When it comes to arthritis, a debilitating and degenerative condition, we always want to take an early and multi-modal approach to ensure the longest and best possible quality of life for our patients.
Together with weight management, environmental control, exercise and activity adaptations, therapeutic exercises, pharmaceutical management and physical rehabilitation, the use of nutraceuticals or joint supplements can be implemented from the earliest phases of the disease to help slow down the progression of OA, improve the health of the joints, and reduce the pain experienced by our patients.
When it comes to joint supplements, the biggest problem we have is choosing a supplement. We need to consider multiple factors when making this choice, including:
- What are the active ingredient/s?
- Where are they sourced?
- How bioavailable are the ingredient/s?
- Has the whole product undergone testing for safety, efficacy and bioavailability?
- Who is the company producing the product?
- Has this product undergone any third party testing, and do they have a certificate of analysis for you?
- Are they voluntarily regulated by a quality control body?
According to Dr Leilani Alvarez, we need to start holding supplements to the same standards we hold pharmaceutical products – they need to have undergone trials proving safety, efficacy and bioavailability in the species that we are using them in.
With the incredible number of supplements available and their widely varying prices, choosing supplements to stock in your clinic or to recommend to clients can be very challenging. In most of the world, supplements are not regulated by a control body, and so manufacturers are not held accountable for whether or not their products back up their claims.
The best course of action for pet owners is to consult their veterinarian or rehab therapist about the best supplements to use. These professionals have already done the homework on which companies and brands are reputable, and which supplements meet the required standards. They have also been able to assess the effects of these supplements in patient after patient over time.
As a vet or veterinary rehab therapist, therefore, you do need to take the time to research the specific brands and products that are available in your area. Try to answer each of the above questions for each of the products, and choose three products in three different price ranges that you can dive into deeper and discuss at length with your clients.
Where to start
Start with the ingredients. A vast array of ingredients are used in joint supplements, and we need to know the scientific backing, or lack of it, for each ingredient. We also need to know whether the ingredients are safe to use, particularly in combination with various medications.
The source of the ingredients is also important – a sustainable and environmentally friendly product source is important to the sustainability of the product as well as our planet.
The next step
Now shift your attention to the company manufacturing the product. How long have they been in business? Dr Leilani Alvarez recommends using a company that has been around for longer than ten years. This will ensure that the manufacturing process is well established, and that the company is probably financially stable – which puts them in a position to run quality control measures and enforce them. These measures could include product recalls, for example.
Third party laboratory verification of product quality and safety is the next step in ensuring that the company you are choosing is adhering to a high standard of quality. The third-party laboratories you have available will depend on where you are in the world.
Making claims and statements is easy, as we learn in The Marketing Rebellion by Mark Schaefer, and making hefty claims about the ability of a product is what led to the ‘first marketing rebellion’. Unfortunately, huge and sometimes unsupported claims are still made, just not as blatantly as in the past.
Choose a product that has undergone high quality in-vitro and in-vivo testing in randomised controlled clinical trials in the specific species that you are treating. This will give you a good idea of how effective the product is, and whether or not the product is safe to use in your patient.
Choosing your ingredients
The list of ingredients available that claim to positively influence joint health is long, but there are a few that are more commonly used than others. In her lecture, ‘How To Choose Joint Supplements’, Dr Leilani Alvarez discusses the following ingredients, amongst others:
Glucosamine and Chondroitin. Although these are the most commonly used ingredients in joint diets and supplements, there is a surprising lack of good quality scientific evidence for their efficacy in improving function, mobility and activity in patients with OA. Additionally, both glucosamine and chondroitin have a poor bioavailability, being 12% and 5% bioavailable respectively. They have, however, been shown to be safe to use in dogs.
Omega 3 fatty acids. EPA and DHA have good evidence for their effective use for OA in canines, playing a role in reducing and mediating inflammation and improving joint health. The source of EPA and DHA is important to consider, with fish oil having the highest concentrations.
Green Lipped Mussel. This is a naturally rich source of glucosamine, chondroitin and omega 3 fatty acids. There is good evidence that supports its use in canines to improve peak vertical force, pain scores and mobility.
Curcumin. An extract from turmeric, curcumin has been used in humans for many generations to treat joint disease, and shows very good anti-inflammatory and anti-neoplastic properties. It has, however, a very low bioavailability in canines, at below 1%.
Boswellia Serrata. More commonly known as Indian frankincense, boswellia serrata has also been used for many generations to support joint health in people. Research in canines has yielded positive outcomes in lameness, improved peak vertical force and daily activity.
Egg Shell Membrane. This was a surprising new one for me, and so I have dissected a research paper on it in this month’s Research Refresh. But for the moment, it is enough to say that the membrane on the inside of the eggshell is a source of elastin, collagen and glycosaminoglycans, and has shown evidence of improving mobility and activity levels in dogs with OA.
Make your list of products
Be sure to watch the webinar by Leilani as she dives deeply into each of these ingredients and the research available on them, and then make your own list of products. Do the research on the manufacturers, ask the hard questions, and prepare yourself to recommend high quality, effective, and safe products to your patients.
Please share your brand and product choices with us in the comments!