Protandim–Snake Oil Marketing at its Best (or Worst)

There are a seemingly infinite number of herbal remedies and dietary supplements marketed for pets, thanks largely to the inadequate regulation of such products and the inability of the government to enforce what rules there are. This creates an open field for unproven or outright quack remedies, which can be cheaply and profitably marketed to worried pet owners trying to prevent or treat serious illnesses. The resources spent in this way would be better used in rigorous scientific evaluation of such remedies to identify which have real value and which do not, but such is not the way of the medical marketplace.

It is impossible to look into even a small proportion of these nostrums and evaluate the evidence for the claims made by the individuals and companies selling them. However, when one of these products is brought to my attention, by a client, advertising literature, or an investigative review done elsewhere, I try to evaluate the claims and evidence for that product and make that information available to pet owners and veterinarians here. In this case, a previous review and a recent update at Science-Based Medicine, by Dr. Harriett Hall, drew my attention to a product called Protandim.

 What Is It
The reported ingredients are milk thistle, bacopa extract, ashwagandha, green tea extract, and turmeric extract, though the blend is “proprietary” and no details are given.

The marketing of Protandim [Note 7/25/2013-Link broken, original page has been removed] resembles that for the DogterRx I investigated recently, in that it has many of the classic warning signs of snake oil, including:

A mixture of multiple herbal ingredients with different proposed effects and mechanisms (though as always there is some overlap since most herbal products are claimed to be useful for a tremendous variety of problems).

Vague claims about treating “oxidative stress” and “inflammation” based on in vitro or lab animals studies, with the implication that “anti-oxidant” and “anti-inflammatory” agents must automatically be safe and beneficial.

Claims for benefits in a wide range of unrelated medical conditions, including

Better skin and coat
Increased energy & endurance
Healthier immune system
Better sleep
Better joint health and mobility
Reduced joint pain and inflammation
Stronger resistance to allergies
Stronger resistance to Valley Fever (Southwest)
Better tooth & gum health
Better cardiovascular health
Increased mental function and alertness
Reduction of age-related cognitive decline
Anti-aging effects at the cellular level
(The claims in the company patent are even more amazing.)

And apparently it is good for conditions which are exactly the opposite of each other:

If  your pet seems moody or lethargic, why not try giving them a dose of Protandim…

High energy dogs and service dogs are also excellent candidates for Protandim.

Claims of perfect universal effectiveness:

It’s been scientifically proven to work in 100% of the people, 100% of the time!

Just one caplet of Protandim per day is clinically proven to reduce oxidative stress an average of 40%, reducing the level of cell aging to that of a 20 year old or a very young child, regardless of your age!

Dramatic testimonials of miraculous effects.

An aggressive distributed, multilevel marketing structure that tries to recruit anyone who buys the product to be an “authorized distributer.”

And of course, “Protandim is all natural, and there are no known side effects except allergic reactions to one of the ingredients…” So it can reverse aging, prevent or treat almost any illness, and fundamentally alter your body’s chemistry without any possible side effects? Amazing!

The makers also make the ridiculous assumption that any benefits in humans (as poorly substantiated as they may be) can automatically be assumed to be seen in “all mammals.” They do not make a veterinary product but simply give this advice:

How to Share Protandim with Your Pet

Start by crushing a caplet and mixing it in a treat your pet enjoys or their usual food. Use less Protandim for smaller animals, more for larger dogs (try a pinch for a small animal or cat, to a  whole capsule for large animals). Observe closely for improvements in behavior, improved energy, pain reduction, sleep, etc. When administering Protandim to an animal, err on the side of using a smaller dose and increase gradually as needed.

The company will produce a special version of Protandim just for pets in the future. But for now, cut down the yellow caplets to create pet-size dosages.  This will work just fine.

Gee, who knew that the entire field of pharmacology was unnecessary and one can just pick what looks like a “pet-sized dose” of a human medicine and it will work just fine!

Does It Work?
The underlying theory used to promote this product, that anti-inflammatory and anti-oxidant effects are beneficial for a wide range of unrelated diseases, is dubious. Anti-inflammatory medications, such as steroids and non-steroidal anti-inflammatories, do have demonstrated benefits, but not surprisingly these come with demonstrated risks. Anything that suppresses inflammation, whether or not it comes from a plant originally, is tinkering with a core physiologic process, and it is simply impossible to do this without risk. the issue of whether the benefits outweigh the risk for particular patients with particular medical conditions, is one that can only be answered with the kind of research that has not been done for this product or its constituent ingredients.

