VETSCOPE

Periodontal Disease and Home Care - P.2

Dr. James Anthony, DVM, BSc (Agr.), MRCVS, FAVD, DAVDC, DEVDC, PAg
- 40 years of veterinary experience
- Western College of Veterinary Medicine, University of Saskatchewan and received his DVM degree in 1983
- 30 years of clinical veterinary practice in USA & Canada
- 1986 Fellow of the Academy of Veterinary Dentistry
- 1989 first group of veterinarians to become a Diplomate of the AVDC.
- One of the founding members of the EVDC and is a Diplomate of the EVDC.
Veterinary Dentistry Professor:
- University of Guelph
- University of Montreal
- University of Prince Edward Island.
- Tenured Professor at the University of Saskatchewan (Western College of Veterinary Medicine) as the Head of Veterinary Oral Surgery and Dentistry.
Author & Speaker:
- Written 40+ articles and book chapters
- Lectured globally at veterinary meetings.
One of the most respected veterinary dental specialists in the world. He has also been a veterinary dental consultant for many zoos and aquariums
throughout North America and Asia and has mentored numerous individuals to become Diplomates in the AVDC.
Dr. Anthony has just retired from practicing advanced dental procedures at Red Bank Veterinary Hospital in Tinton Falls, New Jersey. He is currently teaching advanced veterinary dentistry throughout the world. He mainly teaches in Asia and South America trying to avoid the Canadian winter.
On a side note h e has a vineyard at his farm in Princeton, British Columbia.

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Dental Evolution
Change happens whether you want it or not, veterinary dentistry is changing almost daily
Dr. James Anthony
Veterinary Dentist

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Periodontal Disease
- It is the most common disease in dogs and cats of all ages
- Benefits of prevention include:
- This is a better focus than treatment
- Improvement in attitude and quality of life
- Halitosis, this primarily benefits the owner
- Prevention of more serious disease

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You cannot ignore this

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Veterinary Dentistry 101
Components of periodontium
- Cementum covers the dentin of the tooth root.
- Periodontal ligament surrounds the root and anchors the root to the alveolar bone
- Consists of collagen bundles, nervous and vascular tissue.
- Alveolar bone provides seating for the tooth roots.
- Three layers of bone: in order tooth, cribriform plate, trabecular bone and then compact bone.
- Gingiva
- Attached gingiva: mucogingival margin and extends to the crest of the alveolus and is closely attached to the alveolar bone. Keratinized.
- Free gingiva: the enfolding towards the tooth and attaches at the cemento-enamel junction as the junctional epithelium.
- the gingival sulcus, which is not keratinized.

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Veterinary Dentistry 101
- Periodontitis is simply active inflammation of any of the parts of the periodontium.
- Periodontal disease:
- Resulting loss of the periodontium as a result of periodontitis.
- Once a n animal has attachment loss, it has periodontal disease, even without active inflammation.

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Veterinary Dentistry 101
Periodontal disease
What grade?
Bone loss furcation area

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Veterinary Dentistry 101
Severe Periodontal disease
15 extractions later and oral hygiene

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Steps of oral hygiene procedure
Preliminary examination and initial treatment planning
1. Dental radiographs, charting and oral rinse
2. Removal of calculus, plaque and stains subgingivally
3. Removal of calculus and plaque subgingivally, with gingival curettage.
4. Polishing of the tooth surfaces above and beneath the gingiva.
5. Flushing the gingival sulcus, and oral cavity.
6. Fluoride application
7. A post-prophylactic examination
8. Recheck in 12days

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Plaque!
What periodontal disease starts with
1. Pellicle = salivary mucoproteins
2. Plaque = pellicle with attached bacteria within 24 hrs. Initially Gram + aerobic spps. Such as Staph and actinomyces. Also, have food debris and extracellular glycoproteins.
3. Plaque starts supragingivally and progresses into the gingival sulcus -> gingivitis

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Plaque! (continued)
4. In the sulcus, predominantly Gram – anaerobic such as Bacteroides
- Bacterial by-products = tissue and bone destruction
- More important: host defense response response causes even more inflammation with tissue and bone damage.

