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Evidence Herbal Medicine Companion Animals
#1
EVIDENCE IN COMPANION OR FOOD ANIMALS
There are very few high quality trials for herbal medicines in animals. Below are a few trial summaries for the practitioner to use in conjunction with traditional knowledge in clinical decision-making.
Milk Thistle
In two trials of dogs given hepatotoxic chemicals, silymarin or silibinin improved biochemical and histologic measures of hepatotoxicity, and survival was improved. In the first trial, beagles were given 85 mg/kg Amanita phalloides lyophilizate orally. Results of this study showed that all liver enzymes of dogs receiving milk thistle remained nearly normal throughout the testing period, where those of control dogs and those receiving prednisolone and cytochrome C increased precipitously (Floersheim, 1978). Vogel et al (1984) administered 85 mg/kg of amanita lysate to beagles, then treated half of them with silibinin (78 mg/kg IV at 5 and 24 hours). In the control group, 4 of 12 dogs died and histopathology showed severe liver necrosis. None died in the silibinin treated group, and the liver histopathology was nearly normal.
In one trial of postparturient cattle given milk thistle seeds, milk production was increased and ketonuria reduced, as compared with controls. Tedesco et al (2004) found that 10 g of silymarin (the extract) daily protected postparturient cows from a loss in body condition and also improved lactation performance. No silymarin residues were found in milk or colostrum. The same group examined liver histology and biochemistry of periparturient cows, and found that silymarin had no observable effect on fat accumulation or biochemical parameters of liver pathology. Tedesco et al (2004) also examined the effect of a silymarinphospholipid phytocome complex administered to 14day-old broiler chicks to determine whether it provided protection against aflatoxin B1. Three groups of chicks were administered diet alone, diet plus 0.8 mg/kg of feed of aflatoxin B1, or diet plus aflatoxin plus 600 mg/kg of the silymarin phytosome. The silymarin complex resulted in lower ALT levels and better weight gain than birds given aflatoxin but no silymarin. Birds receiving aflatoxin and silymarin had body weight gain and ALT levels equivalent to those of birds given no aflatoxin.
Tea Tree Oil
Tea tree oil is well known as a topical antibacterial and antifungal agent. A 10% tea tree cream was administered to 53 canine dermatology cases for 4 weeks. There were significant improvements in pruritus, erythema, pustules, oozing, crusts, erosions, alopecia, hyperkeratosis, and scaling (Fitzi, 2002). In another study from the same group, 57 dogs were divided into 2 groups, one receiving 10% tea tree cream and the other receiving a conventional skin care cream for the treatment of localized acute and chronic dermatitis (Reichling, 2004). Tea tree is toxic to cats and small dogs.
Boswellia
Reichling et al (2004) studied 24 dogs seen by 10 different veterinarians for osteoarthritis of joints or spine in a prospective open multicenter clinical trial. The presence of chronic inflammatory joint or spinal disease was determined by clinical examination and confirmed by radiograph. A standardized Boswellia resin extract (≥ 50% triterpenic acids) was given at a dose of 400 mg/10 kg of body weight once daily in food for 6 weeks. No placebo control was included in this study. The investigators claim that after 6 weeks, anywhere from 40 to 70% of the dogs were symptom-free. The signs with statistically significant improvements (using Bowker's test) were intermittent lameness, local pain, lameness when moving, lameness after a long rest, and stiff gait at various times during the study. Eleven of 29 dogs experienced adverse effects during the study, but in only one dog was the study medication apparently suspected.
Echinacea Horses: Changes in Hematologic Measurements
A standardized 1:3 powdered root extract of E. angustifolia was administered to 8 horses in this double-blind, placebo-controlled, cross-over trial. Each horse received either 1000 mg of the extract in sucrose syrup BID, or a placebo of sucrose syrup and were crossed over to the other group at the end of 42 days. Results of this study indicated that administration of 1000 mg Echi-Fend BID to horses increased circulating lymphocyte and neutrophil numbers, as well as increasing neutrophil activity.
