Thoughts on Glucosamine and Chondroitin? [Archive]

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Spartan74

12-30-2004, 22:06

What's the concensus on using Glucosamine and Chondroitin as a preventative measure ? Never taken it myself but do have some friends that swear by it. Thanks.

ccrn

01-03-2005, 15:13

Spartan74

01-03-2005, 16:34

Thank You CCRN.

The Dave

01-04-2005, 16:03

I've been taking Glucosamine & Chondroitrin for about 2 months now, maybe a little longer. It seems like it almost took me this long to feel any beneficial effects from it, and yet, its minimal. If you take a liquid dose of it, it supposedly works a bit faster than the pill form. I started taking it, because my knees were giving me some trouble.

I believe what I'll be doing, instead of continuing to take this, is just go see a physical therapist, and see whats wrong with my running form, if thats the cause of the pain. I'll see if I can find an interesting article I read on this when I get home, and post it up.

ccrn

01-05-2005, 13:17

I believe what I'll be doing, instead of continuing to take this, is just go see a physical therapist, and see whats wrong with my running form, if thats the cause of the pain. I'll see if I can find an interesting article I read on this when I get home, and post it up.

For sure see a sports physiologist about not only your running form but your feet. Some feet are very fliexible and need support and others are not and only need cushioning. Also some runners overpronate or underpronate and need some form of motion control shoe. Foot width will also be a consideration. An experienced physiologist who also runs will be familiar with shoe brands and will be able to recommend.

A physical therapist will be able to help you with asymmetries and muscle weakness and or stiffness.

All of these can hinder performance especially when trying to achieve a certain level within a certain time increasing risk of injury (mostly over use injury of the knees).

A good running shoe store with experienced runners as sales persons can be valuable too.

If all this is old hat my apologies

FWIW

The Dave

01-05-2005, 13:21

For sure see a sports physiologist about not only your running form but your feet. Some feet are very fliexible and need support and others are not and only need cushioning. Also some runners overpronate or underpronate and need some form of motion control shoe. Foot width will also be a consideration. An experienced physiologist who also runs will be familiar with shoe brands and will be able to recommend.

A physical therapist will be able to help you with asymmetries and muscle weakness and or stiffness.

All of these can hinder performance especially when trying to achieve a certain level within a certain time increasing risk of injury (mostly over use injury of the knees).

A good running shoe store with experienced runners as sales persons can be valuable too.

If all this is old hat my apologies

FWIW

Great info!! I appreciate it. I've already had some good luck with insoles, but it doesn't help all the way. So a physiologist is who I shall go see. Again, thank you.

Bill Harsey

01-08-2005, 20:32

The Arthritis Research Center of Canada (ARC) has finished a six month double blind study that has shown no long term benifits of Glucosamine and chondroitin.

Also there has been a long term study of about two or three years called GAIT (Glucosamine/Chondroitin Arthritis Intervention Study) here in the USA that is being peer reviewed. I believe it might be the only true scientific study done besides the ARC study regarding these two supplements.

The EU has had studies that supposedly showed promising results however the doses used there are higher from what is used in American OTC doses. Also, no offense intended, at least one EU study has been discredited in the area of heart research recently.

Other problems with Glucosamine and Chondroitin are dose consistancy, label misrepresentation, and even impurities. Why it is that pharmaceuticals are held to such a high standard by the public yet these OTC's are not is beyond me.

On a personal level, as I type this, my wife who is a DC tells me that her subjective observations of her pt's are that neither of these two supplements are efficacious-

FWIW
If my memory serves, these supplements were first proven on horses for whom which the placebo effect is kinda hard to make happen.

Six months is not a very long study for soft tissue damage repair.

My next question is "peer reviewed" by whom? Think about this one before answering.

An observation I would make is this, because one area of study by the EU has been discredited then all areas of study by same are no longer valid? We could then throw out much of what any given area of science has concluded.

That last word is kinda big for a knifemaker...

CPTAUSRET

01-10-2005, 15:57

Bill Harsey

01-10-2005, 19:15

I have sustained various injuries over the years, broken neck, broken back, GSW's, a few edged weapon wounds, etc, etc. Traumatic Arthritis is what I am told I now have...I take the stuff (G and C), and Nancy does too. Is it subjective that I feel better, who knows?

But I used to take 800mg Motrin 4 times daily, I did so for maybe 20 years, now I do not. Ibuprofen is not good for you at that level over the long term, in fact that is now an illegal dosage for long term use.

