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Matt Brunke, DVM, CCRP, CVPP, CVA
Diplomate, American College of Veterinary Sports Medicine and Rehabilitation

NUTRITIONAL SUPPLEMENTS FOR ANIMAL ATHLETES, WHAT KEEPS JOINT HAPPY?:
PART ONE

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American College of Veterinary Sports Medicine and Rehabilitation

ROSS UNIVERSITY
SCHOOL OF VETERINARY MEDICINE

CHI INSTITUTE
TRADITIONAL CHINESE VETERINARY MEDICINE

IVAPM

IRONMAN
Lake Placid

A little about me... I like to keep busy.

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Goals for this presentation
- Definitions/terminology
- Evidence vs. Claims
- Supplements for
- Joint health
- Muscular recovery/strengthening
- Applying it to your athlete/patient

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Recent publication

Multiorgan dysfunction syndrome secondary to joint supplement overdose in a dog

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Why use a supplement?
- Part of a whole body approach
- Medications if needed
- Diet - well balanced/special need
- Exercise
- Surgery
- Rehab
- Acupuncture
- May reduce/eliminate need for med
- Safety? 22,000 human trips to ER annually

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What is a nutritional supplement?
- Food and Drug Administration (FDA)
- A product intended for ingestion that contains a dietary ingredient...to add further nutritional value to the diet. A dietary ingredient may be any one or a combo of the following
Vitamin
Mineral
Herb/botanical
Amino Acid

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What’s a nutraceutical?
- A non-drug substance that is produced in a purified or extracted form and administered orally to provide compounds required for normal body structure and function with the intent of improving health and well-being.
- The North American Veterinary Nutraceutical Council

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BUT
- Since it’s not a drug it is NOT regulated by the Food and DRUG Administration

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Think critically -
Evidence Claims
- Double blind placebo
- Third-party research
- Provides sources
- Prospective study
- Peer reviewed journal
- Scientific method
- Force plate

Claims
- Catchy terms on a label
- Copying one company’s research
- Self-published
- Marketing
- Organic
- Natural
- Cures Cancer

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Osteoarthritis
Ligament
Cartilage
Synovium
Healthy joint

Destruction of cartilage
Ligament loosening
Synovial inflammation
Damaged joint

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Extracellular matrix (ECM)

Functional relationship of components

Extracellular Matrix
Collagen
Proteoglycan Aggrecan

Maximum Tensile Strength
High Hydration Capacity

From: IAMS Recent advances in Clin. Nutrition Vol III

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Extracellular matrix

Structure of Proteoglycan

Glycosaminoglycan (GAG) Chains

Linked to

Aggrecan

Aggrecan Aggregate

To Form

From: IAMS Recent advances in Clin. Nutrition Vol III

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Compounds for joint health

- Methylsulfonylmethane (MSM)
- Glucosamine hydrochloride (note)
- Boswellia serrata extract
- Hyperimmune Milk Factor
- Chondroitin sulfate
- Curcumin extract
- Hyaluronic Acid
- Undenatured Type 2 Collagen (UC2)
- Avocado/soybean unsaponifiables (ASU)
- Green-lipped mussel
- Elk or deer velvet antler
- CBD???
- Long-chain Omega-3 fatty acids
- Eggshell Membrane (ESM)
- Cetyl-myrestolate

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Glucosamine
- Amino sugar found naturally in the body
- Building block for cartilage matrix
- Stimulates cartilage cells
- Readily available, relatively cheap
- Crab, lobster, shrimp shells
- Not a factor in diabetes

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Glucosamine - which one?
- Need hydrochloride, not the other types
- proven in the joint
- Glucosamine Sulfate may be absorbed better than Glucosamine HCl
- Clinical significance??
- Needs loading dose (2x maint)
- 75 lb dog = 500mg/day for maintenance

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Glucosamine- does it work?
- Does it help dogs?
- Prospective RCCT 35 dogs with hip or elbow OA
- Randomized to glucosamine-chondroitin or NSAID
- Veterinary assessment Day 14, 42, 70
- Glu/CS showed improved pain, weight bearing and disease severity scores (3/5 measures)
- Onset of response was slower for Glu/CS compared to NSAID
- Positive clinical effect for Glu/CS

McCarthy G, Vet J, 2007

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Glucosamine- does it work?
- Does it help dogs?
- Prospective RCCT 71 dogs with OA
- NSAIDs, glucosamine-chondroitin, placebo
- Force plate and subjective assessment (owner and orthopedic surgeon)
- Ground force & assessment improved by NSAIDs , but not nutraceutical
- Nutraceutical was well tolerated .

Moreau M, Vet Record, 2003

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Supplemented Dog Foods
- Don’t buy so quickly - here’s why!
- Average Labrador Retriever eats 1400 Kcal/day at 4.0 kcal/gram. 350 grams of food.
- Inclusion rate is:
- 475 ppm glucosamine = 475 mg per kg food
- 250 ppm chondroitin sulfate = 250 mg/kg food
- Dog only eating 1/3 kg of food so only receiving:
- 160 mg of glucosamine, 85 mg of chondroitin sulfate = 245 mg
- Should get 1000 mg loading dose for 4-6 weeks, then 500 mg daily.
- Still need to supplement is the bottom line.
- Is it absorbed the same when in a food
- Check the inclusion rates!

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Chondroitin Sulfate
- Also naturally in body
- Important part of cartilage
- Inhibits cartilage destroying enzymes
- Difficult to source and extract - $$$
- Shark and cow cartilage
- Needs loading dose
- Treats - catching the craze
- 2 boxes of treats PER DAY (if they have what they even claim! $15 per box!

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Chondroitin Sulfate
- Often a much larger molecule, 50 times larger than glucosamine.
- Likely not absorbed as efficiently.
- Preparations will vary in the molecular size therefore bioavailability can be an issue.
- Cosequin (Nutramax) has shown both glucosamine and chondroitin levels increase 3-6 fold in plasma with supplementation (ACVIM 2009).
- Many human studies show no additive benefits when already giving glucosamine.

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But together.....
- They have greater than a 1+1 effect
- Shown to lessen inflammation and
lameness when given before a joint injury - protection (pre-emptive)
- Help maintain healthy cartilage metabolism
- Published research exists showing safety of ingredients

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Questions?
- Matt Brunke, DVM, CCRP, CVPP, CVA, DACVSMR
DrMattBrunke@gmail.com
DrBrunke.Wordpress.com