I came across an especially egregious example of veterinary quackery recently which I wanted to warn people about. Petwellbeing.com, a subsidiary of the Canadian company Natural Wellbeing Distribution sells a product call Supraglan, which it advertises as a treatment for Cushing’s disease (hyperadrenocorticism). Cushing’s disease is a serious, chronic disease in which the body produces excessive steroid hormones, which have a variety of deleterious effects on many different body systems. It is usually caused by a benign tumor in the pituitary gland in the brain, which tells the adrenal glands to make too much of their normal steroid products. Some cases are caused by a tumor of the adrenal glands, which is almost always an aggressive, highly malignant cancer. The symptoms of Cushing’s disease can be created by chronic use of steroids given to treat other diseases, but this is a different condition in that if the patient stops getting the drugs then the symptoms will resolve.
The PetWellbeing website offers a brief, and inaccurate, description of the disease and then claims their product:
is gentle yet effective, safe for long-term use without adverse side effects…Supraglan is designed to restore your pet’s quality lifestyle and to increase life expectancy by reducing thirst and regulating elimination (liver/kidney and digestive); balancing blood sugar levels (endocrine); increasing muscle use and ability (anti-inflammatory); protecting against infection (immune); and by promoting a healthy skin and coat (natural herbs)
Of course, to cover their behinds legally, the company includes the Quack Miranda Warning on their page acknowledging that the FDA has not approved the product for what they are selling it for, but this is intended to apply only to products that are making so-called “structure and function” claims, meaningless and unscientific statements that the product “supports” some body system, not that it treats or prevents an actual disease. So the treatment claims are illegal to begin with since the drug is not FDA approved as a treatment for Cushing’s disease.
Unfortunately, even the minimal restraint showed by the actual manufacturer is not found on other web sites promoting this snake oil. One site states, “There are many similarities between the symptoms of Cushing’s Disease and Addison’s Disease in dogs–both considered fatal in canines. There are many rumors in regard to the miraculous healing of the natural supplement Supraglan, reported to cure both diseases.” Addison’s disease is a lack of adrenal steroid hormones produces by destruction of the adrenal glands. It is, essentially, the opposite of Cushing’s disease, and yet Supraglan is reported to cure both! How does it accomplish this miracle? Apparently, it uses, “natural ingredients to decrease the adrenal system in dogs from a completely hyperactive state, the product slows the overproduction of the corticosteroid hormones which have become overloaded in the dog’s system. Side effects have not been seen yet in the usage of Supraglan.”
So a natural, side-effect free cure for Cushing’s disease and it’s opposite. See any warning signs of quackery yet? So what’s in this miracle elixir?
- Borage: contains natural precursors of adrenal glands hormones; supports endocrine system functions; helps with detoxification; supports adrenal cortex.
- Astragalus: tonic; nutritive; supports liver function; helps maintain immune system.
- Bistorte: astringent, soothing, anti-inflammatory, has a tonic effect on liver and kidneys.
- Eleutherococus Senticosus: helps maintain normal hormonal actions (ACTH and cortisone) on adrenal glands; supports the immune system.
- Wild Yam: natural inflammation management; contains steroidal saponins (dioscin, dioscorin) used as sources of saponins in the preparation of steroid hormones.
- Licorice: adrenal supporting (contains glycyrrhizin, a compound similar to corticosteroids); immune support; anti-inflammatory.
- Dandelion: highly nutritious food; supports liver function, digestion and appetite.
Ok, now here’s the tough part. What’s the evidence to support these dramatic claims? You guessed it–reams of testimonials from “satisfied customers” and not one single research study of any kind. Some of the claims for the specific ingredients are found in reference guides to herbal therapy, usually based only on tradition or limited suggestive in vitro or lab animal studies. A search of the usual source, including Pubmed, Cochrane Reviews, even the National Center for Complementary and Alternative Medicine, which is quite friendly to herbal medicine in general, turned up not a single study that lent any support at all to the idea that these ingredients, individually or in combination, are a safe and effective treatment for Cushing’s disease.
