The second part in a series examining the claims, benefits, and detriments of enhancers with a focus on injuryIn the second part of our three-part series on performance maximizers, we take a more detailed look at various treatments and medications in relation to repairing injury.
Regardless of tissue type, there are basic stages that occur when a tissue is injured. The degree and severity of the injury determines the extent of the tissue response. The design of a tissue's response to injury is to restore the tissue's integrity and to ensure a return of its function. Following an injury, there is an acute inflammatory stage characterized by a vascular, cellular, hemostatic, and immunologic response. There are several intermediate steps that occur during this phase that are regulated by tissue chemical mediators. After the acute inflammatory phase, a tissue repair stage occurs, and this is then followed by a long-term tissue rehabilitation and remodeling phase. Following a single injury event, the initial inflammatory state occurs immediately and generally lasts several hours.
The repair stage usually takes days to weeks, and the remodeling phase usually occurs in a weeks-to-months time frame. The restoration of a tissue's integrity and its full return to function is the goal of the tissue inflammatory response.
The foundation of a treatment, medication, or therapeutic is based upon: 1) minimizing initial tissue trauma; 2) preventing or minimizing tissue reinjury; 3) manipulating a tissue's inflammatory reaction; or 4) a combination of these factors.
Based upon the treatment foundation then, therapy goals include: pain reduction, restoration of tissue function, reduction of down time and early return to full use, cosmetic result, and prevention of further injury. Regardless of the quality and benefits of a medication or therapeutic, a tissue may be reinjured.
There are several reasons that a clinical or subclinical injury may occur. These include, but are not limited to: poor conformation; lack of fitness; poor equipment; poor footing; poor jockey, trainer, farrier, handler, or veterinarian technique; accident; etc. Consequently, a consideration of these factors, sufficient time for tissue healing, and judicial handling of an injury and the horse are critical factors in a speedy recovery.

The cell switch
Botanical medicines (herbs), synthesized drugs, medications, and therapeutic medicinal feed additives work by activating cell switches. Once these switches have been activated, the cells react in distinct and precise ways. The specific cell response can often be initiated by different compounds or substances. The extent, degree, and strength of the cell response is controlled by the potency of the compound or substance that activates the cell switch.
A cell switch (cell receptor) can be thought of as a lock that takes a specific key or keys (herb or drug) to open (activate). Some locks are very precise and take a very special key to open it, while other locks are less precise and can be opened by any of a number of similar keys. In many situations, an herb mimics a drug and can activate a cell switch and promote the subsequent cellular reaction. Many people think that herbs activate cells with fewer adverse effects on the rest of a horse's body. This is true in some cases. However, as scientific research continues, the active ingredients in some herbs, heretofore thought to be innocuous, has turned out to be deleterious drugs.
In addition, some natural or naturally derived therapeutics have been utilized because they "do not test." However, as science progresses, the active ingredients in some of these natural therapeutics with anti-inflammatory, calming, or stimulating properties will be identified and subsequently tested for.

Nature's compounds-nutraceuticals
A list of herbs and their purported activity will be addressed and presented in the future. The water and fat soluble vitamins and minerals and their functions will be presented at the same time. The following cursory review will cover highlights of some currently utilized nutraceuticals. The following compounds are found in one or more commercially available products.
Antioxidants-Free radicals are highly reactive molecules that can bind to and damage cellular components by virtue of an unpaired electron. They are usually present in small amounts in a horse's body and are successfully inactivated. Trauma and cell injury can result in the production of large numbers of these molecules with further severe tissue damage occurring.
Inactivation of the free radicals (oxygen-free radicals) is usually accomplished by one of four free radical scavenger enzymes that occurs naturally in the horse. These are catalase, methionine reductase, glutathione peroxidase, and superoxide dismutase (SOD). In addition, there are other nutrients that can neutralize free radicals. These antioxidants include: Vitamins A, C, E; selenium; Coenzyme Q; some amino acids; zinc; and MSM. DMSO (dimethyl sulfoxide) is also a free radical scavenger.
Bioflavinoids (Vitamin P)-Bioflavinoids are naturally occurring compounds that usually account for plant pigments, especially in plants rich in Vitamin C. Evidence from Europe suggests bioflavinoids strengthen capillaries, augment immunity, and potentiate Vitamin C in collagen formation and strengthening wounds. Hesperidin and rutin are two common bioflavinoids.
Cartilage compounds-Shark and bovine (cow) cartilage provide usable forms of calcium, phosphorous, and chondroitin sulfates. They are reported to have anti-inflammatory properties as well. In addition, shark cartilage has been shown to prevent micro-vessel formation and vascularization, thus minimizing a step in degenerative joint formation.
Coenzyme Q (CoQ) and creatine-Also known as ubiquinone, Coenzyme Q is an integral part of each cell's power-producing organelles, the mitochondria. These cell "powerhouses" produce the cell's energy currency-ATP (adenosine triphosphate). CoQ is reported to prevent fading and fatigue by permitting maximum exertion to continue for a longer period.
Methyl-guanido acetate is commonly called creatine. It is a normal body metabolite involved with the production of ATP in the body. Once its energy is released, ATP is converted to ADP (adenosine diphosphate). The ATP is regenerated to provide further energy through an aerobic system, an anaerobic system, or through the creatine phosphate system using creatine. Creatine is reported to provide a rapid energy source for ATP regeneration.
DMG (Vitamin B15)-Dimethylglycine, also known as pangamic acid, was originally considered one of the B-complex vitamins. That is debated today. However, it has been categorized as a biologically active nonfuel nutrient, a metabolic enhancer. It improves the function of several metabolic pathways. DMG is important in the ATP production pathways, as well as the function of the immune system. It improves oxygen uptake and transport within cells and has also been shown to decrease the onset of fatigue.
Joint enhancers-Joint surfaces are comprised of an articular cartilage cap over an underlying bed of bone. The cartilage cap is made up of cartilage cells called chondrocytes surrounded by an array of cordlike structural support molecules. The largest of these are collagen "cables" which provide strength. Smaller ropelike structural molecules are called proteoglycans (PGs). They are made of hyaluronic acid (HA) backbones with glycosaminoglycans (GAGs) and polysulfated GAGs (PSGAGs) branches coming out from them. A major component of the GAGs is chondroitin sulfate (CS).
During trauma, these joint components degrade and need to be replenished. The horse's body does this, but slowly. The addition of HA, GAGs, PSGAGs, glucosamine (a PGs precursor), and CSs augment their production at the joint level, inhibit destructive joint enzymes, decrease joint inflammation and pain, and provide more normal joint lubrication. Their continued use is most beneficial.
MSM-methyl sulfonyl methane is the biologically active metabolite of DMSO. It provides biologically available sulfur which is utilized in several biological molecules. It helps minimize the effects of stress, alleviates chronic pain, and appears to reduce inflammation.
Many product claims, theories, and supportive documentation are founded upon basic information of the horse's anatomy and physiology. Knowledge of basic principles provides a foundation for critical evaluation of the claims of the overabundant remedies, medications, and therapy methods that inundate the equine market. Often a choice between competing products can be made based upon understanding of their method of action. The best therapy, though, will not help if common sense is not used to prevent reinjury. Sometimes "tincture of time and Mother Nature" are the best alternatives for our horses.