joint supplements

[Doc-t]

@Katlovan – Thanks for this question. I too have questions about oral supplementation so I listened to a Platinum Performance (PP) podcast on this subject just 2 days ago. Funny how that happens.

While it was a product sponsored podcast, the information was really good in describing what a joint is and how they work. The vet being interviewed is employed by PP.

They discussed joint fluid and the joint cartilage in a clear way. These two absorb the concussion transmitted throughout the joints of the body by compression and expansion. Keeping the joint cartilage “hydrated” requires sulfur being incorporated into a very long chain sugar molecule called polysulfonated glycosaminoglycans. p-GAG for short. This is Adequan which works so well by injection.

The oral supplements including MSM (methylsulfonylmethane) and chondroitin sulfate have the sulfur needed to do this “polysulfonating.” In essence you are adding sulfur to the diet. Glucosamine is a sugar and an amino acid combined. Let me quote wikipedia:

“Glucosamine is one of the most abundant monosaccharides.[1] Produced commercially by the hydrolysis of shellfish exoskeletons or, less commonly, by fermentation of a grain such as corn or wheat, glucosamine has many names depending on country.[2]

Although a common dietary supplement, there is little evidence that it is effective for relief of arthritis or pain, and is not an approved prescription drug.[3][4][5]”

Wikipedia can have a bias and we should all read their material with some thought. With this in mind, they go on to say this:

“As is common with heavily promoted dietary supplements, the claimed benefits of glucosamine are based principally on clinical and laboratory studies. Clinical studies on glucosamine efficacy are divided, with some reporting relief from arthritic pain and stiffness, while others report no benefit above placebo.[3][10][9][11]

As of 2015, there is no evidence that consumption of glucosamine by sport participants prevents or limits joint damage after injury.[12][13] In a randomized placebo-controlled trial, glucosamine supplementation had no additional effect on any rehabilitation outcome when given to athletes after anterior cruciate ligament (ACL) reconstruction.[14]”

Here are some thoughts I have on oral joint supplementation:

1) There is little proof that what is on a supplement label is actually in the container. PP addressed this in their podcast assuring all listeners that their product is analyzed and guaranteed.

2) Marketing is convincing. They say that their product is backed by independent research. However, I remain skeptical of all research especially of nutrition and supplement research. This skepticism is being backed up by researchers who investigate this research.

3) The body is capable of manufacturing all it needs assuming the ingredients are available. Every animal on the planet with joints have these materials obtained from what they eat with no supplement required. Osteoarthritis is not an age related issue but is really a diet issue.

4) The PP podcast as well as the podcast from AAEP on soft tissue injury both state that inflammation is behind the breakdown of connective tissue. This is ALL inflammation including cytokines produced by bad food in the gut and overfilled fat cells (obesity).

5) The placebo effect is strong. If you really want to address a perceived joint issue you should have a) an independent and blinded observer or b) an unlabeled container with a look alike supplement where you don’t know if it is the real supplement or a placebo.

Your horse may have nothing really wrong. Toe wear could come from damage to the joints as your farrier suggests but it could also just be a sign that he is altering the hind limb gait because he feels better from the year long SBM healing front hoof laminitis, the year long removal of gut inflammation or both. You didn’t mention any lameness, asymmetry in gait, stumbling or inability to move. All you said was that he “seems happy.” How then would you determine if the joint supplement was working or if the abnormal toe wear was from a joint issue? I am assuming that the toe wear is on both hind feet. Arthritis is usually asymmetrical accompanied by a shortened stride and a reluctance to flex while being trimmed.

I would try 2 things before I invested in an oral joint supplement. The first are flexion tests. You may have already done this inadvertently by observing him while the farrier is underneath him. Is he comfortable with the hind limbs flexed? The second would be a course of injectable Adequan plus a dose of Legend. However these injections will affect all joints and there is a good chance that he will feel better with them. But if he does improve with the injectables then you can let him return to a “normal” state and then add the oral joint supplements and look for an improvement from them. This would allow for a better understanding if you are using your money wisely in adding oral joint supplements.

