Supplements for Small Animal Cancer Patients | Today&039s Veterinary Practice

in human medicine, a recent review reported that in the united states, 52% of healthy adults use herbs and dietary supplements (hds). 68% of physicians were unaware of supplement use by their cancer patients.2,3

In veterinary medicine, HDs are also used for cancer patients. one study reported that among 254 pet owners with cancer, 65% gave the pet some type of complementary medicine, most commonly dietary supplements, and 57% did not discuss the use of supplements or other complementary medicines with their veterinarian. the reasons for providing complementary therapy and hd were to improve your pet’s well-being and immune function and to reduce pain; only 9% reported seeking complementary therapies to cure their pet’s cancer.4 A survey of 213 healthy dog ​​owners and 132 owners of dogs with cancer found that supplement use was more common among owners of cancer patients. 5 the most used were cannabidiol products, mushroom extracts or turmeric/curcumin.

Reading: Supplements for dogs with cancer

This article completes a two-part series covering nutrition issues for small animal cancer patients. For information that specifically addresses dietary considerations for cancer patients, see the January/February issue or visit Small Animal Cancer Nutrition for Patients.

For human health professionals, a list of the top supplements that are considered relatively safe and have the “best suggestion of benefit” has been published.1 before veterinarians recommend hds for cancer patients , they must understand the products’ mode of action or specific benefits. some hd can increase or decrease the effects of cancer treatment and others can mitigate the side effects of treatment. Some HDs can be used to help manage other co-occurring disease processes and/or support the patient’s overall well-being and quality of life. the use of all treatments, including hd, must be evidence-based, which means considering the client’s values ​​(ie, perspectives and needs). hds can be safely integrated into the care and management of cancer patients with the concept of primum non nocere (first do no harm), perhaps providing some benefits while respecting client values.

Given the wide range of pet supplements available on the market today (Table 1), selecting and recommending safe supplements can be challenging. The following 3 criteria can be used as guidelines to identify safe and appropriate HDs for cancer patients: Supplements are made by manufacturers you have reason to trust, Safety and effectiveness are supported by research, and Supplements are carried by the national animal supplements council (nasc) seal of quality. The NASC Seal indicates that the manufacturing company has passed an independent facility audit every 2 years and demonstrates continued compliance by implementing quality control standards, reporting adverse events, adhering to all labeling guidelines, and randomly testing products.

The authors describe common HDs that, in their clinical experience, are relatively safe and may be beneficial for pets. Products to consider for veterinary cancer patients include mushroom extracts, turmeric/curcumin, milk thistle, probiotics, fish oils, and hemp/cannabinoids.

mushroom extracts

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Mushroom extracts contain β-d-glucans, which are high molecular weight bioactive polysaccharides. These branched-chain polysaccharide complexes promote immunomodulatory activity by activating macrophages, monocytes, natural killer cells, dendritic cells, and lymphocytes. They have been shown to have antitumor effects in melanoma and cancer of the lung, breast, cervix, and prostate. one of the most studied fungi is the turkey tail fungus (coriolus versicolor); its extracts, such as polysaccharide k (psk) and polysaccharopeptide (psp), are used to treat human cancer patients. Numerous peer-reviewed publications on its antitumor effects describe in vitro and in vivo animal studies, as well as human-to-human cancer clinical trials with gastrointestinal, breast, and lung cancer.7,8 In a small, multiple-dose pilot study, 15 dogs with splenic hemangiosarcoma receiving i’m-yunity (hyy, hyy.com.hk) at 100 mg/kg/day experienced a significant delay in the mean time to development or progression of abdominal metastases.9 a randomized controlled clinical trial A large study comparing this turkey tail extract with doxorubicin in dogs with splenic hemangiosarcoma was completed in the spring of 2019 but has not yet been published. d, and yunnan baiyao.11

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the use of maitake mushrooms (grifola frondosa) as a standardized formulation, maitake petfraction (mushroom wisdom inc., mushroom wisdom.com), was evaluated in 15 dogs with intermediate- and high-grade lymphoma .12 Although the supplement was well tolerated with no ill effects, greater than 50% reduction in lymph node size was not reported. given at the same time as chemotherapy in dogs with various types of cancer showed a reduction in the common side effect of neutropenia while maintaining quality of life.13

These studies in dogs with cancer, many other animal studies, and human trials indicate that the use of mushroom extracts should be considered relatively safe and may have some benefits for the veterinary cancer patient.

turmeric/curcumin

Curcumin (diferuloylmethane) is an active component of the spice turmeric (curcuma longa). it influences many cell signaling pathways involved in tumor initiation and proliferation.14 studies also demonstrate the anti-inflammatory effects of curcumin as an inhibitor of cyclooxygenase 2 (cox-2). turmeric and curcumin are non-toxic and have been shown to be safe for oral use in humans and animals;15 curcumin is designated as a substance gras (generally recognized as safe) for humans. Gras is an American Food and Drug Administration (FDA) designation that a substance added to food is considered safe by experts and therefore exempt from the law’s usual food additive tolerance requirements. federal food, drug and cosmetics oral administration of turmeric and curcumin is well tolerated; the only reported concern is gastrointestinal upset in some humans and animals when given in extremely high doses.15,16

Turmeric is a common ingredient in many pet joint supplements, which may benefit dogs with concomitant cancer and osteoarthritis.

milk thistle (silybum marianum)

Silybins are among the active ingredients in the herb milk thistle. silybin a and b are ingredients in denamarin hepatoprotective pet supplement (nutramax labs, nutramaxlabs.com). A study of 50 dogs with cancer showed denamarin to have protective effects on CCNU (lomustine)-induced hepatotoxicity; alanine aminotransferase (alt) levels were increased by 84% in dogs given ccnu alone compared to only 68% in dogs given ccnu plus denamarin.17,18 Other studies have found that this very safe herb also has beneficial properties. renal protectors.19,20

