ChiroACCESS: An Evidenced-Based Intervention for Osteoarthritis: Avocado-soybean Unsaponifiables

An Evidenced-Based Intervention for Osteoarthritis: Avocado-soybean Unsaponifiables

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ChiroACCESS Editorial Staff

Published on November 23, 2009

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Glucosamine sulfate (GS), chondroitin sulfate (CS), and methylsulfonylmethane (MSN) are just a few of many non-drug interventions that are in common usage for the pain and functional loss of osteoarthritis. Evidence for efficacy of GS and CS is present in the scientific literature (1-3) although some still doubt their value (4;5). While the safety of GS has been clearly demonstrated in numerous trials (6), concerns have been raised as to the purity and accuracy of labeling in CS products (7). ConsumerLab.com, an internet based nutritional testing company, found 4 of 21 tested brands of CS contaminated with lead and 4 were mislabeled or failed to disintegrate properly (8).

Avocado soybean unsaponifiables (ASU) is a largely ignored supplement in the popular media and in doctor’s offices. In spite of a lack of recognition it has possibly the highest level of evidence supporting its effectiveness of all the herbal or nutritional supplements. The Cochrane Collaboration reported in 2001 “evidence for avocado-soybean unsaponifiables in the treatment of osteoarthritis is convincing” (9). A second review published in 2006 came to a similar conclusion, rating the evidence as “good” (10). Blotman et al reported in their three month randomized controlled trial (RCT) of 163 subjects that ASU reduced the need for NSAIDs and improved function compared to the placebo (11). Another RCT found NSAID use was reduced by more than 50% in 71% of patients receiving ASU (12). Lastly Maheu et al reported a 20.9 point drop in the visual analog pain scale in their RCT of 164 subjects when using ASU (13).

In addition to positive effects on pain and function, preliminary studies demonstrate positive structure modifying effects as well. Henrotin et al reported ASU “may promote OA cartilage repair by acting on subchondral bone osteoblasts” (14). A second study found ASU “significantly reduced the progression of joint space loss” (15).

Maximum treatment effect requires 2 months of use (13) and 300 mg daily has been shown to be as effective as 600mg daily (12).

In conclusion ASU appears to be an overlooked yet effacious and cost-effective option for functional loss and pain of osteoarthritis, particularly in the hips and knees.

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References

1. Black C, Clar C, Henderson R, Maceachern C, McNamee P, Quayyum Z, et al. The clinical effectiveness of glucosamine and chondroitin supplements in slowing or arresting progression of osteoarthritis of the knee: a systematic review and economic evaluation. Health Technol Assess 2009 Nov;13(52):1-148.

2. Herrero-Beaumont G, Ivorra JA, Del Carmen TM, Blanco FJ, Benito P, Martin-Mola E, et al. Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator. Arthritis Rheum 2007 Feb;56(2):555-67.

3. Lee YH, Woo JH, Choi SJ, Ji JD, Song GG. Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis. Rheumatol Int 2009 Jun 21.

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5. Rozendaal RM, Uitterlinden EJ, van Osch GJ, Garling EH, Willemsen SP, Ginai AZ, et al. Effect of glucosamine sulphate on joint space narrowing, pain and function in patients with hip osteoarthritis; subgroup analyses of a randomized controlled trial. Osteoarthritis Cartilage 2009 Apr;17(4):427-32.

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7. Volpi N. Quality of different chondroitin sulfate preparations in relation to their therapeutic activity. J Pharm Pharmacol 2009 Oct;61(10):1271-80.

8. Product Review: Joint Health Supplements with Glucosamine, Chondroitin, and/or MSM. ConsumerLab 2009 July 6 [cited 2009 Nov 22] [ Full-Text Link ]

9. Little CV, Parsons T. Herbal therapy for treating osteoarthritis. Cochrane Database Syst Rev 2001;1(CD002947).

10. Ameye LG, Chee WS. Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidence. Arthritis Res Ther 2006;8(4):R127.

11. Blotman F, Maheu E, Wulwik A, Caspard H, Lopez A. Efficacy and safety of avocado/soybean unsaponifiables in the treatment of symptomatic osteoarthritis of the knee and hip. A prospective, multicenter, three-month, randomized, double-blind, placebo-controlled trial. Rev Rhum Engl Ed 1997 Dec;64(12):825-34.

12. Appelboom T, Schuermans J, Verbruggen G, Henrotin Y, Reginster JY. Symptoms modifying effect of avocado/soybean unsaponifiables (ASU) in knee osteoarthritis. A double blind, prospective, placebo-controlled study. Scand J Rheumatol 2001;30(4):242-7.

13. Maheu E, Mazieres B, Valat JP, Loyau G, Le L, X, Bourgeois P, et al. Symptomatic efficacy of avocado/soybean unsaponifiables in the treatment of osteoarthritis of the knee and hip: a prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial with a six-month treatment period and a two-month followup demonstrating a persistent effect. Arthritis Rheum 1998 Jan;41(1):81-91.

14. Henrotin YE, Deberg MA, Crielaard JM, Piccardi N, Msika P, Sanchez C. Avocado/soybean unsaponifiables prevent the inhibitory effect of osteoarthritic subchondral osteoblasts on aggrecan and type II collagen synthesis by chondrocytes. J Rheumatol 2006 Aug;33(8):1668-78.

15. Lequesne M, Maheu E, Cadet C, Dreiser RL. Structural effect of avocado/soybean unsaponifiables on joint space loss in osteoarthritis of the hip. Arthritis Rheum 2002 Feb;47(1):50-8.