Dear Doctor: Is pain relief from glucosamine supplement real, or a placebo effect?

DEAR DR. ROACH: I disagree with your recent column about the glucosamine/chondroitin supplements. I have arthritis in my lower back. I am taking this supplement each day, and my lower back pain is completely gone. I can now bend down from the waist. I was very skeptical about this or any other supplement and was surprised when it worked. Give it another look. — R.G.

ANSWER: Glucosamine and chondroitin are commonly used supplements in people with osteoarthritis for many different joints. Many studies, when looked at all together, have been unable to show that these are better than placebo, a pill with no activity.

In a placebo-controlled trial, a person gets either the medicine being studied or a placebo, sometimes called a sugar pill, or dummy pill. In the most rigorous trials, neither the subject nor the researcher knows what any person gets until the end of the trial. The two groups are compared to see how many people responded well in one group compared with the other.

In the case of glucosamine and chondroitin, the number of people with arthritis relief is about the same among those getting the placebo as there are with those getting the glucosamine and chondroitin. However, for any given person, either the medication works, or it doesn’t. People can have striking improvements on placebo.

I think that taking something you think will make you better may lead to increased exercise, and exercise is known to have beneficial effects on arthritis. This leads to even better results.

It’s important to recognize that placebo response works on symptoms. It doesn’t make the arthritis any better, as evidenced by X-rays. But improving symptoms is certainly worthwhile in itself.

If the glucosamine and chondroitin are working well for you, you should keep taking them. I don’t know whether this is a placebo response in you, or whether you are one person in whom it really has a pharmacologic benefit. But since the medicine is safe, hardly toxic at recommended doses and relatively inexpensive, there is no reason not to take it if it is helping you.

DEAR DR. ROACH: I am a 75-year-old female in so-so health. I believe my diet is pretty good, but I know I am not getting enough daily fiber. What is your opinion on fiber gummies as a supplement? I have been reading up on these, and they seem a good idea to me. I would appreciate your thoughts. — W.D.

ANSWER: Fiber is my first choice for most people with diarrhea or constipation who otherwise have no gastrointestinal conditions. Fiber is safe and effective for both conditions for most people, especially when started slowly and taken with plenty of water. You can increase your fiber through diet (whole grains, legumes and fruits are among your best sources), but if you need a supplement, that’s fine. Gummies are easier to take for many people than liquids or capsules.

If you aren’t having any problems, there’s no need for you to supplement. Many studies have been done on supplementary fiber in healthy people, and they have not been successful in reducing cancer risk. A diet high in the foods I mentioned does reduce colon and other cancer risks.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.

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