what supplements have enough evidence for us to "prescribe" for pets? sewvma nov 2013
TRANSCRIPT
WHAT SUPPLEMENTS HAVE ENOUGH EVIDENCE FOR US TO “PRESCRIBE” THEM?
Ken Lambrecht DVM Medical Director
West Towne Veterinary Center
Presented November 3, 2013Southeast Wisconsin Veterinary Medical Association Fall Meeting
www.slideshare/[email protected]
Bug Lance Annie & Georgie
What supplements do we/would we give to our own pets if we thought they would help treat inflammation or pain or prevent illness?
THE OLD “BASKET OF SUPPLEMENTS” TRICK
This is a challenging and time consuming area!
WHY DO WE NEED TO GO THERE?
Human parallels/client demandDesire to reduce drug side effects (NSAIDS, etc.)A more natural, safer & integrative approachPreventive possibilities
OUR ROLE AS VETERINARIANS
1. Trusted advisors2. Scientists/Gatekeepers3. Interactions/side effects4. Above all do no harm
If we can use these products safely and and effectively and maybe prevent some amount disease it is worth all of our time!
MY PATH WITH PET NUTRITION
In December 2010, the American Veterinary Medical Association (AVMA) added prevention of disease to the veterinary oath.
With the companion animal bond being stronger than ever, this is a perfect time for a “guideline umbrella” for optimal wellness and preventive care for dogs at all life stages.
2102 AAHA Canine Life Stage Guidelines
Joe Bartges, PhD, DVM, DACVIM, DACVN, Beth Boynton, DVM, Amy Hoyumpa Vogt, DVM, DABVP (Canine and Feline), Eliza Krauter, CVT, Ken Lambrecht, DVM, Ron Svec, DVM, Steve Thompson, DVM, DABVP (Canine and Feline)
Advocate evidence-based nutrition.13,17 An emerging body of evidence infers that certain nutrients may turn gene expression on and off and help prevent disease.55 Monitor the emerging body of knowledge with regard to supplements, implementing those if and when peer-reviewed evidence-based studies support these potential benefits (e.g., probiotic support of the immune system, the role of eicosapentaenoic acid in inflammation).13,17
Additionally, use and refer to veterinarians who are board-certified through the American College of Veterinary Nutrition to answer questions and provide nutritional consultations (Table 4).
NUTRITION SECTION
DEFINITIONS
Supplement = anything added to food after initial formulation with intention to improve health
Nutraceutical = concentrated nutrient module that is added to the food that has a proven health benefit
LACK OF FDA OVERSIGHT …WHY THIS IS ALL NECESSARY!
DHEA ACT of 2008 clarified rules for supplements to be treated as foods (not drugs) and requires no scrutiny other than basic food processing & safety
In 2008, at the request of the FDA, the National Research Council produced a report on the general safety of animal supplements. The committee found that there were few safety studies on dietary supplements, and also discovered a lack of standardization among active ingredients in animal supplements and no evidence of a comprehensive adverse event reporting system.
Because of these limitations, the committee has since recommended an evidence-based medicine approach when determining the safety and effectiveness of animal supplements.
