Supplements- A Brief Review
Equine Powders and Potions- Fact or Fable?
The list of supplements, herbal remedies, powders and potions is almost endless, tales of their unique magical powers get passed down from generation to generation and yard to yard, but which of them have actual scientific evidence to support their claims? Research into the equine is very limited but human and lab studies can add weight to our analysis, this review will briefly asses the scientific evidence of some of the more common supplements and remedies. Many of the herbal remedies are focused on systemic health, naturally in the equine many owners look to supplement for hoof health/growth as well, so a section will be focused on hoof supplementation. It is important to point out that herbs, vitamins and minerals are not the same thing, vitamins are organic substances and are essential for bodily function such as releasing energy from food, developing red blood cells, helping in blood clotting and in maintaining healthy skin, eyes, and hair. Minerals, which are non-organic are utilised in bone and tooth formation, blood coagulation and muscle contraction.
Bee pollen, as the name suggests is collected from plant sources by honey bees, used as a building material in their hive and to embalm foreign dead invaders. It is important to state that bee pollen/propolis from different Bee hives will have different chemical properties (Williams and Lamprecht 2008), but it has shown to have free-radical fighting properties (Christov et al 2004), free radicals are highly reactive molecules that can cause damage to living cells, anti-oxidant, antibacterial, antifungal, antiviral, anti-inflammatory, hepatoprotective and antitumor properties have all been proven in human research and many off these benefits can be derived from honey too (Gomez-Caravaca et al 2006).
Research specific to the equine, Turner et al (2006) although only a pilot study, showed that bee pollen products enabled increased feed consumption and retaining of nutrition in working horses, suggesting it could have a positive effect on performance due to helping horses meet their nutritional demands. Bee pollen has, as yet, not shown any negative side effects (Williams and Lamprecht 2008).
Devils claw is a plant, native to Southern Africa, it has been widely used in human medicine for the treatment of degenerative joint disease. There has been research to prove the anti-inflammatory and analgesic properties of Devils claw (Braun and Cohen 2015), some of this has been attributed to its additional anti-oxidant properties (Grant et al 2009), administration of Devils claw has shown to be vitally important in its efficacy as stomach acid was shown to render the remedy ineffective in some cases (Soulimani et al 1994). Chondroprotective properties have also been shown and clinical applications include treatment of musculoskeletal inflammatory pathologies (Mcgregor et al 2005), arthritis, back pain and oncology (Braun and Cohen 2015).
The research appertaining to the equine, Pearson et al (2015), again a pilot study, showed the potential beneficial effects of a mixture of herbs : dandelion, devil’s claw, stinging nettle, burdock, and comfrey on joint disease within the horse, it was shown to supress the levels of prostaglandin e2 which has been shown to be associated with pain in arthritic conditions (May et al 1994), however no reduction in lameness was observed. The possible negative effects of Devils claw could include gastric ulcers (Izzo et al 2005) however appertaining to the equine, Harman (2002) found no evidence of adverse effects.
Echinacea is a flower extract from eastern and central north America. Most research has concentrated on its modulatory influence on immunity systems, but is has also shown antiviral, antifungal, antimicrobial, anti-inflammatory, antitumor, antioxidant, mosquitocidal, and psychoactive properties, amongst other properties (Billah et al 2019). Echinacea use in the treatment of upper-respiratory infections has shown positive results (Drisko and Kindcher 2016), Parsons et al (2018) outlined the potentiality of the herb stating that advances in technology and research into the different strands of extract could yield more benefits over and above the anti-inflammatory, anxiolytic (anxiety reduction) and antibiotic properties already proven.
In the horse, O’Neill et al (2010) confirmed the herbs stimulation of equine immunocompetence, increasing the abilities of white blood cells and increasing the amount of red blood cells, haemoglobin and packed cell volume which would point to additional performance enhancing properties. Potential side effects have been shown such as allergic rashes, hyper eosinophilia, and autoimmune diseases and leukopenia with Echinacea overusage or with overdosage (Barrat 2003).