I did find a few studies suggesting why some of the ingredients might be a bad idea to use in these patients. Licorice is known to cause pseudohyperaldosteronism, a hormonal imbalance which messes up the levels of sodium in the blood and can cause high blood pressure and even interfere with proper diagnosis of adrenal disease. Wild yams have been thought to increase some steroid hormones, and so have been used as a treatment for menopausal symptoms, but in reality it does not actually increase steroids, and its apparent effects on symptoms was likely due to adulteration of commercial yam products with synthetic hormones
There probably are some in vitro or lab animal studies, maybe even a small human clinical trial or two, that might have some suggestion of some potential effects on the adrenal hormone system. After all, herbs are essentially drugs, though usually unpurified and inadequately standardized and tested, so they likely do have some effect. I would be interested in any such studies any of you are aware of, but I can promise you there is nothing that would justify selling pet owners whose dogs have a serious, life-threatening disease, this concoction with claims that it will cure them or even meaningfully improve their quality of life. Testimonials, tradition, and blind guesswork based on in vitro studies are not sufficient to make such claims or profit from people with sick animal companions.
I expect I will now receive the usual angry comments of the following sort: “Who do you think you are?! I used it and my dog got better so you’re stupid! You’ve just been bought by Big Pharma to push their toxic drugs!” I have received such comments following previous posts on similar nostrums such as Neoplasene, Yunan-Paiyao, and so on. I don’t expect to be able to head these off, but I will try to save myself some time later and make a few points:
1. For reasons discussed at length here and anywhere critical thinking is respected, anecdotes are not proof, only suggestions of areas to study more formally. A million people are capable of being wrong as easily as one, so if you believe my assessment of this product is incorrect, show me real evidence, not testimonials. The hierarchy of evidence is the best guide to what is real evidence and what isn’t, if there is any doubt.
2. I make my living practicing medicine, and that includes treating Cushing’s disease. This has nothing to do with my objections to this product. If there were proof it worked, I would use it just like I use conventional treatments now. And don’t forget the folks making and selling this have a financial incentive to promote its use the lack of evidence it works that is far greater than any incentive I have to discourage its use. I am motivated by a belief that evidence and the truth serve my patients and clients better than false hope and misleading marketing.
3. I am not closed-minded, dogmatic, and I am happy to change my mind if the evidence warrants it. Being skeptical doesn’t mean disbelieving things automatically. It means withholding judgment until the facts are in. There are almost no facts to base a judgment on here, so the burden of proof is on those making wild claims (and a profit) on the product, not on those of us pointing out there is no good reason to think it works.
My Dog has Cushing’s, we’ve had every test done, in the last 2-3 weeks..I have spent 1200.00, from my Vet to a second opinion Vet, to a Specialist…all to tell me the same thing, her Liver is enlarged and no other reason they claim than Cushing’s…she will be 7 next month, she is a lasa-poo ( lasa apso/mini poodle)…I am heart sick about this I love her so much…and to top it all off..had Grandbabies the other day, we went for Ice Cream took my Lucy( my dog)..she was so excite she loves the babies, had her in the back of my SUV, for the first time her life of riding in my SUV, she in all the excitement( I guess) jumped out, it’s way too high for her short legs, I couldn’t believe she just jumped out and didn’t wait on me to get her, well needless to say she injured her leg back leg…back to the vet..sigh…she has( he calls) a floating knee( pulled Ligament?) anyway he put her on pain pills….my Question is..will any Natural Herbs help her?…or does it have to be all heavy meds?