NOT REGULATED
1.Quantity of ingredients 2.Purity 3.Quality 4.Health benefit
EVIDENCE BASED LEVELS
Grade 1 Randomized, controlled clinical studyGrade 2 Randomized controlled laboratory studyGrade 3 Clinical, cohort or case controlled analytic studies or dramatic results in uncontrolled studiesGrade 4 Opinions based on clinical experience, studies conducted in other species, reports of expert committees
SUPPORT FOR OUR RECOMMENDATIONS
1. Published peer reviewed controlled studies2. Expert opinions of board certified specialists DACVN, DACVIM, DACVS & DACVSM, etc3. Supplement Manufacturer research
Cat 1 Proven safe and efficaciousCat 2 Presumed safe, unknown efficacyCat 3 Unknown safety, unknown efficacy
DR CAILIN HEINZ VMD DACVN
MY CE RELATED TO SUPPLEMENTS 2006-2013
Board certified nutritionistsLisa Freeman DVM PhD DAVNKathryn Michels DVM Ms DACVN Tony Buffington DVM Ms PhD DACVN Julie Churchill DVM DACVNJoe Bartges BS PhD DVM DACVN DACVIM
Board certified InternistsDr Phil Roudebush DVM DACVIMDr Deb Zoran DVM PhD DACVIMMichael Lappin DVM PhD DACVIMGreg Ogilvie DVM DACVIM
Rehab/Sports Medicine specialistsDr Sherman Canapp DVM ACVS DACVSMR CCRT Joseph Wakshlag, DVM PhD DACVN DACVSMRDarryl Millis DVM MS DACVSDuncan Lascelles BSC BVSc PhD CertVA DSAS (ST) DEVCS DACVS
CE (CONTINUED)
PET NUTRITION ALLIANCE PNASally Perea DVM, DACVNJulie Churchill DVM DACVNLaura Eirmann VMD, DACVN(Plus 6 Practicing DVMs & CV's) http://www.petnutritionalliance.org/
The following resources are reliable when determining the quality of supplements:
• National Institutes of Health, Office of Dietary Supplements—
http://ods.od.nih.gov/HealthInformation/
• ConsumerLab.com—https://www.consumerlab.com
• National Animal Supplement Council—http://www.nasc.cc/
• National Center for Complementary and Alternative Medicine (NCCAM),
National Institutes of Health— http://nccam.nih.gov/
FROM THE PNA WEBSITE
OTHER KEY RESOURCES TO FIND EB STUDIES (OR THE BEST EXPERTS IF STUDIES HAVEN’T BEEN DONE)
American Academy of Nutrition AAVN listserveAmerican Academy of Veterinary Nutrition ACVNPublished roundtables Well referenced blog & magazine articlesHuman medical referencesVIN?
MANY SOURCES OF NON-VERIFIED BENEFITS
Smaller manufacturers BreedersInternetLocal big box & boutique retailersRandom bloggers, magazines etc.
DOES A SEAL OF APPROVAL HELP US?
1
23
1
KEEPING OUR EFFORTS FOCUSED ON TREATMENT & PREVENTION OF COMMON DISEASES
Periodontitis (80%)
Obesity (50%)
Osteoarthritis (20%)
Inflammatory skin disease (20%)
Cancer ___%
Cardiac, Renal, Hepatic ____%
Immune system related diseases ____%
NUTRITIONAL ASSESSMENT, BREED & SPECIES
Sporting breeds/athletic dogs/service dogsBreeds prone to Degenerative Orthopedic DiseaseBreeds prone to inflammatory skin diseaseBreeds prone to cardiac, kidney, immune system problems etc. All Cats (IBD, Osteoarthritis, Pancreatitis, Resorptive lesions)
WHAT OUR CLIENTS WANT TO KNOW
Which ones does my dog really need?Can I give them the same ones I take?How can I keep the cost down?How can I give it easily? ( is it in food? etc.)
Are they safe in dogs and cats?What is the dose?Have they been proven effective?Which ones contain what they say they
contain?
WHAT DO WE NEED TO KNOW
CLIENT DIALOGUE
What pet food do you feed?
What supplements do you give your dog?What amounts/what brands?Is anyone in household allergic to fish or shellfish?
Question: Would it help to ask what clients supplements they themselves take?
FOLLOW YOUR PASSIONS!
EVIDENCE BASED SUPPLEMENTS
1) Fish oils (EPA & DHA)2) Joint supplements (pain relief & chondroprotectants)3) Probiotics, prebiotics
FISH OILS (EPA & DHA)
IndicationsEvidenceDose/SourcesChallenges
INDICATIONS FOR CLINICAL DISORDERS Heart Disease (2007 first one I could find)
although studies go back to 1998.
