Nutraceuticals: Do they Really Work?

and Complementary Cancer Treatments

Josh Sosnow, DVM North Scottsdale Animal Hospital www.nsvet.com

Who Am I?
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Native of Arizona Attended Veterinary School at Oregon State University Completed internship at The Animal Medical Center in NYC Practiced Veterinary Medicine in Scarsdale, NY and NYC prior to moving to Arizona Practiced in N. Scottsdale prior to purchasing NSAH

North Scottsdale Animal Hospital

Mission Statement: We strive to provide the highest level of veterinary care using the latest advancements in veterinary medicine to enhance the bond between pet and owner.

My practice philosophy
We treat each patient as an individual . The contact between the doctor and client is paramount. Always try to be accessible for calls, questions and consultations If you always do right by the patient you can never do wrong

Tonights Topics
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Terminology Questions you must always ask Words of Caution Glucosamine/Chondroitin Products Coenzyme Q Milk Thistle Omega-3 Essential Fatty Acids L-Carnitine Traditional Chinese Medicine Complementary Cancer Treatment

Terminology
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Nutraceutical: Proven Treatment (Western Tradition)

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Evidence-based treatment, subject to peer-review, follows the scientific method Investigational study evaluating a drug, supplement or treatment according to scientific method. Not yet approved by FDA or considered mainstream. Usually not validated with scientific trials, based on subjective assessments, may complement mainstream treatments Treatment or drugs that claim to diagnose, cure or prevent disease and are known to be ineffective www.quackwatch.com

Research/Experimental Treatment
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Alternative Treatment
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Quackery
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Questions you must always ask

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Has the product or treatment been critically evaluated in clinical studies? If so, what type? Are there published and validated doses or treatment plans in peer-reviewed journals? Is the product or treatment in widespread use? Are there any current clinical trials in progress? Can the product or treatment be used with more conventional therapies? What are the side effects or risks? Is the product orally absorbed and utilized?

Words of Caution
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Be wary of the words always, never, better or 100%. Most alternative treatments and nutraceuticals, herbs, etc. in veterinary have not been validated. Always ask your vet for legitimate info on a product prior to its use For more info:
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www.quackwatch.com www.nccam.nih.gov Nat. Cen.for Comp. and Alt. Med www.ncbi.nlm.nih.gov Pubmed

Glucosamine/Chondroitin
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Cartilage building blocks Synthesized naturally by the body, but with time and age the bodys production may diminish Commonly available in a variety of forms, little to no guidelines for product standardization

Glucosamine/Chondroitin (continued)
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Proposed Mechanisms of action: " Increased synthesis of new cartilage " Reduction of inflammation " Inhibit destructive enzymes Feline Idiopathic Cystitis " Not validated for male cats with inflammation of the lower urinary tract Availability of controlled studies in veterinary medicine is poor, recent large scale study published in the New England Journal of Medicine suggests that it may provide analgesia in patients with moderate--severe arthritis.

Glucosamine/Chondroition (continued)
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Dose:
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Empirical-has not been standardized for dogs or cats Dosing regimen is traditionally divided into induction and maintenance phases Time to onset of positive effect, 4-8 weeks Type/Brand not shown to affect response My choice? Side Effects: Diarrhea, vomiting, loose stool, excessively high doses can could cause blood clotting abnormalities, manganeese toxicity No known drug interactions

Glucosamine/Chondroitin (continued)
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Glucosamine Analogues
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Glycosaminoglycan polysulfate ester (Adequan)

May inhibit destructive enzymes in joint and production of prostaglandins associated with DJD, may also stimulate new cartilage production Short term studies have had mixed results, long-term benefit unknown My experience?

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Sodium Hyaluronate (Legend)

Intraarticular injection that may decrease inflammation in joint tissues, promote joint healing

Coenzyme Q (CoQ10)
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Compound found within cells, plays an important role in producing energy Deficit may lead to heart disease May act as a free-radical scavenger, protect against blood clots in heart No clinical studies in vet medicine, poor evidence on human side

Milk Thistle (Silybin)

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Used to treat liver disease Acts as a anti-oxidant, may also modulate inflammation within the liver, reduce likelihood of long-term damage No studies in veterinary medicine Effective dose unknown

Omega 3 Fatty Acids

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Plants and animals normally make fatty acids Fatty acids are the starting point for the production of a variety of hormones and structural components in the body Typical sources of fatty acids, fish, marine plants, and vegetable oils Omega-3 vs. Omega-6 EPA-eicosapentaenoic acid DHA-docosahexanoic acid

Omega-3 Fatty Acids (continued)

