Supplements & functional ingredients
discomfort for individuals. While healthy diets and regular exercise can do much to protect cartilage organically, it equally makes sense that osteoarthritis patients and their doctors are constantly on the hunt for more proactive solutions too.
And with chondroitin sulphate, they might just have found it. A chemical found naturally in humans and animals, it’s one of the building blocks of cartilage. It goes without saying, then, that adding more to the body could do much to stymie osteoarthritis, even as it may help the fight against cataracts too. Yet if the global market for chondroitin sulphate was already $1.5bn in 2022, a figure which could rise by about $500m by 2032, obstacles clearly remain. For one thing, the chemical’s purity has a large impact on its practical effects, meaning patients should be careful when choosing their source. For another, and as so often in the ingredients space, the medical evidence in favour of chondroitin sulphate remains positive but inconclusive – even if its ultimate place in the ingredients canon is probably guaranteed.
A century of promise We’ve known about chromium sulphate – and its potential benefits – for a while. First obtained from cartilage back in 1861, it was isolated in a purer form a few decades later. Dovetailed with the steady rise of osteoarthritis, the subsequent century has seen it reach the high peaks of medical promise. In 1997, to give one example, a bestselling book pinpointed it as a cure for arthritis. That, in turn, has led to a scientific bonanza, with researchers rushing to extract the chemical from cow, pig and shark cartilage. Synthetic chondroitin sulphate is proving popular too: a cavalcade of companies, from India to Italy, now produce it in labs, even as the NIH estimates that 6.5 million Americans take chondroitin or similar anti-arthritis supplements. Perhaps unsurprisingly, the easiest way to
understand this boom is through its purported health benefits. “One of the major applications of chondroitin sulphate is the treatment of osteoarthritis,” says Dr Yves Henrotin, a professor of pathology, physical therapy and rehabilitation at the University of Liège in Belgium, describing it as “very important” for both the composition and the mechanical properties of bodily tissue. In practice, meanwhile, things are shepherded along because the chemical is so good at absorbing fluids like water into the cartilage. And if that helps keep the tissue strong, chondroitin sulphate equally blocks enzymes that break cartilage down. Whatever the scientific evidence, at any rate, Henrotin’s view is echoed by an increasing body of work. In 2023, for instance, a major review in the journal Cureus found that chondroitin sulphate
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supplements ‘may have clinically significant benefits’ if standardised properly. That’s reflected by its potential to offer pain relief, with one 2016 paper suggesting it’s especially effective when combined with glucosamine. Nor is osteoarthritis necessarily the only ailment to benefit from the chondroitin treatment, with a study in 2023 investigating the links between the cartilage chemical and successful cataract surgery.
No less important, Henrotin adds, is the way pushing chondroitin sulphate could potentially reduce patient reliance on riskier alternatives. “The advantage of chondroitin sulphate,” he explains, “is also to decrease the consumption of older drugs with a lot of adverse effects – including for example paracetamol. This is a key target in the management of osteoarthritis, even if we aren’t convinced by the efficacy of these kinds of compounds.”
Medical conditions
That last reflection is surely worth dwelling on. For if marketers are keen to push chondroitin sulphate as a kind of miracle cure – an argument shadowed by professional scientists to varying degrees of enthusiasm – the chemical equally suffers from a blight common to the ingredients sector: a lack of conclusive evidence. “There is,” he emphasises, “great heterogeneity in the preclinical and clinical data.” Fair enough: whatever the potential strengths of chondroitin sulphate, a 2022 analysis of eight studies, encompassing some 4,000 knee osteoarthritis patients, found no conclusive proof that the chemical offered any major benefits. It’s a point mirrored in more practical medical settings too. In the UK, for instance, doctors no longer prescribe chondroitin on the NHS because ‘there’s no strong evidence’ it’s an effective osteoporosis treatment.
How to explain this divergence between a soaring market on the one hand – and clinical ambivalence on the other? For Henrotin, fundamental is the sheer variety of chondroitin sources. As he puts it: “They’re different formulations, with different concentrations, different origins and different sulphitations.” That, it should be obvious, makes robust experimentation challenging, with scientists sometimes finding they’re comparing the chemical equivalent of apples and oranges. Just as crucial, Henrotin continues, is the way this panoply of powders sparks uncertainty among the wider medical community. The heterogeneity of the formulation, the number of products in the market, the difference between over- the-counter solutions and prescription drugs – all this, Henrotin says, “creates a lot of confusion in the minds of healthcare professionals and scientists.” Another factor here is the potential for side effects. To be clear, most of the evidence suggests that
600 million
The approximate number of people currently suffering from osteoarthritis worldwide. The Lancet
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