"Contains no fruit or creme" (or, equine nutraceuticals)

I love yogurt, and I eat a lot of it. One day I was shopping at a grocery, and picked up a few tubs of banana creme pie yogurt (pictured right). A few nights later, I went to the fridge and grabbed a tub of yogurt. As I spooned it into my mouth, I casually glanced at the container. On the side, there was a notice: "contains no fruit, creme, or crust." A yogurt called banana creme pie contains NONE of its defining attributes. We also have a can of soup in our cupboard. The manufacturer's label proudly declares "made with real ingredients." I ask you, what on earth are we eating?

Nutraceuticals: Made with real ingredients
Well, as it turns out, ingredients are also a big question mark in the equine nutraceuticals industry. It's scary, especially for someone like me. I know the problems, and yet I buy a lot of them. I'm on a first name basis with the Smartpak phone reps, and I study their joint supplement chart so carefully you'd think it foretold my future. Harvey is always on one or two or three supplements. When he finishes his evening repast, his muzzle is covered with an thick crust of expensive powders. I'm not even sure how much he gets; he flings it out of his feed tub to floor of his stall. Our horses' lips are smeared with Nimble Ultra(tm) for the same reason cosmetics enjoy brisk sales -- because hope springs eternal. If we're going to buy these supplements, we should be aware that the nutraceutical industry is plagued by quality issues.

Joint supplements
The hottest of equine nutraceuticals are the joint supplements, which contain ingredients like chondroitin sulfate, hyaluronic acid, and the glucosamine. The literature on equine nutraceuticals presents some sobering facts. Yes, there is a large body of research showing the effectiveness of these ingredients in humans, rats, dogs, and cats -- but only a handful of studies on horses. While some studies that show that oral joint supplements help, others are inconclusive. My vet says that different horses seem to respond differently -- joint supplements work for some, not for others.

An unregulated industry
Veterinary nutraceuticals are not regulated by the FDA, so there are few guarantees for product quality. Research on commercial supplement content has elicited concern:

• Studies have revealed that many manufacturers of human and veterinary nutraceuticals do not meet their stated ingredient claims. In a study of products for humans, deviation from label claims ranged from 0% to more than 115%.
  
• Many products recommend sub-optimal doses of their products. While there are no standard daily doses, a minimum daily dose of most joint supplements (e.g., Glu/Chon) is 20 grams/day.
  
• Animal nutraceuticals may be contaminated by harmful components, such as heavy metals and pesticides, or by other ingredients during the manufacturing process.

Of the articles I have read, the main talking points for consumers are:

• Read the label. The Smartpak Web site has some great comparison charts.
  
• Call the company. Ask for documentation of product claims and safety (published peer-reviewed research).
  
• Look for North American supplement Council seal. This group tries to oversee the supplement industry, and companies that join must complete a rigorous audit of their facility and manufacturing practices. The NASC seal is considered a quality certification.
  
• Feed the supplement for at least 8 weeks -- the time needed to see clinical improvement for a lot of these supplements.
  