Interestingly, there is also growing doubt about the benefits and safety of anti-oxidants. The hype about anti-oxidants has turned out to be unrealistic, and risks have been seen with Vitamin C, Vitamin E, and other known anti-oxidants. Free radicals and oxidative compounds do have the potential to cause damage and disease. but they are also responsible for some of the protective activities of our immune system, for the beneficial effects of some anti-cancer therapies, and other positive phenomena. As always, tinkering blindly with a common chemical or physiological process is likely to have more risks and fewer benefits than a targeted use of specific and well-researched medicines for specific problems.

There is a fair amount of in vitro and animal model research, a little bit of clinical trial research in humans, and even the occasional small clinical trial in veterinary species, looking at the activity and effects of the individual ingredients. None of them have well-demonstrated benefits or clear evidence that there is negligible risk in using them, but several have interesting properties that warrant further study. It would not at all surprise me if compounds derived from some of these ingredients turned out to have therapeutic value, but that is a far cry from justifying the kind of claims made for this product.

And naturally, the mixture in Protandim is claimed to be more effective than individual ingredients taken separately. The web site even states quite precisely (if meaninglessly) that the ingredients have “1500% greater synergy working in tandem (together) than what they are able to achieve on their own.” This is even more impressive given that isolated and purified compounds are usually safer and more effective than variable mixtures of many chemicals. Synergism in plant-derived remedies has been demonstrated in some cases, but it is not a general rule that can be relied on. Polypharmacy (the use of mutliple drugs and herbal remedies or supplements) significantly increases the risk of undesirable interactions between compounds.  Once again, apparently the rules of pharmacology don’t apply to this product. 

Dr. Hall has reviewed the few studies on the product itself.

My original article only mentioned the 3 studies available at that time. As of this writing (October 2011), a query to PubMed brings up 8 published, peer-reviewed studies:

1. A human studyshowing changes in TBARS, SOD, and catalase.(2006)

2. A cell culture studyshowing increases in glutathione. (2009)

3. A mouse studyshowing an effect on skin tumor carcinogenesis. (2009)

4. A study in a mechanical animal model showing that chronic pulmonary artery pressure elevation is insufficient to explain right heart failure. (2009)

5. Another mouse studyshowing that Protandim suppressed experimental carcinogenesis and suggesting that suppression of p53 and induction of MnSOD may play an important role. (2010)

6. A study of muscular dystrophy miceshowing that Protandim decreased plasma osteopontin and improved markers of oxidative stress. (2010)

7. An ex vivo (tissue culture) study of human saphenous veins, showing that Protandim attenuated intimal hyperplasia. (2011)

8. An evaluation of the role of manganese superoxide dismutase in decreasing tumor incidence in a two-stage skin carcinogenesis model in mice.(2011)

…If I were a mouse being artificially induced to develop skin cancer in a lab study, I might seriously consider taking Protandim. But so far, the only study in humans measured increased antioxidant levels by a blood test but did not even attempt to assess whether those increases corresponded to any measurable clinical benefit, for cancer or for anything else.

So there is no evidence of clinically meaningful effects in humans, limited evidence of physiologic effects in humans which may or may not have any relevance to health, and of course no clinical studies at all in veterinary patients. Clearly, this doesn’t even begin to approach a reasonable justification for the wild claims made by the marketers of this product.

Is It Safe?
Who knows? The individual ingredients have been associated with some adverse reactions, both allergies and others. But in the absence of formal study, we don’t even know how common and serious these are. Far more extensive research is done on pharmaceuticals before they are released into the market, and unexpected problems still show up in those products. Our ignorance about these compounds is much greater, and therefore so is the risk of using them blindly. There is no safety information at all about the combination product.

Bottom Line
The underlying theory used to promote this product, that anti-inflammatory and anti-oxidant effects are always safe and beneficial, is highly doubtful. There is only weak in vitro and animal model research to indicate that the ingredients in Protandim, or the combination product, have potentially useful effects on cells or biochemical markers. There is absolutely no clinical trial evidence to indicate Protandim has any of the claimed benefits in humans or animals. While the absence of evidence is not proof the product is unsafe or ineffective, it is absolutely a reason to be skeptical of wild claims of miraculous benefits. At best, using this product is simply rolling the dice and hoping for the best. That seldom works out for gamblers in Vegas, and it is not an appropriate approach to healthcare except in the most dire of circumstances.