Inflammatory skin disease (1990’s)
Renal disease (1998)
Osteoarthritis (2011)
Cancer
Obesity
Periodontitis
Inflammatory bowel disease
Cognitive
EMERGING CLINICAL INDICATIONS
INDICATIONSOsteoarthritis affects roughly 20% of dogs Johnson SA “Osteoarthritis, joint anatomy Physiology & pathology” Vet Clinics of NA Sm An Pr 1997;27:699-723
Feline elbow arthritis affects 90% of cats over 10 years of age Hardie EM, Roe et al Radiographic evidence of degenerative joint disease in geriatric cats 100 cases JAVMA 2002;220:628-32
INDICATIONSKerwin SC Osteoarthritis in cats. Top Companion Anim Med. 2010 Nov;25(4):218-23.Abstract Osteoarthritis is a common radiographic finding in older cats, with a prevalence of up to 90% in appendicular joints. Many cats experience impaired mobility from osteoarthritis; however, there are more and more treatment options available, including diet modification, environmental modification, medical therapy, and physical rehabilitation.
Continuing challenges involve accurate diagnosis and outcome assessment of treatment, but considerable progress has been made in the last decade.
FIRST EVIDENCE: CARDIAC 1998 Caren E. Smith, Lisa M. Freeman et al Omega-3 Fatty Acids in Boxer Dogs with Arrhythmogenic Right Ventricular Cardiomyopathy unpublished 1998 Conclusions and Clinical Importance: These data suggest that fish oil, but not flax oil, supplementation for 6 weeks reduces arrhythmia in Boxers with ARVC and that it could be useful in treating this common disease. Further studies are needed to determine optimal dose and duration of treatment.
PUBLISHED EVIDENCE: CARDIAC 2007Omega-3 Fatty Acids in Boxer Dogs with Arrhythmogenic Right Ventricular Cardiomyopathy Journal of Veterinary Internal Medicine Volume 21 Issue 2 pages 265–273, March 2007
Caren E. Smith1,
Lisa M. Freeman DVM, PhD, DACVN1,†,
John E. Rush1,
Suzanne M. Cunningham1,
Vincent Biourge2
EVIDENCE/DOSING : CARDIACThe author (Dr Lisa Freeman Waltham Focus 2000) currently recommends a dosage of 40 mg/kg EPA and 25 mg/kg DHA in dogs. “The amount of EPA and DHA in individual fish oil supplements varies widely so it is important to know the exact amount in brand of supplement recommended.” Capsules that contain approximately 180 mg EPA and 120 mg DHA can be purchased over the counter at most human pharmacies or health food stores. Higher concentration capsules/products are more feasible large dogs.
Journal of the American Veterinary Medical Association
September 1, 2012, Vol. 241, No. 5, Pages 583-594
doi: 10.2460/javma.241.5.583
Evaluation of cognitive learning, memory, psychomotor, immunologic, and retinal functions in healthy puppies fed foods fortified with docosahexaenoic acid–rich fish oil from 8 to 52 weeks of age
Steven C. Zicker, DVM, PhD, DACVIM, DACVN; Dennis E. Jewell, PhD; Ryan M. Yamka, PhD; Norton W. Milgram, PhD
Results—Foods had similar proximate analysis results but varied in concentration of DHA from fish oil; the high-DHA food also contained higher concentrations of vitamin E, taurine, choline, and L-carnitine than did other foods. The high-DHA group had significantly better results for reversal task learning, visual contrast discrimination, and early psychomotor performance in side-to-side navigation through an obstacle-containing maze than did the moderate-DHA and low-DHA groups. The high-DHA group had significantly higher anti-rabies antibody titers 1 and 2 weeks after vaccination than did other groups. Peak b-wave amplitudes during scotopic electroretinography were positively correlated with serum DHA concentrations at all evaluated time points.
Conclusions and Clinical Relevance—Dietary fortification with fish oils rich in DHA and possibly other nutrients implicated in neurocognitive development following weaning improved cognitive, memory, psychomotor, immunologic, and retinal functions in growing dogs.
