N-acetylglucosamine
N-acetyl glucosamine is a chemical that comes from the outer shell of shellfish. N-acetyl glucosamine should not be confused with other forms of glucosamine such as glucosamine hydrochloride or glucosamine sulphate, as these forms of glucosamine do not have the same effects. You should read the label of glucosamine products carefully. Most glucosamine products contain glucosamine hydrochloride or glucosamine sulphate. Although glucosamine hydrochloride and glucosamine sulfate are sold together with N-acetyl glucosamine in combination products, there are no human studies that have evaluated these combinations in the treatment of osteoarthritis in humans. Chitosan is also found as an ingredient in some glucosamine products. Chitosan is a form of N-acetyl glucosamine that has been chemically modified.
N-acetylglucosamine is used for osteoarthritis and inflammatory bowel diseases including ulcerative colitis and Crohn's disease.
How does N-Acetyl Glucosamine work?
N-Acetyl Glucosamine may help to protect the mucous membranes of the stomach and intestines.
How effective is N-acetyl glucosamine?
There is not enough scientific data to make a statement about the effectiveness of N-acetyl glucosamine in inflammatory bowel disease. There is early evidence that oral N-acetyl glucosamine may reduce the symptoms of inflammatory bowel disease in children suffering from Crohn's disease or ulcerative colitis. There is also insufficient scientific information on the effectiveness of N-acetyl glucosamine in osteoarthritis. Further scientific research is needed to evaluate the effectiveness of N-acetyl glucosamine in these applications.
Safety and side effects
There is not enough information to say whether N-acetyl glucosamine is safe and harmless. There are concerns that glucosamine products may cause allergic reactions in people who are allergic to crustaceans. Glucosamine is made from the shells of crabs, lobsters and shrimps. However, allergic reactions in people who suffer from allergies to crustaceans are caused by the meat of crustaceans and not by the shell. There are no reports of allergic reactions to glucosamine in people who are allergic to crustaceans. There is also some information that people who suffer from allergies to shellfish can use glucosamine products without risk. There are concerns that glucosamine may increase the amount of insulin in the body. Too much insulin could lead to high blood pressure and high cholesterol and triglyceride levels. While studies conducted with animals seem to confirm that glucosamine can increase cholesterol levels, this effect has not been observed in humans. In fact, studies show that glucosamine does not appear to increase blood pressure and cholesterol levels in people over the age of 45 who have taken glucosamine sulfate for up to 3 years.
Precautions and warnings
Pregnancy and lactation: Not enough is known about the use of N-acetyl-glucosamine during pregnancy and lactation. For this reason, pregnant and breastfeeding women should avoid N-acetyl-glucosamine.
Asthma: Although scientists are not sure why this is the case, glucosamine may aggravate asthma in some people. For this reason, glucosamine should be used with caution if you suffer from asthma.
Diabetes: Some early research suggests that glucosamine may increase blood sugar levels in diabetics. However, more reliable research suggests that glucosamine does not appear to significantly affect blood sugar control in people suffering from type II diabetes. As long as blood sugar levels are controlled regularly, diabetics can probably use glucosamine safely.
Operations: N-acetyl-glucosamine could affect blood sugar levels and interfere with blood sugar control during and after surgery. For this reason, you should stop taking N-acetyl-glucosamine two weeks before upcoming operations.
Interactions
N-acetyl glucosamine should not be used in combination with the following medications:
Care should be taken when combining N-acetyl glucosamine with the following medications:
Anti-cancer drugs
There are concerns that N-acetyl glucosamine may reduce the effectiveness of some anti-cancer drugs. However, it is too early to know if this interaction actually occurs.
Diabetes medications
There are concerns that glucosamine may increase blood sugar levels in diabetics. There are also concerns that glucosamine may reduce the effectiveness of diabetes medications. However, current research suggests that glucosamine is unlikely to increase blood glucose levels in diabetics. For this reason, glucosamine is unlikely to interfere with the effectiveness of diabetes medications. For safety reasons, diabetics should carefully monitor their blood glucose levels when using glucosamine.
