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Uw supplement talk 2012 final

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Evidence based discussion of evidence based supplements presented at the University of Wisconsin Practical Pet Nutrition Conference Jan 21st, 2012

Evidence based discussion of evidence based supplements presented at the University of Wisconsin Practical Pet Nutrition Conference Jan 21st, 2012

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  • 1. Evidence Based Supplements for Pets
    • Ken Lambrecht DVM
    • Medical Director Westside Family Pet Clinic
    • Fitness & Rehab Director 4 Paws Swim & Fitness
    • Presented January 22, 2012
    • Practical Small Animal Nutrition
    • University of Wisconsin School of Veterinary Medicine
    • www.slideshare.net
    • [email_address]
    • www.westsidefamilypet.com
    • Facebook.com/westsidefamilypet
  • 2. Challenges… Bug LANCE
  • 3. Our role as veterinarians
    • 1. Trusted advisors/scientists
    • 2. Gatekeepers
    • 3. Interactions/side effects
    • 4. Above all do no harm
    • 6. Preventive
  • 4. Nutritional Assessment, Breed Specific/Breed Groups
    • Identify at risk dogs/breeds when doing nutritional assessment and counsel client
    • Sporting breeds/athletic dogs
    • Service dogs
    • Breeds prone to Degenerative Orthopedic Disease
    • Breeds prone to inflammatory skin or bowel disease
    • Breeds prone to cardiac, kidney, immune system problems etc
  • 5. Why do we have to go there?
    • Human parallels/client demand
    • Desire to reduce NSAID side effects
    • Cost effective?
    • A more natural approach
    • Preventive
  • 6. Definitions
    • Supplement = anything added to food after initial formulation
    • Nutraceutical = concentrated nutrient modules that are added to the food that have proven health benefits
  • 7. Lack of FDA Oversight or …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
  • 8. Almost Total lack of FDA oversight!
    • Quantity of ingredients not regulated
    • Purity not regulated
    • Quality not regulated
    • Health benefit not regulated
    • None of these are verified or enforced by FDA!
  • 9. Client Dialogue
    • What supplements do you give your dog?
    • What amounts?
    • What food do you feed?
    • Is anyone in household allergic to fish or shellfish?
  • 10. Support for our Recommendations
    • Published peer reviewed controlled studies
    • Expert opinions of board certified specialists
    • DACVN
    • DACVIM
    • DACVS & DACVSM
    • other special certifications CCRT, CCRP
    • Pain management certification
    • Supplement Company research
  • 11. Evidence based nutritional supplements
    • Grade 1 Randomized, controlled clinical study
    • Grade 2 Randomized controlled laboratory study
    • Grade 3 Clinical, cohort or case controlled analytic studies or dramatic results in uncontrolled studies
    • Grade 4 Opinions based on clinical experience, studies conducted in other species, reports of expert committees
  • 12. CE related to supplements 2006-2012
    • Boarded nutritionists
    • Lisa Freeman DVM PhD DAVN
    • Kathryn Michels DVM Ms DACVN
    • Tony Buffington DVM Ms PhD DACVN
    • Joe Bartges BS PhD DVM DACVN DACVIM
    • Boarded Internists
    • Dr Phil Roudebush DVM DACVIM
    • Dr Deb Zoran DVM PhD DACVIM
    • Michael Lappin DVM PhD DACVIM
    • Greg Ogilvie DVM DACVIM
    • Sports Medicine specialists
    • Dr Sherman Canapp DVM ACVS DACVSMR CCRT
    • Joseph Wakshlag, DVM, PhD, DACVN, DACVSMR
  • 13. Many sources of non-verified benefits!
    • Breeders
    • Internet
    • Local big box & boutique retailers
    • Random bloggers, magazines etc
  • 14. Our challenges
    • No incentive to prove they work
    • Quality control issues for OTC products
    • Dose issues
    • Lots of misinformation
    • This is a challenging area!
  • 15.  
  • 16. Key Resources to find evidence based studies (or the best experts if studies haven’t been done)
    • www.consumer lab.com
    • AAVN & ACVN
    • Published roundtables
    • Well referenced blog & magazine articles
    • Human medicine parallels
  • 17. Keeping our efforts focused on treatment & prevention of common diseases
    • Obesity
    • Periodontitis
    • Osteoarthritis
    • Inflammatory bowel disease
    • Inflammatory skin disease
    • Cancer
    • Immune system diseases
    • Cardiac, Renal, Hepatic
  • 18. 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)
  • 19. Our biggest challenges
    • What is the correct dose?