EVIDENCE: COGNITIVE & IMMUNOLOGIC IN DOGS
EVIDENCE: OSTEOARTHRITIS-DOGS
Roush J K et al “Evaluation of the effects of dietary supplementation with fish oil omega 3 fatty acids on weight bearing in dogs with osteoarthritis” JAVMA Vol 236 No 1 Jan 1, 2010
EVIDENCE OSTEOARTHRITIS -CATS
Lascelles, et al “Evaluation of a Therapeutic Diet for Degenerative Joint Disease in Cats” J Vet Intern Med 2010 1-9 (this diet contains omega 3’s & Perna GLM as well as glucosamine & chondroitin sulfate)
EMERGING EVIDENCE : OTHERSPeriodontitis Soukup, Jason DVM AVDC American Veterinary Dental Forum Oct 2009 several citations (human & pet)
Obesity Ishiota, K et al Treatment of obesity in dogs through increasing energy expenditure by mitochondrial uncoupling J Vet Intern Med 2004 18:431 (a level 2 evidence based study)
DOSE/SOURCESDeliver at least 40 mg/kg EPA and 25 mg/kg DHA per day to treat cardiac disease (Lisa Freeman DVM DACVN)
Addendum: Dr Greg Ogilvie recommends dosing fish oils based on DHA 30 mg/kg 1/21/12 University of Wisconsin Small Animal Nutrition Seminar Madison, WI
“Results of studies for osteoarthritis suggest that a dose of 230mg of EPA and DHA per kg of BW 0.75 up to the NRC safe upper limit of 370mg EPA and DHA/kg of BW 0.75 is recommended”
ROYAL CANIN PRODUCT BOOK details EPA/DHA of Feline Mobility Support JS (and some of their other products)
DOSE: CONSUMERLAB.COMRange of EPA + DHA Concentrations and Pill Sizes:
The concentrations of EPA and DHA in the pills and liquids can vary by as much as tenfold -- from as little as 8% to over 80% of the fish oil content. Concentration depends on the source of the omega-3's, how the oil is processed, and the amounts of other ingredients included in the supplement.
DOSE/SOURCESUse high quality products that are fresh, mercury free and have antioxidants (Vit E)Sardines & anchovies for safety & sustainabilityBioavailability, free form etc.
40mg EPA/kg for anti-inflammatory (30mg DHA/kg for anti-cancer) 60lb Lab needs 1200 mg EPA (would usually deliver 2/3 or 900 mg DHA) 8 180 mg EPA/120mg DHA capsules 3 400 mg EPA /120mg DHA capsules 2 700 mg EPA /120mg DHA capsules
1 ml=180mg EPA 1ml=148mg EPA 1ml=165mg EPA
LIQUID SUPPLEMENTS
391 mg EPA/capsule 325mg EPA/capsule 250 mg EPA/capsule
CAPSULE FORMS (OTC & VETERINARY)
CHALLENGES: COST FOR LARGE DOGS
Directions:For Adults, take one (1) soft gel daily, preferably with a meal.Supplement Facts:Serving Size: 1 Soft gelAmount Per Serving - % Daily Value:*Calories 15, Calories from Fat 15, Total Fat 1.5 g - 2%*, Saturated Fat 0 g, Polyunsaturated Fat 1 g **, Monounsaturated Fat 0 g **, Cholesterol < 5 mg - 1%, Fish Oil 1,400 mg (1.4 g) - **, EPA (Eicosapentaenoic Acid) 700 mg - **, DHA (Docosahexaenoic Acid) 280 mg - **, Total Omega 3 Fatty Acids 980 mg - **.*Percent Daily Values are based on a 2,000 calorie diet.**Daily Value not established.Other Ingredients:Gelatin, Vegetable Glycerin, Food Glaze. Contains <2% of: Enteric Coating (Sodium Alginate and Stearic Acid), Ethylcellulose, Medium Chain Triglycerides, Mixed Natural Tocopherols, Soybean Oil.