Feed Efficiency and Immune Function in Pigs
In a study of growing pigs, Echinacea appeared to increase feed efficiency and growth when supplied at up to 3% of the diet. The species of Echinacea was not reported. In weeks 0-2, Echinacea at higher levels gave better results than the antibiotic Mecadox or no treatment at all. In weeks 3-4 weeks, 0.5 and 2% Echinacea diets resulted in greater feed efficiency, but by end of the trial, there was no difference in growth between the Mecadox and Echinacea groups (Holden, 2002). A standardized Echinacea purpurea powder was administered to 120 weaned pigs and its effects on performance, viremia, and development of the humoral antibody response against porcine reproductive and respiratory syndrome virus (PRRSV) infection was assessed. Echinacea at 2% and 4% of the diet had no effect on the rate or level of antibody response detected by ELISA. The investigators concluded that E. purpurea powder did not enhance growth, exhibit antiviral activity against PRRSV, or increase antibody resistance to the virus (Hermann, 2003).
Upper Respiratory Infections in Dogs
Reichling et al investigated a powdered E. purpurea root extract (1:3) in an open, multicenter clinical trial, comparing signs of respiratory disease in dogs before and after treatment. Forty-one dogs were enrolled and were noted to have at least on of the following chronic or seasonal as listed by the authors: "kennel cough, bronchitis, pharyngitis/tonsillitis, and non-thriving young animals," and these signs were expected to persist for at least 8 weeks if untreated. Signs were noted at time zero and at 4 and 8 weeks post treatment initiation; 38 dogs stayed in the trial to its end, and the analysis suggested that 92% of the dogs had "good" or "very good" improvement at 4 weeks, increasing to 95% at 8 weeks. With the subjective clinical parameters and no control group included in this study, it is impossible to assess the efficacy of Echinacea in this particular study.
Choreito (Zhu Ling San or Available Commercially as Polyporus Combination):
This has been shown to decrease struvite crystalluria and hematuria in cats with feline lower urinary tract disease (FLUTD) (Buffington et al, 1994; 1997b). In a study of struvite crystal growth in normal cat urine, 8 cats were divided into 2 groups of 4, and fed canned food supplemented with nothing or with 500 mg/kg of choreito daily. Each group was crossed over to receive the other treatment. The urine was filtered and analyzed for crystal growth visually and using a supersaturation index. Choreito significantly reduced struvite crystal formation and supersaturation index, but did not change urine pH, specific gravity, osmolality, electrolyte composition, or calculated struvite activity product. In another study by the same group, 12 healthy cats were fed a magnesium-supplemented diet to induce struvite crystalluria. In those cats supplemented with 500 mg/kg choreito, the herb formula significantly lowered struvite crystal content of the urine, as well as improving the frequency and severity of hematuria. All nonsupplemented cats had to be removed from the study, while all supplemented cats were able to complete it.
Ginger
Sharma et al induced emesis in healthy mongrel dogs using cisplatin, 3 mg/kg intravenously. Different doses of ethanol and acetone extracts of ginger were tested, and compared with granisetron given at 0.5 mg/kg IV. Ginger administration significantly reduced the number of vomiting episodes at doses as low as 25 m/kg per os. The highest dose tested for both extracts was 200 mg/kg, which led to the fewest vomiting episodes, but a shorter latency in minutes to the first episode. The highest doses were most comparable to the antiemetic efficacy of granisetron. (Sharma, 1997).
