On a weekly basis, I am asked which joint supplement I recommend. I have found this extremely difficult - throughout my university and postgraduate studies, there has been minimal focus on supplementation. When I decided that I wanted to write a blog about joint supplements, I wanted to address the following questions:
The science behind the ingredients.
What constitutes a good supplement?
Which red flags to look out for.
This blog is not meant to be an advertisement for one supplement company over another - rather, a tool to help you decide which supplement is suitable for your horse and why. This should be based on the concentration of the ingredients, how they work and the daily maintenance cost.
One of the major difficulties associated with writing this blog has been the lack of equine specific studies. Past literature reviews have considered studies into equine supplements to be of ‘low quality’ (1). Most of the studies about supplements are based on how the ingredients work in people, and there can, of course, be a placebo effect. This means that if you put someone on a specific ingredient, they could say that they are feeling better because they think that they are feeling better, or because of a change in their normal routine. This can subsequently improve discomfort in their joints during the study period, but it could be wrongly attributed to the supplement.
I would be extremely happy to receive any scientific, published studies about specific ingredients found in joint supplements showing improvement in lameness scores. I will update the blog accordingly. My e-mail address is accessible through my website.
A supplement is a feed additive aimed at counteracting environmental stress. The most common components in joint supplements are:
MSM (Methylsulfonylmethane).
Glucosamine.
Chondroitin sulfate.
Hyaluronic Acid (HA).
Rosehips.
Vitamin C.
Omega 3.
Boswellia.
Amino acids.
Collagen.
Green Lipped Mussel.
MSM
MSM is available naturally though fruit, vegetables and grains and functions as an anti-inflammatory, anti-oxidant and supporting the immune system (2). Supplementation can therefore help with arthritis, cartilage preservation, improving range of motion, decreasing pain (3) and reducing muscle soreness after exercise (2). Interestingly, it may also have some efficacy in improving seasonal allergies within 3 weeks (4).
None of the MSM studies presented were based on how the equine body uses MSM.
Glucosamine
This ingredient is generally obtained from crustacean shells. It is critical in formation of glycosaminoglycans like HA. Although the exact way in which it works is unknown, it is thought to protect the cartilage, and stimulate cartilage cells (5). Inconsistent improvements are present in humans receiving glucosamine, and this may be due to the fact that the rate of absorption is different in different people (6).
In an equine study (7), horses that got 30 mg/kg glucosamine twice a day (15,000 mg for a 500 kg horse twice daily [therefore 30 g a day in total]) showed an improved response to joint inflammation compared to horses that did not receive supplementation - keep an eye out for the normal maintenance dose of glucosamine in supplements below.
Chondroitin
Chondroitin sulfate is generally obtained from bovine trachea and nasal septum. It is thought to counteract the cartilage inflammatory response (8). Frustratingly, there is a lack of scientific research in actual outcomes of horses supplemented with chondroitin.
In combination, evidence suggests that glucosamine and chondroitin work better together at preventing cartilage breakdown in horses (9). However, this study was performed on pieces of equine cartilage in a lab, and not on a live horse, undergoing the normal stressors of ridden work.
Hyaluronic acid
For the third consecutive blog in this series, another route of administration of HA is through supplementation. An average 70 kg human has about 15 g of HA, and 5 g of this is naturally replaced by the body every day (10).
Studies show that daily dosing with 100 mg (11) and 250 mg (12) decreased joint swelling.
Rosehips
Rosehips are naturally occurring plants, all over the world, rich in vitamins C, E and B which have anti-inflammatory and anti-oxidant properties (13). The quality of rosehips is dependent on where they are harvested from, based on exposure to light (14), oxygen levels and freshness (15) - therefore, not all rosehips are created equally.
Human studies show that 5g of rosehip powder every day reduce pain associated with arthritis (16). I have not been able to find equine studies thus far.
Vitamin C
People that do not consume the necessary levels of Vitamin C are at higher risk of developing arthritis in multiple joints (17). Again, I could not find any papers linking vitamin C supplementation with joint disease and pain in the horse.
Omega-3 Fatty Acids
Omega-3 fatty acids have an effect in decreasing occurrence of inflammation, thus playing a role in protection from heart disease, inflammatory bowel disease, and arthritis (18, 19).
