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| ACVN NutritioN Notes 82 today's Veterinary Practice May/June 2014 tvpjournal.com also elevated in many foods and found in joint supplements. Herbal Supplements Single and combination herbal prod- ucts are widely available in human and veterinary markets. Herbs are often subtly sold as drug alternatives, and some may have biologic effects. A brief list of frequently encountered herbs is provided in Table 5. Prebiotics & Probiotics Gastrointestinal bacteria are increas- ingly thought to influence health and disease, and numerous veterinary prod- ucts with ingredients (Table 6, page 83) that capitalize on this area of research are now available. IN SUMMARY Veterinarians should be prepared to ask about dietary supplements and provide guidance. Unfortunately, the evidence quality is low and dosing protocols are uncertain for many common dietary supplements. Veterinarians should ask manufactur- ers of any recommended products for quality control and efficacy information. Further work is needed for many of the products commonly employed by veteri- nary professionals and owners. n table 4. Common Supplements used for Osteoarthritis SUPPLEMENT SUMMARY Glucosamine & Chondroitin • glucosamine is a precursor to glycosaminoglycans, such as chondroitin and hyaluronic acid— critical components in cartilage. • oral absorption of these products has been demonstrated in dogs; however, clinical effects have been mixed. • if given, owners should be prepared to administer for at least 2 months before making a determi- nation about clinical utility. Green-Lipped Mussel • it contains omega-3 fatty acids, minerals, and other compounds. • one study found that some owners perceive huge improvements in oA even when dogs are given placebo, 37 which questions the validity of anecdotal success. Methylsulfonyl- methane (MsM) • Dietary sulfur compound with unclear mechanisms, but interestingly, dimethyl sulfoxide (DMso) is metabolized in part to MsM. • limited evidence of efficacy is available. table 5. Common Herbal Supplements HERBAL SUPPLEMENT SUMMARY Artemisinin • reported role in treatment of protozoal diseases and cancer • In vitro study found inhibition of canine osteosarcoma cell lines 38 • Clinical efficacy not established, but oral doses are commonly employed Chinese Herbal Formulas • yunnan Baiyao, one of the most common formulas in the veterinary market, is a proprietary mix- ture that increases primary hemostasis through promotion of platelet adhesion and aggregation • Dosage recommendations for acute or chronic hemorrhage are available in Table 7 (page 84) • In vitro study demonstrated some inhibitory effects on canine hemangiosarcoma cell lines; small case series for other herbs are available in the literature 39 • gui Pi tang has been suggested as a primary thrombopoietic agent 40 • Concerns about standardization of Chinese herbs are widely disseminated; only one study has examined these issues in veterinary formulae 13 Curcumin • May function as an inhibitor of NF-kB • included as a natural anti-inflammatory in several veterinary oA supplements • In vitro research shows inhibition of all stages of abnormal cell cycle in tumors 41 • in dogs, poorly absorbed from gastrointestinal tract 42 and may, therefore, be best for gastrointes- tinal conditions Milk Thistle • Contains silymarin, a mixture of compounds with possible antioxidant effects, including silybin, which is present in some veterinary products • Milk thistle and derivatives are frequently prescribed for liver disease in dogs and cats • study of co-administration of silybin and sAM-e (Table 3) with lomustine (CCNu) demonstrated reduced hepatocellular and cholestatic enzyme elevation compared to CCNu alone 43 • study doses were variable but were likely 1 to 2 mg/kg of silybin and 15 to 20 mg/kg of sAM-e Mushroom Products • reishi, shiitake, maitake, and coriolus mushrooms have been extensively studied in humans to evaluate medicinal properties 44 • Many contain immunomodulatory polysaccharides; owners of animals with cancer frequently inquire about their benefits • in a small pilot study, Coriolus versicolor (yun Zhi) has shown promise in canine hemangiosar- coma through use of a proprietary extracted form (100 mg/kg/day) 45 • Doses for mushroom products are not well-established 2014-0506_NutritionNotes_Nutraceuticals_RECONFIGURED_FOR ADS.indd 82 5/24/2014 8:17:11 PM