If I were asked to list the “high leverage” nutritional steps that can be taken to help pets live longer, feel better and have fewer health problems, Ideal Weight would top the list, but supplements would be next in importance based on recently published scientific articles.
From a breed specific focus, some supplements are appropriate for all breeds (the omega 3 fish oils = EPA/DHA); others such as dental prevention products have more of a small breed focus, and joint supplements are more important for larger breeds. The expenditure of a pet owner’s hard earned dollars (especially in this economy!) on a pet food or a supplement that claims to prevent tartar on your pet’s teeth or alleviate joint pain needs to be taken seriously!
There is now very good evidence to support the use of certain nutritional supplements in pets. Because supplements are not FDA regulated, proof of effectiveness and quality and even safety is not assured, effective doses are not listed on labels, and consumers (and veterinarians) are offered little support in the form of evidence based studies. A natural product like fish oil cannot even be patented which reduces the incentive for companies to promote and perform in-depth studies. With studies finally emerging, at least for certain categories, the product landscape is getting deeper and more competitive and the time is now for analysis so it can truly benefit our pet’s health.
It is very important that consumers have a place to turn for good information. Many of these products are expensive and effective blood or tissue levels must be reached to see any benefits. Interaction with other medications, purity, quality and recent safety issues are all-important issues. With the veterinary medical credo of “above all do no harm” we feel that we as practicing veterinarians need to be on the cusp of this rapidly emerging area to provide optimal wellness to pets.
A few definitions are in order.
Evidence based simply means that there is enough proof done in a controlled, unbiased manner to substantiate that a product really has a desired effect on a specific condition. Evidence is ranked from level 1 (best) to level 4 (anecdotal) according to how many pets participated, how the study was conducted and generally how unbiased the information is. As scientists, we need quality studies to be able to give you the proper dose or recommend one product over another.
A nutraceutical is any nutritional supplement that has the ability to treat or prevent disease. Because these products are not drugs there is no FDA regulation of effectiveness or quality. That means every claim of health benefit must be scrutinized carefully and the quality & the integrity of the company researched. Quality assurance needs to be proven by independent sources like Consumer Lab www.consumerlab.com, National Animal Supplement Council (NASC) www.nasc.cc or the United States Pharmacopoeia (USP) www.usp.org as some expensive ingredients have been “left out” historically and contaminants identified when independent tests were performed.
Proof of effectiveness is not required for supplements so we need organizations like the Veterinary Oral Health council vohc.org (which is similar to ADA in human dentistry) to insure the effectiveness of products. It is an independent board of veterinary dentistry diplomats that review scientific studies and verify dental product claims. For other categories of supplements we rely on published studies by board certified specialists in peer reviewed scientific journals.
Breed specific wellness If you have followed any of my blog posts you know that veterinarians are increasingly fine-tuning wellness to specific breeds. With over 200 breeds this is a huge collaborative undertaking! We have broached dentistry, ideal weight and now supplements, (breed specific nutrition is next!) because these are the most common things we see in our busy daily preventative practice. It has been predicted this is the future of wellness for pets ….I strongly agree!
Just two IMPORTANT clarifications ….
Who are the experts? There are only 50 or so board certified veterinary nutritionists worldwide. (They are so rare the University of Wisconsin Veterinary Hospital doesn’t have one!) Many work for the larger pet food companies but some are in academia and/or have consulting services. The American Academy of Veterinary Nutrition(AAVN) is a growing community of board certified veterinary nutrition experts devoted to sharing & getting good independent information out there.
All of us (veterinarians,too!) make the final decisions for our pet’s wellness. Given the scarcity of good studies and the lack of a strong motive for companies to educate & prove effectiveness, final decisions need to be a combination of the best information available, applied to a specific breed wellness program, and based on a complete physical exam and appropriate wellness testing. Only your personal veterinarian has the knowledge, training and the established client-patient relationship to provide that.
I am here to simply open the door to the questions that I feel should be posed to your veterinarian and increasingly the pet food & supplement industry to give us better information & regulation. The American Animal Hospital Association(AAHA) task force is just finishing its initial set of Nutritional Guidelines. I look forward to seeing their stance and resources for supplements as those should help us address some of these issues. There is also a great book about pet nutrition coming in May 2010 that I hope will contain some supplement information “Feeding your pet Right” by Marion Nestle & Malden Nesheim.