Terry
Terry, Is this after you got married? :D

I can't quite match that pedigree but have had some pretty good injuries from the 10 seasons I spent logging here in Oregon. All I know about the stuff is that before I started taking it, I couldn't sleep thru the night because of knee pain, for several years. (all this after a major surgery to try and repair several things at once) If I stop for a period of time, the pain creeps back in and I start waking up in the middle of the night thinking "this sucks". I just returned from a 15 mile bicycle ride in below freezing weather and my knees are fine at the moment. I can't prove the stuff works but like you I've quit buying advil by the case.

CPTAUSRET

01-10-2005, 19:36

Terry, Is this after you got married? :D

I can't quite match that pedigree but have had some pretty good injuries from the 10 seasons I spent logging here in Oregon. All I know about the stuff is that before I started taking it, I couldn't sleep thru the night because of knee pain, for several years. (all this after a major surgery to try and repair several things at once) If I stop for a period of time, the pain creeps back in and I start waking up in the middle of the night thinking "this sucks". I just returned from a 15 mile bicycle ride in below freezing weather and my knees are fine at the moment. I can't prove the stuff works but like you I've quit buying advil by the case.

"Terry, Is this after you got married?" :D

Bill, that's funny!

Nancy has had two spinal fusions of her lower back so she is also lives with pain, and subjectively she feels better with the G and C.

Terry

Ambush Master

01-10-2005, 19:39

Terry, Is this after you got married? :D
If I stop for a period of time, the pain creeps back in and I start waking up in the middle of the night thinking "this sucks". I can't prove the stuff works but like you I've quit buying advil by the case.

Same here. Close to 1K Parachute Jumps and being seriously pounded into the ground way too many times, I'm amazed that I can still walk. What got me started taking it was my thumb joints started to lock up on occasion. A friend suggested it because they had been giving it to their Lab Retriever and he had improved dramatically after about a month. I've been taking it for about 10-12 years and everything works fine !!! Like Bill, if I lay off of it for a few days I start to feel things that are not pleasant.

Martin

CPTAUSRET

01-10-2005, 19:43

Same here. Like Bill, if I lay off of it for a few days I start to feel things that are not pleasant.

Martin

I will agree with that also.

Terry

BadMuther

01-10-2005, 21:35

Capt. Terry, I was advised to give it to one of my dogs, because she had a REALLY hard time walking. She was damn near crippled. I was told it takes a while to work.

I gave it to her and after awhile she made a decided improvement. Not perfect, but hey. I switched brands and after about a month on the new stuff she was jumping around like a fricking puppy. She's done great ever since. In my mind it's a fricking miracle combo. My dog is a brand new dog-in fact she acts like such an idiot jumping around some times that I'm scared she's going to hurt herself.

Give it a try-allow at least 2-3 weeks for it to get in your system. I was also advised never to miss a dose, or it takes awhile for it to build back up in your system.

Good luck.

CPTAUSRET

01-10-2005, 21:56

Ambush Master

01-10-2005, 22:06

BadMuther:

Roger, the above. There have been a couple of times when we were travelling, and I forgot to pack enough for the trip, consequently I was able to compare being on, and off the stuff. I am a believer...

Terry

Ditto to this !! I have traveled extensively for the past 30+ years and since I started taking it, I can tell the difference. Also, I started taking MSM in addition, about a year ago, and it has made it work even better !!

Later
Martin

CPTAUSRET

01-10-2005, 22:13

Ditto to this !! I have traveled extensively for the past 30+ years and since I started taking it, I can tell the difference. Also, I started taking MSM in addition, about a year ago, and it has made it work even better !!

Later
Martin

MSM??

Terry

Ambush Master

01-10-2005, 22:20

MSM??

Terry

Damn, this late at night !!!

MSM=Methylsulfonylmethane.

As stated in the disclamer,..............I am not an MD !!!

Later
Martin

CPTAUSRET

01-10-2005, 22:23

Damn, this late at night !!!

MSM=Methylsulfonylmethane.

As stated in the disclamer,..............I am not an MD !!!

Later
Martin

Cute! Didn't mean to throw you a curve this late.

Roger, this stuff is derived from DMSO, I think.

Terry

Ambush Master

01-10-2005, 22:34

Cute! Didn't mean to throw you a curve this late.

