Chondroitin is among the top most popular and best-selling products worldwide for the treatment and prevention of joint diseases, alongside glucosamine.
For medical purposes, doctors typically recommend it (usually in combination with glucosamine) to alleviate joint pain, improve mobility, restore joint cartilage, and prevent its degradation.
In sports, chondroitin is positioned as a chondroprotector, the intake of which is believed to help maintain joint health under increased loads for preventive purposes.
Chondroitin for joints is sold in the form of tablets, ointments/gels, and injections. To find out which is more effective, see the FAQ section.
Below, we will examine what scientific research says about the effectiveness of chondroitin for the treatment and preventive protection of joints, how to take it correctly, and whether there are any side effects.
What is chondroitin?
Chondroitin, as a chemical substance, is a structural component of cartilage – molecules of proteoglycans.
Proteoglycans retain fluid in cartilage, providing its physical properties, the main one being mechanical strength or the ability to dampen load.
As a component of joint supplements (chondroprotectors, dietary supplements), chondroitin is extracted from animal cartilage: cows, pigs, birds, and fish (sharks).
There is also a vegan/vegetarian version of chondroitin (read about its benefits in the section on the Harm of Chondroitin), which is produced chemically through bacterial fermentation 14.
It is believed that the benefits of chondroitin for joints are explained by the following mechanisms of action 10, 11:
- maintaining the necessary viscosity of synovial fluid in the joints by stimulating the function of synovial cells that produce it;
- stimulating the function of chondrocytes – mini-factories for producing the composite components of joint tissues – which produce collagen and proteoglycans for creating new cartilage tissue;
- blocking the action of certain enzymes that have been found in the joint fluid of people with joint diseases (rheumatoid arthritis) and may be responsible for the destruction of joint tissues;
- increasing the number of chondrocytes.
All these properties may potentially contribute to reducing joint pain, improving mobility, and slowing the degradation of cartilage in various joint diseases.
Chondroitin is a structural component of joint cartilage, which explains its use as a drug for the treatment and prevention of joint diseases.
How effective is chondroitin sulfate? Scientific research
As with glucosamine, scientific studies on the effectiveness of chondroitin are very controversial.
The earliest studies do not question the benefits of chondroitin for joint health, while more recent ones question its effectiveness, explaining the positive results of earlier studies as being of low quality due to a small number of participants and lack of detail description.
Larger and longer studies show no positive effects.
For example, in a meta-analysis (analysis of available scientific studies) conducted under the guidance of McAlindon 16, which reviewed the results of 13 studies, it was noted that all of them showed significant effectiveness of chondroitin compared to placebo (40.2%).
However, “in all reviewed studies, incomplete information was provided about the details of their conduct, which does not allow for a judgment on the degree of trust in them“.
Scientific studies on the effectiveness of chondroitin for joints are very controversial. Scientists point to the low quality of “positive” experiments
Benefits of Chondroitin for Joints
The European League Against Rheumatism gives the highest rating to chondroitin (1A) as a drug for the treatment and prevention of joint diseases in terms of the obviousness of its effectiveness based on available scientific data and expert opinions, and recommends it for the prevention and treatment of joint diseases, giving it the highest rating (A) 1.
Individual studies indicate that chondroitin sulfate positively affects the symptoms of osteoarthritis (pain and inflammation) and also has the ability to restore the structure of articular cartilage 2, 3, 4, 5.
One example is a long-term study lasting 2 years involving 622 people with knee joint diseases 12, in which part of the participants took chondroitin at a dose of 800 mg, while the other group received a placebo.
Result: the change in joint space (an indicator of cartilage degradation) was significantly less, and joint pain decreased significantly more in the group taking chondroitin.
The benefits of chondroitin in osteoarthritis are also confirmed by several meta-analyses (analyses of available studies) that demonstrate significant superiority over placebo 6, 7, 8.
The meta-analysis led by Deal CL 15 notes that chondroitin sulfate demonstrates high effectiveness in alleviating joint pain. It is also noted that the effect of taking chondroitin becomes noticeable after 2 months of intake.
A similar result is shown in a review of 39 scientific studies on the effectiveness of chondroitin, in which it was used to treat joint diseases. The main conclusion of these studies is that the benefits of chondroitin for joints are beyond doubt 9.