Flaxseed/Linseed, as the names suggest are crop seeds, it is rich in omega-3 fats, protein and fibre. It has been shown to have anti-oxidant, anti-diabetic, anti-cancerous properties and aid in osseous metabolic moderation, however negative effects are a potential depending on dosage and preparation (Soni et al 2016). Gutte et al (2015) expressed the potential treatment benefits to a range of diseases including cardiovascular diseases, diabetes, hypertension and neurological disorders. The benefits of omega-3 fatty acids are well known, anti-inflammatory properties have been documented (Calder 2015), and studies have shown the importance of correct balance between omega-6 and omega-3 fatty acids in the control of obesity (Simopoulos 2016), providing this balance coupled with the anti-inflammatory properties could be a mechanism for aiding the control of systemic, chronic, inflammatory processes in the equine, such as equine metabolic syndrome and laminitis, however the results were inconclusive in Hansen et al (2008) which administered flaxseed to healthy horses, questioning whether flaxseed contained high levels of omega-6 as well, studies have shown that there are potentially better sources of omega-3 fatty acids, most markedly in marine oils (Hess et al 2012). Flaxseed has shown to reduce allergic skin reactions in the equine, however with an unknown mechanism in O’Neill et al (2002), this study also expressed the different outcomes of flaxseed according to administration methods. Flaxseed has the potential negative effects of the prolonged absorption of other drugs and prolonged bleeding time, also possible cyanide poisoning in some cases if not boiled (Williams and Lamprecht 2008).
Ginseng is one of the widest used herbal supplements on the equine market and human research is widespread, it comes from the root of the plant genus Panax. Properties of ginseng are said to possess antioxidant properties that provide immunological and neurological protection. In human qualitative studies it has shown to be effective in the treatment of dementia, chronic obstructive pulmonary disease, and heart failure, however the results were questionable due to bias (Davis and Behm 2019), other studies have shown it may have benefits in appetite suppression, however Ginseng from different geographical areas were shown to have differing and even opposing effects, so more research is needed to outline its benefits (Zhang et al 2017). Compound K found in ginsenosides has shown potential in the treatment of Alzheimer's disease and cerebral ischemia, more research is needed to establish all of the potential benefits and preventions of neurological disease (Oh and Kim 2016). There have been findings of toxic hepatitis and acute kidney dysfunction associated with ginseng, however this wasn’t ginseng in isolation and could prove to be circumstantial (Lee et al 2017).
Pearson et al (2007) found benefits to the equine with no adverse effects, a low dosage showed to increase the antibody activation in response to viral infection, discussed was the need for further research into the individual ginsenosides found in ginseng to establish their individual benefits. Their interactions with non-steroidal anti-inflammatory drugs has to be considered as this has shown to have potentially adverse effects (Poppenga 2001).
Garlic has been understood as having beneficial properties since the ancient civilisations of India, China and Greece, it is widely used in the poultry industry for its anti-microbial and anti-parasitic properties (Williams and Lamprecht 2008), however Buono et al (2019) bought into question the parasitic effects of garlic in the equine showing that it had little effect on the internal egg count. It has been shown to have anti-oxidant and anti-cancerogenic properties, also having positive effects on the regulation of internal apoptotic pathways, apoptosis being the organised process of cell death, anti-viral properties have also been researched (Chmelikova et al 2017). Commonly it is used for its fly repellent properties in the equine, the mechanism for this is only expectant and is attributed to the assistance of disintegration of mucous (Elghandour et al 2018), garlic has however shown to be beneficial in equine respiratory issues and lung infections (Pearson 2004). Garlic should be fed in moderation as overdose could result in anaemic dysfunction in the equine (Pearson et al 2005), further research is needed to establish safe dosage, Williams and Lamprecht (2008) also discussed other possible side effects including gastric irritation and a lowered sperm count.
Ginger is a flowering plant, its medicinal properties come from its roots and are widely documented, Kaur et al (2015) emphasised its role in the treatment of gastric pathologies including, ulcers, vomiting, nausea, dyspepsia, stomach ache, spasm, and gastrointestinal cancer, ginger has also shown to have benefits in treating cardiovascular disease, attributed to its anti-inflammatory, anti-hyperilidemia, anti-platelet aggregation and anti-hypertension properties (Singletary 2010). It has also been shown to have strong anti-cancerous properties (Akimoto et al 2015), attributed to its anti-oxidant and apoptosis mediation properties.