Roger, this stuff is derived from DMSO, I think.

Terry

DMSO, as I understand it, facilitates the "transdermal" absorbtion of whatever is on your hide before or shortly after it's application. Don't think this stuff is quite that radical !!!

Bill Harsey

01-11-2005, 09:03

Ambush Master, I take the MSM also for same reason.

small detail but when I had my knee worked on the knee specialist surgeon said it was going to need replacing soon. That was 6 years ago now and it continues to get better, not perfect but much better. Again I can't prove anything but note that like AM, my hands and elbow guit hurting too.

When logging I would on occasion load a full 55 gallon drum of oil from the ground into the back of a pickup by grabbing both rims of the barrel and just picking it up and putting it in.(edit to add- DAMN!! :lifter ) I'm surprised I can even move today after doing knucklehead things like that.

I don't dare quit the supplements.

Bill Harsey

01-11-2005, 18:53

The drums we used were full of Rimula 30 weight oil for diesel engines.
The lightest would have been hydralic fluid which is a 10 weight oil.

Thanks for posting the chart. Now my back is getting sore.

ghuinness

01-11-2005, 20:16

If my memory serves, these supplements were first proven on horses for whom which the placebo effect is kinda hard to make happen.

...

I should probably stay out of this..... Mr Harsey you are correct.

I have seen Glucosamine and Chondroitin used and the success rate was questionable. Some people swear by it. I think it depends on the degeneration, bone changes, amount of work etc. All of which would apply to a human as well.

Usually we continued to include Aspirin and Phenylbutazone (nonsteroidal anti-inflammatory drug, no idea the human equiv) and steroid cortozone injections. The use of G&C generally reduced the frequency of injections, but did not eliminate them.

DMSO - I try to avoid using it. A few years ago vets were saying this was a cancer causing agent and it was also connected to blindness. Now it is all the rage in cancer treatment. Generally I only use it for applying steriods and breaking down calcification. Anything mixed with it is absorbed into the bloodstream. I know the local feed store sells more for human use than farm use.....

my .02

Bill Harsey

01-11-2005, 21:27

I should probably stay out of this..... Mr Harsey you are correct.

I have seen Glucosamine and Chondroitin used and the success rate was questionable. Some people swear by it. I think it depends on the degeneration, bone changes, amount of work etc. All of which would apply to a human as well.

Usually we continued to include Aspirin and Phenylbutazone (nonsteroidal anti-inflammatory drug, no idea the human equiv) and steroid cortozone injections. The use of G&C generally reduced the frequency of injections, but did not eliminate them.

DMSO - I try to avoid using it. A few years ago vets were saying this was a cancer causing agent and it was also connected to blindness. Now it is all the rage in cancer treatment. Generally I only use it for applying steriods and breaking down calcification. Anything mixed with it is absorbed into the bloodstream. I know the local feed store sells more for human use than farm use.....

my .02
Thanks for checking in, What I get from your post is this is complicated science with many factors to consider and measure. I have only one lifetime to work with and am willing to take the chance this stuff works. If I and others are proven wrong maybe the next generation won't have to go thru the same mistakes.

ccrn

01-15-2005, 21:41

I dont want to offend anyone here nor is it my intent to dismiss the subjective experience of the vetaran members whos opinions I value.

It is and always will be my intent to question and discriminate without prejudice any treatment , practice, or medication's efficacy. This is essential in nursing which is a practice that should be based on specific and measurable criteria defendable by science, research, and observation.

This is a practice that I carry into my personal life as well as my professionl one. If its not effective or efficient then it should be at least candidate for the chopping block.

A professional example is the Amiodarnone vs Lidocaine debate in the advanced cardiac life support arena. Lidocaine has been the big gun for certain arrhythmias for years. Then along came Amiodarone which was put in favor by the AHA. Their favor was so lop sided that it became a joke. People accused the AHA of being paid off. Now in 2004 their new ACLS recommendations dont necessarily favor amiodarone anymore.In fact the latest research is showing that none of the ACLS medications we are using show efficacy over placebo. Not very comforting is it?

My subjective experience is otherwise. Ive seen these meds save peoples lives in the ER and ICU.. In 2005 AHA will supposedly come out with radical changes in ACLS protocols based upon research.

As far as glucosamine and chondroitin the verdict is still out from my perspect.