Well, to begin with your question contains the implication that somehow “natural” herbs would be inherently safer than “heavy” medications. That simply isn’t true. If an herbal therapy has a beneficial effect, it is going to have undesirable side effects just like nay other medication. In this case, there have been no real scientific studies of the safety or effectiveness of any herbal products for Cushing’s disease. So trying one of these products is a roll of the dice, which is a lot less safe than using medications that have been thoroughly studies and have well-understood beneficial effects and potential risks. Information gives us the best chance for a good outcome, though there are no guarantees. And every choice has risks, but the choice to try something that hasn’t been tested is particularly risky. My recommendation is to find an experience, board-certified internist and follow their advice if you can.
Please tell me your opinion, if you have one an the Cushings treatment called Cushalin.
Here is their website.
We have been giving him Vetoryl for a couple of weeks, but we are not happy with the side effects. Loss of appetite, vomiting every morning.
Your thoughts would be appreciated. He is 12 yrs old and we just want to make him feel better.
The web site says very little about the product, but I can point out a few problems.
1. The site suggests homeopathy is part of the products and an effective therapy for Cushing’s. Homeopathy is never an effective therapy for any disease, as I have discussed in great detail elsewhere. Anyone who suggests homeopathy as a remedy is already misguided and mistaken, so that is a cause for concern.
2. The site says “The fact that Cushalin is completely herbal makes it completely safe for dogs and no matter what type of Cushing’s disease your dog is suffering from, Cushalin’s beneficial properties will help!” This is completely, dangerously wrong. Herbal remedies may sometimes be effective, but any that are also have potential side effects, and the evidence that they can be just as harmful as any other medicine is overwhelming. Once again, anyone who claims that any herbal remedy is guaranteed to be effective and guaranteed to be safe is either lying or doesn’t know what they are talking about. A money-back guarantee is worthless is a pet is sickened or killed by the product.
3. There is no indication of any research investigating this product, and the ingredients are not disclosed (supposedly because they are different for every pet, which sounds like a good thing until you realize that there is no way anyone can actually know precisely what combination of ingredients will be right for each patient, certainly not a company you order something from off the internet without any exam or diagnostic testing at all).
These and many other warning signs of quackery are all over the web site. The claims being made are quite likely illegal, though for practical and political reasons the FDA rarely pursues inappropriate medical claims made on the internet for veterinary supplements. In the absence of any scientific evidence at all, I think you would be substituting known risks and benefits for a complete roll of the dice on something unknown. If your dog is having trouble with the current therapy, I would discuss this with your veterinarian and talk about the options (changes in dose, supportive medication, other Cushing’s treatments, or even discontinuing treatment). All of these options are likely to be better for your dog than some internet snake oil.
I was researching my options and read your opinion on supraglan. I read all those wonderful reviews from their page and thought hundreds of reviews and not one low rating, something is fishy here. I further looked at reseller rating web site and saw lots of bad reviews for the company mostly on not receiving the product and extremely slow shipping on a product for a sick animal that shouldn’t have to wait, but one caught my eye saying she wrote two reviews that explained problems with the products and to date neither of her not so shiny review have made the list………..telling me they clearly either make up those shiny reviews or only handpick the ones that make the page.
Three years ago I was told that my Miniature Schnauzer had the symptoms of Cushing’s disease…excessive thirst and urination. Since the medications are so “dangerous” the vet recommended against treatment. He always took excellent care of her so I agreed. We now live in another state so she’ll see a new vet in a week and a half. But since you seem to know so much about Cushing’s and herbs, I’d like to ask you. What do you think of Dandelion, Astralagus and Burdock as supplements? They are reputed to help detox the body and normalize liver function. Do you think these can be harmful if given in an appropriate dosage? Would I be wasting my money?
Honestly, my dog seems fine. She doesn’t even drink as much as she used to and of course doesn’t void as much. She eats fine. She plays. She will be ten in September and doesn’t act like an old dog except sometimes in the morning her joints seem a little stiff.
I would recommend no therapy for Cushing’s disease unless it is properly diagnosed. So before giving anything, I would have the appropriate blood tests and imaging studies done. Sometimes, if the symptoms are minimal or if there are other considerations (other disease, cost, etc.), it may be appropriate to monitor and not treat.