The only omega-3 study I could find in horses showed that they can help to manage chronic lower airway inflammation. When supplemented with 30-60 g of Omega-3, together with improved management strategies, significantly improved recovery (20).
A 2018 study looked into linoleic acid, an Omega-6 Fatty acid, used in horses (21). This showed that after 14 days of supplementation, it reduced inflammation, potentially delaying the onset of arthritis.
Boswellia
Boswellia serrata is a plant which produces Indian frankincense, showing anti-inflammatory, anti-arthritis, pain relief and performance improving qualities. The recommended dose in people effective in treating arthritis is 100-250 mg a day for at least 4 weeks (22). Absorption is increased when combined with Piper longum (Indian long pepper) (23) which is commercially available to buy online. This is not the same as normal black pepper - no studies show whether normal black pepper has the same effect on improving absorption. This study was done on rabbits, and not on people.
Again, I have not found any equine-specific research.
Amino acids
Amino acids are building blocks of proteins. Certain amino acids (building blocks) may not be routinely available in a horse’s vegetarian diet. They may also have specific roles in decreasing inflammation.
Collagen
Collagen is the main structural protein within the connective tissue making up cartilage, bones, ligaments, tendons and skin. A recent study showed the effect of collagen obtained from fish skin and cartilage on samples of equine joint cartilage. This showed promise in delaying inflammation and increasing healing (24). This is from a 2021 study, and again, it shows the effect of the collagen on equine cartilage in a laboratory, and not actually in a real life situation as an oral supplement.
Green Lipped Mussels
Green Lipped Mussels provide a rich source of polyunsaturated fatty acids (omega fatty acids). It has been shown to be effective in chronic joint pain (25).
An actual equine study exists, within which horses with fetlock arthritis received 25 mg/ kg (12,500 mg for a 500 kg horse) per day of a green lipped mussel supplement. After 56 days, the horses which received the supplement had decreased lameness and joint pain (26).
Therefore, in summary, based on the research currently available, the following doses have been shown to be effective in horses (500kg):
Glucosamine - 15,000mg.
HA - 100mg.
Omega-3 - 30,000mg
Green Lipped Mussel - 12,500mg.
More information is needed about effective doses of the other ingredients in horses.
What should you look out for when deciding which product to purchase? A basic guide to picking the right supplement for you and your horse.
Whilst preparing to write this blog, I spent a lot of time looking at, and contacting, different supplement companies. I wanted to try to understand variations between different companies through the standards they set, and the way that they market their products. The responses I received were as expected - companies that do list the actual quantity of each ingredient in their supplement on their website responded in a thorough and passionate manner about their accreditation and testing. I therefore created a checklist of what I would look for if I was purchasing a joint supplement, however, I feel that this can be used for a number of other types of supplement as well.
Types of Accreditation
BETA NOPS
British Equine Trade Association (BETA) Naturally Occurring Prohibited Substances (NOPS) accreditation - companies which are involved with this scheme have more rigorous testing to try to ensure that no prohibited substances. This mainly includes other plants which may be cultivated when collecting other ingredients found in supplements or feed, which accidentally make their way into them. Basically, this aims to ensure that there is minimal risk of contamination which may affect the competition eligibility of your horse.
A company cannot ‘100% guarantee’ BETA NOPS as there is always potential for accidental contamination.
A list of accredited companies can be found here: https://www.beta-uk.org/pages/feed-safety/beta-nops-scheme.php
2. UFAS
Universal Feed Assurance Scheme - Started after mad cow disease in the 1990s - main objective is to ensure that the supplement is fit for purpose by providing regulations about where materials are sourced from, to ensure that suppliers are accredited.
Red flags
Different supplement companies provide the amount of each ingredient in milligram (mg) or as a percentage, some do not even provide the amount of ingredients in each scoop. I would not purchase a supplement without knowing the exact amount of how much of each ingredient was in the maintenance dose.
When starting a supplement, the supplement company usually recommends a loading dose, which is typically double the maintenance dose. Make sure that when looking at the ingredient list, the quantity that your horse will be receiving daily is the maintenance amount. Some companies list the amount of ingredients based on the loading dose, so the value looks significantly inflated (double) what your horse would be getting on a daily basis, at the maintenance dose.