Contains fish (Anchovy, Mackerel, Sardine) ingredients.
CHALLENGES: COMPLIANCE
294mg EPA/cup
300 mg EPA/cup
390 mg EPA/cup
CONSUMERLAB.COM: CONCERNS HUMAN
Concerns and Cautions:
Up to about 20 grams of fish oil can be well tolerated by most adults. However, such high amounts may not be beneficial and the FDA recommends that consumers not exceed more than a total of 3 grams per day of EPA and DHA omega-3 fatty acids, with no more than 2 grams per day from a dietary supplement.
Be aware that cod or other fish liver oils are not always a good substitute for fish oil supplements as these may be high in vitamins A and D.
CONSUMERLAB.COM: CONCERNS HUMAN
The only significant safety concerns regarding fish oil involve its apparent "blood thinning" effect. On this basis, fish oil should be used only under a physician's care by people with bleeding disorders such as hemophilia, those taking strong prescription blood thinners, such as Coumadin (warfarin) or heparin, and those expecting to undergo surgery.If you take blood pressure lowering medication, be aware that fish oil may further lower blood pressure.High doses (over 3 grams per day) of fish oil may suppress the immune system. Unless medically necessary, such doses should be avoided, particularly by immunocompromised individuals.
CONSUMERLAB.COM: CONCERNS PET (CL ACCESSED 1/2012)
Contamination:One product, 1-800-PetMeds Super Omega 3 for Cats and Dogs, exceeded the contamination limit for dioxin-like PCBs (or dl-PCBs, which are PCBs with established toxicity). It contained slightly more than the 3 picograms per 1,000 milligrams (mg) limit established by the Global Organization for EPA and DHA (GOED). The U.S. FDA has not set a limit.
It is unlikely that this exposure alone would cause toxicity, but it is preferable to avoid unnecessary exposure to toxins. However, bear in mind that, in comparison to a serving of most fish, even this product contains only a small amount of PCBs.
Long term safely has not been determined in cats nor has an upper level of safety been set by NRC.
In light of findings that platelet activation can be decreased and immune system affected benefits need to be weighed against possibility of immunosuppression at some doses.
Bauer, John E DVM,PhD,DACVN Therapeutic use of fish oils in companion animals JAVMA, Vol 239, No 11 Dec 1, 2011
DOSING IN CATS
JOINT SUPPLEMENTS
IndicationsEvidenceDose SourcesChallenges
INDICATIONSOsteoarthritis affects roughly 20% of dogs
Johnson SA “Osteoarthritis, joint anatomy Physiology & pathology” Vet Clinics of NA Sm An Pr 1997;27:699-723
Feline elbow arthritis affects 90% of cats over 10 years of age
Hardie EM, Roe et al Radiographic evidence of degenerative joint disease in geriatric cats 100 cases JAVMA 2002;220:628-32
EVIDENCE: DOGS
Sanderson RO et al “Systematic review of the management of canine osteoarthritis.” Vet Rec 2009 Apr 4;164(14):418-24.between 1985 and July 2007. Sixty-eight papers were identified and evaluated. They considered four alternative therapies, one use of functional food, two intra-articular agents, six nutraceutical agents, 21 pharmacological agents, two physical therapies, three surgical techniques and two combinations of weight control.
EVIDENCE CONTINUEDThere was a high level of comfort (strong evidence) for the efficacy of carprofen, firocoxib and meloxicam, …. a moderate level of comfort for the efficacy of etodolac in modifying the signs of osteoarthritis.
There was also a moderate level of comfort for the efficacy of glycosaminoglycan polysulphate (Adequan), licofelone, elk velvet antler and a functional food containing green-lipped mussel.