NUTRACEUTICAL ARTICLES THAT ARE ENCOURAGING The scoop on joint supplements from Equusource Upbeat article on joint supplements. Overviews the major ingredients and how they're supposed to work. Concludes there is a growing body of evidence that oral joint supplements are helpful to horses. Forsyth RK, Brigden CV, Northrop AJ. Double blind investigation of the effects of oral supplementation of combined glucosamine hydrochloride (GHCL) and chondroitin sulphate (CS) on stride characteristics of veteran horses. Equine Vet J Suppl. 2006 Aug;(36). p.622-5. Study showing improvement in gait of horses on oral GHCL. 20 horses showed improvmeent in stride length and duration, range of motion in elbow, stifle, and hind fetlock. Differences noticed at week 8 of the 12 week treatment. Harman, Joyce. Joint supplements: Should you believe the hype? Practical Horseman. Mar 2001. 29(3) pg. 106. Great illustrations and detailed discussion of nutraceuticals, their physiological effect, and the nutraceutical industry. Concludes that in the absence of conclusive studies, horse owners need to "try them out." New generation joint products from Horse Journal Reviews new products and provides anecdotal case studies to support their efficacy. Oral hyaluronan gel reduces post operative effusion in the yearling thoroughbred. Equine veterinary journal 2006, 38(4), p. 375. A study of 48 yearlings. After OCD surgery, HA reduced postoperative swelling. The scoop on joint supplements from Equusource Upbeat article on joint supplements. Overviews the major ingredients and how they're supposed to work. Concludes there is a growing body of evidence that oral joint supplements are helpful to horses. Soya-avocado nutraceutical shown to benefit equine osteoarthritis Colorado State Unversith newsletter on Equine orthopedics. Another supplement! See page 2 for an article on soya-avocado, a nutraceutical shown to benefit osteoarthritis. Rutgers University advice column on joint supplements Concise summary that helps owners answer the question "should I or shouldn't I?" Marcella, Kenneth. Exploring the supplement jungle. DVM. Jun 1999. 30(6) pg. 1E. Older article but summarizes the types of nutraceuticals and offers advice for reading labels. AAEP 2002: One joint nutraceutical's effect on hock lameness from The Horse magazine. Brief report on a study of eight horses. Signficant improvement in range of motion, tarsal joint energy, and symmetry of gait. Product used was Corta-flx. Something extra for joints. Thoroughbred Times, July 2005. Well-researched article concluding that nutraceuticals bring clear benefits to horses with joint pain. Equine Joint Nutraceuticals in November issue of Horse Journal. I'm including this one because it's current. McIlwraith, C.W. Effectively diagnosing, treating equine degenerative joint disease. DVM News. Nov. 1, 2003. This survey of treatment options includes oral supplements. Platt, David. Feed supplements that claim to improve equine joint function remain a controversial subject but there is evidence to support their use in horses. Aha! This is a librarian critical thinking skills test! Look at this article that I googled. He has lots of letters after his name, but there is no institutional affiliation or context for this oh-so-white paper. The Web address looks vaguely commercial and it turns out this is a nutraceutical manufacturer. Platt makes unsupported statements about a product and heartily endorses it. A little research reveals he's an advisor for Cortalfex, and he's probably on their payroll. I'm throwing this one out as an example of an article NOT to fall for, hook/line/sinker. ARTICLES THAT ARE SKEPTICAL White, Gary W. Using glycosaminoglycans for treating equine joint diseases. DVM. Nov 2003. p. 8 Author concludes that there is no evidence supporting the efficacy of oral supplements. Richardson, DW. An evidence-based approach to selected joint therapies in horses. Vet Clin North Am Equine Pract. 2007 Aug;23(2). p. 443-60. "Most of the claims made by nearly all purveyors of arthritis medications in such media are largely unsubstantiated." Pascoe, Elain. Joint Supplements: Buyer Beware. Practical Horseman. Oct 2006. Vol. 34, Iss. 10; pg. 18. Discusses the (lack of) federal regulation of nutraceuticals and the NASC. The kinds of studies that must be conducted to be FDA approved as too expensive to be realistic for most comapnies. Is Corta-Flx Mislabelled? A reprint from a 1999 issue of The Horse Journal Perhaps it's old news, but it is interesting to read the "buzz" about product labelling. It gives you a taste of the issues at hand. Oral Joint Supplements from The Horse magazine. "Low bioavailability of oral glucosamine chondroitin sulfate, poor product quality, label-prescribed doses that are below veterinarian-recommended levels, and a lack of scientific evidence supporting efficacy of popular oral joint supplements are major concerns." Article concludes "talk to your vet" and look for the NASC seal. Trumble, T. The Use of Nutraceuticals for Osteoarthritis in Horses. Veterinary Clinics of North America: Equine Practice, 21(3), p. 575-597. "This article attempts to define a nut5raceutical, identifies areas that need to be considered when these products are used, and describes the known scientific effects of the most common compounds contained in currently available equine nutraceuticals." Oral Joint Supplements: Do They Work? from The Horse magazine, July 2007 Outlines problems with the nutraceutical industry. Excellent skeptical article. Nutraceuticals: What are they and do they work? Kentucky Equine Research. Very science-y article, discusses chemical components and their actions on humans. Makes the point that in the absence of studies, our own horses become the experimental subjects. Oral Joint supplements: Panacea or expensive fad? Kentucky Equine Research. Discusses the problems and stresses of the equine athlete and the potential of joint supplements. Concludes that scientific evidence of their benefit is lacking, although there is anecdotal evidence. Rodgers, Martha. Effect of oral glucosamine and chondroitin sulfates supplementation on intra-articular therapy of the horse tarsus. Study of ten horses over the course of eight years. Author reports a notable drop in frequency of joint injections when oral supplement is used. Nutraceuticals: Why every pony clubber should read labels Great discussion on the implications of nutraceuticals for the horse show competitor. Links to lists of forbidden substances for various horse show organizations--USEA, USPC, and USEF.