Supplements in veterinary medicine (Proceedings)

According to a statement provided in a recent Veterinary Practice News article (May 2009) entitled "Supplements Gaining Sales and Respect" Bob Brookout, founder and president of the National Animal Supplement Council (NASC), claims: "Supplements are used by 90 to 95 percent of general practitioners and 100 percent of holistic veterinarians." This despite the fact that the Food and Drug Administration's Center for Veterinary Medicine (CVM) says that some producers don't provide enough evidence that their products work.

While some questions of efficacy remain, the industry is experiencing a much greater acceptance of supplements in all areas of pet care. And, while there are certainly some scrofflaws in the field of supplements who continue to make hyperbolic and unfounded claims (as there are in any area of medicine), reputable manufactures strive to make their labels reflect the products inside. And more and more scientific research is being done to back up claims for efficacy.

Supplements, how big are they?

Again, according to the Veterinary Practice News article (cited above), consumers spent $1.3 billion on veterinary supplements in 2007. The industry is experiencing 15-18% growth each year, with annual revenue of $1.8 billion projected by 2012.

Other sources have similar figures: According to the Nutritional Business Journal US pet supplement sales reached $923 million in 2007, an increase of 8% over 2006 sales, and Packaged Facts estimates retail sales of pet supplements and nutraceutical treats at $1.2 billion in 2007 with 74% of this figure representing supplement sales. According to the Packaged Facts report, the majority of pet supplements (51%) are purchased for horses, while dog supplements represent 38% of the market and cat supplements represent 6%. (From an article in HerbalGram, the Journal of the American Botanical Council, # 82, May-July, 2009)

According to industry insiders, the supplement industry's growth is due to a new respect among veterinarians, to the increased amount of research available, and to client demand. Client demand is fueled by several factors, including: efficacy (perceived or actual); ease of administration (many products are dosed in the food); ease of purchase (products are available over the counter, at veterinary clinics, and via internet sources); readily available information (provided in user-friendly format on the internet); and the relatively inexpensive dosing.

Regulating supplements

The dietary supplement act Health and Education act of 1994 (DSHEA) established regulations for human dietary supplements at a time when there were few similar products for pets on the market. DSHEA did not specifically address the topic of supplements for pets, but a posting in the Federal Register later specified that the US Food and Drug Administration does not consider such supplements to be covered under DSHEA. Supplements for dogs, cats, and horses have therefore been left with two possible legal categories under US law – they may be defined as animal foods/feeds or animal drugs. Most supplement products for pets are classified by the manufacturers as nutritional or feed supplements.

Supplements were nearly removed from the marketplace beginning in 2002, after the American Association of Feed Control Officials (AAFCO) organized a committee to develop an enforcement strategy for unrecognized, undefined animal feed ingredients as well as accepted ingredients that were being marketed for unapproved uses.

NASC was established in 2002 to address consumer and regulator concerns. NASC has created quality control guidelines and has instituted risk monitoring procedures for the industry, and it is estimated that 90% of companies that produce supplements are members.

Safety

The National Animal Supplement Council (NASC) defines an adverse event broadly as any complaint for a product linked to a physical effect or health problem that may be (but is not necessarily) connected to or associated with use of the product – including transient events like vomiting, diarrhea etc. This adverse event system indicates that there have been, on average, 0.31 adverse events reported per million per supplement administrations (dosage unit administered to an animal) sold by NASC member companies.

Serious events are defined by NASC as any event with a transient incapacitating effect or a long-term or permanent health effect that requires follow-up with a veterinarian. These adverse serious events have amounted to, on average 0.001 events reported per million supplement administrations sold by NASC member companies.

(Info contained in these sections – Regulating Supplements and Safety – was taken from the HerbalGram, May-July, 2009, article cited above.)

Common supplements

Some (or all) of the following supplements will be discussed in this session.

• Vitamins A, B, C, D, E, H (biotin), K, etc.