EVIDENCE CONTINUEDThere was weak or no evidence in support of the use of doxycycline, electrostimulated acupuncture, extracorporeal shockwave therapy, gold wire acupuncture, hyaluronan, pentosan polysulphate, P54FP (extract of turmeric), tiaprofenic acid or tibial plateau leveling osteotomy
QUESTION…Why wasn’t glucosamine/chondroitin sulfate mentioned, nor the two forms of physical therapy or weight control????
COMMONLY USED JOINT SUPPLEMENT “INGREDIENTS”
Glucosamine HCL
Chondroitin sulfate (LMW or not)
Perna Green Lipped Mussel
Avocado Soybean Unsaponifiables (ASU)
EVIDENCE: GLUCOSAMINE & CHONDROITIN SULFATE PETS
Neil, K et al “The role of glucosamine and chondroitin sulfate in treatment and for prevention of osteoarthritis in animals JAVMA 2005 Vol 226:7 1079-88
EVIDENCE: HUMANS THE GAIT STUDY
“Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis” N Engl J Med 2006; 354:795-808 Feb 23, 2006
Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee.
Exploratory analyses suggest that the combination of glucosamine and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain.
EVIDENCE: HUMAN (FROM CONSUMER LAB)
Humans—Several clinical trials have been performedin humans with mostly favorable results. Despiteflaws in study design and assessment of outcome inearly studies, moderate effects were detected.72-74
In a meta-analysis and quality assessment of 15 randomized double-blind placebo-controlled studies, all but 1 revealed beneficial effects in terms of decreasing pain and improving mobility, with greater effects detected forchondroitin sulfate than glucosamine.109
EVIDENCE: HUMANS-PREVENTIONFurthermore, glucosamine prevented the progressive joint-space narrowing that was detected radiographically in placebo-treatedpatients.113
“Extrapolating from these studies, the best effects of glucosamine supplementation will be achieved with preventative use, or at least in patients with incipient lesion for whom use for advanced osteoarthritis is not likely to yield favorable results.
CHALLENGES: QUALITYIn a major study 81% of labeled products (human) were not what the label stated (Canapp study)
Almost all studies done with high quality Glucosamine HCL and low molecular weight purified chondroitin sulfate (a Nutramax patented products)
www.Consumerlab.com
VETRI SCIENCE GLYCO FLEX III LABEL
Active Ingredients Per Tablet or 2 Chews:Glucosamine HCl (Shrimp and Crab) . . . . . . . . 1000 mgMethylsulfonylmethane (MSM) . . . . . . . . . . . 1000 mgPerna Canaliculus(GlycOmega™ brand Green Lipped Mussel) . . . . . . 600 mgN,N-Dimethylglycine HCl (DMG) . . . . . . . . . . .100 mgdl-alpha Tocopheryl Acetate (Vitamin E) . . . . . . 50 IUCalcium Ascorbate (Vitamin C) Tablet . . . . . . . .30 mgAscorbic Acid (Vitamin C) Chew . . . . . . . . . . .24 mgManganese (as Manganese Amino Acid Chelate) Tablet .10 mgManganese (as Mn Proteinate) Chew . . . . . . . . . 10 mgGrape Seed Extract . . . . . . . . . . . . . . . . . 5 mgL-Glutathione . . . . . . . . . . . . . . . . . . . .2 mgSelenium (as Sodium Selenite) . . . . . . . . . .0.002 mg
GlycOmega™ is a trademark of Aroma New Zealand Ltd.Patented in : Austria, Belgium, Switzerland/Liechtenstein, Cyprus, Germany, Denmark, Spain, Finland, France, United Kingdom, Greece, Italy, Luxembourg, Monaco, Netherlands, Portugal, Sweden, Ireland, Albania, Lithuania, Latvia, Macedonia, Romania, and Slovenia. European Patent No. 1 227826
NUTRAMAX DASUQUIN LABEL NMX1000®* ASU (avocado/soybean unsaponifiables)
decaffeinated tea
Cosequin's FCHG49®* glucosamine hydrochloride
TRH122®* low molecular weight chondroitin sulfate
to provide the most comprehensive joint health
management formula available for dogs.
