldom actually recommend the Shiitake mushrooms since so few people will actually eat them, but the rest of the list is solid.