If you have a real diagnosis and decide it is worthwhile to treat, I would absolutely begin with the medications that have been proven to work and for which we understand the risks, lysodren and trilostane. They are not without risks, which has to be considered in making the decision whether or not to treat, but the risks and benefits are understood. For the herbal remedies and the dozens of concoctions like Supraglan, the risks and benefits are either completely unknown, or there are none. The herbs you mention have sometimes been recommended for Cushing’s, but there have been zero clinical trials to determine if they are safe or if they work. Sure, you can probably find anecdotes suggesting they do, but you can find the same for every other treatment out there, including things like homeopathy, which has been proven not to work, and all kinds of things which can only be described as magic. So either science isn’t useful and everything works sometimes, or anecdotes aren’t really reliable.
So while I can’t tell you what is right for you and your dog, I would be cautious about experimenting with treatments without going through the steps of getting a proper diagnosis and making sure the treatments you choose have been tested appropriately.
Briar does have an enlarged liver and her labs have shown worse numbers r/t liver damage over three years. However, I do agree with not treating unless we’re sure. We’ll meet with our new vet and see what their opinion is of her current condition. At the moment the only symptom I see is panting. I just don’t want to do the wrong thing and how can you possibly know for sure until you can look back and evaluate the results. Thank you for your comments. I’m glad I found this site.
As an update to Pepsi’s condition, he is still going strong at 17 years. The vet is amazed he is still alive after seeing the condition he was in when he saw him in 2012. He only has fur left on his face and legs, but his skin is completely free of bleeding scabs. I thought I would add the Pet Alive Skin and Coat Tonic to his Cushex Drops to see if that would improve his coat any. That proved to no avail. But I did notice he had extra energy and at the time did not attribute it the herbs. When the bottle ran out, I did not buy anymore. But then I noticed his energy levels decreased back to his normal level. So I decided to try the skin tonic again and his energy increased. Every time he goes off the tonic, he loses some energy, so now I am keeping him on it all the time. I have no explanation for this weird occurrence.
Occasionally he will pee on the carpet, but compared to 2 years ago when he was nonstop peeing while he was walking, that is more than I could expect, and he still does not pace all the time along with his belly back to normal size and drinking a normal amount of water.
I also make his food from equal parts chicken breast, pumpkin, and yams. I do not know if that plays any part in his health.
Let me get this straight, A product that’s supposed to treat a disorder where the body overproduces steroid hormones that’s active ingredient is steroids and steroid glycosides? *FACEPALM*
This case study seems to have some pretty good references and supporting published journal articles regarding the successful treatment of a Cushing’s dog using a combination of both Western and traditional Chinese medicines. Trilostane and Si Miao San (SMS) an ancient herbal formulation were used. I had never heard of it before. Very interesting reading! Here’s another study regarding the herbal formula: https://www.researchgate.net/publication/257247725_In_Vitro_Anti-inflammatory_and_Antioxidant_Potential_of_Si-Miao-San_its_Modifications_and_Pure_Compounds.
Perhaps we are finally starting to listen to each other and share our sciences! It would be awesome to see more of our Western world funding given to academic research or peer-reviewed scientific studies, willing to explore other cultures practices. Who knows what discoveries are just around the corner.
It is very common for purveyors of alternative therapies to use both science-based treatments and CAM and then suggest the CAM therapy made a difference. Given the thousands of dogs successfully treated with trilostane and NO TCM, a case report like this is pretty meaningless. It’s just a dressed-up anecdote, and it doesn’t substitute for a plausible scientific mechanism or actual comparative controlled research evidence.
I used Supraglan on my lab Shepard mix dog. It worked very well for her. The vet wanted to use harsh drugs on her. Constant trips to the vet for exams and bloodwork. She kept all her hair on Supraglan and lived to be 16 years.
Glad your dog is doing well, but anecdotes like this don’t actually prove anything. Here’s a bit more detail on why:
Why Anecdotes Can’t be Trusted