    • What evidence is there to support?
    • Does it contain what it says it does on label?
    • Purity/Contaminations/Interactions
  • 20. What is the best seal of approval?
  • 21. Follow your passions!
  • 22. Evidence based Supplements: The big 3
    • 1) Fish oils (EPA & DHA)
    • 2) Chondroprotectants (joint supplements)
    • 3) Probiotics, prebiotics
    • 4) Others (Denamarin, anti-oxidants, Vit D)
  • 23. Fish Oils ( EPA & DHA)
    • Indications
    • Evidence
    • Dose/Sources
    • Challenges
  • 24. Indications
    • Osteoarthritis (2010 first published/peer reviewed)
    • Heart Disease (2007 first one I could find)
    • although studies go back to 1998 .
    • Inflammatory skin disease (1990’s)
    • Cancer (1990’s)
    • Kidney disease
    • Periodontitis & Obesity
  • 25. Indications
    • Osteoarthritis 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
  • 26. Indications
    • Kerwin 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.
  • 27. First Evidence: Cardiac
    • 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.
  • 28. Evidence/dosing : Cardiac
    • The 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 dosages can be obtained from medical supply catalogues and are more feasible large
    • dogs.
  • 29. Evidence: cardiac
    • Omega-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. Smith 1 , 
    • Lisa M. Freeman DVM, PhD, DACVN 1,† , 
    • John E. Rush 1 , 
    • Suzanne M. Cunningham 1 , 
    • Vincent Biourge 2
  • 30. Evidence: Cardiac Human
    • Christine M. Albert, M.D., M.P.H. Et al Blood Levels of Long-Chain n–3 Fatty Acids and the Risk of Sudden Death N Engl J Med 2002; 346:1113-1118 April 11, 2002
    • CONCLUSIONS
    • The n–3 fatty acids found in fish are strongly associated with a reduced
    • risk of sudden death among men without evidence of prior cardiovascular
    • disease
    • Base-line blood levels of long-chain n–3 fatty acids were inversely related
    • to the risk of sudden death both before adjustment for potential
    • confounders
  • 31. Evidence: Osteoarthritis-Dogs
    • Rousch 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
  • 32. 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)
  • 33. Evidence : others
    • Periodontitis
    • 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 cited by Dr Phil Roudebush)
  • 34. Dose/Sources
    • Deliver 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 30mg/kg
    • 1/21/12 University of Wisconsin Small Animal Nutrition Seminar Madison, WI
  • 35. Dose: Consumerlab.com
    • Range 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.
    • If you are trying to get as much EPA or DHA from the smallest serving size (i.e., fewer or smaller pills or smaller liquid amounts), look for supplements with higher concentrations of EPA and DHA. A more concentrated product will generally allow you to ingest less total fish oil 
  • 36. Dose/Sources
    • Use high quality products that are fresh, mercury free and have antioxidants (Vit E)
    • Sardines & anchovies for safety & sustainability
    • Bioavailability, 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
  • 37. Liquid supplements 1 ml=180mg EPA 1ml=148mg EPA 1ml=165mg EPA
  • 38. Capsule Forms (OTC & Veterinary) 391 mg EPA/capsule 325mg EPA/capsule 250 mg EPA/capsule
  • 39. Challenges: Cost for large dogs Directions: For Adults, take one (1) softgel daily, preferably with a meal. Supplement Facts: Serving Size: 1 Softgel Amount 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 .
  • 40. Challenges: Compliance 294mg EPA/cup 300 mg EPA/cup 390 mg EPA/cup
  • 41. Consumerlab.com: Concerns
    • Concerns and Cautions: While fish oil supplements are generally considered safe, there are a few caveats and cautions you should take into consideration before you buy. While krill oil has not been as extensively studied as fish oil, it is reasonable to assume that the same concerns and cautions apply. The most common side effects are fishy smelling burps and diarrhea. 
    • 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 . Because these vitamins can be toxic, make sure that you do not exceed safe levels (see  Multivitamin Product Review for Tolerable Upper Intake Levels (ULs) for vitamins and minerals ).
  • 42.
    • The only significant safety concerns regarding fish oil involve its apparent &quot;blood thinning&quot; 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 .