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62 Responses to Protandim–Snake Oil Marketing at its Best (or Worst)

  1. Cindy M Durham says:

    I am neither scientist or doctor, but am a horse dog and cat owner in my 50’s. My horses are also in their 50″s (in people years- they are actually 20) and one of my dogs is very old and still trying to battle the valley fever he contracted 2 years ago.

    With all of that being said I am not one to just buy into the the latest fad. However I do compete with a lot of people who are. This proves helpful for me because they get to be my “test subjects”. I’ve been watching people rave about the “little yellow pill” that they have been giving their horses. The claims of “Shaved a full second off of our barrel run” was heard over and over again. I wasn’t really buying it…..until a close friend of mine tried it on her retired barrel horse. I have known this horse personally for years. I knew him when he was at the top of his game, and I saw the decline of “his game” as he aged. He has navicular (an internal hoof issue- for those who don’t know) and he has breathing issues. After 30 days of being on the protandim I saw this horse go out there and flat out smoke a barrel run, just like he did when he was younger. I admit to being impressed.

    So…I tried it. I have a 20 year old Appaloosa mare named Melody and a 20 year old paint horse named Trax. Trax just started barrel racing at the age of 19, and Melody is a semi retired show horse.

    Melody has severe arthritis in her hocks and stifle, and a torn hamstring in her right hind leg which limits her range of motion. Also Melody has not shown a normal heat cycle in the 3 years that I have owned her. So I assumed she was past breeding age.

    Trax is in a little bit better shape than her but also has severe arthritis. Both horses are still very active but compete on a much lower level than younger horses.

    Because of the changes I saw in my friends horse I gave this snake oil a try in both of my old horses. Here are the results that I see.

    Trax, is moving in a more full stride at a lope. Before he would keep his hind legs together moving in more of a bunny hop motion to protect his hind end. Last year I had to inject his hocks to relieve that pain. But the injections had worn off, so before injecting him again I tried the protandim. It seems to have made a difference. When Trax is not in pain he is a more willing partner. He enjoys his job, which makes him easier to ride.

    With Melody the changes are much more evident. She is also is moving better. She is naturally a horse that loves to work. She lives to work a cow, or to run a barrel pattern, or really to do anything you ask. But in the last couple of years her energy level had dropped, and her ability to perform was becoming more and more limited. I had to prompt her harder to perform the moves that she used to be able to do with ease. With the protandim she really honestly and truly is more like her younger self. She feels good and it is evident every time I saddle her. She is excited to get out there and work, she is clocking a full 2 seconds faster on her barrel times, and it takes very little “ask” from me to get her to do those difficult show moves. BUT the biggest change is that for the first time since I owned her she had a normal heat cycle. I was literally blown away. Alot of people don’t want their mares to cycle, but I’m a firm believer that a healthy cycle means you have a healthy horse (insert dog cat or human).

    I actually had to back the dosage down on both horses because Melody was getting a little too “hot”, which is exactly who she was as a young mare. I know that some people are going to think that maybe instead of pushing these horses to keep working as they age I am being unfair. But I can assure you that in the horse world, the longer you keep these old horses moving, the longer they live.

    With that in mind I have just started my old labrador on the pill also. I don’t know if it will help, but I am willing to try it. I talked to my rep, and did my research on the dosage. Maybe it will help maybe it won’t, but nothing else is helping him so why in the hell wouldn’t I try it?

    On another note, I am personally afflicted with a certain type of lupus which causes my nose to break out in blisters almost all the time. While I have not started the protandim, I did start a daily dose of just the Tumeric, and noticed the other day that my skin had cleared up. Is it related? I don’t know. Only time will tell for sure.

    In conclusion- I don’t know if Protandim is the end all be all. I know that some people see results, and some don’t. I know when you get to the point that nothing else is helping, it doesn’t really hurt to try it. I know that some people/animals have allergic reactions too it, but then again we all have something that we are allergic too. I can’t take certain antibiotics, but that doesn’t mean that they aren’t a valid drug for other people. I feel like there is value in this product for some animals/people. I feel like for someone who is tired of ten million drugs, it is worth a try. Maybe I am wrong. If so I am ok with that too. This is just my personal experience with it.