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Ingestion of high levels of Omega-3s reduces the production of inflammatory chemicals in the body Commonly used in veterinary medicine to treat allergic skin disease, arthritis, kidney disease, cancer and heart disease Atopy (allergies)
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May have direct antiinflammatory role, or inhibit production of inflammatory compounds w/out secondary infections, omega-3s can be used as sole treatment or in combination

Omega 3 Fatty Acids (continued)

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Arthritis
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Several studies demonstrate efficacy Increased ROM, decreased pain, reduction in use of drugs May be used as supplement or fed in specially formulated diet

Omega-3 Fatty Acids (continued)

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Cancer
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Reduces side effects from chemo and radiation therapy Improves survival time in patients treated w/ chemo, improves quality of life Helps minimize metabolic changes associated with cancer May have direct anti-tumor effects May improve muscle wasting that typically occurs with heart failure

Heart Disease
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Omega-3 Fatty Acids (continued)

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How to use Omega-3 Fatty Acids?

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Initial dose of 50-250 mg/kg per day Which fatty acids are most effective? What absolute amount is necessary in animals with disease? What trace nutrients may be necessary to assist omega-3 fatty acids? Soft feces, diarrhea, flatulence, vomiting and fishy breath most common; cats may develop bleeding problems with high doses, unlikely in dogs

Unanswered questions
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Side Effects
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L-Carnitine
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L- carnitine is an amino acid synthesized in the body Helps move fatty acids into mitochondria for cellular energy production Used to treat patients with dilated cardiomyopathy, will improve heart function and possibly survival; Boxers, Cocker Spaniels, Dobermans Difficult to accurately assess whether patient has a deficiency, unknown as to whether patients without a deficiency will benefit Dose: 1-6 grams daily (variable)

L-Carnitine (continued)
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Cats
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Used to enhance fat metabolism in cats with hepatic lipidosis Also as an additive to weight loss diets in dogs and cats

May also reduce cardiac damage from chemotherapeutic agents (i.e. doxorubicin) Expensive

Traditional Chinese Medicine for Cancer Treatment

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The goals of traditional medicine are: " Induce or aid induction of remission " Meet or exceed survivals obtained by conventional treatment, but with reduced expense, invasiveness, and toxicity. " Improve quality of life and prolong survival " Reduce side effects associated with conventional treatments. " Enhance efficacy of conventional treatments. Cancer is thought, to arise by one of two principle pathways: " Pathological accumulations The digestive tract was the site of accumulation of toxins, treatment is aimed at improving digestion Traditional therapies have demonstrated efficacy in treating liver disease Examples of tumors with this presentation include: Squamous cell carcinoma Malignant melanoma Osteosarcoma Fibrosarcoma " Obstructed blood circulation or blood stasis Examples of tumors with this presentation include: " Mast Cell tumors, Hemangiosarcoma, Thyroid Adenocarcinoma

Traditional Chinese Medicine (continued)

Key Drug
Vitamin D (given in combination with vitamin A) Ginger Hoxsey Formula Xue Fu Zhu Yu Tang

Indications
Inhibit metastasis, angiogenesis, and tumor growth Enhance vitamin A activity by up-regulating vitamin A receptors Induce differentiation Reduce vomiting associated with conventional treatments Cytotoxic and immune stimulating activity; induce cell differentiation Blood stasis tumors above the diaphragm; cutaneous mast cell tumors; thyroid adenocarcinoma; external hemangiosarcoma Blood stasis tumors of the lower abdomen; prostatic adenocarcinoma; transitional cell carcinoma; consider for abdominal hemangiosarcoma Bleeding tumors; abdominal hemangiosarcoma Thyroid adenocarcinoma

Shao Fu Zhu Yu Yunnan Bai Yao Xiao Chai Hu Tang

Complementary Cancer Treatment

Cancer patients have a greater need for protein due to their altered metabolism " Arginine (amino acid) improve quality of life along with administration of fatty acids - mechanism is unknown

Complementary Cancer Treatment (continued)

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High levels may:

Increase survival time Reduces pain associated with radiation therapy Suppresses the clinical signs of cancer for longer periods Help counteract the metabolic changes caused by cancer Supplementation with omega-3 EFAs and Arginine must be at levels many times that found in fish oil capsules.

Complementary Cancer Treatment (continued)

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Other Nutraceuticals of Interest:

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Antioxidant Vitamins: +/Glutamine (amino acid): + Garlic: Green Tea/Green Tea Extracts: +/-

Acupuncture: +/-

Next Lecture:
Wednesday, October 18, 2006 Time: 7pm Location: McDowell Center (HERE) Topic: "Cats and their Kidneys: What we REALLY know and how to diagnose and treat Kidney Disease?" and What is the "Canine Flu"?