In the horse, ginger has been shown to reduce cardiovascular recovery time after exercise (Liburt et al 2010) this would have positive effects for performance horses, however this benefit should be balanced with the possible gastrointestinal tract irritation associated with ginger extract (Liburt et al 2009).
Turmeric is actually a type of ginger, native to the Indian sub-continent and South East Asia and widely used in traditional medicines for centuries. Turmeric has been widely researched and has been shown to have anti-inflammatory, antioxidant, hepatoprotective, anticarcinogenic, antidiabetic, antimicrobial and antidepressant properties in addition to its use in cardiovascular disease, gastrointestinal and neurological disorder (Verma et al 2018). Its anti-oxidant properties were discovered as long ago as Sharma (1976) and has been shown to have scavenging properties and prevent oxidation in gastric lesions (Verma et al 2018). Turmeric has been shown to have apoptotic regulatory and anti-progressive cell-cycle properties which can aid in the prevention and treatment of cancer (Verma et al 2018). The author could not find any research appertaining to the equine.
Valerian is a flowering plant native to Europe and Asia, it is widely used in human medicine to treat anxiety, stress, and insomnia (Elghandour et al 2018), Ilango (2018) described the various and vast uses of the extract including its anti-cancerous and neurological protective properties, used in the treatment of Parkinson’s, Alzheimers and epilepsy. It is thought that Valerian has sedative properties, the mechanism for this is debated, Hattesohl et al (2008) attributed this to its anti-anxiety and anti-depression properties, there is limited quantitative research into its effects on the equine, however a qualitative survey (Ross and Roberts 2018) found it had calming effects.
Essential Amino acids
Amino acids are organic compounds necessary for many bodily functions, they are the building blocks of the body, turned into proteins that control the processes within each cell, used to grow, repair, control your muscles and protect the nervous system. Amino acids are broken down into essential and non-essential, essential amino acids can not be formed internally and must be sourced from food, non-essential amino acids can be created within the body. The essential amino acids and their brief description are
Phenylalanine: Helps in boosting memory power and helps to maintain a healthy nervous system
Valine: Helps in growth of muscles.
Threonine: It promotes the functioning of immune system.
Tryptophan: Plays a vital role in maintaining our appetite.
Isoleucine: Plays a vital role in synthesis of haemoglobin and it is a major component of RBC (red blood cells)
Methionine: Helps in maintaining a good and healthy skin.
Leucine: It promotes the synthesis of growth hormones.
Lysine: They are involved in the synthesis of enzymes and other hormones.
Histidine: Helps in the production and synthesis of both RBC (red blood cells) and WBC (white blood cells)
Humans and horses share the same mammalian cell structure (Fig1), therefore the same chemical processes of amino acid utilisation are assumed, an interesting way at looking at the similarities or lack of between amino-acid utilisation in humans and horses is to study their milk, a study that looked at equine milk lysozymes found that there was only a 51% sequence homology with human milk (McKenzie and Shaw 1985) perhaps indicating a difference in amino acid recruitment between species, however Brinkman (2015) found that horse milk had a higher similarity to human milk than others and was similar. A study into Threonine needs of the equine was inconclusive, however it did show to decrease phenylalanine oxidation (Mok et al 2018). Increase of a single amino acid can affect the amino-acid metabolism at a cellular level in horses, the levels of amino acids required in the equine could potentially be much lower than expected by previous studies (Masteller et al 2016), and there are upper limits for amino-acid intake. studies have shown that horses do utilise amino-acids similarly to humans showing lysine as an inhibiting amino-acid in multiple species (Masteller et al 2018), however due to the lack of evidence in required levels it would be unclear as to whether supplementation would be beneficial, pointless or even have potential long term negative effects as unused amino acids are oxidized to carbon dioxide (Masteller et al 2016).
