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Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank

BMJ 2019; 365 doi: (Published 14 May 2019) Cite this as: BMJ 2019;365:l1628

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Re: Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank

In the “Strengths and Limitations” section of this study the authors note that ‘most glucosamine products available on the market contain glucosamine sulphate’. A quick in-store review of the contents of such supplements will usually reveal, in the UK, that they also contain chondroitin sulphate. The “Conclusion” suggests further clinical trials are needed to test the hypothesis that glucosamine supplements might be related to lower risks of CVD events.

As a citizen scientist, may I respectfully suggest that focus also be placed on the sulphate aspect of glucosamine sulphate and chondroitin sulphate. It may be that that such supplements, to the extent that they are associated with CVD, satisfy a deficiency of sulphur, rather than, or as well as, glucosamine or chondroitin.

Of the many papers that have already been published on the topic, I cite the following, being well-aware of the possibility of personal bias.

Lack of dietary sulphur:

In their paper “Are we getting enough sulfur in our diet?” Nimni et al concluded “Out of this study came information that suggested that a significant proportion of the population that included disproportionally the aged, may not be receiving sufficient sulfur and that these dietary supplements, were very likely exhibiting their pharmacological actions by supplying inorganic sulfur.”

Nutrition & Metabolism 2007 4:24

Link between sulphur and atherosclerosis:

In 1960, GV Mann et al fed cholesterol to monkeys and induced atherosclerosis. Subsequently, sulphur containing nutrients were provided and atherosclerosis was prevented. They said ‘A form of vascular disease resembling human atherosclerosis has been produced in the New World primate Cebus fatuella … in order to produce these phenomena, the diets had to be rich in cholesterol, choline and neutral fat but relatively low in organic sulfur compounds. Without this deprivation of organic sulphur the response of the serum lipids to cholesterol feeding was small’.

Treatment of heart disease with chondroitin sulphate:

Morrison et al reported apparently significant results from the use of chondroitin sulphate with one hundred and twenty patients with demonstrable ischemic heart disease or coronary heart disease, divided equally into a CSA-treatment group (with chondroitin sulphate A) and control group. After a 2.5 year observation period, 21 of the 60 patients in the control group had experienced acute cardiac episodes or myocardial ischemia, of which 4 were fatal. In the matched CSA-treated group there were 5 deaths.

Association with C-Reactive Protein:

Finally, the authors of this paper state (under “Biological plausibility”) that ‘regular use of glucosamine was associated with a statistically significant reduction in C reactive protein concentrations, which is a marker for systemic inflammation.’. In their paper “C-Reactive Protein test to screen for heart disease: Why do we need another test?”, Harvard Health Publishing discuss the use of hs-CRP testing to detect the 50% of people who have heart attacks but who did not have high LDL.

Harvard Health Publishing:

Another paper titled “High-Sensitivity C-Reactive Protein and Cardiovascular Disease” in the Journal of the American College of Cardiology discusses the current state of the art.

Journal of the American College of Cardiology, Vol 62,No 5, 2013:

Competing interests: No competing interests

19 May 2019
John Needham
Chartered Accountant
London, England