The Use of Supplements in Canine and Feline Veterinary Medicine 2012 A Fourth Year Nutrition Elective Assignment

 1 The Use of Supplements in Canine and Feline Medicine

Introduction

A variety of supplements are available to feline and canine veterinary patients with professed health benefits for a number of disease conditions. In order to determine the type of supplement product available to cat and dog owners in both the veterinary and commercial markets, a brief survey of local veterinary practices and pet supply stores was conducted. A formal discussion of the supplements available for different disease conditions are included in articles pertaining to the individual disorder or supplement class written by the individual students.

Materials and Methods

A brief survey was developed and distributed to 22 veterinary clinics and seven local pet supply retailers in Saskatoon, Saskatchewan. The survey contained questions pertaining to the type of supplements or diets recommended for apparently healthy animals and animals with joint disease, skin and allergic diseases, gastrointestinal disease, liver disease, cardiac disease or urinary tract diseases, as well as the rationale for the recommendations. Additional questions investigated the most common supplements sold, the source(s) of information used to evaluate available supplements, where clients were directed in order to purchase supplements (i.e. veterinary clinic, pet store, or human pharmacy), and information regarding to use of alternative or naturopathic therapies within the clinic. When specific supplement formulations were recommended by a pet store or veterinary clinic, the ingredients and health claims pertaining to the supplement were obtained from the manufacturer’s label in order to determine the type of supplements contained within each product. The mean number of respondents recommending a given type of supplement was tabulated based independently on the survey results obtained from veterinary clinics and retail pet stores.

Results

Although information regarding available supplements was provided by all of the pet supply retailers surveyed, inconsistent knowledge of available products or managerial intervention preventing disclosure of product recommendations made it difficult to evaluate the nature of supplement recommendations in the majority of the stores. As such, data pertaining to supplements in the retail pet supply market was limited to an analysis of the ingredients of different supplement formulations available in local pet stores relative to health claims made by the manufacturer.

Of the local veterinary clinics approached to complete the survey, only 41% (9/22) veterinary clinics responded. Only 78% of the veterinary clinics surveyed reported referring clients to human pharmacies or pet stores as alternate sources for pet supplements. The most common sources of information regarding the use of supplements in canine and feline patients were journal articles and product representatives, which were each used by 56% of the respondents from veterinary clinics, followed by veterinary conferences or continuing education (44%), non-peer reviewed veterinary literature (33%) and from senior clinicians or colleagues (22%). According to the responding veterinary clinics, the most common supplements purchased by clients, with or without a veterinarian’s recommendation were glucosamine (56%), chondroitin (44%) and omega fatty acids (44%). Over half of the respondents from local veterinary clinics reported recommending the use of supplements in apparently healthy animals, including glucosamine and chondroitin, omega fatty acids, cranberry, lysine and amino acid supplements. Alternative or naturopathic therapies including therapeutic laser treatments, acupuncture, chiropractic care and herbal medicine were used by 78% of the veterinary respondents.

Supplements for Joint Support and Mobility

In retail pet stores, 16 different supplements were available with alleged or perceived benefit for joint disease, as outlined in Table 1. According to evaluation of the ingredients contained in joint supplements available through retail pet stores, the most common ingredients encountered in supplements for joint disease available to the pet stores surveyed were glucosamine (81%), chondroitin (69%), methylsulfonylmethane or MSM (56%), and vitamin C (44%). Additional ingredients contained within commercially-available joint supplements with alleged therapeutic benefit include omega fatty acids (19%), hyaluronic acid (13%), vitamin E (13%), green lipped mussel (13%), Boswellia extract (13%), Grape seed extract (13%), yucca extract (13%), turmeric extract (6%), rosemary extract (6%), ginger extract (6%), miscellaneous herbs (6%) and cetyl myristoleate (6%).