Because many chemotherapeutics negatively affect liver and kidney function, a milk thistle supplement may benefit veterinary cancer patients receiving chemotherapy. furthermore, these patients may already have concurrent liver or kidney disease, making milk thistle supplementation a logical recommendation.

probiotics

The World Health Organization defines probiotics as “live microorganisms that, when administered in adequate amounts, confer a health benefit to the host.” and modulate the host immune response.22-24 Studies of probiotic use in dogs and cats have focused primarily on gastrointestinal disease, but human studies have found probiotics to have positive effects in cancer patients receiving treatments.25,26

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Because many veterinary cancer patients experience gastrointestinal dysfunction primarily or secondary to their cancer and/or cancer treatment, the use of probiotics for these patients seems logical.

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fish oils

Fish oils are a potent source of omega-3 (n-3) fatty acids or n-3 polyunsaturated fatty acids, especially eicosapentaenoic acid (epa) and docosahexaenoic acid (dha). for inflammatory states resulting from various diseases in dogs, epa plus dha has been recommended in a dose range of 50 to 150 mg/kg/day.27 a clinical trial comparing the effects of n-3 fatty acids with oil of soy in 32 dogs receiving doxorubicin for stage III lymphoma found that dogs receiving n-3 fatty acids had higher dha levels, longer disease-free intervals, and longer survival times.28 other studies of n-3 fatty acids 3 in dog, human, and rodent cancer models have shown similar benefits and/or reduction of detrimental inflammation associated with cancer and/or anticancer treatments.29-31

Recommending n-3 supplementation due to its anti-inflammatory properties for the canine cancer patient is safe and appropriate. note, however, that doses of n-3 supplements may need to be modified for patients who cannot tolerate higher levels of dietary fat (eg, those with pancreatitis, hyperlipidemia, or enteropathy with concurrent protein loss).

hemp/cannabinoid products

The use of cannabis products to reduce pain and improve quality of life in veterinary cancer patients is gaining interest. Cannabis refers to the plant cannabis sativa, of which there are thousands of varieties with different types and amounts of cannabinoids and other constituents (eg, terpenes). The 2 main cannabinoids in the cannabis plant are cannabidiol (CBD) and ∆-9-tetrahydrocannabinol (THC). hemp and marijuana are legal terms that refer to varieties of cannabis plants with very different compositions of thc. hemp refers to cannabis plant varieties with very low levels of thc (less than 0.3% dry weight), while marijuana refers to cannabis plant varieties with higher levels of thc (more than 0 ,3 %). thc is the active ingredient associated with the intoxicating effect (“high”) of marijuana. The active principles of c sativa have therapeutic efficacy in pain control in humans and animals, although studies in veterinary patients are limited.32

the fda recognizes the public interest in hemp/cannabinoid products and has an internal cbd working group committed to making evidence-based decisions and ensuring the health and safety of humans and animals (including pets). The FDA currently states that cannabis and cannabis derivatives, such as CBD, cannot be added to food or dietary supplements. The FDA’s position that cannabis and cannabis derivatives are not approved or appropriate for use in food/feed is recognized and supported by state regulators, the Association of Animal Feed Control Officials and the nasc because pet supplements do not have a clear regulatory definition, the nasc allows companies to use cannabis and/or cbd or hemp in pet supplement products that are not food/feed and are used for non-nutritional purposes, provided that The company acts responsibly. Due to complex and changing regulatory oversight, veterinarians should contact and follow their own state board’s regulations regarding hemp/cannabinoid supplements for pets and at the very least make sure which hemp/cannabis products have FDA approval. the nasc

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a 2018 study of the use of a cbd oil product in 16 dogs with osteoarthritis reported improved pain scores and increased comfort and activity in the home environment. Pharmacokinetic evaluation in the same study suggested that CBD at 2 mg/kg q12h may help increase comfort and activity in dogs with osteoarthritis.33 A single-dose pharmacokinetic study in conjunction with a 12-week dose of 2 mg /kg po q12h in dogs and cats reported no changes in physical examination findings, minimal changes in blood test parameters (one feline patient had a persistent increase in alt), and some cats licked and shook their heads.34 other study tested 29 pet supplements that use c sativa extracts in their production of cbd, thc and other cannabinoids; All products were found to contain less than the federal (FDA) limit of 0.3% THC and varying amounts of CBD (0 to 88 mg/mL or mg/g). of these 29 supplements were properly labeled.35

Veterinarians wishing to recommend cbd-rich c sativa products should be aware of the range of cbd concentrations in these products. obtaining a certificate of analysis from the manufacturer is also recommended to determine proper use and dosage for pets.35

summary

Veterinarians face multiple questions and challenges from clients whose pets have cancer. Veterinarians must rely on scientific evidence but cannot ignore the client’s perspective. Human cancer patients reportedly use nutrition, supplements, and natural products to empower themselves, attempt to take control of their health, and improve quality of life. Given the humanization of pets today, it makes sense to respect these same emotions of clients dealing with cancer in their pet. clients are often highly motivated to participate in the health care of their pet with cancer and often seek nutritional and supplement recommendations to maintain quality of life and improve outcomes. The veterinarian and healthcare team are expected to be familiar with safe and appropriate HDs and to address their use. Discussing the complementary role of HDs with clients provides an opportunity for the veterinarian to strengthen the bond between the veterinary care team, the client, and the patient. Veterinarians should feel comfortable recommending HDS products that are first and foremost safe but also appropriate for the cancer patient. In the authors’ clinical experience, clients appreciate veterinary guidance and the logical integration of appropriate HDS supplementation with conventional therapies.

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