    • Contrary to earlier reports, fish oil does not appear to adversely affect blood sugar levels in people with diabetes.
    • Some people are allergic to proteins in fish and krill (among other foods).
    Consumerlab.com: Concerns
  • 43.
    • 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 . 
    • Consumer lab accessed online 1/22/2012
    Consumerlab.com: Concerns
  • 44.  
  • 45. Joint Supplements
    • Indications
    • Evidence
    • Dose Sources
    • Challenges
  • 46. Indications
    • Osteoarthritis affects roughly 20% of dogs
    • Johnson SA “Osteoarthritis, joint anatomy Physiology & pathology” Vet Clinics of NA Sm An Pr 1997;27:699-723
    • Feline elbows 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
  • 47. 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.
  • 48. Evidence continued
    • There 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 .
  • 49. Evidence continued
    • There 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 levelling osteotomy
  • 50. Question…
    • Why wasn’t glucosamine/chondroitin sulfate mentioned, nor the two forms of physical therapy or weight control????
  • 51. Commonly used joint supplement “ingredients”
    • Glucosamine HCL
    • Chondroitin sulfate ( LMW or not)
    • Perna Green Lipped Mussel
    • Avocado Soybean Unsaponifiables (ASU)
    • Elk Antler
  • 52. Evidence: Glucosamine & Chondroitin Sulfate
    • 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
  • 53.  
  • 54.  
  • 55. 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 . 
  • 56. Evidence: human study
    • Humans—Several clinical trials have been performed
    • in humans with mostly favorable results. Despite
    • flaws in study design and assessment of outcome in
    • early 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 for
    • chondroitin sulfate than glucosamine.109
  • 57. Evidence: humans-prevention
    • Furthermore, glucosamine prevented the progressive joint-space
    • narrowing that was detected radiographically in placebo-treated
    • patients.113
    • “ Extrapolating from these studies, the best effects of
    • glucosamine supplementation will be achieved with
    • preventative use , or at least in patients with incipient lesions
    • for whom use for advanced osteoarthritis is not likely to yield
    • favorable results.
  • 58.
    • In a major study 81% of labeled products (human) were not what the label stated
    • Almost all studies done with high quality Glucosamine HCL and low molecular weight purified chondroitin sulfate (Nutramax patented products)
    • www.Consumerlab.com
    Challenges: Quality
  • 59.
    • 88. Russell AS, Aghazadeh-Habashi A, Jamali F. Active ingredient consistency of commercially available glucosamine sulfate products . J Rheumatol 2002;29:2407–2409.
    • 89. Consumer Laboratory Web site. Product review: joint supplements (glucosamine, chondroitin and MSM). Available at:
    • www.consumerlabs.com/results/gluco.asp. Accessed Jan 30, 2004
    References from JAVMA April 2005 article
  • 60. If cats do agility should they get joint supplements???
  • 61. VetriScience Glycoflex III
    • Active Ingredients Per Tablet or 2 Chews: Glucosamine HCl (Shrimp and Crab) . . . . . . . . 1000 mg Methylsulfonylmethane (MSM) . . . . . . . . . . . 1000 mg Perna Canaliculus (GlycOmega™ brand Green Lipped Mussel) . . . . . . 600 mg
    • N,N-Dimethylglycine HCl (DMG) . . . . . . . . . . .100 mg dl-alpha Tocopheryl Acetate (Vitamin E) . . . . . . 50 IU Calcium Ascorbate (Vitamin C)  Tablet  . . . . . . . .30 mg Ascorbic Acid (Vitamin C)  Chew  . . . . . . . . . . .24 mg Manganese (as Manganese Amino Acid Chelate)  Tablet  .10 mg Manganese (as Mn Proteinate)  Chew  . . . . . . . . . 10 mg Grape Seed Extract . . . . . . . . . . . . . . . . . 5 mg L-Glutathione . . . . . . . . . . . . . . . . . . . .2 mg Selenium (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
  • 62. DASUquin
    • DASUquin combines
    • 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)
  • 63. 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)
  • 64. Challenges: Convenience of “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?)
  • 65. Evidence: Since July 2007 or emerging
    • 2007 VetriScience force plate study abstract at NAVC “submitted for publication”
    • 2010 Feline functional food (RC Mobility JS) containing Perna GLM, glucosamine, CS & omega 3 published, peer reviewed
    • 2011 DASUquin force plate study 5 dogs Dr Daryl Millis not published
    • Others?