Work out the cost per day. If a supplement comes in varying tub sizes, you may be paying close to 50% more per day by opting for a smaller tub.
To calculate the daily dose, figure out the amount of doses in a tub and divide that by the cost. So if a tub has 10kg (1kg = 1000g, therefore 10kg is 10,000g) of supplement in it, and the maintenance dose is 100 g a day, that tub will last you 100 days (100g x 100 days = 10,000g = 10kg). If the 10kg tub is £50, then you will be spending £50 over 100 days, and this works out to £0.50 per day.
1,000 mg makes up 1 gram.
Supplement List
I have taken the time to go through a number of supplement providers and some of their products, to try to show the ingredient lists within their maintenance dose, and approximate daily cost. Hopefully, this helps with decision making. Please note that this is correct as of the day of posting the blog, and may not hold true for a very long time. It is meant as a guide, not as a definitive list.
Conclusion
As I said in the introduction, this post has been both interesting and difficult to write. The aim was to give you a better understanding into what makes up joint supplements. If you are uncertain whether to use one supplement over another, I would recommend contacting a BETA NOPS accredited supplement company, informing them about which supplements you are interested in, and asking why their product is better than the other ones you are considering getting.
References
Pearson, W. and Lindinger, M., 2009. Low quality of evidence for glucosamine-based nutraceuticals in equine joint disease: Review of in vivo studies. Equine Veterinary Journal, 41(7), pp.706-712.
Butawan, M., Benjamin, R. and Bloomer, R., 2017. Methylsulfonylmethane: Applications and Safety of a Novel Dietary Supplement. Nutrients, 9(3), p.290.
Kim, L., Axelrod, L., Howard, P., Buratovich, N. and Waters, R., 2006. Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial. Osteoarthritis and Cartilage, 14(3), pp.286-294.
Barrager, E., Veltmann, J., Schauss, A. and Schiller, R., 2002. A Multicentered, Open-Label Trial on the Safety and Efficacy of Methylsulfonylmethane in the Treatment of Seasonal Allergic Rhinitis. The Journal of Alternative and Complementary Medicine, 8(2), pp.167-173.
Nagaoka, I., Tsuruta, A. and Yoshimura, M., 2019. Chondroprotective action of glucosamine, a chitosan monomer, on the joint health of athletes. International Journal of Biological Macromolecules, 132, pp.795-800.
Asthana, C., Peterson, G., Shastri, M., Jones, G. and Patel, R., 2020. Variation in Plasma Levels of Glucosamine With Chronic Dosing: A Possible Reason for Inconsistent Clinical Outcomes in Osteoarthritis. Clinical Therapeutics, 42(8), pp.e140-e149.
Leatherwood, J., Gehl, K., Coverdale, J., Arnold, C., Dabareiner, R., Walter, K. and Lamprecht, E., 2016. Influence of oral glucosamine supplementation in young horses challenged with intra-articular lipopolysaccharide. Journal of Animal Science, 94(8), pp.3294-3302.
McIlwraith, C., 2016. Oral joint supplements in the management of osteoarthritis. [online] Veterian Key. Available at: <https://veteriankey.com/oral-joint-supplements-in-the-management-of-osteoarthritis/> [Accessed 28 March 2022].
Dechant, J., Baxter, G., Frisbie, D., Trotter, G. and McIlwraith, C., 2005. Effects of glucosamine hydrochloride and chondroitin sulphate, alone and in combination, on normal and interleukin-1 conditioned equine articular cartilage explant metabolism. Equine Veterinary Journal, 37(3), pp.227-231.
McCourt, P., 1999. How does the hyaluronan scrap-yard operate?. Matrix Biology, 18(5), pp.427-432.
Bergin, B., Pierce, S., Bramlage, L. and Stormberg, A., 2010. Oral hyaluronan gel reduces post operative tarsocrural effusion in the yearling Thoroughbred. Equine Veterinary Journal, 38(4), pp.375-378.
Carmona, J., Arguelles, D., Deulofeu, R., Martinez-Puig, D. and Prades, M., 2009. Effect of the administration of an oral hyaluronan formulation on clinical and biochemical parameters in young horses with osteochondrosis. Veterinary and Comparative Orthopaedics and Traumatology, 22(06), pp.455-459.