The future is bright for evidence-based veterinary nutrition!
Dr Ken
Based on available evidence here is my list of well referenced supplements that have good science to support their use and what breeds should benefit the most:
1) Fish oils = Eicosapentanoic (EPA) & Docosahexanoic acid (DHA)
Breed specific information: All breeds will benefit! There is not a single breed that doesn't have one or more inflammation related diseases (heart, kidney, inflammatory skin disease, osteoarthritis, cancer, periodontitis) The "inflammation of daily activity" has even been recently researched!
Why: If we could only stock one supplement at our clinic my staff knows it would be EPA/DHA fish oils! I first began prescribing fish oils for skin allergies in 2002 based on the advice of a UW Veterinary Medical Hospital veterinary dermatologist. In the 8 years since, good studies have emerged supporting their use (at ever increasing doses) not only in allergic skin disease but heart disease, kidney disease, osteoarthritis, cancer, and now even dental disease in human dentistry, if used at anti-inflammatory levels. Dr Lisa Freeman’s DVM PhD DACVN study is very well respected for this work. (See dosing & references below)
Most common confusion/myths: an effective anti-inflammatory dose is MUCH higher than what most labels state…Flax seed oil is NOT fish oil (flax seed oil is poorly converted in pets, less than 20% and will not confer the same benefits as fish oils)… The ratio of Omega 6 to 3 in pets is not as important as the absolute level of EPA delivered… I know these statements will surprise many people, but I have verified these statements with some of the most highly regarded veterinary nutritionists (Thanks to Drs Lisa Freeman, Kathryn Michels, Phil Roudebush, et al!) and they are all referenced below.
Purity and quality: Hg levels and other contaminants are concerns but seem to be minor issues for most products (See consumerlab.com) Stability and getting the right doses are the major issues. They need to be kept protected from light, and contain Vit E to preserve their freshness. Not found typically in OTC foods as fish oils decrease shelf life and are more expensive than other fats/oils.
Evidence based proof: Lisa Freeman’s article applies to heart disease but most veterinary nutritionists use the dose she established as the minimum dose to treat any inflammatory disease. Recently published studies support the effectiveness of an anti-inflammatory dose of EPA in Hill’s Rx pet food J/D to treat osteo-arthritis in dogs.
Dosing: The anti-inflammatory dose is 20mg EPA per lb given daily. For a 60lb ideal weight Labrador retriever, that would require giving 7 of the typical human fish oil capsules (each contain 180mg EPA) to achieve an anti-inflammatory effect of 1200 mg EPA for a 60lb dog.
Best products and way to Deliver/dose:
Human/over the counter products
1) Typical human fish oil capsules contain 180mg EPA per capsule (some newer high potency capsules contain up to 400 mg EPA per capsule).
2) Unflavored human liquids (Nordic Naturals) are usually between 160 to 180 mg EPA per ml but many are far less.
Veterinary products
1) Veterinary liquid formulations are our favorites for cost, purity & compliance are unflavored Omega G3, Ascenta meat flavored, or EFA-Z a premeasured deodorized product (all are from 160 to 180mg EPA per ml)
2) Rx Foods: Purina JM ® & Hills J/D ® Force plate studies have been done by each company and peer review articles have been published by Hills for J/D JAVMA reference (Contains 395 mg EPA per cup of food-amt delivered will depend upon calories consumed)
Bottom line: Check labels carefully and go by the concentration listed on the label and calculations NOT the bottle dose if you are interested in achieving the health benefits of anti-inflammatory effects. The concentration of EPA in many over the counter (OTC) products is often too low, making effective supplementation expensive, diarrhea a possibility and adding excessive fat calories which could cause weight gain and unbalance the diet.
Remember 1 tsp = 5ml and need to deliver 20mg per lb of EPA for each pound of body weight to be anti-inflammatory. (Will be about 1200 mg for a 60 lb dog)
The future: Will be found in over the counter foods at high enough levels to prevent supplementation?, labels indicating how much EPA in each cup of dog food, bioavailability of different forms (free fatty acid form vs. ethyl esterification) and super concentrated tablets? (We can dream, can’t we?)