Fig.1 Mammalian cell structure. Papertrell.com
A recent study (Dorsch et al 2018) showed that horses with equine metabolic syndrome had an exacerbated response to their condition when fed a high protein diet, showing that intake of a high protein meal causes a hyper insulinemic response and affected amino acid metabolism in horses with EMS, this shows again that considerations must be made to the individual when supplementing and the horse does not necessarily respond the same as a human would to amino-acid supplementation. Deboer et al (2018) expressed that there were distinct differences in species reactions to growth stimulants such as Leucine but stated that in the equine this amino-acid did stimulate the rapamycin translation and transcription of global proteins, mechanisms in muscle and protein synthesis. To summarize, we do not have enough evidence as to the requirement and usability of individual amino-acids in the horse to formulate an opinion on the effectiveness of its supplementation, giving imbalanced levels of amino-acids could show zero benefits as the interaction between amino-acids is limited by the amounts of each (Deboer 2016), however horses do use amino-acids to synthesize tissues, hormones, and enzymes as well as repair tissues, so ensuring they have enough can not be disregarded.
Supplementing for optimal hoof growth is very common amongst horse owners, in my experience as a farrier, sometimes it works and I can come back to feet that are starting to grow more rapidly, but sometimes it hasn’t made any difference, so what does the research say? Buffa et al (1992) claimed statistically significant improvement in growth rates with biotin supplementation with a secondary increase in hoof hardness, this was echoed by Jossek et al (1995) which added maintained hoof improvement after 3 years of observation, subsequent studies have shown similar results. An earlier microscopic study (Kempson 1990), which took some horses showing no improvement from biotin isolate supplementation, revealed an improvement in structure of the hoof wall in horses fed with a multi nutrient supplement (Fig.2-3), possibly showing that biotin utilisation could depend on other nutrient deficiencies, accounting for the hit/miss experience of the author, the study also added that healthy hooves were less effected by environmental factors. The improvements in the hoof experienced in this study were similar to a much earlier study (Kempson 1987), which found horn improvements in Bran fed horses, attributing the mechanism to calcium: phosphorous ratios, again adding weight to the need for overall nutrient balance for optimal hoof growth. Ley et al (2010) expressed the effects of seasonal trends and complete nutrition on the quality of hoof wall strength and also associated tensile strength with sulphur content, this echoes a “bigger picture” of hoof quality being more complexed then single nutrient supplementation and that hoof health can be a reflection of general systemic health (Kellon 2008).
Fig.2 Improvement in hoof wall on a microscopic level after supplementation of mixed nutrients, shown in fig.3 (Kempson 1990).
Fig.3 nutrient content of proven hoof supplement. (Kempson 1990).
The primary makeup of the hoof wall is keratin, keratin is made up of amino-acids, Alanine, glycine and the sulphur containing amino acid cysteine (produced from methionine) (Kellon 2008), vitamin B6 is required to utilise these amino-acids and so we can derive that poor quality hoof wall could be attributed to protein and amino-acid deficiency and/or a vitamin B6 deficiency, Kellon (2008) also mentioned the fat content of the outer layer of wall, the importance of calcium in activating the enzyme responsible for crosslinking keratin fibres and zinc and copper for cell proliferation, the lack of biotin was also highlighted as a cause for exfoliative dermatitis and other keratin based dysfunction, this again shows the importance of a multitude of factors in the hoof growing process, poor hoof quality could be an expression of a lack of any one of the following: Crude protein, Sulphur containing amino acids (methionine primarily, cysteine), Essential fatty acids, Zinc, Copper, Selenium, Vitamin E, Biotin, pyridoxine (Kellon 2008). In the authors opinion this complexity is why hoof supplementation can sometimes work and sometimes not, the horses’ nutrition should be assessed holistically for potential deficiencies.
Osteoarthritis (Fig.4) and other degenerative joint diseases are a huge contributing factor to equine lameness, so it is not surprising to find joint supplements (nutraceuticals) being a popular choice. Firstly it is important to make clear that cartilage can not be repaired! largely due to its very limited blood supply, so supplementation looks to provide protection of existing cartilage and to slow down the degenerative mechanisms, unfortunately many claims are unsubstantiated and the research available is inconsistent (Richardson and Loinaz 2007), Pearson and Lindinger (2010) echoed this statement, pointing out that only 3 of 15 published papers on the effects of glucosamine‐based nutraceuticals for horses, including that on Cosequin, Cortaflex, Synequin, Sasha's EQ, Myristol, chondroitin sulphate, glucosamine sulphate and glucosamine hydrochloride, showed quality, reliable results. Having said all of that, limited studies have shown improvement in movement of horses with degenerative joint disease after supplementation with a glucosamine-chondroitin sulphate compound (Clayton et al 2002), rapid improvement was seen in the first 2 weeks which slowed. Verde et al (2006) concluded that there was a relief of clinical signs after 10 weeks of chondroitin sulphate oral administration, attributed to its anti-inflammatory and chondroprotective properties, however a systematic review, Vandeweerd et al (2012) questioned these findings, stating that standardised criteria are needed across nutraceutical research to substantiate any findings, an important point being the assessment of lameness being objective, a more recent study (Murray et al 2017) showed that more objective assessment methods did show supplementation improved clinical signs of degenerative joint disease, unfortunately it was unclear as to what the supplement contained. Dobenecker et al (2018) has shown the potential for bioactive collagen peptides in the treatment of osteoarthritis. As with the rest of this review a re-occurring theme has again been highlighted, there is potential and limited evidence to show usefulness of joint supplementation but more research is needed.