Ive seen research that supports it, mostly that done by the manufacturer. Ive seen the 25 horse study that supports glucosamine/chondroitin. It apparently was done via measurable criteria ie lameness grade, flexion test and stride length. However it wasnt a double blind study with a placebo control group and the trainers knew their animals were on the supplement. Also that study involved Cosamine DS and Cosequin which are much stronger than OTC supplements available for human consumption here in the USA so cannot be extrapolated to other glucosamine/chondroitin products. It was for six weeks compared to the six month ARC study.

Speaking of which it is my understanding the studies in the EU involve prescription strength products not the comparitively lower strength OTC supplements available here.

Which leads to another issue. My searching reveals there have been studies of products for human and equine use here in the US and dose strength, consistancy, and impurities are an issue also.

One study claims that neither product is absorbed by the human GI tract, Another claims it is. Yet another claims that only 20% of the product is absorbed at all. If it is in fact absorbed at all how does having an overabundance of a molecule found naturally in the body effect the matrix of cartilage if at all?

Some of the claims of product manufacturers are tainted with studies that involve IM injections as opposed to oral administration, and injections directly into joints. This is all in the fine print to be read freely on product websites.

Much of the manufacturer based research states that their products have regenerative properties. Independent double blind placebo research does not duplicate this at this point to my knowledge. There does appear to be some anti inflammotory properties which in itself would be valuable especially with the inherent hazards of NSAID use.

"As of May 2004, the data from the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) were being analyzed, with the results to be published in a peer-reviewed medical or scientific journal." I do not know which one and I dont understand why I have to be careful at all regarding this issue Mr Harsey (respecfully), it might be a peer review by the allopathic medicine community or other scientific body.

My position is that I hope they find out exactly what the actions of glucasamine HCI, glucosamine sulfate, or chondriotin are. At the very least it would be fantastic to know exactly what results are achivied by its therapy. Other medications actions are unkown and so too may be gl/ch. But if its efficacy can be known and side effects as well as complications it would aide persons taking this supplemt as well as other supplents andmedications. At the very least it would be nice to have label regulations applied to both.

The medical community and general population has everything to gain if this can be done-

ccrn

Bill Harsey

01-17-2005, 09:08

CCRN, Have you ever had a catastrophic, life changing injury to a major joint or your spine?

ccrn

01-17-2005, 12:25

Sir,

No I have not.

As an RN I have worked with many people whom have had major, catastophic, life changing injuries, somtimes of which the most that could be done was to assist in transition to death with dignity and hopefully some amount of comfort ie pain control.

As a healthcare provider I welcome supplements such as Glucosamine and chondroitin if they decrease pain and add to quality of life.

My only issue has been, and will be, some form of disclosure perhaps regulatory label control and therefore level of quality and efficacy. A can of soup is held to no less standard.

I do believe I can grasp your sentiment at least in part, that being those who suffer will reach out even taking risks.

It seems that Glucosamine and chondriotin work to decrease pain in those who suffer osteoarthritis and other debilitating degenerative joint processes. If we can know exactly what forms work, how, and in what dosage then the more efficient they can be administered. This can only be for the better, especialy for those on limited incomes.

My apologies if I offended. I was only trying to add to the conversation not diminish it. I feel it is my obligation to add information to the community in any way I can be it direct experience or points to take into consideration-

Respectfully

(edit grammar)

DoctorDoom

01-24-2005, 02:20

CPTAUSRET

01-24-2005, 10:07

Sir,

I do believe I can grasp your sentiment at least in part, that being those who suffer will reach out even taking risks.

It seems that Glucosamine and chondriotin work to decrease pain in those who suffer osteoarthritis and other debilitating degenerative joint processes. If we can know exactly what forms work, how, and in what dosage then the more efficient they can be administered. This can only be for the better, especialy for those on limited incomes.

My apologies if I offended. I was only trying to add to the conversation not diminish it. I feel it is my obligation to add information to the community in any way I can be it direct experience or points to take into consideration-

Respectfully

(edit grammar)

ccrn:

You didn't offend! I doubt that any of the people you are addressing are so thin skinned as to take offense at your study based beliefs.

You may have read the thread I created re using "piano wire" as suture matrerial during Vietnam. Irregardless, I had several wounds which I was told would result in traumatic arthritis years down the road. I was too young to accept that advice, but I certainly relate at this stage of my life. I went to the VA with significant shoulder pain, I had a difficult time moving my right arm above my head, I was hoping for a diagnosis of Rotator Cuff injury, but after X-rays I was informed that I had Degenerative Joint Disease, bone on bone, no cartilege left. I had to give up Racquetball, but after taking G and C for a goodly portion of time I again was able to play again...I have given up the sport again because of my knees.