U.S. Patent Nos. 5,587,363 and 6,797,289 (Additional Patent Pending)
NUTRAMAX DASUQUIN“We also support studies including efficacy, bioavailability (absorption) and safety at leading veterinary schools such as Cornell, Colorado State, U.C. Davis, N.C. State, Tennessee, Texas A&M and Tufts to name a few. More information is available to veterinary professionals.”
Joint health research & review articles using or referencing Nutramax Laboratories products or ingredients (80+ references)
CHALLENGES: “FUNCTIONAL FOODS”
By FDA law Glucosamine cannot be added to food to a therapeutic level (unless therapeutic effect is proven)
By using Perna GLM Royal Canin seems to have sidestepped this regulation …..or is it the EPA/DHA that is working or ….synergism?)
EVIDENCE: SINCE JULY 2007 OR EMERGING2007 Vetri Science force plate study abstract at NAVC “submitted for publication”
2010 Feline functional food (RC Mobility JS) containing Perna GLM, glucosamine, CS & PUFA LC Omega 3’s published, peer reviewed but contains multiple ingredients
2011 DASUquin force plate study 8 dogs Dr Darryl Millis not published shows efficacy similar to NSAIDS
CHALLENGES: SUMMARY
Which combination of ingredients?Force plate studies vs in vitro?Perna vs manufactured ingredientsQuality of ingredientsIncentive (dis-incentive) to prove effective
CHALLENGES: BOTTOM LINE FOR MY COMFORT LEVELNutramax DASUquin ® or Vetri Science Glyco Flex®
Royal Canin Feline Mobility JS ®
Royal Canin Canine Mobility JS ®
Hills JD ®
Nutramax & Vetri Science have patented products, both have some studies (mostly in vitro) to support their use, both have extensive human lines
What others have you used and what evidence have you seen that support them?
Why only 8 dogs in the Darryl Millis study?Why don’t Nutramax ASU products show up
in Consumerlab.com reviews?
QUESTIONS I HAVE….
ARE WE FAR ENOUGH OUT ON A LIMB YET?
PROBIOTICS/PREBIOTICS
DEFINITIONSProbiotic products contain helpful bacteria and/or yeasts that assist in balancing the levels of indigenous microorganisms in the human (pet) body.
Prebiotic serves as food or support for probiotic
e.g. Fructooligosaccharides
Synbiotics combinations of the two
INDICATIONS/EVIDENCE: HUMANDiarrhea (antibiotic, viral or chemo induced)
Vaginal bacterial infections
Prevention of allergies and atopic disease in infants
Prevention of respiratory tract other infectious diseases and treatment of urogenital infections
Inflammatory diseases of GI tract
Weight & fat loss
Reducing cold & flu symptoms
(26 listed references when ConsumerLab.com accessed 10/29/13)
EVIDENCE : PETSDiarrhea
Immune system stimulation in puppies
Immune system stimulation in cats
previously mentioned human diseases?
VETERINARY EVIDENCE
Baillon et al “Effects of probiotic Lactobacillus acidophilus strain DSM13241 in adult healthy dogs” Am J Vet Res 2004 65:338-43
Benyacoub J et al “Supplementation of food with Enterococcus faecium (SF68) stimulates immune function in young dogs J Nutr 2003 133:1158-62
CONTRAINDICATIONS
Pancreatitis
Compromise of intestinal mucosal barrier (parvoviral enteritis etc)
Others?
DR DEB ZORAN WVMA OCT 2010
Practices clinical nutrition at Texas A&M (not board certified in nutrition)
To treat inflammatory bowel disease in cats
Good for urinary tract, immune system, diarrheas
DR JOE BARTGES DVM MS DACVIM DACVN
Multi-strain best
Need to use much higher concentrations 45 Billion/10#
May be an immune stimulant at higher concentrations (urinary infections etc)
CHALLENGES: QUALITY CONTROL
Genus & species identified on label
Not pathogenic
Guaranteed number of live organisms at date of manufacturer or “good till date”
Kept refrigerated (or at least protected from extremes)
Effective in species being used in
SOURCESNatural (yogurt, kefir, sauerkraut, etc.)