2 The Use of Supplements in Cats and Dogs

Table 1. Supplement Formulations for Joint Support in Cats and Dogs Supplements Available through Retail Pet Stores
Supplement	Manufacturer’s Claims and Ingredients
Advanced Cetyl M (Response Products)	Marketed benefits include joint support, and relief of pain and discomfort associated with athleticism. Contains cetyl myristoleate, glucosamine hydrochloride, garlic root, and ginger root extract.
BioJoint (Biologic Vet)	Supplement marketed for dogs with joint discomfort and reduced mobility. Contains Boswellia serrata extract, vitamin C, grapeseed proanthrocyanidins, chondroitin sulfate, glucosamine hydrochloride and methylsulfonylmethane (MSM).
Cosequin for Cats (Nutramax Laboratories)	Supplement marketed for joint support and bladder health. Contains glucosamine hydrochloride and chondroitin sulfate.
Cosequin DS (Nutramax Laboratories)	Supplement marketed for maintaining mobility. Contains glucosamine hydrochloride and chondroitin sulfate.
Flax Forward (Juka Organics)	Marketed for improved pet nutrition. Contains omega fatty acids, lignans, protein, minerals and fiber.
Glucosamine/Chondroitin (21st Century)	Supplement marketed for joint health and support. Contains glucosamine hydrochloride, chondroitin sulfate, methylsulfonylmethane (MSM), vitamin C, and hyaluronic acid.
Glucosamine HCl (Ubavet)	·          Marketed as a preventative for all pets. Contains glucosamine hydrochloride, chondroitin sulfate, green lipped mussels, Yucca, methylsulfonylmethane (MSM), vitamin C, vitamin E, and flax.
Hip & Joint Plus Paw Gel (Nutri-Vet)	·          Marketed to maintain healthy cartilage and joint function. Contains glucosamine, methylsulfonylmethane (MSM), chondroitin sulfate, Yucca extract, and vitamin C.
Hip & Joint Level 2 Canine (Nutri-Vet)	Supplement marketed for support of joint function and connective tissue. Contains glucosamine hydrochloride (from shellfish), methylsulfonylmethane (MSM), and green-lipped mussel.
Hip & Joint Level 3 Canine (Nutri-Vet)	Supplement marketed for support of joint function and connective tissue in dogs with long-stranding joint problems. Contains glucosamine hydrochloride (from shellfish), chondroitin sulfate (from bovine trachea), methylsulfonylmethane (MSM), vitamin C, and hyaluronic acid.
Hip & Joint (Pet Naturals)	Marketed benefits include mobility support, comfort and exercise tolerance. Contains glucosamine hydrochloride, methylsulfonylmethane (MSM), chondroitin sulfate and vitamin C.
Joint Stress (Homeopet)	Marketed benefits include for relief of joint stiffness, lower back and joint pain, and muscle tension. Contains monkshood, leopard’s bane, pot marigold, witch hazel, St. John’s wart, chick pea and poison oak.
Liquid Joint Care (Spring Meadows)	Marketed benefits include joint lubrication, cartilage repair, anti-inflammatory and improved mobility. Contains glucosamine hydrochloride, chondroitin sulfate, bioflavinoids, and grape seed extract.
Stride Powder (TRM Pet Products)	Supplement marketed for the maintenance of cartilage and joint health. Contains glucosamine hydrochloride, chondroitin sulfate, methylsulfonylmethane (MSM) and vitamin E.
Muscle & Joint (Vet’s Best)	Supplement marketed for support of normal joint function and muscle discomfort during normal activity. Contains methylsulfonylmethane (MSM), Boswellia extract, Turmeric extract, Yucca extract, Rosemary extract and a proprietary antioxidant blend.
Vita-Glo Hip & Joint Supplement (Halo)	Supplement marketed for the maintenance of hip, ligaments and joint health. Contains glucosamine hydrochloride, chondroitin sulfate, vitamin C, and flax seed meal.

Table 2 Supplements Recommended by Local Veterinarians
Supplement	Manufacturer’s Claims and Ingredients
Adequan (Novartis)*	Marketed as a veterinary product with demonstrated empirical efficacy for IM use in dogs with osteoarthritis. Contains polysulfated glycosaminoglycans.
Chondroflex (Sogeval)	Marketed for the support of healthy joint function and alleviation of pain associated with normal activity in cats and dogs. Contains glucosamine hydrochloride, methylsulfonylmethane (MSM), chondroitin sulfate, vitamin C, and shavegrass.
Cosequin (NutraMax)	Marketed benefit for maintaining optimal joint function by supporting cartilage production and preventing cartilage breakdown. Contains glucosamine hydrochloride and chondroitin sulfate.
Dasuquin (NutraMax)	Supplement marketed for comprehensive joint health management. Contains glucosamine hydrochloride, chondroitin sulfate and avocado/soybean unsaponifables (ASU) powder.
Flexadin (Vetoquinol)	Marketed for the support of joint function in cats and dogs. Contains glucosamine hydrochloride, chondroitin sulfate and Harpagophytum procumbens (Devil’s Claw).
Liquid Plus (Ubavet)	Marketed as a fast-acting supplement suitable for all pets. Contains glucosamine hydrochloride, chondroitin sulfate, methylsulfonylmethane (MSM), green lipped mussels, bioflavinoids, Angelica pubescens, Rehmania glutinosa, Gentiana macrophylla, Acantopanax gracillustylus, and Piper futokadsura.
Omega-3 Pro (Pro Concepts Animal Health)	Manufacturer’s label not available. Contains omega fatty acids.
Hip Action (Zukes)	Supplement marketed to help prevent decrease joint pain and improve mobility. Contains glucosamine hydrochloride, chondroitin sulfate, flax seed and vitamin C.
* Despite its recommendation as a supplement, the manufacturer’s product label limits the use of this product to licensed veterinarians.

