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Shark Cartilage

Shark cartiledge  

Natural Standard Monograph, Copyright © 2014 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified health care professional before making decisions about therapies and/or health conditions.

Related Terms

  • AE-941, Arthrovas®, BeneFin®, calcium, calcium salts, cartilage, cartilage-derived inhibitor, cartílago de tiburón (Spanish), CDI, Cephaloscyllium ventriosum, chondroitin-6-sulfate, chondroitin sulfate, chondroitin sulfate-D, chondrosine, collagenase, copper, galactosamines, glucosamine, glycosaminoglycans, Haifischknorpel (German), Houtsmuller diet, iron, keratan sulfate, manganese, matrix Gla protein, MIA Shark Powder®, molybdenum, Mustelus californicus, Neoretna®, Neovastat®, Novastal®, octasaccharides, polar shark cartilage, proteoglycans, Psovascar™, selenium, shark, shark fin soup, Sharkilage®, smooth-hound shark, Sphyrna lewini (hammerhead shark), sphyrnastatin-1, squalamine, Squalus acanthias (spiny dogfish shark), strontium, swell shark, tetranectin-type protein, trimethylamine N-oxide, troponin-I, U-955, zinc.
  • Note: The product Catrix® is made from cow cartilage, not from shark cartilage.

Background

  • Shark cartilage is one of the most popular supplements in the United States, with over 40 brand name products sold in 1995 alone. Primarily used for cancer, its use became popular in the 1980s after several poor-quality studies reported "miracle" cancer cures.
  • Research on the shark cartilage derivative product AE-941 has renewed interest in shark cartilage for cancer, eye disorders, skin disorders, and a range of inflammatory disorders. However, there is currently insufficient evidence to recommend for or against shark cartilage for any indication. AE-941 is marketed under different names for different conditions: Neovastat® is used for cancer, Psovascar™ is used for skin conditions, Neoretna® is used for eye conditions, and Arthrovas® is used for joint conditions. The U.S. Food and Drug Administration (FDA) granted orphan drug status to this agent in 2002.
  • Commercial shark cartilage is primarily composed of chondroitin sulfate (a type of glycosaminoglycan), which is further broken down in the body into glucosamine and other end products. Although chondroitin and glucosamine have been extensively studied for arthritis, there is a lack of evidence supporting the use of unprocessed shark cartilage preparations for this condition. Shark cartilage also contains calcium. Manufacturers sometimes promote its use for calcium supplementation.
  • Shark cartilage supplements at common doses can cost as much as $700-1,000 per month.

Evidence

 

Uses based on scientific evidence 

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare professional.

Grade* 

Arthritis 

Derivatives of shark cartilage, such as AE-941, have been shown to reduce inflammatory responses. It has been proposed that shark cartilage, as an agent that blocks new blood vessel growth, may have potency against inflammatory conditions. Chondroitin sulfate and glucosamine sulfate, components of shark cartilage, may be too low in shark cartilage preparations for clinical benefit. There is insufficient data on the use of shark cartilage for inflammatory joint diseases, such as arthritis.

C 

Macular degeneration (eye disorder leading to vision loss) 

Early evidence suggests that shark cartilage may improve or stabilize vision in people with an eye disease that leads to loss of vision. Well-designed studies are required.

C 

Pain 

There is insufficient research on the use of shark cartilage as a pain relieving agent. Although not well studied in humans, anti-inflammatory and pain relieving properties of shark cartilage have been demonstrated.

C 

Skin inflammatory conditions 

There is insufficient data on the use of shark cartilage in the treatment of inflammatory skin conditions. The application of a shark cartilage preparation (Neovastat®) resulted in the reduction of skin irritation on the forearms of people. Several studies have been undertaken in people with skin conditions. Although promising, larger studies for this indication are needed.