This session will not discuss the benefits of vitamins (the assumption is that veterinarians already know these), but rather will discuss some of the following about dosages:

• What are RDA's, MDA's and how are/were they formulated

• What's enough; what's too much

• How to balance vitamins

• Therapeutic vs daily doses

• Some of the holistic vs conventional veterinary ideas of vitamins

Minerals: Calcium, Phosphorous; Ca/Phos ratio; magnesium; manganese; copper; zinc; iron; chromium; etc.

• Once again, this session will not discuss the benefits of minerals, but rather will discuss dosages, ratios and balances, and holistic uses

• Glucosamine. The amino-sugar building block for cartilage, collagen, and connective tissue, involved in the synthesis of proteoglycans such as chondroitin. Used to repair damaged joints, reduce inflammation, enhance wound healing, induce the regeneration of connective tissue, and maintain proper viscosity of synovial fluid. Available in several forms – glucosamine sulfate, glucosamine hydrochloride, and N-acetyl-glucosamine, and there is much controversy over which form is the best to use. It is often combined with MSM and/or chondroitin, and again, which is the best combination (and in what ratios) are controversial subjects.

o Chondroitin (sulfate). A glucosaminoglycan (GAG) that helps to lubricate the joints by drawing water into the cartilage as well as helping to regenerate collagen and connective tissue. Reduces inflammation, enhances regrowth of connective tissue and seems to alleviate pain.

o MSM (methylsulfonylmethane). An organic sulfur-containing mineral supplement found in a wide variety of foods. A metabolite of DMSO. Sulfur is a component of methionine and cysteine, and is involved in maintaining the health of joints and connective tissue. Used to treat arthritis.

• Omega fatty acids – essential fatty acids (EFA's) are necessary for rebuilding and producing new cells and for producing prostaglandins along with other substances. In this session we will discuss the following essential fatty acids, including: what body systems they affect; where they can be found naturally and in supplements; how to balance them in a diet; and their safety and efficacy for use in animals.

o Omega 3's

o Omega 6's

o Omega 9's

o DHA, docosahexaenoic acid. An omega-3 oil, found primarily in fish oils. It is essential for normal brain function and for normal development of the fetus.

o EPA, eicosapentaenoic acid. Used by the body to produce prostaglandins.

o Balance and total amounts

Note that many nutritionists believe that, because most processed foods (human and animal) contain high levels of omega-6 fatty acids (corn-based foods are especially high in omega-6's), the result is a relative deficiency of omega-3's. This can suppress the conversion of omega-3's to EPA and DHA, which can be further exacerbated (at least in humans) by deficiencies of vitamins C, B6, niacin, and zinc.

• Probiotics. Live microorganisms that improve the balance of "GI bugs". A variety of species are used including lactobacillus, bifidobacterium, lactococci, saccharomyces, streptococcus thermophilus, and enterococci and yeasts, with conflicting claims for efficacy of species and ratios of species. When the beneficial GI bugs predominate, they have been shown to exert antimicrobial, immunomodulatory, anticarcinogenic, anti-allergic, and antidiarrheal activity.

Holistic veterinarians use probiotics to create and maintain gut health, believing that a healthy gut will not be susceptible to food allergies. They also feel that probiotics are mandatory before, during and after any regime of antibiotics, steroids, or external form of stress.

o Prebiotics –inulin, etc.

• Herbs

Herbal remedies are discussed in another session, so the discussion here will be minimal, but may include the general topics of: dosages; delivery systems; safety; efficacy; active ingredient(s); etc.

• Anti-aging supplements

o Include @ any organ-specific supplement along with anti-oxidants, vitamins, minerals, detoxifiers (liver, kidney and lymph), brain helpers, etc.

o Novifit etc = examples from conventional medicine for cognitive dysfunction

o Herbs: Gingko etc. along with many herbs that are anti-inflammatory, immune enhancing, and/or organ specific.

o Resveritrol, carnosine, etc. (see below)

• Liver helpers: choline, inositol, herbs (milk thistle, turmeric, dandelion root, etc.)

Etc's

(Note: Much of the following info is adapted from the Best Supplements for Your Health, by Goldberg, Gitomer, and Abel, a human-oriented book)

• 5-HTP, Tryptophan. A neurotransmitter used to make serotonin and melatonin. Enhances mood – calming and anti-depressive.