Zemaphyte Derivative
A number of controlled studies have shown that a specific combination of Chinese herbs is helpful in managing atopic eczema in human patients (Xu, 1997; Sheehan, 1992; Sheehan, 1995). A recent study from the University of Minnesota College of Veterinary Medicine investigated three herbs contained in Zemaphyte for control of pruritus in atopic dogs. Fifty dogs with atopic dermatitis were assessed by both owners and veterinarians and given either a placebo or a combination of licorice (Glycyrrhiza glabra), white peony (Paeonia lactiflora), and Rehmannia (Rehmannia glutinosa). These herbs were chosen on the basis of company (Phytopharm, LLC, United Kingdom) bioassay and palatability. Of dogs receiving herbs, 37.5% improved compared with 13% of the placebo group, and the deterioration scores were worse in the placebo group at the final visit. Although neither result reached statistical significance, the researchers were encouraged at the results and suggested further study (Nagle, 2001).
Guggul
Guggul contains resins that have been shown to have cholesterol- and triglyceride-lowering activity in humans (Singh, 1994) and laboratory animals. Six dogs were given 25 mg/kg Guggul gum powder IV. Total cholesterol levels were significantly reduced at 2 - 4 hours and triglyceride levels significantly reduced at 4 - 24 hours. Phospholipid levels were unaffected (Dixit, 1980). However, the overall effect is mild to moderate compared with cholesterol-lowering drugs used in people (Caron, 2001).
Garlic
Garlic has shown modest efficacy in lowering cholesterol and triglyceride levels in laboratory animals and people (Ackermann, 2001). Garlic has potential for causing Heinz-body anemia in dogs and especially in cats. Many veterinarians use garlic for their patients and monitor blood parameters. Garlic therapy can be attempted at a dose of 1 clove per 40 lb of animal, or 10 to 30 mg/lb of body weight of the common brand Kyolic. Six dogs were given 25 mg/kg garlic powder IV in a study by Dixit et al. Total cholesterol levels were significantly reduced at 2 hours. Triglyceride and phospholipid levels significantly reduced at 4 - 24 hours (Dixit, 1980).
GOOD EVIDENCE IN PEOPLE
The Cochrane Collaboration is an international nonprofit and independent organization that produces and disseminates systematic reviews of healthcare interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. The major product of the Collaboration is the Cochrane Database of Systematic Reviews which is published quarterly as part of The Cochrane Library, available at http://www.cochrane.org.
The Cochrane reviewers have examined the strength of evidence for various "alternative therapies" by searching the literature. Most reviews concluded that there was insufficient evidence to recommend a particular therapy. Sixteen of 23 herbal reviews were positive or possibly positive, which was a higher percentage than other alternative therapies reviewed (Manheimer, 2004) in people.
Cochrane also reported on the quality of randomized controlled trials of herbal medicines, and found them to be generally poor. The reviewers especially pointed out that it is important to fully describe the intervention, such as the kind of herbal extract (Gagnier, 2003).
With the above being said, the Cochrane reviews are positive for:
Zemaphyte for the treatment of atopic dermatitis in people
Kava kava for the treatment of anxiety in people
Saw palmetto for the treatment of benign prostatic hyperplasia in men (note that the only RCT in dogs was negative)
Artichoke leaf for hypercholesterolemia
SUMMARY
When trying to decide whether to use a particular herb, and from a particular company, ask these questions:
What are the claims? If clinical efficacy is claimed, is this supported by EITHER scientific trials or by tradition?
Is the herb in use by a majority of herbalists in any tradition?
Are veterinarians, biochemists, or board-certified herbalists involved in formula design?
Is the company selling it a member of the National Animal Supplement Council?
Is the product appropriately labeled?
Holistic practitioners treat individual patients, and recognize that the available science may not hold all of the answers for their problems. Cockcroft and Holmes (2003) have good advice for holistic practitioners: "EBVM is another facet of the constantly changing face of veterinary medicine. In general practice, no two situations are ever identical, we are constantly forced to compromise, and juggle competing needs. At the end of the day, we examine our consciences to assess our performance. EBVM provides one yardstick for us to measure up to, whoever we believe we are accountable to."
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http://www.cochrane.org/
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