Mármol, I., Sánchez-de-Diego, C., Jiménez-Moreno, N., Ancín-Azpilicueta, C. and Rodríguez-Yoldi, M., 2017. Therapeutic Applications of Rose Hips from Different Rosa Species. International Journal of Molecular Sciences, 18(6), p.1137.
Dogan, A. and Kazankaya, A., 2005. Fruit Properties of Rose Hip Species Grown in Lake Van Basin (Eastern Anatolia Region). Asian Journal of Plant Sciences, 5(1), pp.120-122.
Strålsjö, L., Alklint, C., Olsson, M. and Sjöholm, I., 2003. Total Folate Content and Retention in Rosehips (Rosa ssp.) after Drying. Journal of Agricultural and Food Chemistry, 51(15), pp.4291-4295.
Christensen, R., Bartels, E., Altman, R., Astrup, A. and Bliddal, H., 2008. Does the hip powder of Rosa canina (rosehip) reduce pain in osteoarthritis patients? – a meta-analysis of randomized controlled trials. Osteoarthritis and Cartilage, 16(9), pp.965-972.
Pattison, D., 2004. Vitamin C and the risk of developing inflammatory polyarthritis: prospective nested case-control study. Annals of the Rheumatic Diseases, 63(7), pp.843-847.
Kostoglou-Athanassiou, I., Athanassiou, L. and Athanassiou, P., 2020. The Effect of Omega-3 Fatty Acids on Rheumatoid Arthritis. Mediterranean Journal of Rheumatology, 31(2), p.190.
Djuricic, I. and Calder, P., 2021. Beneficial Outcomes of Omega-6 and Omega-3 Polyunsaturated Fatty Acids on Human Health: An Update for 2021. Nutrients, 13(7), p.2421.
Nogradi, N., Couetil, L., Messick, J., Stochelski, M. and Burgess, J., 2015. Omega-3 Fatty Acid Supplementation Provides an Additional Benefit to a Low-Dust Diet in the Management of Horses with Chronic Lower Airway Inflammatory Disease. Journal of Veterinary Internal Medicine, 29(1), pp.299-306.
Bradbery, A., Coverdale, J., Vernon, K., Leatherwood, J., Arnold, C., Dabareiner, R., Kahn, M., Millican, A., Welsh, T. and Smith, S., 2018. Evaluation of conjugated linoleic acid supplementation on markers of joint inflammation and cartilage metabolism in young horses challenged with lipopolysaccharide (LPS). Journal of Animal Science, 96(2), pp.579-590.
Yu, G., Xiang, W., Zhang, T., Zeng, L., Yang, K. and Li, J., 2020. Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC Complementary Medicine and Therapies, 20(1).
Vijayarani, K., Govindarajulu, M., Ramesh, S., Alturki, M., Majrashi, M., Fujihashi, A., Almaghrabi, M., Kirubakaran, N., Ren, J., Babu, R., Smith, F., Moore, T. and Dhanasekaran, M., 2020. Enhanced Bioavailability of Boswellic Acid by Piper longum: A Computational and Pharmacokinetic Study. Frontiers in Pharmacology, 11.
Bourdon, B., Contentin, R., Cassé, F., Maspimby, C., Oddoux, S., Noël, A., Legendre, F., Gruchy, N. and Galéra, P., 2021. Marine Collagen Hydrolysates Downregulate the Synthesis of Pro-Catabolic and Pro-Inflammatory Markers of Osteoarthritis and Favor Collagen Production and Metabolic Activity in Equine Articular Chondrocyte Organoids. International Journal of Molecular Sciences, 22(2), p.580.
Chakraborty, K., Chakkalakal, S. and Joseph, D., 2014. Response of pro-inflammatory prostaglandin contents in anti-inflammatory supplements from green mussel Perna viridis L. in a time-dependent accelerated shelf-life study. Journal of Functional Foods, 7, pp.527-540.
Cayzer, J., Hedderley, D. and Gray, S., 2011. A randomised, double-blinded, placebo-controlled study on the efficacy of a unique extract of green-lipped mussel (Perna canaliculus) in horses with chronic fetlock lameness attributed to osteoarthritis. Equine Veterinary Journal, 44(4), pp.393-398.