In patients with joint disease, 90% of responding veterinarians recommended the use of a veterinary diet formulated for joint support, including Royal Canin Mobility Support (56%), Hills J/D (56%) and Purina JM (33%). Nutritional supplements for feline and canine patients with joint disease were recommended by all of the veterinarians surveyed. Rationale for the inclusion specific supplements recommended by veterinarians included anti-inflammatory effects, evidence of benefits for joint health and the need to supplement deficiencies in the normal diet of veterinary patients. Specific formulations were outlined in recommendations from some of the veterinarians surveyed (Table 1). Flexadin (Vetoquinol), Adequan (Novartis), and Liquid Plus (Ubavet) were the most commonly recommended supplements for joint disease by veterinarian practitioners, however there was considerable variability in the specific product recommendations among clinics. The most common supplement ingredients recommended by veterinarians for feline and canine patients with joint disease were glucosamine hydrochloride (89%), chondroitin sulfate (78%) and omega fatty acids (56%). Methylsulfonylmethane or MSM (33%), polusulfated glycosaminoglycan (33%), devil’s claw (22%), miscellaneous herbal supplements (22%), vitamin C (11%), and ASU powder containing avocado and soybean unsaponafiables (11%) were also found in the supplements recommended through local veterinarians. Chondroflex, Dasuquin, Flexadin and OmegaPro-3 are veterinary exclusive products.

Supplements for Skin and Allergic Diseases

Supplements for skin and allergic diseases were available through 71% of the retail pet stores, with specific reference to dietary changes noted by 40% of the pet stores surveyed (Table 2). The majority of the products surveyed contained omega 3 (73%) and omega 6 (53%) fatty acids, derived from fish oil (47%), flax seed (20%), sunflower oil (27%), safflower oil (13%), soy (13%), olive oil (0.7%), wheatgerm oil (0.7%), and garlic oil (0.7%). Additional supplemental ingredients with suggested benefit for patients with skin disease or allergies included vitamin E (53%), vitamin A (27%), antioxidants such as rosemary extract (27%), vitamin D (20%), omega 9 (0.7%), vitamin B6 (0.7%), bioflavinoids (0.7%), zinc (0.7%) and mixed herbs (0.7%). The nutrient content of omega 3 (DHA/EPA) and omega 6 was not available for all of the formulations, making it difficult to determine whether the guaranteed analysis was sufficient to achieve potentially therapeutic levels of fatty acid supplementation and the recommended dose.

Supplements recommended by veterinary practitioners were based on the anti-inflammatory properties of the ingredients within the supplements. All of the veterinary practitioners surveyed recommended at least some form of supplementation in veterinary patients with skin disease or allergies. Based on recommendations and ingredients available from specific product references the most common supplements used by veterinarians in patients with skin disease are omega 3 fatty acids (100%) and omega 6 fatty acids (56%), as well as vitamin E, vitamin A, and vitamin D. The majority of specific supplement formulations recommended by veterinarians (Table 2) contained omega 3 fatty acids (67%), omega 6 fatty acids (33%) derived from fish oil (33%), flax seeds (17%) or other essential oils such as hemp, tea tree or primrose oil (33%). Vitamin E (50%), vitamin D (17%), vitamin A (17%) and antioxidants such as rosemary oil (17%) were also found in these supplements. One supplement, Oximunol (Avivagen) contained OxCbeta 5, a proprietary ingredient.