Periodontal Disease and Home Care - P.13

Periodontal Disease of Yesterday vs. Today
Yesterday
- Researchers believed that gingival loss in periodontal disease was caused by bacteria
Today
- Researchers have determined that the gingival loss in periodontal disease is caused by the inflammatory response to the bacteria

Periodontal Disease and Home Care - P.14

Pathogenesis of Periodontal Disease
Oral Bacteria / Pathogens
Dental Plaque / Tartar
Host Defense
Inflammatory and Immune Response
Chronic / Pathological Levels of
Inflammatory Mediators
Tissue Destruction / Bone Resorption
Yucel-Lindberg, T. and T. Bage (2013). Inflammatory mediators in the pathogenesis of periodontitis. Expert Rev Mol Med 15: e7.

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What Is Inflammation?
Inflammation is the bodies first response to an injury
- Acute inflammation includes redness, swelling, heat, and altered function as well as being self-perpetuating.
- There are several biological markers of inflammation in blood, including C-reactive proteins.
- Inflammation appears to be a common link between several common diseases of aging.

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Inflammation’s Objective
Inflammation tries to contain the injury to the local site
• The body’s reaction is immediate (innate response)
• Its ultimate purpose is to protect the body from further damage

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Inflammation is Damaging When Uncontrolled
Though inflammation can be helpful under certain conditions, uncontrolled inflammation, also called chronic inflammation, is harmful and causes tissue loss.
Chronic inflammation occurs when there is a sustained infection, like periodontitis.
Chronic inflammation involves more inflammatory mediators than the immediate innate response.
Chronic inflammation can negatively affect all organs and tissues of the body.
Chronic diseases of aging are connected through common chronic inflammatory mechanisms.

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Why Encourage Homecare?

- Maintain oral health
- Increased quality of life
- Oral problems detected earlier (treated earlier)
- Oral hygiene procedures are easier
- Increased time between oral hygiene procedures
- Increased bond between owner patient
- Increased bond between owner-hospital
- Decreased oral infection
- Relieves oral pain
- Improved mastication
- Decreased bacteremia
- Increased life span

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Homecare in Practice

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UNDERSTANDING Clients Expectations and Perceptions
Moments of truth with you in the practice
Good communication principles (listen)

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Home Care vs. No Home Care

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Lack of Time is Not an Excuse

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Methods of Plaque Prevention
- Antibiotics
- Irrigation
- Chemical (suppress oral flora, inhibit bacterial colonization, inhibit plaque forming factors, dissolution of plaque, prevention of plaque mineralization)
- Mechanical
- Chew toys
- Treats
- Diets
- Brushing
- Natural Products
- Combinations

Periodontal Disease and Home Care - P.24

Todays’ Periodontal Home Care
Detect active inflammation
Reduction of tissue inflammation
Reducing one type of inflammation may reduce another

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How To Reduce Inflammation
- Reduce direct sources of inflammation (chronic infections)
- Oral examination and hygiene when needed
- Homecare program
- Control bacteria (plaque)
- Activate inflammation resolution systems
- Anti-inflammatories
- Omega - 3 fatty acid to diet
- 1-TetraDecanol Complex
- Other

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Factors in Home Care Success
- Adequate client education in product use
- Cooperative patient
- Adequate education of normal
- Owner compliance
- Reasonable goals for the owners
- Provide home care products that are acceptable
- Regular follow up and monitoring:
- 10-14 days (exam)
- 21 days (phone)
- 3-6 months (exam)

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VOHC

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Gold Standard of Home Care
Daily brushing
- Sulcular method, horizontal plane
- 45 angle towards the tooth
- Soft bristle human toothbrush - not veterinary brushes
- Adult - large and medium dog
- Child - small dog
- Proxabrush - cat
- Replace once a month
- Buccal/ labial aspect
- Veterinary toothpaste

