Glucosamin har været brugt i årtier mod slidgigt, og marked et med præparater er stort. Ikke mindst på nettet. Men da glucosamin som kosttilskud desværre har resulteret i mangelfuld effekt og misvisende metaanalyser, bør man tage sig i agt og vælge glucosamin som lægemiddel af flere årsager.
Af Pernille Lund, naturopath ibm og videnskabsjournalist
Artiklen blev bragt i magasinet sund-forskning og //mig// – februar 2016
I løbet af de sidste år er der opstået en stor uenighed om glucosamins effekt på slidgigt, og denne uenighed skyldes fejlagtige fortolkninger af en række metaanalyser, som går ud på at analysere mange studier. Det har desværre resulteret i, at glucosamin som lægemiddel mistede tilskud fra staten, og at de mange tilfredse brugere nu må betale det fulde beløb for den nødvendige medicin.
Gigteksperter kommenterer misvisende metaanalyser
Der er stor forskel på kosttilskud og lægemidler, hvad angår krav til produktion, kvalitet, indhold og dokumentation. Derfor er det også misvisende at lave metaanalyser på stoffer som glucosamin, hvor hovedparten af produkterne er produceret som kosttilskud. Det fremgår af en artikel, som er skrevet af en stor gruppe gigteksperter og forskere i “Cur-rent Medical Research and Opinion” marts 2015. Danmark er et af de få lande, hvor glucosamin skal være et lægemiddel. I langt de fleste lande har glucosamin været tilladt som kosttilskud. Det betyder, at pågældende metaanalyser er baseret på en masse kosttilskudsprodukter, hvor kvaliteten kan være dårlig og effekten derefter.
Man kan ikke lave forskning på lægemidler og kosttilskud efter samme opskrift
Læger og forskere er vant til, at indholdet af aktive stoffer i lægemidler er 100 procent ens. Derfor er det ligegyldigt, om et paracetamol-produkt hedder Pinex, Pamol eller Panodil, fordi indholdet af paracetamol bør være 100 procent ens, og indholdet af tilsætningsstoffer bør være 90 procent ens. På lægemidler vil virkningen af de aktive indholdsstoffer altså altid være den samme, men der kan godt være en forskel på form, farve og smag. Desværre tror mange forskere, at de bare kan lave metaanalyser af kosttilskud som glucosamin, selen, Q10 og D-vitamin efter samme opskrift som ved lægemidler. Det vil sige, at man finder alle de studier, som opfylder de sædvanlige videnskabelige krav, som at de skal være dobbelt-blinde, placebo-kontrollerede og publicerede i videnskabelige tidsskrifter. Men forskerne, der er vant til at forske i lægemidler, vil ikke drømme om at så tvivl om de aktive stoffers beskaffenhed i de forskellige kosttilskud, og det kan godt være et problem.
Det er heller ikke lige meget, hvilken glucosaminform man vælger
Glucosaminprodukter baseret på glucosaminsulfat har været anvendt til behandling af slidgigt siden 1980’erne med de bedste resultater. I Danmark sælges glucosamin derfor som lægemiddel i form af glucosaminsulfat.
Glucosaminprodukter baseret på glucosaminhydroklorid har ikke medført samme positive resultater. Men de har været med til at skabe forvirring og fejlfortolkninger vedrørende glucosamins effekt.
Glucosamin som lægemiddel som første valg ved slidgigt
Ifølge en nyere rapport bør tilskud med glucosamin være det første valg i behandlingen af slidgigt frem for smertestillende medicin, der er forbundet med en del bivirkninger bl.a. mavesår. Rapporten er udarbejdet af en økonomisk uafhængig europæisk ekspertgruppe, ESCEO (European Society for Clinical and Economic Aspect of Osteoarthritis). Gigt-eksperterne granskede den tilgængelige dokumentation på glucosamin, og de fandt som flere andre forskere, at det er glucosaminsulfat, som er mest effektivt, hvorfor de også anbefaler denne glucosaminform i deres rapport.
Hvordan virker glucosaminsulfat og tilskud?
Tilskud med glucosaminsulfat virker på lettere til moderat slidgigt, hvor der stadig er noget brusk tilbage at ”bygge videre på”. Glucosaminsulfat indgår i ledbruskens byggesten. Samtidig hæmmer glucosaminsulfat via enzymprocesser og nedbrydningen af brusk i led. Det bevirker, at glucosaminsulfat også har en antiinflammatorisk effekt.
Man skal tage sig i agt for fortolkninger af forsøg og metaanalyser
Forsøg med glucosamin bør være baseret på glucosaminsulfat, og metaanalyser bør være baseret på glucosamintilskud som lægemiddel for at give et troværdigt billede af glucosamins positive effekt på slidgigt.
Kun glucosamintilskud kan bremse den egentlige sygdom
Selvom mange andre præparater fjerner smerten hos slidgigtpatienter, er det kun glucosaminpræparater, som kan bremse nedbrydningen af ledbrusken, som er årsag til den egentlige sygdom. Smerterne er de beklagelige følgevirkninger, som ikke stopper, medmindre nedbrydningen af brusken stopper.
Lægemidler er registreret i Sundhedsstyrelsen, og godkendelse kræver dokumentation
Lægemidler skal være godkendt af Lægemiddelstyrelsen eller Europa-Kommissionen, før de må sælges i Danmark. Det gælder også for naturlægemidler samt stærke vitamin- og mineralpræparater. Godkendelsen, som går forud for markedsføringstilladelsen, kræver dokumentation for lægemidlets virkning, sikkerhed og kvalitet.
Vidste du, at Glucosamin Pharma Nord var det første glucosaminlægemiddel, der blev godkendt i Danmark ?
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