2) Dental treats foods & supplements
Breed specific information: All dogs that weigh less than 20 pounds (thinner bone around teeth is more rapidly destroyed), especially the very small & toy breeds like yorkies, shitzus, Maltese, all Brachycephalics (bulldogs, pugs, etc) because of teeth crowding and greyhounds (have a genetic predisposition towards Periodontitis) Recently I have found 3 Labradors with severe bone loss evident on dental radiographs at a young age and although not ready to add them to this list I will be watching closely for a genetic or dietary cause/effect.
Why: Periodontitis affects 80% of the patients that wellness veterinarians see on a daily basis. Even though brushing (using dog approved tooth pastes)is the gold standard of pet dental homecare it is not very popular among most pet owners! The use of foods, treats, and water additives (that have proof of effectiveness) often gets better compliance because they are easier to implement for most pet owners.
Most common confusions/myths: Products that contain a label claim of preventing tartar do not have to do ANYTHING to support that claim! Only the Veterinary Oral Health Council (VOHC) seal of approval gives consumers any assurance that the products are actually effective. To get the VOHC seal foods have to be 20% or better than an average food and treats and water products 10% better.
Important side note:
No bones or hard chews please! They don’t do anything to improve oral health in dogs! Nylabone, cow hooves, etc that “hurt when you hit them on your shin” are too hard and will chip teeth and do little if anything for the gums. Rawhide chews are much more effective at softening and rubbing on gum line where most dental disease occurs. The myth that bones are naturally OK for dogs is an all too pervasive! We seal teeth and do root canals daily on teeth that have been chipped by bones which can be avoided!
The proof: Veterinary Oral Health Council www.vohc.org American Veterinary Dental College www.AVDC.org
Evidence based Products: Rawhide chews: Purina Cheweez rawhide chews® have VOHC acceptance, Virbac CET Hextras ® are NOT VOHC listed but are rawhide chews with added evidence based ingredients (Chlorhexidene & hexametaphosphate a safe calcium chelater) By default, all rawhides should be effective to some degree.
Water additives: Healthymouth 1st VOHC seal for a water additive with natural ingredients including Zinc Gluconate (safe & found in many products) there are many others but none with VOHC proof of effectiveness.
Rx Foods: Although not technically a supplement they are very effective when fed as a primary food and some people do use these as treats. Hills T/D ® & Oral Care ® both have the VOHC plaque & tartar claim, Rx Purina DH has a VOHC tartar claim & Iams Dental Defense ® has a VOHC tartar claim for one product in family There are many other products that can promote healthy mouths with evidence based products. Here are the products we use at our clinic. Westside Family Pet Clinic's website
The future: Sogeval Clenzadent ® water & food additives and mouth rinses are claiming to control the biofilm (bacteria & cell layer that makes up plaque) and look promising but no peer reviewed studies yet.
3) Joint supplements (Glucosamine, Chondroitin sulfate, Avocado Soybean Unsaponifiables (ASU), Perna green lipped mussel, blue green algae, etc)
Breed Specific information: Labradors, Golden Retrievers, German Shepherds, Great Danes, Newfoundlands, St Bernards, and many other large breeds, some small breeds like Cavalier King Charles Spaniels and Boston & Yorkshire Terriers are predisposed to orthopedic disease.
Why: Joint supplements have been shown effective in treating disease and it a very reasonable leap that they should be able to help prevent disease especially in very active breeds, although very few studies are available to support this presently. Proceeding with “do no harm” philosophy, supplementation should be done with the most effective products.
Degenerative orthopedic disease (hip dysplasia, elbow dysplasia, OCD of many joints) and resulting in osteoarthritis in over 20% of a typical clinics patients.
Hip dysplasia affects most breeds over 40 lbs and disproportionately affects German Shepherd Dogs, Labradors, Golden Retrievers, Newfoundlands, Rottweilers with 2 medium breeds, English Bulldogs & Cavalier King Charles Spaniels overrepresented.