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Gold Standard of Home Care
Drinking water additive
- Xylitol is a hydrogenated carbohydrate that has a n antibacterial effect resulting in plaque reduction in humans and animals
- Xylitol taken u p by bacteria -> metabolized to xylitol-5-phosphate
- Xylitol-5-phosphate inhibits the uptake of glucose by bacteria -> bacterial growth
- Toxicity???
- Healthy mouth

Periodontal Disease and Home Care - P.30

Gold Standard of Home Care
Oral hygiene rinse
- Antimicrobial- dilute chlorhexidine
- Reduces bacterial load in the oral cavity plaque accumulation
- Binds to the salivary pellicle and is released over a prolonged period

Periodontal Disease and Home Care - P.31

Gold Standard of Home Care
Oral hygiene gel
- Muco-adhesive gel contains zinc ascorbate and taurine
- Zinc ascorbate heals gingiva by stimulating collagen production & bond strength between collagen fibers, slight antibacterial action
- Taurine is a sulfur amino acid, chelates with malodorous sulfur compounds produced by bacteria in the mouth providing a rapid reduction of halitosis

Periodontal Disease and Home Care - P.32

Gold Standard of Home Care
Dental diets
- VOHC
- Use as treats
- 1kibble per 5 lbs. (2kg) body weight
- If more, reduce regular diet
- Mechanical and/or chemical plaque removal
- Squeegee effect
- Use appropriate-sized kibble
- If used as a treat recommend the largest size
- Don’t use as a substitute for an oral hygiene

Periodontal Disease and Home Care - P.33

How To Reduce Inflammation
1-TetraDecanol Complex
- To decrease and prevent gingival inflammation
- To help promote gingival reattachment
- To help promote bone regrowth
- To decrease resorptive lesions?
- To enhance the healing of the gingival post surgery

Periodontal Disease and Home Care - P.34

Conclusion
- Dental health is a very important aspect of the animal’s quality of life, don’t let your clients ignore it!
- Many options for the owner.
- Can mix different methods but brushing optimal!
- Client-Veterinarian / AHT / Receptionist communication is critical
- Customize the home care to meet the owners and patients needs
- Remember to control inflammation
- Bi-annual veterinary oral exam

Periodontal Disease and Home Care - P.35

Thank You

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 1 - P.2

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.

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 1 - P.3

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 3 - P.2

Green Lipped Mussel
- New Zealand shellfish
- Perna canaliculus
- Studies in dogs suggest benefit, but results not consistent
- Omega-3?
- Minerals
- Vitamins C and E
- Chondroitin?

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Green Lipped Mussel
- Found in the waters around Australia and New Zealand
- Contains n-3 fatty acids
- EPA
- DHA
- ETA
- Contain about 15% GAG’s (chondroitin sulfate)
- Glycoproteins
- Freeze dried processing to retain its pharmacologic properties.

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Green Lipped Mussel (Perna spp)
- Studies - using subjective measures, RCCT
- Score reduction
- Pain
- Crepitus
- Joint Swelling
- Average intake in food - 77 mg/kg BW
- Third Study - RCCT
- 25 mg/kg intake showed no difference - blinded study

Bierer TL, Bui LM. J.Nutr 2002. Bui LM, Bierer TL. Vet Ther 2003

Dobenaker B, J Nutr, 2006

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RCCT Green Lipped Mussel
- Dogs with Clinical OA
- GLM vs. Carpofen vs. Placebo (n = 15 per group)
- No NSAIDS or steroids - 30 days before
- Carprofen 2 mg/kg
- Lyproflex (500 mg capsules)
- Initial dose 2000 mg 40 kg; 3000 mg over 40 kg; 10 days
- Half this dose - day 10
- Assessment Subjective and Force Plate at 4,8,12 weeks
- Owner and veterinary
- NSAIDs for rescue recorded
- Difference between GLM and placebo

Hielm-Bjorkman A et al, Evid. Based Alt. Comp.Med, 2007

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Eggshell Membrane (ESM)
- What is it?
- Thin membrane between raw eggshell and membrane
- Protein rich
- Naturally rich in elastin, collagen, glycosaminoglycans (gags)

