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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 TWO

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Avocado/Soybean Unsaponifiables (ASU)
- Extract of the oils
- Inhibits inflammation
- Complements effects of glucosamine and chondroitin. (1+1+1= >3)
- Adding ASU decreases the amount of chondroitin needed - less $

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So what’s it do?
- ASU supports cartilage matrix production and helps protect against cartilage damage
- Safety demonstrated
- Dasuquin efficacy may be similar to NSAIDs in dogs (for joint problems)

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ASU - Canine Cruciate Model
- Surgical Model of Cr Dx
- 16 cross bred (20-25 kg)
- 8 placebo
- 8 Tx 10 mg/kg Daily
- Transect the cruciate
- 8 wks - examine joints
- Gross/Histological
- Fewer osteophytes
- Thicker cartilage
- More normal chondrocyte morphology
- Calcified Cartilage

Boileau C et al, Arth Res Therapy, 2009

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ASU and Dogs

Protective effects of total fraction of avocado/ soybean unsaponifiables on the structural changes in experimental dog osteoarthritis: inhibition of nitric oxide synthase and matrix metalloproteinase-13

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Results
Femoral condyles Tibial plateaus

Placebo

ASU (10mg/kg)

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Results
Femoral condyles Tibial plateaus

Placebo

ASU (10mg/kg)

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Results
Placebo

ASU (10mg/kg)

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Results
Placebo

ASU (10mg/kg)

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Results
Placebo

ASU (10mg/kg)

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Inhibition of Pro-inflammatory Gene Expression in Chondrocytes, Monocytes, and Fibroblasts by the Combination of Avocado Soybean Unsaponifiables, Glucosamine, and Chondroitin Sulfate

Rebecca Aul; Angela Aut; Ann Rashmir-Raven?; Carmelita G. Frondoza1,2,3

1Nutramax Laboratories, Inc., 2208 Lakeside Blvd, Edgewood, MD 21040
2Mississippi State University, College of Veterinary Medicine, Mississippi State, MS 39762
3Johns Hopkins University, Department of Orthopaedic Surgery, Baltimore, MD 21239

MATERIALS AND METHODS:

Equine Chondrocytes, Human Chondrocytes, Human Fibroblasts, or Human THP-1 Cells 5.0x105 cells/well

Activate for 1 hr with, Lipopolysaccharide (LPS; 20 ng/ml) or IL-1B (10 ng/ml)

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cox-2
GAPDH
C C+L ASU+L Glu+CS+L ASU+Glu+CS+L

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CHLASUL GU-CS ASU+Glu
+L +CS.L

JIL
C
C+L
ASU+L
Glu+CS+L
ASU+Glu+CS+L

*CSAL
TNF

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DISCUSSION/CONCLUSION:
We demonstrated that the combination of ASU, Glu, and CS profoundly pressed pro-inflammatory gene expression in chondrocytes, fibroblasts and monocyte/macrophages. The combination treatment was effective in reducing the expression of chemokines, cytokines, and mediators of the arachidonic and nitric oxide pathways (COX-2 and iNOS). Our results reinforce the potential clinical utility of the combination of ASU, Glu, and CS in the management of inflammatory disorders, providing an alternative option to patients who fail to respond to the single agents alone.
DECEDENCES.

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Long-chain Omega-3 fatty acids
- Eicosapentaenoic acid (EPA)
- Docosahexaenoic acid (DHA)
- Found in oil from wild caught COLD water fish (anchovy, sardine, salmon)
- Farm raised has low levels -3, high -6

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Omega-3
- Support heart health
- Joints
- Skin and coat
- Nervous system - trainability
- Kidneys
- Immune system
- All at slightly DIFFERENT doses.....

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Controlling inflammation with n-3 fatty acids
Chondrocyte damage
Cell membrane phospholipid
Omega 3-FA Replace
Arachadonic Acid (n-6 FA)
Lipoxygenase Cyclooxygenase
Omega-3 FA Inhibit
Leukotrienes Prostaglandins (PGE2) Thromboxanes

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Inflammation
Fish oil and Carprofen
- RCCT
- Dogs 109
- Omega three fortified food vs nearly identical non fortified food
- 52 test diet
- 57 Control diet
- Subjective measures
- 3 month follow up biweekly to determine if carprofen could be decreased.