It is clear that I do not believe in oral joint supplements but rather in the elimination of as much inflammation as possible plus providing the needed ingredients in the diet (SBM has the sulfur in the amino acids). This gets to the underlying issue. Many people have experienced resolution of their joint stiffness once they change their diet and remove grains and other carbohydrates.

I would like to hear from others about their experience with oral joint supplements as well as hear what you do and the experience you have if you do supplement. My point of view is to help horses survive in a human world but it is also to help horse owners survive too!

[LisaE]

@doc-t do you see a significant difference in horses on Adequan? A couple decades ago we did Adequan on my eventing mare at our vet’s recommendation as a preventative. It was given in a different course back then. I’ve considered it for the mare I have now, as she fills and has general stiffness in many places. My vet just recommended putting her on Equioxx as a broad blanket and we didn’t revisit the Adequan. He’s 100% anti oral supplements as well. I’ve read conflicting information about Adequan and am also skeptical of studies. Some say it’s a waste of money, can’t possibly work in the manner it’s claimed, and placebo is responsible for supposed successes. It’s an awfully expensive experiment to try, but if it could do actual help and possibly replace Equioxx (which I think is probably bad, but is perhaps doing slightly more good than damage) then it would be worth a try.

[Doc-t]

Adequan is a very useful medication to help repair damaged cartilage. Equioxx is a NSAID (non-steroidal anti-inflammatory drug) that reduces pain along the prostaglandin pathway. Therefore these 2 medications are not comparable.

There is no disadvantage to Adequan (other than cost) but when used for the correct condition, it is worth the price. There is no conflict in my mind with Adequan. But using it for generalized stiffness and limb edema (“filling”) is probably not warranted. This said, it is worth trying. Usually one dose will show relief if there is going to be relief but continuing the full course is also beneficial.

Equioxx should help with the stiffness but like all NSAID’s, it will alter the gut microbiome and over time may lead to ulceration of the intestines. One dose of Equioxx has been shown to kill a family of normal and good oral bacteria. However for older horses needing help to get up or lay down, NSAID’s are a good choice.

Other reasons for stiffness and filling should be considered including a poor diet and lack of exercise. Make sure you are not feeding any PUFA’s (poly unsaturated fatty acids – all seed oils like vegetable, soy, corn, flax, canols, etc). These have beed seen attached to LPS’s (lipopolysacchaides or dead gut bacterial parts) in the joints of humans. Removal immediately helps these humans in “joint stiffness” and joint pain. These oils are common in horse treats, balancers and most horse feeds.

Summary – Adequan is good and might be worth experimenting, however you will need to continue it as needed for her whole life. Equioxx is good and is less expensive than Adequan but bute is less expensive than Equioxx and can do the same thing. This will als need to be given as needed for life. Double check the diet to be sure all she eats is forage, water and salt. Adding soybean meal should help heal cartilage but is a slow process with no immediate results. Remaining outside where movement is unrestricted is better for stiffness than confinement.

[LisaE]

Thank you! Yes, very different modes of action, which is why I’m hopeful Adequan might be helpful in managing the issues. I gave her an Equioxx break recently and with cumulative work she becomes slightly irregular and she had a little harder time with her back-end when I trimmed her last. Diet has never been high in grains or oils, but she was on Triple Crown Balancer and some flax oil until a week ago. Lifelong she’s had a pound or two of some sort of feed and a flax or other omega oil. She does have signs on protein deficiency in the topline and I’m sure always has being a lifelong “easy keeper”. I put in an Adequan order with my vet and perhaps it will help in the cartilage healing as the soybean meal has some time to work. I’ve toyed with the idea of Adequan over the past couple years based on friend’s anecdotal stories, but then I have read that the efficacy studies where deceptive and that it’s not biologically possible it’s in the horse long enough to have the claimed effect. I’m interested to see!

She isn’t confined to a stall and she does stay in fairly consistent work, so at least in those parts we are good.