Hyaluronic acid, NAG and glucosamine all contraindicated in patients with multiple myeloma

Jacob Schor ND, FABNO
November 20, 2011
We want definitive answers in life.  What is good?  What is bad?  Unfortunately science and particularly medical science rarely provides that sort of black and white information. 
People ask if a supplement is good or bad? It rarely works out that way.
Case in point, consider glucosamine sulfate.  We recently sent out a newsletter reviewing the VITAL data that suggest taking glucosamine lowers risk of lung cancer.  Suddenly glucosamine’s status as a ‘good’ supplement went way up. 
Before we put glucosamine on a too high a pedestal and start adding it to our drinking water, here is a note of caution.  Glucosamine may interfere with the treatment of multiple myeloma and should probably be used with great caution, if at all, by people diagnosed with this disease. 
Let me explain why.
Multiple myeloma is a cancer of the ‘plasma cells.’  Plasma cells help fight infection by producing antibodies.  In multiple myeloma these plasma cells grow out of control in the bone marrow, forming tumors in areas of solid bone.
These tumors hinder the bone marrow from making healthy cells and platelets.  This leads to anemia, broken bones, fevers, fatigue and shortness of breath. It’s common practice to treat multiple myeloma with high doses of steroids, in particular prednisone.  [1]
A 2008 paper by Ohwada et al announced that a substance called hyaluronic acid led multiple myeloma cells to become resistant to prednisone so that this kind of drug becomes ineffective as treatment.   [2]        Hyaluronic acid increases connective tissue providing a framework in which some myeloma cells can hide from attack.
Knowing that hyaluronic acid might limit multiple myeloma treatment places a strong impetus on us to avoid increasing this substance in people with multiple myeloma.
Hyaluronic acid is not a bad thing, it is important for repairing connective tissues and is often prescribed as a supplement to improve connective tissue, in particular to improve skin texture.  If you search online you will quickly see that the words hyaluronic acid are often closely associated with the words like, “natural face lift.”        [3]   It seems to really improve skin texture, reduce skin cracking and make wrinkles disappear.
Hyaluronic acid is made from several building blocks, including n-acetyl-glucosamine (NAG) and glucuronic acid.  NAG is sold in supplement form and is often prescribed to treat connective tissue disorders, in particular what is popularly known as ‘leaky gut syndrome.’ It’s also used to treat a rare condition called vulvadynia. Taking NAG though increases levels of hyaluronic acid.  [4]  Thus people with multiple myeloma should also avoid taking NAG.
The same should be said for glucosamine.  Glucosamine is typically prescribed for people with osteoarthritis.  Taking supplemental glucosamine increases levels of hyaluronic acid.   Although this is indirect evidence and far from solid proof, there is no reason to wait and find out the hard way.
So is glucosamine good or bad?        The answer is probably, “depends on where, when and who.”
1. http://www.nlm.nih.gov/medlineplus/ency/article/000583.htm
2. Ohwada C, Nakaseko C, Koizumi M, Takeuchi M, Ozawa S, Naito M, Tanaka H, Oda K, Cho R, Nishimura M, Saito Y. CD44 and hyaluronan engagement promotes dexamethasone resistance in human myeloma cells. Eur J Haematol. 2008 Mar;80(3):245-50.
3. Vincent T, Mechti N. Extracellular matrix in bone marrow can mediate drug resistance in myeloma. Leuk Lymphoma. 2005 Jun;46(6):803-11.
4. Vincent T, Molina L, Espert L, Mechti N. Hyaluronan, a major non-protein glycosaminoglycan component of the extracellular matrix in human bone marrow, mediates dexamethasone resistance in multiple myeloma. Br J Haematol. 2003 Apr;121(2):259-69.
5.  http://www.positivearticles.com/Article/Hyaluronic-Acid-Natural-Face-Lift/34248
6. Tu CX, Zhang RX, Zhang XJ, Huang T. Exogenous N-acetylglucosamine increases hyaluronan production in cultured human dermal fibroblasts. Arch Dermatol Res. 2009 Aug;301(7):549-51. Epub 2009 Feb 27.
7. Uitterlinden EJ, Koevoet JL, Verkoelen CF, Bierma-Zeinstra SM, Jahr H, Weinans H, Verhaar JA, van Osch GJ. Glucosamine increases hyaluronic acid production in human osteoarthritic synovium explants. BMC Musculoskelet Disord. 2008 Sep 11;9:120.