Canine cruciate ligament tears (CCL) commonly referred to as ACLs, occurring in many breeds (especially Labradors & Golden Retrievers, Boxers & Rottweilers) and Medial Patellar Luxation (MPL) being over represented in Boston & Yorkshire Terriers, and other small breeds. Once cartilage deterioration and inflammation starts in a joint, it will continue life long so the inflammation needs to be controlled early on.
Ideal weight and a good exercise program is paramount and evidence based supplementation (fish oils & joint supplements) should strongly be considered to help moderate these diseases.
Most common myths: That there is enough glucosamine in a pet food that supplementation is not necessary (it is in fact a labeling (legal)issue that foods cannot have enough to be therapeutic so supplementation is ALWAYS necessary) We as veterinarians are bombarded with claims from products that claim effectiveness from a long list of ingredients. The ones we know are active are often listed in very small sub-therapeutic doses. Good studies are few and far between!
The newest myth that needs to be addressed immediately is that this group of products are all pretty safe. The ASPCA poison control just published a letter to the editor in the March 1st JAVMA that there have been 21 incidents of liver poisoning in 2008 & 2009 including 2 reported deaths from overdoses of chewable over the counter joint supplements. 5 different brands of supplements were involved with 10 incidents involving a single brand, 8 involving a second brand. It is unknown if it is an ingredient issue, a contaminant or an interaction as many of these supplements contain multiple ingredients and and all are unregulated. The authors suggest aggressive measures to treat any overdose of these OTC and unregulated products. Based on this and quality issues I do NOT recommend any joint supplements except two that have long safety & effectiveness records.
The evidence: Cosequin & DASUquin studies, Glycoflex force plate study (not yet published) see below
Purity & Safety: www.consumerlab.com, www.nasc.cc, www.usp.org
Recommended products: unlike EPA/DHA, in this category there are lots of issues with purity and effectiveness and very recently safety. Because there is no FDA regulation of products and many do not contain what they claim. I only have two current recommendations both currently available only from your veterinarian.
DASUquin ® by Nutramax is the only one that contains Glucosamine, Chondroitin Sulfate & Avocado Soybean Unsaponifiables (ASU).
Note: All studies for glucosamine & chondrotin sulfate performed (human or pet) have used Nutramax's patented ingredients. Further, this company produces a high quality human line recommended by more orthopedic surgeons & rheumatologists than any other product. Additionally they continually provide the best evidence for their extensive line of veterinary nutraceutical (antioxidants, liver & urinary tract support, and Probiotics)
Their most recent study is McCarthy G, O’Donovan J, Jones B, et al: Randomized double-blind, positive-controlled study to assess the efficacy of glucosamine/Chondroitin sulfate for the treatment of dogs with osteoarthritis Vet J 174(1):54-61, 2007
Glycoflex ® made by VetriScience uses Perna green lipped mussel as their active ingredient. A recent force plate study was reported at a major national veterinary conference (NAVC) but not published yet in a peer reviewed journal.
University of Washington Pullman supported the effectiveness of this product. Martinez S, McCormick D, Powers M, Davies N, Yanez J, Hughes K and Lincoln J. The effects of GlycoFlex® III on a stable stifle osteoarthritis model in dogs: a pilot study. 2006. Presented at NAVC 2007
The future: I would like to see a peer reviewed published force plate study that puts the best products “head to head” in their effectiveness to modulate osteoarthritis. We need more proof and a dose that these products actually prevent disease. More evidence based studies on blue green algae; products like Metagenics (human product) for pets, etc are hopefully in progress.
4) Supplements for weight loss/management
Breed specific information: Labradors, Goldens, Beagles, Pugs, Bichons, Yorkies, Dalmatians, Cocker Spaniels, Cavalier King Charles Spaniels (and many other breeds) are obesity prone!
Why: With close to 50% of pets over their Ideal Weight this represents a huge place for a supplement to make a difference. Of course careful measuring of food & treats, a good exercise program and knowing the Calories in each cup of food fed is all important(groundbreaking article on range of caloric density, cost per calorie etc in "weight managment foods" by Lisa Freeman)
Typically we use a prescription food with adequate protein levels and a low Calorie desnity per cup if pet is 20% more over ideal weight per Dr Julie Churchill or an OTC food if less than 20% over. Pet satiety, preserving lean muscle mass and handling the oxidative stress that occurs as fat is metabolized as well as down regulating inflammatory mediators are the goals of both the food and/or effective supplement. There are certain these foods already contain these as ingredients and have level 1 evidence but they may need to be added to other foods. JAVMA article by Dr Phil Roudebush
Products:
L-Carnitine is added to many pet foods and has level 1 evidence in cats and level 2 in dogs.
