Nutrition Q&A

with Dan Lukaczer, N.D.

Chronic Fatigue News
Is there any new information about chronic fatigue syndrome?

There is little federal funding for studying chronic fatigue immunodeficiency syndrome (CFIDS), and therefore the condition doesn't get much attention. A 1999 study, however, suggests it continues to be a major problem. It also debunks the myth that CFIDS is a "yuppie flu" that generally strikes young urban professionals.⁵

Researchers at DePaul University in Chicago screened more than 28,000 adults by phone, then medically evaluated those suspected of having CFIDS. The results suggest that CFIDS is much more prevalent then previously thought. If extrapolated to the entire U.S. population, the data suggest 800,000 people fit the CFIDS criteria—almost double previous estimates.⁵

Chronic fatigue was most prevalent among minority groups, the uneducated and the poor. Researchers also confirmed that women seem to suffer from the condition twice as often as men do, and the women are more likely to be aged 40 to 59. If nothing else, this study will make it more difficult to trivialize the extent or breadth of the condition.

Blood-Sugar Quagmire
What are the best carbohydrates to control blood sugar?

You're referring to the effect a particular food has on blood sugar. In 1981, the term glycemic index (GI) was coined to describe the body's blood-sugar response following ingestion of a standard amount of carbohydrate as measured against a standard test food.⁶ Therefore, if 50 g of glucose elicited a blood-sugar response of 100, other foods with the same carbohydrate content could be scored against it. The higher the score, the higher the blood-sugar response. For example, french bread scores a high glycemic index of 95, whereas pumpernickel scores a low 41.

Why is this important? Some research suggests that the higher the glycemic index of a person's diet, the higher her risk for diabetes.⁷ The traditional classification of carbohydrates as "simple" or "complex" is of little use in predicting blood-sugar response. The GI of a baked potato is similar to that of pure sugar, while an apple has a far lower GI then a banana. Many factors contribute to glycemic index including starch structure, fiber content, cooking, food processing, ripeness and storage.

The GI has been researched extensively and more than 600 foods have been categorized. The GI concept is widely adopted as a diabetes management tool in Australia, New Zealand and Great Britain but remains controversial in the United States. You may wish to stock a useful book on the subject, The Glucose Revolution: The Authoritative Guide to the Glycemic Index by Jennie Brand Miller, et al. (Marlowe & Co., 1999).

For more information on blood sugar, see "Cancer's Sweet Tooth."

Osteoarthritis is the most common form of joint disease. Conventional medications such as aspirin and ibuprofen often relieve symptoms, but they do not slow the progression of the disease and can also cause significant side effects including gastric bleeding and kidney damage. Two natural substances, chondroitin sulfate and glucosamine sulfate, offer an alternative.

The cartilage that is damaged and wears out in people with osteoarthritis contains a group of large protein molecules called proteoglycans. These proteins make up the ground substance, or the cement, of cartilage. Chondroitin sulfate belongs to this group of proteoglycans and glucosamine is a precursor molecule, or a building block, in their synthesis. Clinical evidence shows that ingesting chondroitin sulfate has favorable results in osteoarthritis treatment.¹ Glucosamine, as glucosamine sulfate, also decreases osteoarthritic joint pain, tenderness, and swelling and increases range of motion in a number of human trials.^2,3

So which treatment is best? It's likely that glucosamine sulfate is more easily absorbed orally than chondroitin sulfate because it is a smaller molecule. In fact, some evidence indicates chondroitin sulfate is broken down in the intestinal tract prior to absorption.⁴ If so, it may be acting as glucosamine does—providing the raw materials for proteoglycan synthesis. Unfortunately, no work has compared the two treatments, or compared the combination.

My advice is that customers start with a therapeutic dose of glucosamine sulfate (500 mg three times/day) for six to eight weeks before trying chondroitin sulfate (400 mg three times/day). These doses are based on clinical trial results. Taking a combination formula wouldn't hurt, but such products generally have quite a bit less of both glucosamine sulfate and chondroitin sulfate per capsule or tablet, so your customers may not receive the therapeutic dose of either.

Dan Lukaczer, N.D., is director of clinical services at the Functional Medicine Research Center, a division of HealthComm International Inc., in Gig Harbor, Wash.

References

1. Morreale P, et al. Comparison of the anti-inflammatory efficiency of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis. J Rheumatol 1996;23:1385-91.
2. Drovanti A, et al. Therapeutic activity of oral glucosamine sulfate in osteoarthrosis: a placebo-controlled double-blind investigation. Clin Ther 1980;3:260-72.
3. Muller-Fassbender H, et al. Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis Cartilage 1994;2:61-9.
4. Conte A, et al. Biochemistry and pharmacokinetic aspects of oral treatment with chondroitin sulfate. Arzneimittelforschung 1995;45:918-25.
5. Jason LA, et al. A community-based study of chronic fatigue syndrome. Arch Intern Med 1999;159:2129-37.
6. Jenkins D, et al. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr 1981;34:362-6.
7. Brand J, et al. Low glycemic index foods improve long-term glycemic control in NIDDM. Diabetes Care 1991;14:95-101.