Nancy too has led a pretty rugged life resulting in two spinal fusions from I believe, L3 to S something, she too has significant pain, and she firmly believes that G and C helps. All subjective I know, but...

Terry

Bill Harsey

01-24-2005, 21:20

The Dave

01-25-2005, 12:28

ccrn:

I had to give up Racquetball, but after taking G and C for a goodly portion of time I again was able to play again...I have given up the sport again because of my knees.

Terry

CPTAUSRET,

What kind of dosage are you currently taking? And in what form? Pill, liquid, chewie? I'm just curious. I've been taking 2000mg's in the hard pill form, and I read somewhere that you only get about 65 to 70% of that actually absorbed. I've definitely noticed a difference, thats for sure.

CPTAUSRET

01-25-2005, 12:33

CPTAUSRET,

What kind of dosage are you currently taking? And in what form? Pill, liquid, chewie? I'm just curious. I've been taking 2000mg's in the hard pill form, and I read somewhere that you only get about 65 to 70% of that actually absorbed. I've definitely noticed a difference, thats for sure.

I will ask Nancy, she's my MD, and she lays out all my pills every morning.

Terry

ccrn

01-25-2005, 22:00

Would you mind posting a link to a representative article? I'm just curious. Thanks.

I have googled for about two hours on this one and have found some articles dating as far back as 1998. However those arent what I am looking for so I have not referenced them for you.

From what I heard during my last ACLS cert a few months ago AHA will revise in 2005 based on research showing poor survival rate to discharge (not admit) involving ALS. Much of this is prehospital.

From my searching I have seen survival rates of 3-10% prehospital to discharge. Interestingly one study I glanced at showed survival rates of witnessed codes inhospital by ACLS certified nurses to be about 1 in 4 as opposed to nurse that werent certified.

The following is from the 1999 Bethesda Conference:

http://www.acc.org/clinical/bethesda/beth31/task1.htm

"Pharmacologic Adjuncts to Defibrillation

The prognosis is ominous for a sizable proportion of patients with cardiac arrest in whom spontaneous circulation is not restored by the first few defibrillation shocks and in whom additional ACLS measures, such as endotracheal intubation, epinephrine and antiarrhythmic medications, are required.

Antiarrhythmic drugs. Antiarrhythmic drugs, including lidocaine, bretylium, magnesium and procainamide, have been classified as an "acceptable, probably helpful" treatment for cardiac arrest secondary to ventricular tachyarrhythmias unresponsive to three or more shocks under current ACLS guidelines. Although these drugs represent current clinical practice in the U.S., there is limited evidence supporting the benefit from use of these agents in treating cardiac arrest victims. Use of antiarrhythmic agents has not been universally embraced as an essential component of treatment algorithms for shock-refractory cardiac arrest.

Evidence supporting any clinical benefit from early administration of antiarrhythmic drugs in cardiac arrest is scarce. In early animal trials, either resuscitation of VF was not improved by the addition of procainamide or lidocaine, or any benefit was offset by worsened short-term survival attributed to the drugs' adverse circulatory depressant effects. Ironically, lidocaine, procainamide, quinidine, phenytoin and oral and higher doses of intravenous amiodarone (10 mg/kg body weight) have all been observed to increase the defibrillation threshold and, in theory, make it more difficult to resuscitate hearts from VF (50–55) .

In the only published case-controlled clinical trial in which shock-refractory victims of out-of-hospital VF were stratified according to those who did and those who did not receive lidocaine, no significant differences were observed in the return of an organized rhythm, admission to the hospital or survival to hospital discharge between the treatment groups (56) . A retrospective evaluation of antiarrhythmic drug use during a trial of active compression–decompression CPR found that lidocaine and bretylium were independently associated with a lower likelihood of survival to 1 h after cardiac arrest (57) . Another retrospective study comparing outcomes from a time when ambulances were or were not staffed by personnel who were authorized to give medications found that recipients of lidocaine were more likely to have a return of spontaneous circulation and to be admitted to the hospital, although no survival benefit was demonstrated (58) . In contrast, in a prospective, randomized trial comparing administration of lidocaine with standard doses of epinephrine in shock-refractory VF, not only was there absence of benefit, but survival actually worsened when such pharmacologic therapies served to delay defibrillation (59) .