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Boswellia serrata extract
- Frankincense - tree bark from India
- Mix of boswellia acids
- KBA, AKBA
- Anti-inflammatory effect (NSAID?)
- Anti- LOX
- Benefits seen in human DJD patients
- A study in dogs showed improved clinical signs - lameness, pain, stiff gait

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Boswellia Study in Dogs
- Unblinded open label study
- Subjective measures based on scoring systems in Austrian canine population.
- No other meds for 3-6 weeks. Confirmed radiographs and visual lameness
- 29 dogs; 24 completed
- Dose 400 mg per 10 kg/BW
- Assessed 2,4 and 6 weeks.
- 71% positive response
- No placebo

Reichling J. et al, Schweiz Arch Tiereheik, 2004

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Curcumin extract
- Active part of turmeric
- Antioxidant and anti-inflammatory effects
- One study in dogs showed improvement in clinical score by veterinarians
- Standard extracts are not well absorbed, but special ones are
- Got turmeric? It won’t provide equivalent effects
- But will stain everything yellow!

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Elk (or deer) Velvet
- Traditional Chinese Medicine modality
- From antler in fast growing stage (when its cartilage!)
- Farmed deer or elk
- Ethics??
- Active ingredient?
- Pilose antler peptide
- Omega-3’s and -6’s
- Chondroitin sulfate
- Minerals, amino acids, collagen

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Elk Velvet
- Quality Elk Velvet
- Inner core of elk antler at velvet stage
- Contains CS and collagen
- Pilose antler peptide
- Study Design
- Dogs more than 20 kg
- 1 or more affected joint
- No concurrent supplements or NSAIDS
- Owner and Veterinary Assessments
- Force plate analysis
- Day 0 - 30 on placebo
- Day 60 - 30-60 on QEVA
- 280 g of QEVA capsules start 20-40 kg one capsule

Moreau M et al, Can Vet J, 2004

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Cetyl-m
- Fatty acid from Swiss albino mice
- Mechanisms?
- Joint lubrication
- Decrease inflammation
- No studies in dogs

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Hyperimmune milk factor
- Natural component of milk - manage inflammation
- Cows immunized with intestinal bacterial antigens.
- High molecular weight IgG and antiinflammatory low molecular weight components.
- Concentrated version - MicroLactin - active ingredient in Duralactin.
- May reduce inflammation by blocking entry of neutrophil attachment to the endothelial wall

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HIMF
- Study of 8000 people with OA - 80% reported considerable improvement in joint pain and 72% reported less stiffness in morning.

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UC-2
Undenatured Type 2 Collagen
- Active immune modulator
- Reduces secretion of enzymes thatbreak down collagen
- Slows the inflammatory response
- 10mg SID per patient

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UC-2 - Research

Efficacy and Safety of Glycosylated Undenatured type-II Collagen (UC-II) in Therapy of Arthritic Dogs

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UC-2 - Research

Therapeutic Efficacy and Safety of Undenatured Type II Collagen Singly or in Combination With Glucosamine and Chondroitin in Arthritis Dongs

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UC-2 - Research

Therapeutic Efficacy of Undenatured type-II Collagen (UC-II) in Comparison to Glucosamine and Chondroitin in Arthritic Horses

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UC-2 - Research

Evolution of the Effects of Undenatured Type-II Collagen (UC-II) as Compared to Robenacoxib on the Mobility Impairment Induced by Osteoarthritis in Dogs

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.2

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.14

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.

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.15

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.16

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.17

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.18

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.19

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.

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.20

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.

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.21

Peak vertical force (% Body weight)

Baseline W7 W13
Veterinary therapeutic diet

Baseline W7 W13
Control diet

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.22

Control diet
Veterinary therapeutic diet

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.23

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.25

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.26

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?