  2. Deanna says:

    I have known as many people who take Protandim and swear by it. Our dog was having grand mal seizures we gave her Protandim and took her off the vet medication over a two-day. She did not get any more seizures so a couple weeks later we broke her Protandim and half and she got a small seizure so we put her back on Protandim she never had another seizure again. We did this because of another dog family who had done the same thing. They make Protandim for pets now it’s just a little different is my understanding and what they put in there. It’s really really sad that this vet page is so against Protandim when they could be helping so many animals the medication they put our dog on for seizures was absolutely the worst side effects it was so horrible

  3. skeptvet says:

    Anecdotes don’t prove anything because we are easily misled by our own experiences. Scientific research is far more reliable. If Protandim did all the things claimed for it, it should be easy to prove this in research studies, but this hasn’t happened, which is good reason to be skeptical.

    Why Anecdotes Can’t Be Trusted

  4. Angela says:

    Well, animals don’t lie, nor do they know placebo effects. They are my best testimony of the proof that there are huge benefits in taking an NRF2 activator.

    I don’t know what you can say against 27 peer reviewed studies. Most pharmaceuticals only have 2-3. Not to mention the other 9k studies on the effects of NRF2 activation and disease.
    If it didn’t work, pharmaceutical companies wouldn’t be trying to make synthetic versions of NRF2 ie Ticfedera by BioGen for MS patients…. by the way, the cost for Ticfedera is roughly $15k a year. Can’t be on it long because it harms your liver and kidneys. You might want to do a little research and find the study where BioGen paid an outside researcher to compare Protandim with Ticfedera. The researcher wrote that Protandim out preformed Ticfedera and suggested it would be better for patients to take Protandim since it does spare oliogodendrites.

    With all the studies that just keep rolling out… it’s more that proven to NOT be snake oil.

  5. skeptvet says:

    To begin with, you are wrong about the placebo effect. Animals in clinical trials show effects on placebo all the time. Some are due to people who are assessing the animals being fooled, others are due to non-specific effects from participation in trials, conditioning, etc. But it is well established that placebo controls are needed for veterinary clinical trials because a relevant placebo effect does exist.
    Here is a brief article discussing this:
    What is a placebo?

    There are not 27 clinical trials showing Protandim works, so that’s simply false. Not only has the product not been shown to be safe and effective through clinical trials, but the FDA has actually issued a warning letter to the company for false claims about this. Your defense of this product contains clear and obvious statements that are not true.
    Here is an ongoing series of articles reviewing the evidence for this product:
    Protandim: Science-based Medicine

  6. Whitney Blake says:

    Love this response. It changed my life. I couldn’t walk or sit without ridiculous pain in my body on my left side, low back down to my feet. 3-4 years of pain pills, tears, horrible chiro adjustments and many more painful avenues. Within 2 weeks I had NO pain! And I am a medical/therapeutic massage therapy and tried almost everything. It was the only thing that gave me permanent relief. I hope it does the same for you and your animals.

  7. Whitney Blake says:

    Regardless. It works. After several years of pain it relieved it, in two weeks. Period.

  8. skeptvet says:

    If only it were that easy. But then we’d have to believe in every single therapy ever invented because at least one person says it worked for them.

    Here is some more information on why anecdotes mislead us.

    Why Anecdotes Can’t Be Trusted

  9. Sean Bowers says:

    The problem is there’s actually peer reviewed studies that prove it works. Being a Dr. that should mean something to you. Don’t let the vehicle it used to be distributed blind you to actual proof.

    Yes I’m technically a “distributer” but I don’t really sell it but I’ll never go a day without it again. But I realize my word isn’t worth much. That’s why I always point to peer reviewed research that backs it.

  10. skeptvet says:

    Actually there are not trials showing it works. There are three trials on pubmed and none show a meaningful effect on any clinical important outcome measure. Here are some discussions of the published studies.

  11. Lori Atkins says:

    I tried nrf2 protandim to help ease my dogs allergies. After about five days her allergies exploded. Was told by our Vet that the supplement was the cause.

  12. skeptvet says:

    Well, to be fair I don’t think that proves anything any more than all the stories about allergies going away on Protandim prove it works. However, one big problem with products like this is that most of the time only people who have had a positive experience share that, which creates the false impression that everything thinks the product works, so it’s useful to have stories like this for balance.

    I hope your dog feels better!

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