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

 

DCM Heart.jpg

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.