Elizabeth Warren: Introduction to Nutraceuticals is our topic tonight. We will cover definitions of supplement, drug, food, etc and the "controversy" of nutraceuticals, then some specific nutraceutical supplements.
There is no *legal* definition of nutraceutical. It is a marketing term developed for a nutritional supplement that is being sold with the intent to treat or prevent disease.
A supplement is a product known to provide an essential nutrient (one that is required in the diet) and is sold for use in preventing deficiencies and problems related to deficiency.
A food is a substance eaten or drunk that provides taste, aroma, or nutritive value.
A drug is a substance that is used to treat, cure, mitigate, or prevent a disease and/or is intended to affect the structure of the body

So, is a nutraceutical a food or a drug?

Lori: I would think drug, but the FDA doesn't have any ruling over them, right?

Elizabeth Warren: Exactly the conflict, manufacturers of nutraceuticals tout the supplement/food angle, pharmacologists and the FDA are looking at the drug angle. Bottom line is that nutraceuticals appear to be "not quite" drugs.
For example, you hear the argument that glucosamine is a food, not a drug and the argument that the herb digitalis is a drug, not a food; both probably correct.

Lori: Some of the nutraceuticals have been FDA approved, haven't they?

Elizabeth Warren: Only if they are being marketed as drugs with intended use to treat or ameliorate disease. Which ones are you thinking about?

Lori: I was thinking Denosyl SD4 and Cosequin

Elizabeth Warren: I'm not sure either of those are FDA approved--maybe Denosyl is...and it is marketed for treatment of hepatopathy
So there you have it. On the one hand, people say these things don't need to be regulated because they have unreliable benefits (work for some, not for others) and that they are as "safe" as foods. Foods are generally regarded as safe by the government.
OTOH, there are clearly foods and herbs etc that can be toxic and even deadly so, do they need regulation or not?

Lori: Regulation is important, IMO, just for the mere fact that most people don't know how herbals, etc, interact.

Elizabeth Warren: On the pro side of regulation, you get safety and efficacy assurances. On the con side, you find that many smaller companies cannot afford to put their products through new drug testing so they would never get to the market

So why is or why isn't regulation important? Is it because clients need to know how to use nutraceuticals and in what combinations?

Lori: exactly...
Mike: right

Elizabeth Warren: Also to have some assurance of product safety in the animals they are being given to and product purity, so we know what's "really" in there. The market for nutritional products is growing in huge proportions. I use them. Almost everyone I know gives their dog, cat, or bird one or more supplements or other nutraceutical product

Lori: it's amazing how many people come in for boarding with Fluffy's Joint-a-Lube or whatever
Mike: that's true

Elizabeth Warren: Have we had any problems in vet med with people using the nutraceuticals ignorantly? Have you seen any problems? I've seen a few toxicity cases with pets ingesting the owner's nutritional products, but not with products made for pets. I bet it happens too, but HOW WOULD WE KNOW, since we don't know much about them ourselves

Lori: not IME, but I'm sure it happens.... We have a great Complementary Medicine book, with lot's o' info in it.... If it would all just seep into my brain by osmosis, life would be good.

Elizabeth Warren: So, given that some type of regulation would be helpful, if not necessary, and given that it's not likely to happen anytime soon due to economic pressures, I think the best thing we all can do is to have an herbal/alternative formulary available in the hospital for reference.

Mike: yea that would be a good idea. Are there any products which you know to be problem causing?
Lori: I would think that herbal estrogens could be of potential problem, as well as those stupid herbal diet pills
Mike: lol

Elizabeth Warren: So we can tell clients WHAT they are getting, HOW MUCH they should be giving, the EFFECTS they could see, possible INTERACTIONS, etc

Lori: Do you have a name of such a reference?

Elizabeth Warren: I believe it's actually called the PDR of alternative medicines and herbals, something like that, its format is very similar to PDR

Lori: really! Cool.... need to look into getting one of those wish they'd combine them
Mike: o cool have to look for it

Elizabeth Warren: Lori, then you get into what is a "medicine" and all that argument!

Lori: LOL

Elizabeth Warren: So let's talk a little about what nutraceuticals are out there, in common use for pets. It's hard to draw the line between an herbal "medicine" and a nutritional product, but I'll stick with basics.