Rousch JK, JAVMA, 2009

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Omega-3 fatty acids in arthritis
- RCCT 38 client owned dogs with OA fed test or control diet
- Orthopedic exam and force plate analysis at Day 0, 45, 90
- 5.6% mean change in vertical peak force of most severely affected limb in treatment group (no significant change in control)
- Statistical improvement in 2/5 parameters on ortho exam.

Roush JK, JAVMA, 2010.

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Omega-3 fatty acids in arthritis
- RCCT 30 client owned dogs with OA
- 13 treatment diet enriched with EPA and DHA
- 14 Similar control diet without EPA/DHA.
- Subjective owner and veterinary exam and force plate analysis at week 7 and week 13
- 3.5% mean change in vertical peak force of most severely affected limb in treatment group.
- 0.5% mean change in control (not significant).
- Owner perceived case specific outcomes were better in treatment group. (control no significance)

Moreau M, J An Nutr Phys., 2010.

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Peak vertical force (% Body weight)

Baseline W7 W13
Veterinary therapeutic diet

Baseline W7 W13
Control diet

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Control diet
Veterinary therapeutic diet

Case-specific outcome measures
Days (days of assessment are specified)

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RCCT using Fish Oil
- Dogs
- 39 fish oil treatment
- 38 dogs on corn oil placebo
- Controlled diet (2 weeks before)
- No NSAIDS or Steroids
- Dosing
- 1 ml/5 kg = 550 mg EPA/DHA
- Force plate
- Subjective scoring
- Locomotion, QoL ,VAS, Helsinki pain index

Hielm-Bjorkman A, BMC Vet Res, 2012

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Fish Oil Titration in Food
- Subjective assessment by owners
- Dogs 212 originally enrolled - 27 clinics
- Diet A - 55, Diet B - 62, Diet C - 60
- Assumed a 2:1 ratio of canned to dry fed.
- EPA/DHA; A=0.79% DM, B= 1.98% DM,C= 2.94%
- 250 g/20 kg body weight
- A = 100 mg/kg B = 250 mg/kg, C = 375 mg/kg
- Subjective scoring - 0,21,45,90 days
- All groups improved - C more than A.

Fritsch D. et al, JVIM, 2010

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Fish oil intake in the 4 studies
- If a 20 kg dog ate 250 g a day
- Rousch, JAVMA, 2009 - 84-110 mg/kg
- Morneau, JAPAN, 2010 - 101 mg/kg
- Fritsch, JVIM, 2010 - 3 diets - 100-375 mg/kg
- Hielm-Bjorkman - 110 mg/kg
- How much is too much?
- NRC - suggests around 375mg/kg
- Possible clotting abnormalities
- Immune Suppression?
- Vitamin E supplementation?

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Math!
- 100lb dog (50kg)
- DJD - 80-120mg/kg/DAY Omega-3
- 50 x 100 = 5000
- Equals =
- 3 pumps of Welactin 2x day NOTE BID
- 3 cups of Hill’s J/D twice a day
- Up to 25 Omega-3 capsules twice a day!
- If they have what they are supposed to have

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Methylsulfonylmethane (MSM)
- Sulfur containing compound in small quantities in the body as well as fruits, veggies and grains - Breakdown product of DMSO
- DMSO (smells like onions/garlic)
- Horses and dogs - neurological conditions
- People - interstitial cystitis

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Evidence?
- Two studies in humans with knee DJD published that it helps
- No published research in dogs yet
- Dosage?
- Safety? Very good - diarrhea?

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Hyaluronic Acid (HA)
- Naturally found in the body - joint fluid component
- Given in the joint or vein of horses/dogs
- Oral absorption?
- One report did...
- But they were also on other supplements

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