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Are supplements for cystitis worth it in cats?


As an owner it can be very upsetting and frustrating if you cats start to show signs of cystitis. They are often uncomfortable, agitated, distressed and may produce small but frequent amounts of urine – often house soiling rather than using their litter tray.  But are those supplements advertised everywhere likely to be effective?

What is cystitis?

Feline lower urinary tract disease (FLUTD) is a term describing conditions that can affect the urinary bladder and/or urethra (the lower urinary tract) of cats.  There are MANY diseases can affect a cat’s urinary tract. In a number of these cases cats develop a disease without any obvious underlying cause therefore it is called ‘feline idiopathic cystitis‘.

According the International Society of Feline Medicine, this form of disease appears to bear many similarities to a disease in humans called ‘interstitial cystitis’. In both cats and humans, it can be difficult to manage and many people have to adopt a management plan that includes multiple interventions. This may include the use of:

  • Medication
  • Diet changes
  • Home adaptations
  • Supplements 

As these conditions can reoccur and can take up lots of time and money to manage – lets investigate if the supplements are worth it.

Supplements

As usual when it comes to supplements, which are not controlled in the same ways as medicines and do not need to prove that they work to be sold, the evidence is sometimes contradictory and confusing.  Let’s explore the common ingredients found in supplements aimed at cats with cystitis. 

Raw ingredients

Common ingredients seen include:

Milk Protein Hydrolysate 

One study showed a positive effect of a urinary food supplemented with ingredients (milk protein hydolysate and L-typtophan) to control anxiety-related behaviours on signs of lower urinary tract disease and anxiety-related behaviours in cats with FIC. However, this study was heavily flawed in that it only had 10 participants with full clinical history – no strong conclusion can be drawn and more robust methodology is required.

Quercetin

In theory, this is added to regulate inflammation and help to support stress coping mechanisms. There is some weak evidence that Quercetin derivative has some anti-inflammatory activities. Therefore, it is plausible that there may be some benefits seen in administration.

L-Theaninean

Is added as an amino acid found in green tea with claimed natural calming properties to reduce stress behaviours in cats. There is some weak evidence that this supplement helped to improve the undesirable manifestations of stress in cats. While the basic principle that l-theanine is biochemically active is plausible, there is still little compelling evidence it actually helps. Indeed, in this particular study using a small sample size the caregiver placebo effect among numerous other potential confounders and sources of error makes it impossible to draw reliable conclusions. 

L-tryptophan

A study showed some potentially positive results – In cats, after L-tryptophan supplementation all the stereotypies decreased. Another study though had variable results as to whether it helped. 

Hyaluronic acid

Hyaluronic acid is an important constituent of bladder surface glycosaminoglycans and is a barrier. 

One study in humans found positive results with the use of intravesical (directly into the bladder) hyaluronan therapy, however when orally ingested the bioavailability is variable, and the amount that could ultimately be used by the body for helping in reducing inflammation within the cats bladder is unclear.

N-acetyl glucosamine

Glucosamine is added to supplements as it has been suggested to aid in the replenishment of GAG, an important constituent chemical found in the mucous lining of the bladder. This means that its use could aid in supporting the integrity of the bladder – studies have once again shown variability in how useful these actually are with some showing no difference in the cat’s health when administered. The theory is plausible – with one very small study finding administration did increase levels of plasma GAG concentrations, and in cats with idiopathic cystitis these typically had lower urinary GAG-to-creatinine concentration ratios than did clinically normal cats.

Other considerations

Although supplements theoretically may benefit your cats, they should not be the sole intervention you use to manage feline cystitis. Indeed, there are actually interventions I would deem much more significant given the evidence for supplements can often be weak. This is typically not a drug responsive disease for the long-term management, although medications are commonly required in the acute phase to keep your cat comfortable.

What else do I think are more important?

Dilute the urine

More dilute urine is potentially less irritant to the cells lining the bladder. Encouraging more frequent urination and producing urine that is more dilute appears to be helpful in these cases.

We can achieve this by:

  • Modifying the diet by changing to a wet diet rather than a dry diet.
  • Making sure a good supply of fresh water is always available – cats should be encouraged to drink by offering water from different bowls.
  • Using water fountains to encourage drinking
  • Adding flavours to water such as chicken
  • Adding a litter more water to their wet food if they allow

Stress

Stress plays a very important role in triggering cystitis, see the 5 pillars to assess your cat’s needs.

Five pillars of a healthy feline environment include providing:

  1. A safe place
  2. Multiple and separated key environmental resources: food, water, toileting areas, scratching areas, play areas, and resting or sleeping areas
  3. An opportunity for play and predatory behavior
  4. Positive, consistent and predictable human–cat social interaction
  5. An environment that respects the importance of the cat’s sense of smell

Conclusion

Feline cystitis is sometimes as frustrating to treat for a veterinary professional as it is for the owner – it’s not always an ‘easy fix’ and requires lots of changes to different aspects of a cat’s life and environment to help.

Supplements may be a small part of this management, and certainly some of the constituents in the supplements have very plausible claims to how they could help. However, given the weaker evidence I would not choose to put my trust in these as the ‘miracle cure’. There are many other important factors such as diet type and providing an environment that meets your cats very unique needs as well as seeking timely veterinary care in the acute phase of the disease when cats can be very distressed and uncomfortable.

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