Supplements (capsules, packets)
Pet Foods ???? (killed by conventional processing unless added after heat)
CONSUMERLAB.COM 2006: VIABILITY Probiotics for Human Use: Only 8 of 13 Pass TestsConsumer Lab selected thirteen probiotic products for human consumption sold in the U.S. and/or Canada. Testing showed that four of these products provided less than one billion viable organisms in a daily serving — the minimum amount generally used clinically. In fact, one of these — a major pharmacy brand — provided less than ten percent of this minimum level.
Only eight products were found to meet the one billion minimum and contain the amounts claimed on their labels.
CONSUMER LAB 2011Probiotics for Pets: Only 1 of 3 Pass TestsConsumerLab.com also tested probiotic supplements marketed for use by pets. Among the three products selected, one was contaminated with mold and did not contain its listed amount of probiotic organisms. Another provided only ten million organisms per day.
Only one pet product contained a large dose of viable organisms — 2.3 billion per day.
CONSUMERLAB: 2013 (ACCESSED 10/29/13)
Four pet probiotics, tested through ConsumerLab.com's Voluntary Certification Program were found to meet their claimed amounts: Natural Pet Probiotic Blend 1.6B CFU/capsule (blend)Total Biotics Powder 500M CFU’s /scoop (blend) Vetribiotic Everyday SoftChews (blend) Nutramax Pet Bactaquin for Dogs delivered 1 billion cells per capsule. (E faecium)Comparing the daily dosage among the pet products reveals an enormous difference in the number of cells being provided, highlighting the need for pet owners to carefully compare products.
CHALLENGES: WHICH ORGANISMS?Nutramax Proviable DC®
Purina Fortiflora ® VSL#3
Form Paste/capsule packet packetNumber of organisms 5 billion/capsule 1 billion/pkt 458 billion/pkt
Species Enterococcus faecium
Lactobacillus acidophilusL bifidumL bulgaricusL caseiL plantarum
Streptococcus thermophilum
Enterococcus faecium SF-68
Bifidobacterium breve, B longum, B infantis
Lactobacillus acidophilus, L plantarum, L paracasei, L bulgaricus
Streptococcus thermophilus.
VETRI SCIENCEVETRI-PROBIOTIC EVERYDAY chews are recommended to support overall health of the dog.Guaranteed Analysis:Moisture (max) 8.0%*Total Microorganisms: 286 Million CFU/gram Bacillus subtilis**Bacillus coagulans Lactobacillus acidophilus Bifidobacterium thermophilum Bifidobacterium longum Lactobacillus fermentum Lactobacillus casei Bifidobacterium bifidum Enterococcus faecium*FOS (Fructooligosaccharides) 200 mg
CHALLENGES: COSTPurina Fortiflora
Nutramax Proviable
VSL #3 Other human products
organisms 785M 5B 450B 1B to 36B
Cost for 5 billion organisms
$2.50 $0.25 $0.02 ??
Published Veterinaryresearch
Y Y N N
OUR ROLE AS VETERINARIANS1. Trusted advisors/scientists
2. Gatekeepers
3. Interactions/side effects
4. Above all do no harm
5. Preventive
WHAT DOES THE FUTURE HOLD???
THE FUTURE??
EPA/DHA concentrated to 1000 mg/capsule for large dogs?
Glucosamine/Chondroitin Sulfate/ASU (or Perna GLM) force plate study with at least 50 dogs?
Reach to the refrigerator for a probiotic for a specific disease?
Probiotics sprayed on the outside of food after cooked ?
EPA/DHA added to diets to NRC levels and labelled clearly?
FDA decides to regulate supplements????
