Raw, raw, raw ‘yer boat…Take 2019

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The practise of feeding raw and homemade diets to cats and dogs has been written about before- by others along with yours truly (Reviewing Raw Diets, Raw Raw Raw ‘Yer Boat). Regardless of how you (or I) may feel about this practice, raw and homemade food diets are a rising share of the pet food market and it’s good to have information about what’s occurring in one’s own neck of the woods, i.e. regionally.

 

This research from the Atlantic Veterinary College (AVC) was recently presented at the American College of Veterinary Nutrition (AAVN) conference in Phoenix, AZ. Data from the questionnaire, together with considerable input from AVC’s infection control team, led to the creation of a raw food feeding policy for the hospital in order to keep patients, students and staff safe.

Research that targets regional practices and associated risks may not be sexy (i.e. attract much funding), but this type of program evaluation effort is priceless (and practical) as it helps us do things on the local level, such as:

1) Reducing (and ideally eliminating) entry of raw food into the veterinary hospital

2) Preventing infectious disease transmission of pathogens (bacteria and parasites) from pets eating raw food diets and shedding these pathogens to other hospital patients (i.e. dogs and cats), and hospital staff (i.e. humans) who come into contact with these pets.

3) Establish risk awareness and trace-back in case of outbreaks

Reduction of disease risk for our pets and fellow humans is something I think we all want. And while I am a proponent of doing whatever ‘floats ‘yer boat’ for your pet nutritionally, (provided you’ve taken steps to reduce risks and provide balanced and complete nutrition), one of the biggest reasons we performed this study was to connect with the folks who know their cats and dogs best, so we can work together to optimize their care.

As always, our sincere thanks to the dedicated pet-owners who voluntarily provided information to help us understand client choices for pets and identify areas where we can communicate and educate in order to work as a TEAM in optimizing pet health.

Top 5 Reasons to Read a Review on Raw Meat-based Diets

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Continuing along with the ‘Top 5’ theme from the last blog , a recent review article on ‘Raw diets for dogs and cats’ nicely summarizes the rationale behind (and concerns related to) feeding raw meat-based diets and products.

The publication divvies subject matter into layer-cake categories and tables of scientific evidence. I’ve condensed the topics below for those of you with the attention span of the proverbial gnat (like me) or an interest in specific sections of the paper.

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1.     Practice, rationale and motivation for feeding raw meat-based diets, i.e. ‘what are the reasons behind feeding these products to one’s dog or cat?’ This is an important section, in part to help prompt veterinarians and clinic support staff to remember to ask about diet history during vet visits. Our own research here at AVC showed a startlingly high percentage of raw meat feeding practices (homemade and commercial diet format), which led to establishment of a raw food policy in order to reduce infection risk between animal patients, human staff and my lovely veterinary students.

2.     Evidence behind raw food benefits. Spoiler alert- There is some evidence, but it seems related to the creation of small firm poopies by a group of Boxers and kittens, which may (or may not) be considered a benefit, dependent on how one prefers poop to look…I’m not sure how the Boxers or kittens felt about it. The rest of the evidence (tackled in other reviews and addressed by the AVMA and WSAVA) appears to warrant a 6 or 7 on a Fecal Grading Chart, i.e. the evidence is thin and watery.

3.     Controls on raw food diets source materials and processors, i.e. safety regulations in the EU and USA. This isn’t a big section…partly because while there is regulation…there isn’t always all that much occurring in terms of oversight.

4.     Health risks of raw feeding related to nutrition and infection

a.     Nutritional imbalance and deficiency risks. This underlines the importance of feeding a diet that is complete and balanced, and unfortunately these diets are frequently neither.

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b.     Infection risks (bacterial) to dogs, cats and humans. This category covers various bugs, such as Salmonella, E. coli, etc…this isn’t a short list of risks and it’s a big section.

c.     Infection risks (other germs) to dogs, cats and humans, +/- livestock. This category covers other germs, e.g. Toxoplasma gondii, pseudorabies. These are a concern when these diets and products are not properly freeze-thawed and is due to the varying effect of this manufacturing practise on specific bugs and more practically (and possibly frequently) due to human error, i.e. when proper freeze temperatures and durations aren’t followed.