• ALA, Alpha Lipoic Acid.

• Blue Green Algae. Related = spirulina, wheat and barley grass, chlorophyll, chlorella. All green-food supplements are rich in protein, chlorophyll, and carotenoids. Claims = anti-cancer activity; modulation of immune system; lower cholesterol; treat GI problems; and function as detoxifiers.

• Carnosine. Made up of two amino acids histidine and alanine. A water soluble anti-oxidant found in muscle tissue and brain. May function as a neurotransmitter. Current interest is in its potential as an anti-aging factor.

• Cartilage – shark and bovine cartilage and green-lipped mussel extract. Used as a source for mucopolysaccharides to help reduce inflammation and joint damage in arthritis. Often in combination with glucosamine, MSM, and/or chondroitin.

• Choline, related to lecithin, phosphatidylcholine, CDP-choline. An essential nutrient, used to make cell membranes and inner cell compounds. Also a precursor for acetylcholine. Needed for neurotransmission and used for liver and heart disorders and skin conditions.

• Colostrum. Usually bovine colostrums. Used by many holistic vets for a variety of ailments, but especially to enhance the immune system.

• Co-Q10. Belongs to a class of compounds called ubiquinones, fat-soluble compounds involved in electron transport and energy production in the cell's mitochondria. Cardioprotective; also used for treatment of periodontal disease, diabetes, cancers, and may enhance athletic performance.

• Flavenoids; ("Vitamin P"). Related = quercitin, anthocyanidins and proanthocyanidins, polyphenols (green tea), and citrus bioflavenoids (rutin, hesperidin). Powerful antioxidant activity; protect cell walls; prevent capillary fragility, and have antiviral, anticarcinogenic and antiallergy properties.

• Flaxseed oil: A rich source of omega-3 oils in general and especially alpha linolenic acid (ALA), which can be metabolized to EPA (eicosapentaenoic acid). High lignan flaxseed contains plant lignans which also have antioxidant properties. While flaxseed oil is a source of omega-6 oils, it is not a rich source, and since older animals may be less efficient in converting ALA to EPA, they may need additional EPA/DHA, from sources high in these nutrients, such as fish oils.

• Grape seed extract. (See also pycnogenol) A rich source of plant flavenoids, the proanthocyanidins. At this writing, no problems have been seen with grape seed extract (as opposed to the problems with grapes), however ...

• Inositol. A vitamin-like substance with functions similar to choline.

• Kombucha. A tea prepared from a mixture of bacteria and yeasts. Many claims; unknown if they apply to animals.

• Lecithin. A phospholipid containing phosphatidylcholine.

• Lutein. A fat-soluble carotenoid found in the retina and lens of the eye. Protects the eye from retinal degeneration and cataract formation.

• Lycopene. Related = carotenoids and lutein. Best known source is tomatoes. A powerful antioxidant, used to help prevent and treat prostate and lung cancer.

• Olive leaf extract. Contains oleuropein and flavenoids. Used for a variety of cardiovascular problems and as an antimicrobial.

• Pycnogenol. Trademarked as the proanthocyanidin flavenoid from the French maritime pine. Is a powerful antioxidant, anti0inflammatory, and enhances the health of collagen.

• Resveratrol. A polyphenol found in grape skin and red wine, and the roots and stems of the plant Polgonum cuspidatum. An antioxidant with cardioprotective, anticancer and immune-stimulating activity. Much recent interest as an anti-aging factor. Evidence indicates that several glasses of wine a day may help us old humans live longer ... and be happy happy.

• SAMe. A methyl donor used for the treatment of liver disorders and arthritis and to help maintain emotional well-being.

Selected bibliography

Balch, Phyllis and James Balch, Prescription for Dietary Wellness, Avery Publishing

Balch, James and Phyllis Balch, Prescription for Nutritional Healing Avery Publishing

Goldberg, Donald, Arnold Gitomer and Robert Abel; The Best Supplements For Your Health; Twin Streams Pub.

Lininger, Schuyler, etal, Natural Pharmacy, Prima Health