  • 66. Challenges: Summary
    • Which combination of ingredients?
    • Force plate studies vs in vitro?
    • Perna vs manufactured ingredients
    • Quality of ingredients
  • 67. Challenges: bottom line
    • Nutramax DASUquin ® or VetriScience Glycoflex®
    • Royal Canin Feline Mobility JS ®
    • Royal Canin Canine Mobility JS ®
    • Nutramax & VetriScience have patented products, both have some studies (mostly in vitro) to support their use, both have extensive human lines
    • Others????
  • 68.  
  • 69. Probiotics/prebiotics
  • 70. Definition
    • Probiotic 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
  • 71. Indications/Evidence: Human
    • Diarrhea (antibiotic, viral or chemo induced)
    • Vaginal bacterial infections
    • Reduce cancer promoting enzymes in gut
    • Prevention of allergies & atopic disease in infants
    • Prevention of respiratory tract other infectious diseases and treatment of urogenital infections
    • Inflammatory diseases of GI tract
    • VRL#3 has Mayo clinic studies as top 2 references
  • 72. Evidence : Pets
    • Immune system stimulation in puppies
    • Immune system stimulation in cats
    • Diarrhea
    • previously mentioned human diseases?
  • 73. Contra-indications
    • Pancreatitis
    • Compromise of intestinal mucosal barrier
    • Others?
  • 74. Dr Deb Zoran WVMA Oct 2010
    • practices clinical nutrition at Texas A & M
    • To treat inflammatory bowel disease in cats
    • Good for urinary tract, immune system, diarrheas
  • 75. Dr Joe Bartges at WVMA 2010
    • University of Tennessee
    • Prevent urinary infections minimum of 5 billion CFU’S (people 10 to 20 billion)
    • Multi-strain best
    • Immune stimulant at higher concentrations
  • 76. Challenges: Quality Control
    • Genus & species identified
    • Not pathogenic
    • Guaranteed number of live organisms at date of manufacturer vs “good till date”
    • Kept refrigerated
    • Effective in species being used in
  • 77. Sources
    • Natural (yogurt, kefir, sauerkraut, etc)
    • Supplements (capsules, packets)
    • Pet Foods? (killed by processing unless added after heat)
  • 78. Consumerlab.com: viability 2006
    • Probiotics for Human Use: Only 8 of 13 Pass Tests Consumer 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. An additional six products tested through CL's  Voluntary Certification Program  also met these criteria. Some products provided several billion organisms per day, with one containing 35 billion.  Probiotics for Pets: Only 1 of 3 Pass Tests ConsumerLab.com also tested probiotic supplements marketed for use by pets. Among the three products selected, one was contaminated with mold and did not even 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.
  • 79. Consumerlab:2011
    • Two other pet probiotics, tested through ConsumerLab.com's  Voluntary Certification Program  were found to meet their claimed amounts:  Nutri-Vet Probiotics with Wild Alaskan Salmon Oil  delivered its claimed 400 million cells per 2 teaspoon dose and  Proviable DC for Dogs and Cats  delivered all 5 billion cells per capsule.  
    • 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 .
  • 80. Challenges: which organisms Nutramax Proviable DC® Purina Fortiflora ® VSL#3 Form Paste/capsule packet packet Number of organisms 5 billion/capsule 758 million/pkt 458 billion/pkt Species Enterococus faecium Lactobacillus acidophilus L bifidum L bulgaricus L casei L plantarum Streptococcus thermophilum Enterococcus faecium SF-68 Bifidobacterium breve, B longum, B infantis Lactobacillus acidophilus, L plantarum, L paracasei, L bulgaricus Streptococcus thermophilus.
  • 81. 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 Enterococus faecium (SF68) stimulates immune function in young dogs J Nutr 2003 133:1158-62
  • 82. VetriScience
    • VETRI-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
  • 83. Challenges: cost Purina 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 Veterinary research Y Y N N
  • 84. Our role as veterinarians
    • 1. Trusted advisors/scientists
    • 2. Gatekeepers
    • 3. Interactions/side effects
    • 4. Above all do no harm
    • 6. Preventive
  • 85. The future??
    • 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 ?
    • Prebiotics used like probiotics for immune support?
    • FDA decides to regulate supplements????
  • 86. Thank you for your attention! Questions? Slideshare.net www.westsidefamilypet.com

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