5.     Antimicrobial resistance (AMR) concerns related to these diets, e.g. extended-spectrum beta-lactamase (ESBL) resistance. This may sound like something a cat might do (i.e. hack, gag, ESBL all over the clean floor, bed, etc.), but just goes to show how interconnected the choices we make for our pets are on us, i.e. the members of the human race. The concern of AMR in pets and people is a real one and something we all need to be cognizant of. Here’s a bit more information on the topic: http://www.akcchf.org/canine-health/top-health-concerns/top-health-concerns.html

As a veterinarian, I’ve been lucky enough to meet (and be inspired by) many pet-owners over the years- I also freely admit to being all kinds of ridiculous about my own pair of E. Setters.  And I am very aware that folks who choose to feed raw meat based diets, (either complete or partial feeding), do so because they genuinely want the very best for their fur babies-and love them just like I love my nutter dogs.

However, the choice to feed these diets comes with accountability to other animals and humans, besides one’s own, and this article does a nice job laying those concerns and considerations out, along with providing information regarding what impact this choice might have on the individual pet.

Finger on the ‘pulse’ of dog diets & DCM

Heart of the Matter: V-day edition: 2019

Perfectly ‘pulsed’, heart-themed and evidence-based, comes another publication on the topic of dog diet, taurine and the potential association of both with dilated cardiomyopathy (DCM):

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Similar to previously posted about (original post here, Nov 2018 update here. Dec 2018 update here) articles on this palpitating subject, there are solid reasons for anyone with an interest in educating themselves on dog diet to take the time to read beyond this pub’s abstract.

Perhaps the top 3 being,

1) Representative author list, i.e. vet boarded nutritionists, PhD nutritionists, industry and academia,

2) Once again learning that there is a lot we (and the ‘experts’) don’t know about animal nutrition and that these needs may vary between dogs, and

3) That pet-food should be manufactured by people who have been educated on (and understand) ingredient components, e.g. pulses (peas, lentils, chickpeas, etc.) and requirements for nutrient balances in diets fed long-term, i.e. what the vast majority of pet-owners do and as typically advised by their veterinary team.

Once again, I was thrilled to see a group of folks collaborate to try and identify nutritional concerns related to keeping animals (dogs mainly) safe. This included the article tackling topics and raising questions like, ‘What might processing do to nutrients?’, along with providing recommendations (and aid) for formulating dog foods with specific ingredients, e.g. novel ingredients, higher fibre, and closing their discussion with a helpful review and effective referencing of recent publications on the topic of DCM and dog diet.

The researchers concluded with a heart-felt statement regarding dog diet manufacture accountability,

“It is the responsibility of animal nutritionists to formulate balanced diets for dogs, and other animals, by looking beyond the goal of meeting AAFCO recommendations or satisfying unsubstantiated market trends.”

The statement above, combined with the article’s call for action and mini-plan towards learning what dogs might need nutritionally, i.e. “ Greater awareness of amino acid (AA) balance is crucial for ensuring that AA requirements are met for dogs consuming static diets.”, made my wish for veterinary nutrition awareness and start to the Year of The Pig complete.

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The Heart of the Matter: Update December 2018

Day 13 on my ‘veterinary publications advent calendar’ opened to reveal something much more nutritionally dense than chocolate…a peer-reviewed (and free-access!) article on dog diet, taurine and the potential association of both with heart disease (dilated cardiomyopathy-DCM)) in 24 DCM diagnosed golden retrievers.

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The study began with a total of 40 (no doubt super cutie) goldens, with 16 dogs subsequently excluded for the usual reasons clinical research is challenging, e.g. not up to ‘snuff echocardiogram (heart ultrasound) results, incomplete diet histories, etc. Importantly, the publication also contained one year follow-up on 16 of these dogs.