The current recommended use of magnesium in torsade de pointes is supported only by case reports. Two recent prospective, double-blind, randomized trials of cardiac arrest in patients in the hospital and in the Emergency Department found no benefit from routine treatment with magnesium (60,61) . Finally, none of the reported randomized trials comparing bretylium with placebo or with lidocaine in victims of cardiac arrest demonstrated any significant differences in outcome between treatment groups (62) .

In most studies to date, intravenous amiodarone has been administered only after failure of other antiarrhythmic medications to terminate malignant ventricular tachyarrhythmias. When compared with additional lidocaine and epinephrine in dogs with shock-refractory VF pretreated with prophylactic lidocaine, intravenous amiodarone significantly improved the success of subsequent defibrillation (63) . The Amiodarone in out-of-hospital Resuscitation of REfractory Sustained ventricular Tachyarrhythmias trial (ARREST), a recently published randomized, prospective, double-blind, placebo-controlled trial, evaluated intravenous amiodarone in out-of-hospital cardiac arrest due to VF or pulseless ventricular tachycardia (64) . In 504 randomized patients, a significant improvement in admission to hospital was observed in recipients of intravenous amiodarone as compared with placebo (44% vs. 34%, p = 0.03). The trial was underpowered to detect differences in survival to hospital discharge between the two treatment groups, which tended to favor recipients of intravenous amiodarone. However, this is the only randomized, placebo-controlled clinical trial ever to show a significant benefit from antiarrhythmic drug therapy during CPR.

Conclusions. With the possible exception of intravenous amiodarone, available evidence is inconclusive concerning benefit of antiarrhythmic drugs in cardiac arrest. Most studies addressing this question have been unpowered either to demonstrate or necessarily exclude benefit from such treatment or to have employed a positive but equally unproven control (lidocaine) comparison. The dose and manner in which to administer antiarrhythmic medications during cardiac arrest and the optimal variables by which to measure benefit from treatment (e.g., return of spontaneous circulation, admission alive to the hospital, 24 h survival, discharge from the hospital, neurologic function at hospital discharge, one-year survival) also remain controversial."

Although I have personally seen Amiodarone control arrythmias I doubt it is as effective as AHA or ARREST study in Washington State claims it is.

Also there isnt much evidence supporting ET route for ACLS medications that I am aware of.

Being in your current postition you have better access to this information than I but I will make it my mission to find whatever current research that is out there that actually contradicts the Myths of ACLS-

ccrn

DoctorDoom

02-04-2005, 08:52

BadMuther

02-13-2005, 12:42

I'm just a barely out of the cave knifemaker. I know If I drink too much my head hurts the next morning. If I don't drink, my head doesn't hurt, as much.

If I take the G and C stuff, my knee quits hurting. If I don't take it, my knee hurts.

I'm just a knifemaker, this is all I know.

Ditto. My doggy could hardly walk before, now she jumps around like a puppy.....and I doubt she read all the tests on placebos, horses and flying monkeys.... ;)

Boomer-61

07-23-2008, 19:26

I was a bit dubious myself until one of my patients, an orthopedic surgeon, relayed the following. He is a former college and NFL football player with bad knees. He developed a loose body and had his knee scoped, took pictures etc. He then started on Cosamin DS. Nine months later he developed another loose body and had another scope. They snatched out the loose body and noted some changes in the articular cartilage, for the better.
In the fall of 2006 at the annual PAOS (Physician Assistants in Orthopedic Surgery) conference I sat through a session about glucosamine/chondroitin sulfate. They presented study after study and the bottom line at that time was that it does support articular cartilage, it does not regenerate articular cartilage. The interesting fact I gleaned was that they tested several different brands and found them to contain from 0% to 100% of the claimed ingredients. The more expensive brands generally contained a higher percentage of the ingredients. Cosimin DS came out on top. They are the only company that pharmceutically prepares their product and they have the data to back it up. The recommended dose is 1500mg a day in a single or divided doses for all other brands. Yet the Cosamin DS recommends a loading phase of three capsules a day, then taper to a maintainence dose of one to two per day.
I have no stock in the company. If you're going to use a glu/chon product, pay a bit more and get the best. There is no reported down side to this product.