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.27

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.28

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.29

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.30

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 2 - P.32

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

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 4 - P.4

Cannabis vs. Hemp
- Cannabis Sativa
- Recreational andmedical drug
- Restricted substance
- Leaves and flowers
- THC >0.3%
- Hemp - Cannabis
- Industrial
- Tall, sturdy stalks
- Paper, textiles, health food, fuel, biodegradable plastics
- THC<0.3%

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 4 - P.5

CBDs - Cannabidioils
- December 2018 - Hemp Farming Act
- Hemp legal - as “agricultural commodity”
- Removed from Schedule 1 status
- Under FDA jurisdiction
- Currently DSHEA - supplement act for humans; NOT animals
- Can’t discuss specific chemicals or have drug claims on label
- State laws for vet med - will vary

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 4 - P.7

CBD - Cannnabidiol

Single-Dose Pharamacokinetics and Preliminary Safety Assessment with Use of CBD-Rich Hemp Nutraceutical in Healthy Dogs and Cats.

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 4 - P.8

CBD - But how safe is it?

- Dogs given 25mg/kg CBD - no issues
- In a long term study (56 weeks)

Species- specific Susceptibility to Cannabis-Induced Convulsions

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 4 - P.9

Are they all the same?

- http://www.cannabissciencetech.com/article/analysis-veterinary-hemp-based-oils-
product-integrity-lcms/page/0/3

Analysis of Veterinary Hemp-Based Oils for Product Integrity by LC/MS

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 4 - P.10

Abstract/Synopsis

Pet owners continue to seek alternative therapies for pain relief in their favorite companion animals. Instead of routine nonsteroidal anti-inflammatory drug (NSAID) treatment, there is a trend toward trying hemp-based products rich in cannabinoids. There are increasing number of companies producing hemp-based oils enriched with various mixtures of cannabinoidsfor pain and other maladies inducing seizures, cancer and anxiety. These products post labels attesting to the composition in the products, usually labelling for the cannabidiol (CBD) concentration in the products. But in the absence of regulatory control we questioned how accurate the information is on the label. The chemical composition of 13 commercially available oils intended for veterinary or a crossover of human and veterinary use was determined by selected ion monitoring liquid chromatography/mass spectrometry (SIM LC/MS). It was found that many of the labels were inaccurate regarding the cannabidiol concentration and/or the presence of other cannabinoids. In general, the label o most of the medicinal veterinary samples indicated higher levels of CBD than found in these studies by 20% or more. The precision and accuracy of SIM LC/MS analysis of the samples fell within the acceptable limits of regulated bioanalysis guidelines of +/- 15%.

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 4 - P.11

Table II. Summary of veterinary CBD oil concentration for the six cannabinoids measured in samples 1-13. Concentration are mg/mL of indicated cannabinoids. It should be noted that sample 6 was crude hemp leaf extract without subsequent sample cleanup or concentration

Vet CBD Oil CBDA CBG CBD CBN THC THCA
1 0.005 0.070 13.4 0.078 0.347 0.107
2 0.007 0.051 10.6 0.005 0.194 0.026
3 0.001 N/D 1.65 0.030 0.023 0.075
4 N/D N/D 6.51 0.003 0.001 0.088
5 0.042 0.026 4.34 0.018 0.103 0.076
6 0.153 N/D 0.88 0.002 0.014 0.244
7 1.42 0.061 5.76 N/D 0.205 0.049
8 0.291 0.274 15.5 0.062 0.348 0.180
9 0.005 0.147 8.82 0.009 0.278 N/D
10 N/D 0.102 11.6 0.017 0.352 N/D
11 N/D 0.018 7.86 N/D 0.049 0.079
12 11.8 0.372 27.5 0.005 1.29 0.693
13 0.123 0.116 13.9 N/D 0.374 0.032