C 

Cancer 

Promotion of new blood vessels is necessary for tumors to grow and spread. Enthusiasm about shark cartilage has stemmed from evidence of its properties that block new blood vessel growth and from several poor-quality studies of people with numerous types of cancer. However, several studies of shark cartilage lacked evidence of benefit in the treatment of cancer. In the United States, shark cartilage products cannot claim to cure cancer, and the U.S. Food and Drug Administration (FDA) has sent warning letters to companies not to promote products in this way. Without further evidence from well-designed human trials, it remains unclear if shark cartilage is of any benefit in cancer.

D 

 

*Key to grades: 

A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

For full grading rationale, click here.

Uses based on tradition or theory 

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified health care professional

Allergic skin rashes, ankylosing spondylitis (spinal arthritis), anti-inflammatory, atherosclerosis (clogged arteries), bacterial infections, contact dermatitis, degenerative diseases (chronic), diabetic retinopathy (retina damage due to diabetes), diarrhea, fungal infections, glaucoma, immune system stimulant, intestinal disorders, Kaposi's sarcoma, kidney disease, kidney stones, lupus, nervous system disorders, osteoporosis, Reiter's syndrome (arthritis in response to infection), sarcoidosis (chronic lung disease), scar healing, Sjogren's syndrome (autoimmune disorder affecting the tear and saliva glands), skin rash, wound healing, wrinkle prevention.


Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare professional before starting a new therapy. Consult a healthcare professional immediately if you experience side effects.

Allergies

  • Avoid with known allergy or sensitivity to shark cartilage or any of its ingredients, including chondroitin sulfate and glucosamine. Caution should also be used in people with a sulfur allergy since shark cartilage products may be sulfated.
  • Occupational asthma in workers exposed to shark cartilage powder or dust has been reported, including one death possibly related to sensitivity with lung complications in a 38 year-old male, although it is not clear if shark cartilage or underlying severe reactive airway disease was the cause.

Side Effects and Warnings

  • A limited amount of published research suggests that shark cartilage is well tolerated in most people at recommended doses. The most common side effects reported are mild-to-moderate stomach upset and nausea.
  • Shark cartilage is likely safe when taken in recommended doses for up to 18 months.
  • Shark cartilage may alter blood sugar levels. Caution is advised in people with diabetes and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.
  • Shark cartilage may cause low blood pressure. Caution is advised in people taking drugs or herbs and supplements that lower blood pressure.
  • Use cautiously in people with abnormal heart rhythms, heart conditions, kidney dysfunction, liver dysfunction, lung disorders, musculoskeletal disorders, stomach and intestinal disorders, and sulfur allergies.
  • Use cautiously in people receiving chemotherapy and those needing a troponin-I assay to test for decreased blood flow to the heart.
  • Avoid in people prior to surgery and after trauma.
  • Avoid with known allergy or sensitivity to shark cartilage or any of its ingredients, including chondroitin sulfate and glucosamine.
  • Avoid in pregnant or breastfeeding women and children.
  • Shark cartilage may cause abnormal heart rhythms, altered consciousness, bloating, blocked blood vessel growth, bone pain, cramping, decreased motor strength, decreased sensation, diarrhea, difficulty breathing, dizziness, generalized weakness, fatigue, increased levels of calcium, inhibit wound healing, liver inflammation, low levels of white blood cells, nausea, taste alteration, and upset stomach.

Pregnancy and Breastfeeding

  • Shark cartilage should be avoided in pregnant or breastfeeding women. Shark cartilage may block the growth of new blood vessels and drugs with similar properties, such as thalidomide, can cause birth defects. There is limited study of shark cartilage in these areas.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare professional before starting a new therapy.

Interactions with Drugs

  • Shark cartilage may alter blood sugar levels. Caution is advised when using medications that may also alter blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Shark cartilage may cause low blood pressure. Caution is advised in people taking agents that lower blood pressure
  • Shark cartilage may also interact with agents for arthritis, agents for the blood, agents for the heart, agents for the kidneys, agents for the stomach and intestines, agents that alter the immune system, agents that block new blood vessel growth, agents toxic to the liver, anesthetics, anticancer agents, anti-inflammatories, cisplatin, diuretics, heart rate regulating agents, interferons (α and β), pain relievers, thalidomide, and thiazide.