Several veterinary and commercial diets were recommended by veterinary practitioners for the treatment of allergic and skin disease. The most common recommendations with regard to diet were Royal Canin Hypoallergenic (89%), Royal Canin Hypoallergenic HP (44%), Royal Canin Skin Support (44%) and Royal Canin Sensitivity RC (22%). Additional dietary recommendations included Acana Lamb and Apple, Orijen 6 Fish, Purina Dermatologic Management (DRM), Iams Skin & Coat Plus Response FP, and Hills Prescription Diet Duck and Potato d/d. The most common ingredients were encountered in these diets were single protein sources (90%), omega 3 (80%) and 6 (40%) fatty acids from fish oil (80%), vegetable or soy oils (40%) and sunflower oil (10%), novel proteins (40%), hydrolyzed proteins (10%) and digestive aids (60%) such as prebiotics and probiotics. Additional ingredients suggested to improve skin condition or to alleviate allergies include pathothenic acid, inositol, nicotinamide, choline, histidine, curcumin, taurine, vitamin C, vitamin E, aloe vera extract, rosemary extract, marigold extract and various other herbal supplements.

Supplements for Liver Disease

None of the retail pet stores surveyed contained supplements with claimed benefits for patients with liver diseases. In contrast, 78% of the veterinary clinics surveyed had specific supplement recommendations with regard to patients with liver disease including s-adenosylmethionine or SAMe (56%), milk thistle (44%), and vitamin E (22%). With regard to s-adenosylmethionine, specific reference was made to commercially available products including Zentonil (Vetoquinol) and Denosyl (Nutramax Labs). More than half (56%) of the veterinarians surveyed also recommended the use of a liver-specific diet including Royal Canin Hepatic (44%) with soy protein and restricted dietary copper, sodium and zinc, and Hills Prescription Diet Liver Health L/D (11%) containing L-carnitine, antioxidants and reduced sodium.

Supplements for Gastrointestinal Disease

Supplements for gastrointestinal disorders in dogs and cats were available through 89% of the retail pet stores surveyed. Commercially available gastrointestinal supplements available through retail pet stores are summarized in Table 3. The most common supplement ingredients contained in formulations available through retail pet stores included dietary fiber sources (46%), probiotics (38%) and prebiotics (38%). Additional ingredients included probiotic fermentation products or digestive enzymes (15%), slippery elm (15%), colostrum (15%), miscellaneous herbal supplements (15%), ginger root (8%) and omega fatty acids (8%). In addition to supplements, 43% of the retail pet stores surveyed also recommended dietary changes or specific diets for patients with gastrointestinal disease.

Of the veterinary practioners surveyed, 89% recommended at least one supplement for use in patients with gastrointestinal disease and 78% of practitioners recommended a specific dietary formulation. Rationale for supplement recommendations included anti-inflammatory properties of the supplement, restoration or augmentation of normal gastrointestinal microbiotia and vitamin supplementation. The most common supplement ingredients included probiotics (67%), prebiotics (56%), vitamin B12 (22%), dietary fiber (22%) and omega fatty acids (11%). Specific formulations recommended by veterinary practitioners included Purina FortiFlora (44%), Iams Prostora Max (22%), Vetoquinol Progut (22%), Aventix Florentero (22%) and Metamucil (11%). Within these supplements, the most common ingredients with supposed benefit for patients with gastrointestinal disease included probiotics (60%), prebiotics (40%), and psyllium fiber (20%). Specific diet recommendations included Royal Canin Gastro, Royal Canin Fiber Response, Royal Canin Hypoallergenic, Purina Dual Fiber Control, Purina Hypoallergenic, Purina Diabetes Management DM , Purina Gastroenteric and Iams Skin Support FP.