Antioxidants are probably one of the most commonly used and with the new b/d diet coming out, we'd all better know something about them.
Lori: free radical nabbers, aren't they?
Elizabeth Warren: Essentially, aging and disease processes cause the build-up of free radicals.
What do the free radicals do? They cause oxidative damage (trauma) to cells--beat them up--so antioxidants neutralize them. Vitamins E and C are the "big" antioxidants, but there are dozens

Lori: Can we tangent to b/d for a second? I haven't gotten the "low down" on the diet...what does it have that a good vitamin wouldn't?
Elizabeth Warren: Well, it's a "whole" food, so it meets all the requirements and has a little extras in the following areas:
1. Antioxidants to protect cells from free radical damage
2. Fatty acids to support cell membranes
3. L-carnitine to feed the mitochondria inside the cells
4. Bioflavinoids, which are also free radical neutralizers
So b/d is essentially a "brain" supplement! I have no idea if this new food is just a bunch of hype

Lori: don't Eukanuba foods already have all of those in it? (except bioflavinoids, not sure on those...)
Elizabeth Warren: the b/d formula is "patent pending," so I guess Eukanuba isn't exactly the same
Lori: If it's a food with those four extras, you can get those in a good vitamin supplement, and not have to deal with food issues at all
Elizabeth Warren: But in "ideal" proportions?
Lori: what's ideal? Who set that standard?
Elizabeth Warren: just being devil's advocate, I have no idea!
Lori: Does the food have glucosamine in it?
Elizabeth Warren: haven't looked, but I assume yes. It would be kind of stupid not to, eh? I just go with the flow on these products. Some of them seem to work and some clients swear by them, so how do you argue with that?
Lori: Well, I certainly swear by glucosamine products... I send it home with ALL of our orthopedic cases
Elizabeth Warren: see, they've never worked for my dogs; go figure!
Lori: really? What did you use?
Elizabeth Warren: several brands, but I maybe wasn't diligent enough. I would try Adequan; it's on my list of things to do.
Lori: got to be diligent *G*. We used Adequan in the beginning, but it seems price prohibitive for the results we were seeing and with the positive results we've seen with glucosamine. Along with the advent of Etogesic we haven't used Adequan in eons. Elizabeth Warren: I love Adequan!

Elizabeth Warren: Anyway, some other nutraceuticals: Garlic is a favorite and its one that is definitely a food and not a drug, would you agree? It does NOT work for flea control! There is some evidence that it does support the immune system

Lori: yeah.... people will use it for EVERYTHING!
Elizabeth Warren: of course, it may not do anything either... but people like it for lots of things
Lori: makes the dog's food taste good though! We recommend garlic powder to enhance food for the old farts that aren't eating well
Elizabeth Warren: Right, it might also be somewhat of an antioxidant

Elizabeth Warren: Ginger is another food product used as a mental stimulant and also to combat nausea. I've heard of people feeding ginger snap cookies to car sick dogs
Lori: really? That's interesting. Sounds like a good way to have ginger snap puke, though. Would it work with cats, do you think? Elizabeth Warren: worth a try, I guess.

Elizabeth Warren: Ginseng is supposed to increase blood flow to the brain; why that's a selling point for animals I don't know.

EFAs or essential fatty acids are required nutrients in the diet that are important in cell health, immune function other things like skin and coat health, etc. Most important are the omega 6 commonly found in fish oils, flax seed oil, etc.

Co -enzyme q-10 was big for a while. It feeds the mitochondria in heart cells and was thought to be a good adjunct to cardiac meds

Lori: what about MSM?
Elizabeth Warren: a derivative of DMSO, it's an anti-inflammatory and antioxidant. Had any luck with it?
Lori: have only used in on one dog... they lady wasn't having much luck with glucosamine... and her horse racing friends swore by MSM... so we just started her on a supplement with it in it. I don't know if it's helping yet or not

Elizabeth Warren: Glucosamine--glycosaminoglycans in general--help to rebuild joint tissue and fluid and delay further degeneration. Most vets agree that a formulation containing glucosamine and chondroitin (shark cartilage) is helpful for some arthritis cases

Milk thistle and SAMe (Denosyl) both are supposed to help an ailing liver to perform its detoxification processes and so ameliorate hepatopathy related toxicity.

Lori: we've had excellent luck with SAMe... just wish it wasn't so pricey for big dogs

Lori: Any suggestions on marketing nutraceuticals? In clinic, that is. I hung a sign, figuring people that wanted them would ask... but nothing so far
Elizabeth Warren: That's tough. I don't believe in using them just to *increase* health, but if animals have specific conditions such as arthritis, liver disease, senility, etc. I would tell clients about specific products.
Multivitamins are completely unnecessary, IMHO. A good diet is best.
Lori: I agree totally! Although I know we have clients that use them on themselves and pets... My thought was people that were interested in a natural product would let me know; then I would review the chart and recommend the appropriate product Elizabeth Warren: exactly

Participants: Lori, Mike