Interactions with Herbs and Dietary Supplements

  • Shark cartilage may alter blood sugar levels. Caution is advised when using herbs or supplements that may also alter blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • Shark cartilage may cause low blood pressure. Caution is advised in people taking agents that lower blood pressure
  • Shark cartilage may also interact with anesthetics, anticancer herbs and supplements, anti-inflammatories, antioxidants, calcium supplements, chondroitin sulfate, diuretics, glucosamine sulfate, heart rate regulating herbs and supplements, herbs and supplements for arthritis, herbs and supplements for the blood, herbs and supplements for the heart, herbs and supplements for the kidneys, herbs and supplements for the stomach and intestines, herbs and supplements that alter the immune system, herbs and supplements that block new blood vessel growth, herbs and supplements toxic to the liver, minerals, and pain relievers.

Authors

Selected References

Natural Standard developed the above evidence-based information based on a systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Alifrangis C and Stebbing J. Shark cartilage: has the popularisation of science failed? Lancet Oncol 2012;13(1):22.
  2. Batist G, Patenaude F, Champagne P, et al. Neovastat (AE-941) in refractory renal cell carcinoma patients: report of a phase II trial with two dose levels. Ann Oncol 2002;13(8):1259-1263.
  3. Escudier B, Choueiri TK, Oudard S, et al. Prognostic factors of metastatic renal cell carcinoma after failure of immunotherapy: new paradigm from a large phase III trial with shark cartilage extract AE 941. J Urol 2007 Nov;178(5):1901-5.
  4. Dupont E, Savard RE, Jourdain C, et al. Antiangiogenic properties of a novel shark cartilage extract: potential role in the treatment of psoriasis. J Cutan Med Surg 1998;2(3):146-152.
  5. Gingras D, Boivin D, Deckers,C, et al. Neovastat-a novel antiangiogenic drug for cancer therapy. Anticancer Drugs 2003;14(2):91-96.
  6. Hyodo M, Mikami T, Faissner A, et al. Nationwide survey on complementary and alternative medicine in cancer patients in Japan. J Clin Oncol 4-20-2005;23(12):2645-2654.
  7. Kralovec JA, Guan Y, Metera K, et al. Immunomodulating principles from shark cartilage. Part 1. Isolation and biological assessment in vitro. Int Immunopharmacol 2003;3(5):657-669.
  8. Lagman R, Walsh D. Dangerous nutrition? Calcium, vitamin D, and shark cartilage nutritional supplements and cancer-related hypercalcemia. Support Care Cancer 2003;11(4):232-235.
  9. Leitner SP, Rothkopf MM, Haverstick DD, et al. Two phase II studies of oral dry shark cartilage powder (SCP) in patients with either metastatic breast or prostate cancer refractory to standard treatment. Amer Soc Clin Oncol 1998;17:A240.
  10. Lu C, Lee JJ, Komaki R, et al. Chemoradiotherapy with or without AE-941 in stage III non-small cell lung cancer: a randomized phase III trial. J Natl.Cancer Inst 6-16-2010;102(12):859-865.
  11. Miller DR, Anderson GT, Stark JJ, et al. Phase I/II trial of the safety and efficacy of shark cartilage in the treatment of advanced cancer. J Clin Oncol 1998;16(11):3649-3655.
  12. Ortega HG, Kreiss K, Schill DP, et al. Fatal asthma from powdering shark cartilage and review of fatal occupational asthma literature. Am J Ind Med 2002;42(1):50-54.
  13. Riviere M, Falardeau P, Latreille J, et al. Phase I/II lung cancer clinical trial results with AE-941 (Neovastat®) an inhibitor of angiogenesis. Clin Invest Med (supplement) 1998;S14.
  14. Riviere M, Latreille J, Falardeau P. AE-941 (Neovastat), an inhibitor of angiogenesis: phase I/II cancer clinical trial results. Cancer Invest 1999;17(suppl 1):16-17.
  15. Roudebush P, Davenport DJ, Novotny BJ. The use of nutraceuticals in cancer therapy. Vet Clin North Am Small Anim Pract 2004;34(1):249-69, viii.
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