Fig.4 Osteoarthritis of the Metacarpo-phalangeal articulation. Studyblue.com
This paper only scratches the surface of reviewing supplementation, the chemical mechanisms for all the potential applications of the substances we have reviewed are complexed and continue to be researched, many of the traditional remedies have been scientifically demonstrated and as research becomes more established may become more prevalent in veterinary practice as well as owner use, however, research into equine supplementation in each of the fields we have covered, is very young and it can not be assumed that the effects will be inter-individual or inter-special so further research is needed to confirm the benefits seen in humans and previous equine studies.
Many of the systemic remedies we have reviewed have the same characteristics, anti-inflammatory, antitumor and antioxidant being prevalent and are inherently beneficial.
Inflammation in the body is a contributing factor in many chronic, systemic and degenerative diseases, supplementing with anti-inflammatory substances can aid in long term health and delayed onset of these pathologies, and indeed help treat post diagnosis.
Oxidants cause damage to biological structures, free radicals react with organic substances and are held partly responsible for aging and the pathogenesis of many diseases, supplementing with anti-oxidants and free radical scavengers can help to control these diseases.
Regulation of apoptosis (Regulated cell death) has shown to be an important anti-cancerous/carcinogenic mechanism (Verma et al 2018) so supplementing with appoptic regulators also has obvious preventative benefits.
Equine supplementation due to the limited amount of research is, on the whole, trial and error and subjective, often based on the assumption that horses will respond to a stimulant the same as humans and indeed another horse, this shouldn’t take away from the possible benefits that have been proven. In the authors opinion, equine supplementation requires substantially more research and should be much more individual than it currently is, based on the genetics of the particular subject. Nutrigenetics and nutrigenomics could be the answer to the lack of reliability of supplementation , it is the study of genetic variations and their responses to nutrients, an area of research still in its infancy in the human let alone in the equine but is the foundation for enabling dietary recommendations based on biological individuality (Bouchard and Ordovas 2012).
It is important to note that herbal remedies contain chemical properties that effect the systems of the body, therefore they could potentially be prohibited in equestrian sports, for instance at the 2008 Beijing Olympics several riders were disqualified from competition for testing positive for capsaicin (Capsicum frutescens). Capsaicin is banned by the Federation Equestre Internationale (FEI) as it stimulates P substance and has pain-relieving properties, Chase (2014) explained the FEI rules sharing some quotes on the subject, “Trainers, owners, exhibitors are cautioned against the use of medicinal preparations, tonics, pastes, powders, and products of any kind, including those used topically, the ingredients and quantitative analysis of which are not specifically known, as they might contain a forbidden substance. This is especially true of those containing plant ingredients. The plant origin of any ingredient does not preclude its containing a pharmacologically potent and readily detectable forbidden substance.” This highlights the importance of horse owners fully researching their supplementation.
Supplementation is a huge, complexed subject, most supplements we have covered work, anecdotally, evidence-based research is limited but the potential of supplements to provide certain individuals with health benefits shouldn’t be discredited and on the whole trial and error is low risk, however not risk free.
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3Department of Food Science and Center for Advanced Food Technology, Rutgers, The State University of New Jersey, 63 Dudley Road, New Burnswick, NJ08901-8525, USA
2Department of Veterinary Sciences, Maxwell H. Gluck Equine Research Center, University of Kentucky, Lexington, KY40546-0099, USA
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