Individual studies indicate that the intake of chondroitin sulfate positively affects the symptoms of osteoarthritis (pain and inflammation) and may restore the structure of joint cartilage.
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The Uselessness of Chondroitin for Joints
Now let’s look at the other side of the coin.
The results of the most recent studies, on the contrary, indicate that the effect of taking chondroitin does not exceed that of placebo and the correlation between the improvement of joint disease symptoms and its intake is very weak.
The most extensive and widely cited is the so-called GAIT experiment (Glucosamine/chondroitin Arthritis Intervention Trial) 18, which was initiated by the U.S. National Institutes of Health to determine the actual benefits/harm/uselessness of the two most popular chondroprotectors – chondroitin and glucosamine.
(Here, we will only consider the results related to chondroitin. The effectiveness of the glucosamine + chondroitin combination is discussed here.)
More than 1500 people participated in the experiment, including both healthy individuals and those with joint diseases of varying severity, some of whom had not taken chondroprotectors before, while others had been taking them for a long time (at least 3 months).
The studies were conducted in several directions:
- how chondroitin affects joint pain;
- whether its intake helps stop the process of degradation of joint cartilage;
- how well it is absorbed.
Conclusions of scientists:
“The intake of chondroitin in any doses, whether prolonged or single, does not increase its concentration in the blood (both in healthy patients and those who have taken chondroprotectors for a long time).” 19
“Chondroitin is not more effective than placebo in relieving joint pain in patients with mild to moderate pain, but shows some effectiveness in patients with severe pain” 18.
“The change in joint space width (an indicator of joint cartilage degradation) over time does not significantly differ between patients taking chondroitin and those not taking it.” 17
These conclusions are supported by other experts.
Wandel and colleagues showed 22 based on the analysis of 10 studies with a total of 3803 patients with joint diseases, that the effect of chondroitin in reducing joint pain, if represented on a 10 cm scale, differs on average by 0.3 cm from placebo, and its protective properties in preventing cartilage destruction are virtually negligible.
Their conclusion: chondroitin sulfate is ineffective in combating joint pain and does not protect joint cartilage from destruction.
The results of the largest and most widely cited GAIT experiment refute the benefits of chondroitin as a joint medication and reveal a very weak correlation between its intake and the reduction of joint pain, as well as a decrease in the rate of joint cartilage degradation.
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Why are the research results so contradictory?
To summarize the available information on chondroitin, the following can be concluded: chondroitin shows some effectiveness in alleviating joint pain and preventing the destruction of joint cartilage in certain groups of patients, but in many cases this effect does not exceed that of placebo.
At the same time, paradoxically, patient reviews about chondroitin, like those about glucosamine, undoubtedly confirm its effectiveness at least in alleviating joint pain in osteoarthritis.
There are several possible explanations for this paradox:
The Power of the “Placebo” Effect
This is confirmed by a large number of studies, including the GAIT experiment described above.
A good illustration is provided in the material Glucosamine: Reviews from Doctors, Scientists, and Patients. It describes an experiment by English doctors, in which 55% of participants taking a “dummy” pill for 2 months experienced reduced joint pain.
Low Quality of Most Chondroitin Studies
In general, studies with a small number of participants, as well as those whose details are described inaccurately, show a more significant effect than larger studies with more participants 23.
Most “Positive” Experiments Were Funded by Chondroprotective Manufacturers
This fact is pointed out by some experts 24.
Wide Variation in the Quality of Chondroitin Sulfate Products from Different Manufacturers
Numerous analyses of chondroitin products available in the US market show that the active ingredient content in many of them is significantly lower than stated on the packaging, and in some cases, it is completely absent 15.
The controversy surrounding scientific research on chondroitin may be explained by the varying quality of the products used in them, the strength of the “placebo” effect, and the low quality of the “positive” experiments conducted.
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Instructions for Using Chondroitin Sulfate for Joints
Chondroitin is generally recommended to be taken at a dose of 1000-1200 mg per day with meals. The daily dose can be divided into two to three doses of 500 mg and 400 mg, respectively.
The effect of taking it begins to manifest after 2-3 weeks of starting the intake 2. If there is no effect after 2-3 months, some experts recommend discontinuing the use of the product.
After discontinuation, the effect may last up to 3 months with oral intake and up to 6-9 months with injections 2.