Dog diet was clearly identified, and somewhat unexpectedly (& pleasantly) a complete (i.e. treats, supplements, etc.) diet history was available on the dogs. The study team also performed a diet ‘deep-dive’ review of nutritional parameters (i.e. calories, ingredient deck, fibre composition), feeding trial information (yes they did one or nope-they did not) and/or whether formulated to meet AAFCO (or nope-they did not). Additional nutritional information included whether diets were marketed by manufacturers as grain-free and if diets listed legumes (i.e. beans, chickpeas, lentils, peas, pea protein or fibre) within the first five label ingredients.

There are many reasons to give the article a read, but one (or someone trying to avoid excess rambling) could attempt to re-phrase the heart of the matter as:

In the study, dogs (16) diagnosed with DCM and available to follow-up had…”Significant improvement in echocardiographic parameters and normalization of whole blood taurine concentrations from baseline (close to when the dog was diagnosed) to follow-up visits after implementing a diet change and supplementation with taurine +/- L-carnitine…This occurred by a median of 8 months in all but one dog (15 of 16).”

The researchers identified other nutritional tidbits on this golden grouping. Two of the more interesting, (to me at least), being that: 1) many (most) dogs were eating less than their predicted diet intake needs (based on metabolic energy requirements (MER), and 2) that a clear association with diet meat protein (type of meat) was not found…stay tuned on the ‘baa baa humbug’ aspect of that one.

As I said in November, it seems that we all agree that:

a) nutrition is uber-important,

b) obtainment of a complete diet history needs to occur at every veterinary visits, and

c) we still have an awful lot to learn about pet food, taurine, K9 heart and overall health & nutrition.

However, it’s wonderful (possibly Christmas miracle category) to see such a large group of researchers collaborating to try and identify concerns towards keeping dogs safe- and maybe even learning more about what they might (or might not) need nutritionally. And that (i.e. collaboration and raised nutrition awareness) sums up what I’d asked Santa to ‘veterinary gift’ me with in 2018.

My veterinary wish list looks a bit different for 2019...but more on that (and hopefully a cup or two of spiked cider) in the New Year.

 

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Getting to the Heart of the Matter: November 2018 UPDATE

About 4 months ago, I wrote about a specific type of canine heart disease (dilated cardiomyopathy, DCM) and the recent concern over its association with diet (pet food).

This past week a commentary appeared in a veterinary journal on the subject . It was important to see what is considered expert opinion and have a peek at the results of a survey on this concern, as there’s no doubt it’s a complex issue with serious canine health impacts.

The commentary (quite rightly IMHO) highlights the importance of nutrition and incredible value of obtaining a thorough diet history on all pets as part of a clinic visit. Perhaps as importantly (for me), it also indicates that:

1) there is still an awful lot to learn about nutritional needs-requirements (and how these may vary from dog-to-dog and in dogs of different health states),

2) there is a dearth of peer-reviewed studies, articles or commentaries on canine nutrition, and, 3) there are myriad complexities (and lack of clarity) when it comes to pet food formulation, manufacturing and sales.

The commentary also introduces new terminology (i.e. boutique or exotic diets) to the pet food dialogue. I’m not convinced these terms assist with causation of concern (with respect to cardiac disease or any other). I’d also guess they further cloud a complicated issue (and for me at least, conjure images of fancy French shops) …vs. convey what is (or isn’t) known about these diets and why they may be associated with DCM. The connotation of boutique, i.e. ‘perceived as high-end’, is hard to miss as well….

At present, we simply do not know why (or if) these diets may be linked with canine DCM…and there is much speculation on cause, i.e. low taurine, reduced taurine precursors (i.e. methionine and cysteine), deceased bioavailability, increased (high) fibre preventing enterohepatic binding and recycling, increased taurine loss via the gut and potentially a heightened breed susceptibility…or the association may be naught, i.e. there isn’t one. After all, …a LOT of dogs eat diets containing these ingredients (or ingredients in the speculated proportions), and it appears that the vast majority are unaffected.