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 4 - P.12

Table III. A listing of the indicated concentrations on the product labels of the 13 veterinary medicinal oils studied. The lack of uniform guidelines or practices for labelling medicinal CBD oils leads to considerable confusion for customers.
Sample Numbers CBD label
1 25 mg hemp extract/ml
2 N/A
3 200 mg/oz
4 10 mg/mL
5 4.2 mg/mL
6 56 mg hemp leaf extract/ml
7 250 mg cannabinoids
8 5 mg hemp oil/0.5 ml
9 350 mg/30 ml
10 225 mg total in 15 ml
11 150 mg/18 ml
12 website 3000 mg/60 ml
13 8 mg/mL

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 4 - P.13

CBD content

CBD (mg/mL)
Vet CBD Oil

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 4 - P.14

THC Content

THC (ppm)
Vet CBD Oil

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 4 - P.15

Conclusions
- How accurate is the label?
- Most were not
- Varied in CBD by 20% or more
- Ask for their analytical composition data

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 4 - P.17

Conclusions
- Feeding enhances absorption
- 2mg/kg BID is starting point and safe

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 4 - P.18

CBD
- Cannabinoid compound in hemp
- Cannabinoid receptors in CNS and PNS
- Decreases pain
- Inhibits spinal nociceptive processing?
- Decreases inflammation
- Decreases IL-1 and TNF-alpha
- Increases Il-10 (anti-inflam)

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.1

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 FIVE

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.2

Nutritional Supplements for Muscle Recovery/Strengthening

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.3

What’s in them?
- Creatine
- Whey protein isolate/protein/specific amino acids (DL-methionine, L-lysine, L-carnitine)
- Chromium
- Dimethylglycine
- Lecithin

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.4

Creatine
- Amino acid derivative in the body - skeletal muscle, heart, brain, other
- Anaerobic formation of ATP
- Human studies show may help performance and strength in repeated bouts of MAXIMAL exercise of short duration (<30 seconds) weights, cycling
- No studies in dogs
- Side effect: WEIGHT GAIN

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.5

Whey protein isolate
- Milk!
- Human studies - resistance training
- Mixed results for muscle recovery, mass, strength
- No studies in dogs
- Dosage???

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.6

Chromium
- Essential trace mineral found in many foods: meat, cheese, whole grain foods, fresh fruits, fresh veggies, brewer’s yeast
- Needed for carbohydrate and fat metabolism
- Helpful for people with diabetes, not in dogs.
- Supplement promoted for building muscle. NO RESEARCH PROVES

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.7

Dimethylglycine
- Antioxidant naturally in the body, beans, cereal grains
- Marketed to support performance by decreasing lactic acid build up
- BUT NO RESEARCH
- May support immune function - conflicting research

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.8

Lecithin
- Fat in the body, egg yolks, soybeans
- Emulsifying agent
- May support gut barrier
- Marketed to support athletic performance, but no data.

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.10

Reading at home

Nutraceuticals in Veterinary Medicine

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.13

What’s that mean?
- Journal of the American Neutraceutical
Association: 3(1) 32038, 2000.
- No correlation between price and label claim
- Only 6/32 had at least 90% of what they claimed to have.
- Report didn’t look at source, efficacy, etc.

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.14

Systematic Review

Dietary Supplements for Treating Osteoarthritis: A Systematic Review and Meta- Analysis

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.15

What about what I am using? - Client

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.16

Math!!!
- 130 lb Newfoundland (should be 100)
- Joint treats - $10/bag
- 3-5 bags a month
- Supplement $26.95 a month
- $70 a month
- $70 x 12 = $840 a year
- Been doing this for 8 years
- $6720!!!!!!

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.17

Implementing a plan
- How to decide?
- Breed? Job? Goals? Sport? History of injury or illness
- Manufacturers are NOT held to same standards as pharmaceuticals
- Accuracy of the label???
- Purity? Source?
- Free from contaminants?
- Claims? (vs. evidence)
- Efficacy

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.18

What should your clients do?
- Ask you! THE VETERINARIAN
- Avoid products backed only by testimonials
- Ask for research from companies
- Require that what is on the label actually be in the product
- Reputation of manufacturer

Nutritional Supplements for Animal Athletes - What Keeps Joints Happy? Part 5 - P.19

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