Care should be taken when combining N-acetyl glucosamine with the following medications:
Acetaminophen
There are concerns that glucosamine and acetaminophen may interfere with each other when taken in combination. However, more information is needed to assess whether this interaction is a cause for concern.
Dosage
An appropriate dosage of N-acetyl-glucosamine depends on various factors such as age, health status and others. At this time, there is insufficient scientific data to determine appropriate dosage ranges for N-acetyl-glucosamine. For this reason, you should follow the dosage instructions on the label and/or consult a doctor or pharmacist before use.
References
- Adams ME. Hype about glucosamine. Lancet 1999;354:353-4.
- Almada A, Harvey P, Platt K. Effects of chronic oral glucosamine sulfate on fasting insulin resistance index (FIRI) in non-diabetic individuals. FASEB J 2000;14:A750.
- Balkan B, Dunning BE. Glucosamine inhibits glucokinase in vitro and produces a glucose-specific impairment of in vivo insulin secretion in rats. Diabetes 1994;43:1173-9.
- Barclay TS, Tsourounis C, McCart GM. Glucosamine. Ann Pharmacother 1998;32:574-9.
- Burton AF, Anderson FH. Decreased incorporation of 14C-glucosamine relative to 3H-N-acetyl glucosamine in the intestinal mucosa of patients with inflammatory bowel disease. Am J Gastroenterol 1983;78:19-22.
- Bush TM, Rayburn KS, Holloway SW, et al. Adverse interactions between herbal and dietary substances and prescription medications: a clinical survey. Altern Ther Health Med 2007;13:30-5.
- Danao-Camara T. Potential side effects of treatment with glucosamine and chondroitin. Arthritis Rheum 2000;43:2853.
- Does glucosamine increase serum lipid levels and blood pressure? Pharmacist's Letter/Prescriber's Letter 2001;17(11):171115.
- Du XL, Edelstein D, Dimmeler S, et al. Hyperglycemia inhibits endothelial nitric oxide synthase activity by post-translational modification at the Akt site. J Clin Invest 2001;108:1341-8.
- Giaccari A, Morviducci L, Zorretta D, et al. In vivo effects of glucosamine on insulin secretion and insulin sensitivity in the rat: possible relevance to the maladaptive responses to chronic hyperglycaemia. Diabetologia 1995;38:518-24.
- Gray HC, Hutcheson PS, Slavin RG. Is glucosamine safe in patients with seafood allergy (letter)? J Allergy Clin Immunol 2004;114:459-60.
- Guillaume MP, Peretz A. Possible association between glucosamine treatment and renal toxicity: comment on the letter by Danao-Camara. Arthritis Rheum 2001;44:2943-4.
- Holmang A, Nilsson C, Niklasson M, et al. Induction of insulin resistance by glucosamine reduces blood flow but not interstitial levels of either glucose or insulin. Diabetes 1999;48:106-11.
- Kim YB, Zhu JS, Zierath JR, et al. Glucosamine infusion in rats rapidly impairs insulin stimulation of phosphoinositide 3-kinase but does not alter activation of Akt/protein kinase B in skeletal muscle. Diabetes 1999;48:310-20.
- Knudsen J, Sokol GH. Potential glucosamine-warfarin interaction resulting in increased international normalized ratio: Case report and review of the literature and MedWatch database. Pharmacotherapy 2008;28:540-8.
- Monauni T, Zenti MG, Cretti A, et al. Effects of glucosamine infusion on insulin secretion and insulin action in humans. Diabetes 2000;49:926-35.
- Muniyappa R, Karne RJ, Hall G, et al. Oral glucosamine for 6 weeks at standard doses does not cause or worsen insulin resistance or endothelial dysfunction in lean or obese subjects. Diabetes 2006;55:3142-50.