Unfortunately, along with the lack of veterinary peer reviewed publications on this subject there has not been disclosure by the FDA on what diets are being investigated… However, I strongly suspect (and really hope!) that plenty of canine diet reformulating (change in diet recipe) has been occurring since this concern was raised, and have my fingers crossed that manufacturers are doing things like:

1)    Ensuring all diets have increased taurine (vs. prior levels)

2)    Ensuring all diets with significant amounts of water-soluble fibre (peas, lentils, chickpeas, tomato pomace, beet pulp, pea fibre, pea protein) have even higher allotments of taurine (again vs. prior levels)

3)    Limiting all new canine diets to 30% legumes (i.e. peas, lentils, chickpeas, pea fibre, tomato pomace)

4)    Including additional methionine to try and provide additional precursors for taurine synthesis (if necessary, and vs. prior levels) 

The recommendations provided by the commentary similarly provided insight on what we do not know about laboratory sampling and various dietary supplements, e.g. taurine. It’s a tough order to advise the checking of taurine when there is a known lack of consistency in lab standards for analysis, or good understanding of what sample is optimum, i.e. whole blood or plasma. Additionally, it’s hard to feel good about advising taurine supplementation without a standardized supplement and/or optimal dose…

So, what’s a dedicated dog-owner (or DVM) to do? Ask (or keep asking) the tough questions about the diet your dog (or your client’s dog) is eating, be aware of this concern and critically evaluate what information is available, and after a thoughtful dialogue on what makes that dog unique (e.g.  risk factors, susceptibilities) and what the diet(s) in question does (or doesn’t) contain…make an informed decision (together) on what is best- for that dog.

We may still have a lot to learn about pet food, K9 heart and overall health & nutrition, but in the meantime, we can work together in a collaborative way to try and keep dogs safe- and maybe even learn more about what they might (or might not) need in the process.

FDA: https://www.fda.gov/AnimalVeterinary/ResourcesforYou/AnimalHealthLiteracy/ucm616279.htm

 

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Quibbles about kibbles...what does 'diet' mean?

Quibbles about kibbles...what does 'diet' mean?

I spend a lot of time talking about food. And while it’s true that I enjoy a good meal and a glass of wine…it’s typically dog (or kitty) kibble in the context of a veterinary visit that I am talking about.

Those who’ve stumbled on this blog before (n = blood relations), have read my mention of definitions and how these can vary markedly between individuals. As another example of this, the word ‘diet’ is defined by most of us who practise clinical nutrition as everything the dog or cat in question consumes in a typical week. In addition to the bulk of the diet (usually kibble), this encompasses treats, supplements, snacks and whatever other ‘little something’ he or she might get from his/her owner, the floor, grandma, etc. However, the word ‘diet’ can mean something rather different to the average pet-owner when asked, ‘what does your pet eat?’ and due to my disinterest in quibbling (and desire for brevity) I’ll leave the variations of responses to your imagination. To try to get everyone on the same nutritional page, and because I try to teach my students how to be efficient and consistent (aka I’m a slacker and compensating for poor detail-oriented task skills), I typically advise obtaining pet diet information via a nutrition history-questionnaire. 

 

Here’s an example of a standardized diet history questionnaire: http://www.wsava.org/WSAVA/media/Arpita-and-Emma-editorial/Diet-History-Form.pdf

These types of questionnaires let me know what the pet is eating (the whole diet) and their activity level. The rest of the pet’s nutritional assessment (weight, body and muscle condition score), other history and physical exam helps me figure out how they are doing with their current diet/exercise. Putting all that info together allows us (vets) to provide recommendations for ongoing care... However, the first step in any type of planning is obtaining information, and that (i.e. pet specific nutrition information) can vary dependent on where you practise and who is coming to your veterinary clinic.

Here are a few bite sized pieces of recently presented research that surveyed clients coming into the Atlantic Veterinary College small animal veterinary teaching hospital, with some interesting results from a nutrition, exercise and infection control standpoint:

Nutritional Knowledge, Attitudes, Perceptions and Practices of Clients Presenting to a Small Animal Veterinary Teaching Hospital , VSRA Texas 2018

M. Peace, J. Stull, G. Munguia, and M. Evason

Objectives: 

1)Determine teaching hospital small animal clientele current knowledge, attitudes, perceptions and practices regarding nutrition and exercise 

2) Evaluate client recall on veterinary recommendations related to diet and exercise 

Methods:

Sample of clients visiting the small animal Atlantic Veterinary College Teaching Hospital from June 8th to July 4th, 2018 were invited to complete a paper questionnaire. Descriptive statistics were used to evaluate questionnaire data.