The recommended daily dose of chondroitin sulfate is 1000-1200 mg
Harm of Chondroitin and Side Effects
Chondroitin is considered a safe dietary supplement.
The most likely side effects are mild digestive disorders.
Additionally, its intake may worsen asthma symptoms, and it has a blood-thinning effect. This should be taken into account by those who have relevant health issues 25.
Some forms of chondroitin contain sodium and manganese. Their excess in the body can lead to certain side effects. In the case of sodium, it can lead to increased blood pressure. This is important for those with hypertension to keep in mind.
Finally, since most supplements are made from animal cartilage (cows, pigs, birds), theoretically, pathogens from diseases that these animals suffer from (such as mad cow disease) may be present in dietary supplements made from their “parts,” which is especially relevant in case of production technology violations 25.
For those concerned about this issue, vegan/vegetarian chondroitin may be a good alternative.
Chondroitin is a relatively safe dietary supplement. The most likely side effects are digestive disorders
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How to Buy Chondroitin, Which is Better? Recommendations
The market offers a wide variety of chondroitin sulfate products from different manufacturers, and, as noted above, their quality varies widely.
By quality, we primarily mean the quantitative content of the active substance, which often significantly differs from what is stated on the packaging 15.
There are reasons to believe that chondroitin supplements sold in Europe undergo stricter testing, as they are classified as “pharmaceuticals” there, unlike in the USA, Russia (Ukraine, Belarus, etc.), where they are categorized as “dietary supplements” that are sold without oversight from competent authorities 26.
Thus, if you reside in Russia, Belarus, Ukraine, or Kazakhstan, it is best to prefer chondroitin sulfate products that have been tested for quality in an independent laboratory when making a purchase.
Are there such laboratories? Yes, but testing is voluntary and, of course, not all manufacturers/sellers find it interesting.
How can you find out if the chondroitin from your pharmacy or dietary supplement/sports nutrition store has been tested for quality?
This question has no answer. Asking the sellers is useless.
On the website of the online store iHerb.ru, for example, there are products for sale that are tested by an independent laboratory (the iTested option). There are not many, but nevertheless, there is something in each category. It is recommended to use this option when purchasing chondroprotectors.
Quality standards also include the Informed Choice, NSF International, and the US Pharmacopeial Convention (USP) labels on the product packaging. These are more characteristic of the US market, but many American-made products are sold in Russia, so the logos of these organizations on the packaging can also be worth looking at.
When purchasing chondroitin sulfate supplements for joints, prefer those that have been tested for quality in independent laboratories.
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FAQ about chondroitin
Which chondroitin is better for joints?
Quality chondroitin, i.e., one that contains the declared amount of active substance. It is impossible to name a specific brand. Prefer products that have been tested in independent laboratories (see the previous point).
In what form is chondroitin (gel/ointment, tablets, injections) more effective?
According to the general rule, the effectiveness of different forms of supplements increases in the following order: ointments/gels, tablets, injections.
However, in the case of chondroitin and other chondroprotectors, the situation may be different.
Since there are no blood vessels in joint cartilage, and nutrients penetrate them through diffusion from surrounding tissues, chondroitin sulfate in the form of ointments and gels may be no less effective than in the form of tablets and injections.
Chondroitin injections are definitely more effective than tablets, as this form eliminates the stage of absorption by the digestive tract – a process whose effectiveness is almost always less than 100%.
Is there any point in taking chondroitin with glucosamine?
It is believed that taking both substances in combination enhances their benefits for the joints due to their synergistic effect.
For this reason, there are practically no preparations with pure chondroitin, and in available products, it is usually always found in combination with other substances (glucosamine, MSM, hyaluronic acid, shark cartilage, etc.)
Some studies indicate a lower effectiveness of the combination of glucosamine and chondroitin.
Details can be found in the article Glucosamine with chondroitin for joints: how much more effective is the combination of drugs than each of them separately?
Conclusion
Based on the studies reviewed above, it can be concluded that chondroitin sulfate does not have unequivocal experimental confirmation of its effectiveness as a chondroprotector and a drug for the treatment of joint diseases.
Is there any point in taking it? Yes and no.
Since there are no serious side effects associated with chondroitin, it can be recommended for use in joint diseases. Nothing terrible will happen.
However, if there is no effect within a few months, it is unlikely that continuing to take it is advisable.