Table 3. Supplement Formulations for Gastrointestinal Diseases in Dogs and Cats Supplements Available through Retail Pet Stores
Supplement	Manufacturer’s Claims and Ingredients
Digestive Support Probiotics (21st Century)	Marketed to promote the growth of healthy bacteria in the digestive tract. Contains dried whey, cellulose, probiotics (Lactobacillus salivarius, Lactobacillus acidophilus, Bifidobacterium bifidum, Streptoccous thermophilus), frutooligosaccharides, citrus pectin.
Digestive Upsets (Homeopet)	Marketed as a homeopathic remedy for minor digestive problems. Contains silver nitrate, arsenic oxide, bitter cucumber, St. John’s wart, pasque flower and white hellbore.
Esbilac (PetAg)	Marketed as a complete food source for orphaned or rejected puppies.
Gas Buster (Vets Best)	Marketed for the maintenance of a healthy digestive system. Contains slippery elm bark, parley, ginger root, apple pectins and allzyme.
Groundwork (Juka Organics)	Marketed for a healing energy and synergism within the cell and cell membrane. Contains flax hulls, black currant, raspberry, blueberry, alfalfa, papaya, spirulina, kale, milk thistle and green tea.
Holistic Solution (Eagle Pack)	Marketed for the prevention and relief of diarrhea, loose stool or gastric upset. Contains probiotics (Saccharomyces cerevisiae, Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium subtilus, Bifidobacterium subtillus, Bifidobacterium coagulans, Aspergillus niger, Enterococcus faecium), digestive enzymes (A.niger extract, A. Oryzae extract), inulin and rice bran.
Holistic Transition (Eagle Pack)	Marketed to maintain a healthy digestive system under normal conditions. Contains rice bran, probiotics (Lactobacillus acidophilus, Lactobacillus casei, Enterococcus faecium, Bifidobacterium subtillus, Bacillus licheniformis, Bacillus coagulans, Aspergillus oryzae).
KMR (PetAg)	Marketed as a complete food source for orphaned or rejected kittens.
Milk Replacer for Kittens (21st Century)	Marketed as a food supplement for newborn kittens. Contains dried colostrum.
Milk Replacer for Puppies (21st Century)	Marketed as a food supplement for newborn puppies. Contains dried colostrum.
Probiotics Capsules (NutriVet)	Marketed to support a strong immune system and promote vitality. Contains dried whey, cellulose, probiotics (Lactobacillus acidophilus, Lactobacillus salivarius, Bifidobacterium bifidum, Streptococcus thermophilus), frutooligosaccharides, and citrus pectin.
Proviable DC (Nutramax)	Supplement claims to re-establish a healthy intestinal flora. Contains fermentation products from several probiotic species (Bifidobacterium bifidum, Streptococcus thermophilus, Lactobacillus bulgaricus, Enterococcus faecium, Lactobacillus acidophilus, Lactobacillus casei and Lactobacillus plantarum), as well as fructooligosaccharide.
Slippery Elm (Urban Carnivore)	Marketed claims to sooth, coat and lubricate the mucous membranes of the digestive tract. Contains slippery elm bark.

Table 3. Supplement Formulations for Gastrointestinal Diseases in Dogs and Cats Continued Supplements Recommended by Local Veterinarians
Supplement	Manufacturer’s Claims and Ingredients
Florentero (Aventix)	Marketed to improve overall health and defenses against pathogens, as well as for use in patients with gastrointestinal disorders. Contains niacin, probiotics (Lactobacillus acidophilus, Enterotoccus faecium, Lactobacillus sporogenes), prebiotics (fructo-oligosaccharides, manno-oligosaccharides), and B vitamins (cobalamin, thiamine and vitamin B6).
FortiFlora (Purina)	Marketed for the management of patients with diarrhea. Contains probiotics (Enterococcus faecium), and vitamins (A, E, and C).
Metamucil	Marketed for humans for a number of health benefits including promoting digestive health and reducing cholesterol. Contains natural psyllium fiber.
Prostora Max (Iams)	Marketed for the maintenance of digestive balance in dogs. Contains probiotics (Bifidobacterium animalis) and whey.
Progut (Vetoquinol)	Marketed as a nutritional supplement for patients with intestinal disease. Contains fructi-oligosaccharides.

Supplements for Cardiac Disease

Flax Forward (Juka Organics), which contains flax seed oil with omega 3 and omega 6 fatty acids, was recommended by one retail pet store for patients with cardiac disease. Specific supplements recommended by 44% of veterinary practitioners surveyed including L-carnitine (22%), vitamin E (11%), taurine (11%) and coenzyme Q-10 (11%). In contrast, 78% of veterinarians surveyed recommended specific diets for patients with cardiac disease including Royal Canin Cardiac Diets (67%), which are marketed for patients with hypertension and cardiac disease or cardiac failure, and contain polyphenols, moderate phosphorus, restricted sodium, taurine and L-carnitine. Royal Canin Reduced Protein (22%) and Royal Canin Mature (11%) were also recommended.