Results:

Total of 143 clients were invited to participate- 140 agreed to participate, with 106 pet-owners returning the questionnaire. 

Surveys that were <50% completed were excluded, providing a 71% response rate (n=101).

This is wonderfully high level of interest, cooperation and response.

A variety of responses were recorded in response to ‘What does your pet’s diet consist of in a typical week?’ The majority of responses to this question were similar to other studies of this nature; however, total raw food intake (commercial, homemade, treats) was 30%. This result is higher than other studies of this type and VERY important information for hospital infection control planning and prevention of disease transmission (e.g. salmonella) to other pets and staff.

Pet-owner interest in learning more about their pet’s nutrition was reported as:

▪Yes-very interested (63%), No- not interested (22%), Unsure (15%)

As in other studies, pet-owner interest in the topic of nutrition and diet for their pet is high.

Pet-owner recollection of discussing nutrition with vet:

▪Always speak about nutrition (35%)

▪Sometimes speak about nutrition (44%)

▪Unsure (19%), never (3%) 

Again, similar to other studies while pet-owners indicate a desire to speak about nutrition this isn’t something that appears to be occurring regularly during visits to the vet clinic, i.e. over 20% of the time it isn’t happening, and it’s hit or miss about half the time.

Pet-owners varied in their interest in having their veterinarian discuss their pet’s exercise requirements. Responses to this query were as follows: somewhat agree that I’d like my vet to talk about my pet’s exercise needs (36%), strongly agree and want vet to discuss (27%), felt neutral about having this discussion(26%), strongly disagree and do not want to talk about exercise for pet (8%), somewhat disagree (3%).

This was an interesting result and worth exploring further to assess differences between cat vs. dog owners, and whether things differed between reported exercise (amount, frequency) and interest in exercise related discussions.

The heart of the matter...

The heart of the matter...

One subject (along with Lyme disease), that tends to stir the pot and set it to boil, is the topic of pet-food. And it seems that with some regularity (i.e. every 2-3 years) veterinary researchers and nutritionists stumble upon something that is lacking in (or being added to) the diets we feed our dogs and cats that can make them sick- particularly if they happen to be a certain breed (or species) with a heightened nutritional sensitivity (or susceptibility), e.g. a need for taurine. 

Right now, there are pet-foods for sale on grocery and pet store shelves (being manufactured for, purchased and then fed to dogs) that are actively being investigated by the FDA. The feeding of these diets to over 80 different dogs (of various breeds, ages and sizes) has been associated with development of a severe form of heart disease- dilated cardiomyopathy: (https://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm613305.htm).  

Associated diets appear to be deficient in taurine (+/- cysteine, methionine) or have increased taurine loss (due to containing high levels of water-soluble fibre).  Ongoing research is working toward determining other possible dietary or dog related risk factors.For those of us who don’t speak ‘ingredient composition’ fluently, these diets are composed of peas (and likely their by-products, e.g. pea fiber and protein), lentils, chickpeas, legumes (vegetables or seeds of them), and (although less likely to be a primary culprit) potatoes. To break this down even further (and because marketing is purposefully confusing), many of the diets composed of these ingredients fall under the ‘grain-free’ banner. 

I could spend a lot of time talking about definitions (i.e. grain-free) and how terms like this can mean radically different things to different individuals (and pet-food companies), but that would be a lengthy (and heated) blog… so I’ll focus on the heart of the matter. This is (and should be) identifying dogs at risk from eating these diets, in order to keep them safe through prevention of a potentially fatal heart condition. 

We (pet-owners and veterinarians) need to be asking (demanding) questions of pet food companies prior to making (or advising) a pet-food purchase. These questions should be: 1) ingredient focused, i.e. what ingredients and levels of these are (or are not) in the food, and 2) quality assurance and testing protocols based, i.e. what tests (ideally performed by qualified labs) are completed on diet ingredients and final product prior to its being available for purchase (sale). In this moment, along with these questions (and particularly if your dog is eating a diet marketed as grain-free) you should be asking the pet-food manufacturer the following specific questions: 

1)    Do you add taurine to your pet-food? 