Isoflavones (green tea active ingredient) Purina OM ® uses this and level 3 evidence exists for its use.
The fish oils (EPA/DHA) have Grade 2 evidence in dogs and can be found in two prescription foods or supplemented as outlined previously (Need to account for 9 Calories per capsule!).
Slentrol is a prescription appetite suppressant supplement that has Grade 1 evidence.
The future: With upwards of 40% of the pet population overweight this represents a huge VetriScience (the makers of Glycoflex) has just brought a new weight loss product to market, Vetri-Lean Plus which contains a “Phase 2 pet starch neutralizer”. They will be presenting the science to my staff in late March. Stay tuned!
5) Probiotics
Breed specific information: Any breed with higher incidence of GI issues, urinary infections, and immune system deficiencies.
Why: These are typically presently used to treat or prevent diarrhea. There are new uses and areas emerging almost as fast as in human medicine. Over 400 new bacteria have been recently DNA mapped in dog’s gastrointestinal tracts. Stay tuned in this exciting area!
The proof: No published studies exist to my knowledge but the multi-strain product by Nutramax evidently presented a paper at ACVIM in 2009
Products Proviable ® by Nutramax, Purina Nutriflora®, VetriScience® Iams Prostora ®
Dose/Delivery/Quality control: are huge issues (colony forming units should be listed and should be in billions) proper storage (these are live organisms) and should be dated as these products have a limited shelf life. One study showed of 13 available products none contained what the label claimed. The major recent concern is the ability of pathogenic strains to be present. Be careful in choosing these products! Consumerlab.com does a great job for human products and they now include pet products too!
The future: Multiple vs. single strain, canine or feline specific better? Better labeling. Stay tuned! …evidence seems to be coming faster!
My colleagues, clients and any visitors here....Your thoughts welcomed. Let’s begin the dialogue!
Dr Ken
EPA/DHA Fish oils resources
Freeman LM, Rush JE, Keyhayias et al: Nutritional alterations and the effects of fish oil supplementations in dogs with heart failure J Vet Internal Med 12 (6):440-448, 1998
Mueller RS, et al. J Sm An Proc 2004, 45:293-297.
Simopoulos AP. J Amer Coll Nutr 2002, 21:495-505
Bauer JE. I Am Vet Med Assoc 2006, 229:680-684.
Caterson B, et al. Hills European Symposium Genoa, Italy, Apr 2005:14-18.
Brown SA, et al. J Nutr 1998, 128:2765S-2767S.
Smith CE, et al. J Vet Inter Med 2007, 21:265-273.
Ideal Weight & weight management resources
1. “Feeding for Fitness” Dr Julie Churchill DVM DACVIM PhD Intl Rehabilitation Symposium Aug 13 2008.
2. “Obesity’s missing link: The union of metabolism, genome & disease” Dr Jane Armstrong DVM MS MBA DACVIM U of Minn
3. “An evidence-based review of the use of therapeutic foods, owner education, exercise, and drugs for the management of obese and overweight pets” Dr Phillip Roudebush DVM, DACVIM et al JAVMA Vol 233 No 5 Sept 1, 2008
4. “An evidence-based review of the use of nutraceutical and dietary supplementation for the management of obese and overweight pets” Phillip Roudebush DVM, DACVIM et al JAVMA Vol 232 No 11 June 1, 2008
5. Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis Mark A Tetrick, Peter Muir Journal of the American Veterinary Medical Association Apr 2000, Vol. 216, No. 7, Pages 1089-1091: 1089-1091.
Misc resources
Isoflavones Research Report Purina Research Report Volume 12 Issue 1
Obesity’s Missing Link: The union of metabolism, genome and disease Hills Publication
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About Me
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- I am Bug's dad a veterinarian in Madison WI. I have owned and operated Westside Family Pet Clinic since 1984.