- Nowak A, Szczesniak L, Rychlewski T, et al. Glucosamine levels in people with ischaemic heart disease with and without type II diabetes. Pol Arch Med Wewn 1998;100:419-25.
- Olszewski AJ, Szostak WB, McCully KS. Plasma glucosamine and galactosamine in ischemic heart disease. Atherosclerosis 1990;82:75-83.
- Pavelka K, Gatterova J, Olejarova M, et al. Glucosamine sulfate use and delay of progression of knee osteoarthritis: A 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med 2002;162:2113-23.
- Pham T, Cornea A, Blick KE, et al. Oral glucosamine in doses used to treat osteoarthritis worsens insulin resistance. Am J Med Sci 2007;333:333-9.
- Pouwels MJ, Jacobs JR, Span PN, et al. Short-term glucosamine infusion does not affect insulin sensitivity in humans. J Clin Endocrinol Metab 2001;86:2099-103.
- Qiu GX, Gao SN, Giacovelli G, et al. Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee osteoarthritis. Arzneimittelforschung 1998;48:469-74.
- Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomized, placebo-controlled trial. Lancet 2001;357:251-6.
- Rossetti L, Hawkins M, Chen W, et al. In vivo glucosamine infusion induces insulin resistance in normoglycemic but not in hyperglycemic conscious rats. J Clin Invest 1995;96:132-40.
- Rozenfeld V, Crain JL, Callahan AK. Possible augmentation of warfarin effect by glucosamine-chondroitin. Am J Health Syst Pharm 2004;61:306-307.
- Salvatore S, Heuschkel R, Tomlin S, et al. A pilot study of N-acetyl glucosamine, a nutritional substrate for glycosaminoglycan synthesis, in pediatric chronic inflammatory bowel disease. Aliment Pharmacol Ther 2000;14:1567-79.
- Scroggie DA, Albright A, Harris MD. The effect of glucosamine-chondroitin supplementation on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial. Arch Intern Med 2003;163:1587-90.
- Setnikar I, Palumbo R, Canali S, et al. Pharmacokinetics of glucosamine in man. Arzneimittelforschung 1993;43:1109-13.
- Shankar RR, Zhu JS, Baron AD. Glucosamine infusion in rats mimics the beta-cell dysfunction of non-insulin-dependent diabetes mellitus. Metabolism 1998;47:573-7.
- Stumpf JL, Lin SW. Effect of glucosamine on glucose control. Ann Pharmacother 2006;40:694-8.
- Tallia AF, Cardone DA. Asthma exacerbation associated with glucosamine-chondroitin supplement. J Am Board Fam Pract 2002;15:481-4.
- Tannis AJ, Barban J, Conquer JA. Effect of glucosamine supplementation on fasting and non-fasting plasma glucose and serum insulin concentrations in healthy individuals. Osteoarthritis Cartilage 2004;12:506-11.
- Tannock LR, Kirk EA, King VL, et al. Glucosamine supplementation accelerates early but not late atherosclerosis in LDL receptor-deficient mice. J Nutr 2006;136:2856-61.
- Weimann G, Lubenow N, Selleng K, et al. Glucosamine sulfate does not crossreact with the antibodies of patients with heparin-induced thrombocytopenia. Eur J Haematol 2001;66:195-9.
- Yu JG, Boies SM, Olefsky JM. The effect of oral glucosamine sulfate on insulin sensitivity in human subjects. Diabetes Care 2003;26:1941-2.
- Yue QY, Strandell J, Myrberg O. Concomitant use of glucosamine may potential the effect of warfarin. The Uppsala Monitoring Center. Available at: www.who-umc.org/graphics/9722.pdf (Accessed April 28, 2008).
- Yun J, Tomida A, Nagata K, Tsuruo T. Glucose-regulated stresses confer resistance to VP-16 in human cancer cells through a decreased expression of DNA topoisomerase II. Oncol Res 1995;7:583-90.