Nibbling nutraceutical factsone veterinary client question at a time

(Shutterstock.com)How many of you are taking a daily, over-the-counter vitamin or supplement? Supplements are a global $2.7 billion industry on the human side. Two-thirds of all adults in the United States take supplements to promote health. And chances are good that you have veterinary clients who are already giving supplements or interested in supplements for their pets. Jennifer Wardlaw, DVM, MS, DACVS-SA, a concierge surgeon at Gateway Veterinary Surgery in St. Louis, Missouri, had some advice for recent Fetch dvm360 conference attendees: Don't be afraid to talk about supplements with your clients and carry high-quality supplements you recommend for them to buy. Here are her top tips for talking supplements with clients.

The rest of the best supplementary supplement facts

• When recommending omega-3 fatty acids, Dr. Wardlaw keeps liquid fish oil in stock for cats and small dogs. For big dogs, she recommends her clients buy over-the-counter capsules and give two to three times the adult human dose (80 to 100 mg/kh of combined DHA/EPA) to reach therapeutic levels necessary for osteoarthritis.

• Fun fact: S-adenosylmethionine (SAM-e) can be effective for arthritis pain. A 2002 analysis of 14 SAM-e studies showed it's effective for reducing pain and improving mobility in people with osteoarthritis. For the overweight, arthritic old Labrador with elevated liver activities, SAM-e could provide multiple benefits.

• What about clients who give pets human supplements? Dr. Wardlaw stresses the need to counsel clients away from this, because many human bone and joint supplements contain calcium and vitamin C for osteoporosis. Dogs don't get osteoporosis, and excessive calcium supplementation can actually exacerbate arthritic conditions.

• Turmeric is fabulous for joints and arthritis, but it's not bioavailable to dogs in most formulations. Knowing the bioavailability is critical to assessing whether the supplement is working or not.

“Look this over, doc.” If a client brings in a supplement and asks you to evaluate it, you can use consumerlab.com. You'll need to pay for a subscription, but you can evaluate a bulk list of products you're curious about all at once. This organization verifies ingredients in supplements; however, it doesn't address bioavailability.

“I think it's working!” Be aware of the placebo effect when you ask clients if they think a supplement is working. Many clients will show a cognitive bias toward the supplement they give, assuming that since it was expensive it must be working. Take client reports on efficacy with a grain of salt. Instead, rely on concrete answers, such as objective measurements of mobility, coat quality and blood work.

“Which one will work?” Different products work better for different patients, Dr. Wardlaw says. Nutraceutical recommendations are not one-size-fits-all. Some dogs may respond better to Dasuquin, other dogs may see better results with Adequan injections. Consider having your practice management stock your top three products so veterinarians have some choices for supplement recommendations. Remember to offer options for reasons of palatability and food allergies.

“What's the one thing we can do for pain here, doc?” When communicating options for arthritis pain management to clients, it's important to emphasize a multimodal approach. Most clients don't want to give their dog arthritis medication for the rest of the dog's life, but they're willing to give a healthy supplement. Emphasize to clients that you need to start with higher doses of arthritis pain medication along with a joint supplement to control pain and increase mobility, but the goal is to combine diet, exercise, and joint supplements so that the client can possibly reduce the amount of NSAIDs.

“But has it really worked?” Don't underestimate the power of a personal story, Dr. Wardlaw says. If you've used the supplements in your own pets or seen other patients benefit, tell those stories. Personal endorsement from real experience communicates trust and validity and can be a very effective way to move your client to action.

“How many do we need?” When it comes to arthritis supplements, combination therapy is the best. We now know that glucosamine hydrochloride and chondroitin sulfate work better together than they do alone, and adding in oils and omega-3 fatty acids to an arthritis supplement decreases inflammation. Other synergistic compounds to consider are Boswellia serrata and manganese.