2)   Do you have pet-food on shelves for sale (right now) that was made prior to your decision to add more taurine?

3)   How to I decipher the date code on your products (i.e. determine the date of manufacture), so I can figure out if your pet food was produced before (or after) your decision to add more taurine?

4)   If you are aware (or suspect) that your product is potentially harmful (and know that you are being investigated by the FDA), why haven’t you issued a recall of the product?

The bad news story is that no-one (i.e. the FDA, nor anyone else) has released a list of diets that are of concern or have been linked to heart disease. This leaves pet-owners (and veterinarians) unable to identify which diets are worrisome and proactively make changes (e.g. diet change, taurine supplementation, both), thus meaning extra steps (such as the questions above) are needed to identify pets at risk. However, the good news is that this form of dilated cardiomyopathy can be treated- provided it is caught early. 

Asking pet-food manufacturers the questions above NOW and speaking to your veterinarian if you are concerned about your dog’s diet (i.e. the pet food manufacturer cannot answer these questions, or you’re worried about their answer) could help you help your vet save your dog’s life.

 

July 23, 2018

Michelle Evason, DVM, BSc, DACVIM

Raw Raw Raw 'Yer Boat...

Raw Raw Raw 'Yer Boat...

Raw, raw, raw ‘yer boat…

 

One of the many things I am particularly passionate about is pet nutrition. To clarify (and because I’ve come to understand that definitions on things can (and do) vary wildly), I’m passionate about feeding dogs and cats balanced diets (prepared with strict quality assurance) that meet their specific and unique needs for optimum health outcomes. This means that I am constantly thinking (and asking people) about food for pets. Sometimes while doing my nutritional assessment and asking pet-owners questions, it’ll come up that the pet in question is consuming a raw meat diet.

 

These days many veterinary clinics (especially those associated with veterinary teaching hospitals) have infection control programs that include a ‘Raw Food Diet’ Policy. Typically, the intent of a ‘Raw Food Diet’ policy is to: 1) reduce (and ideally eliminate) entry of raw food into veterinary hospitals, and 2) prevent infectious disease transmission of pathogens (bacteria and parasites) from pets eating raw food diets to other hospital patients (i.e. dogs and cats) and hospital staff (i.e. humans) who come into contact with these pets. Yes, the bacteria and parasites often found in raw foods can (and do) cause disease in other pets as well as people (especially those people who are under 5 years of age, greater than 65 years of age, pregnant or immunocompromised).

 

There are multiple N. American publications that have investigated the presence of bacteria and parasites in animal foods, including raw food diets. Here’s a relatively recent one from the Netherlands (https://veterinaryrecord.bmj.com/content/182/2/50) that analyzed 35 frozen raw meat diets from 8 different brands and found: 1) ‘beaucoup’ bacteria (E.coliO157:H7 (cause of renal failure in humans) in 23% of the food samples, extended spectrum beta-lactamase-producing (ESBL) E.coli(major cause of antimicrobial resistance) in 80%, Listeria monocytogenesin 54%, and Salmonellasp. in 20%), and 2) plentiful parasites (Sarcocytis cruziand/or S. tenellain a total of 22%, and Toxoplasma gondiiin 6%). 

 

Keeping cats and dogs healthy by reducing the amount of infectious disease they are exposed to (intentionally or unintentionally, i.e. being housed next to a dog or cat that is a raw food eater), along with the humans who care for them (e.g. veterinary students, nurses, etc.), is something I feel very accountable for. And while I won’t argue with doing whatever ‘floats ‘yer boat’ for your pet nutritionally (provided the diet is safely prepared, balanced to meet your pet’s specific needs and you’ve taken steps to reduce risks) … the reason to have a Raw Food Diet Protocol in a veterinary clinic is to keep both pets and people safe from bacteria and parasites like those listed above.