Medical update for dogs

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It seems like there is no good answer as to what we feed our dogs.

http://vetnutrition.tufts.edu/2018/11/dcm-update/

You may have read my June 4 post, “
A broken heart: Risk of heart disease in boutique or grain-free diets and
exotic ingredients.
”  This post had more than 180,000 page views in the first week and
continues to get more than 2000 page views a day.   So, I’m pleased that
people are
interested in this important issue and trying to learn about it.  But I’ve
also found a tremendous amount of confusion and misinformation in the past 5
months including people who doubt that this is a real issue, some who still
haven’t heard about it, and people who mistakenly think it’s just grain-free
diets or that it’s only related to taurine.

As a result of the continued confusion, some of my cardiologist colleagues
and I wrote an article which was published in the latest issue of the
Journal of the American Veterinary Medical Association.
This article provides a summary of our current understanding of
diet-associated dilated cardiomyopathy (DCM), how to recognize it, and a
recommended protocol
for veterinarians to follow when they see dogs with DCM.

To be sure this information reaches as wide an audience as possible and to
clear up confusion, I thought I’d provide some updates to address the most
common
misconceptions I’m hearing:

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1. It’s not just grain-free. This does not appear to be just an issue with
grain-free diets.  I am calling the suspected diets, “BEG” diets – boutique
companies,
exotic ingredients,
or grain-free diets.  The apparent link between BEG diets and DCM may be due
to ingredients used to replace grains in grain-free diets, such as lentils
or chickpeas, but also may be due to other common ingredients commonly found
in BEG diets, such as exotic meats, vegetables, and fruits.  In addition,
not all pet food manufacturers have the same level of nutritional expertise
and quality control, and this variability could introduce potential issues
with some products.
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2. Most dogs being diagnosed with DCM do not have low taurine levels. Some
owners continue to feed a BEG diet but supplement taurine thinking that this
will reduce their risk for heart disease.  In our hospital, we currently
measure taurine in all dogs with DCM, but more than 90% of our patients with
DCM
in which taurine has been measured have normal levels (and the majority are
eating BEG diets).  Yet some of these dogs with DCM and normal taurine
levels
improve when their diets are changed.  This suggests that there’s something
else playing a role in most cases – either a deficiency of a different
nutrient
or even a toxicity that may be associated with BEG diets.  Giving taurine is
unlikely to prevent DCM unless your dog has taurine deficiency.  And given
the
lack of quality control for dietary supplements,
you can introduce new risks to your dog if you give a supplement without
evidence that she needs it.
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list of 1 items
3. Raw diets and homemade diets are not safe alternatives. Out of concern,
some owners are switching from BEG diets to a
raw
or
home-cooked
diet.  However, we have diagnosed DCM in dogs eating these diets too.  And
raw and home-cooked diets increase your dog’s risk for many other health
problems.
So, forego the raw or home-cooked diets and stick with a commercial pet food
made by a well-established manufacturer that contains common ingredients,
including grains.  If your dog requires a home-prepared diet for a medical
condition or you feel strongly about feeding one, I strongly recommend you
consult
with a Board-Certified Veterinary NutritionistTM
(acvn.org).
However, because home-cooked diets are not tested for safety and
nutritional adequacy like good quality commercial diets, deficiencies could
still develop.
list end

Current thoughts on DCM

Currently, it appears that there may be three separate groups of dogs with
DCM (although this may change as we learn more). I am listing them in the
approximate
frequency that we are currently seeing them in our hospital:

list of 3 items
1. Diet-associated DCM with normal taurine levels. While this form of the
disease was first identified in dogs of breeds not predisposed to DCM that
are
eating BEG diets, it appears to also occur in dogs of typical DCM breeds
that are eating a BEG diet.
2. Primary DCM in predisposed breeds that is unrelated to diet. This is the
traditional, genetically-related DCM in typical breeds, such as the Doberman
Pinscher, Boxer, Irish Wolfhound, and Great Dane.
3. Diet-associated DCM with taurine deficiency: This is the least common
form we are seeing in our hospital. This appears to happen both in breeds
predisposed
to DCM and breeds that are not predisposed to DCM.
list end

Common questions

We still have a great deal to learn about diet-associated DCM.  However, I’m
providing answers to some common questions I’ve been getting based on what
is currently known:

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1. What’s causing diet-associated DCM in dogs? For the vast majority of
dogs, we do not yet know what is causing this disease. There are definitely
some
dogs with DCM that have low taurine levels, many of which will improve with
taurine supplementation and change of diet.  For dogs that have normal
taurine
levels, however, other nutritional deficiencies may be present. Some
nutritional deficiencies can affect the heart’s normal function, so an
insufficient
amount of these nutrients (or reduced bioavailability) in the diet could
cause heart disease.  Diet-associated DCM could also be due to an ingredient
in
the food that is toxic to the heart.  The
FDA
and many researchers are actively studying this issue so that it can be
solved as quickly as possible.
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list of 1 items
2. My dog was diagnosed with DCM. What should I do? Ask your veterinarian to
measure taurine levels and give heart medications as directed by your
veterinarian.
If your dog is eating a BEG diet or other unconventional diet (including
vegetarian, vegan,
or home-prepared diets), I recommend following the steps outlined in my
previous post,
including switching to a non-BEG diet.  Three updates to my previous post
are:
list of 3 items nesting level 1
• Taurine supplements:
Consumer Lab
is expected to release a report on independent quality control testing of
taurine supplements in late 2018. Given the lack of quality control for
dietary
supplements (human and pet), having these results will be very useful to
find good quality products for dogs that require taurine supplementation.
Your
veterinarian or veterinary cardiologist can help you determine an optimal
dose for your dog.
• Other dogs in the household: We are now recommending that other dogs in
the household of dogs with DCM that are eating the same BEG diet be screened
by their veterinarian since their hearts could also be affected (even if
they are showing no symptoms).
• Outcome: Not all dogs with DCM will improve and improvements in the
echocardiogram, when they do occur, can take a long time (often more than 6
months).
list end nesting level 1
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list of 2 items
3. If my dog is eating a BEG diet but has no symptoms, should I test for DCM
or switch to a different diet? It’s unlikely that most dogs eating a BEG
diet
will develop DCM. However, given the fact that we don’t yet understand why
BEG diets are affecting some dogs and because DCM is a life-threatening
disease,
I recommend you reconsider your dog’s diet until we know more.  Contrary to
popular belief, there are no health benefits of grain-free or exotic
ingredient
diets except in the rare case of food allergy. If your dog is a part of your
family and you want to feed him the very best, be sure to base this
important
decision on more objective factors than marketing and the ingredient list
(see our
post).

Be sure to watch for early signs of heart disease – weakness, slowing down,
less able to exercise, shortness of breath, coughing, or fainting. If you
notice
any of these, get your dog checked out by your veterinarian who will listen
for a heart murmur or abnormal heart rhythm (although not all dogs with DCM
have any changes that can be heard with a stethoscope). Your veterinarian
(or a veterinary cardiologist) may do additional tests, such as x-rays,
blood
tests, electrocardiogram, and ultrasound of the heart (echocardiogram – the
test of choice to diagnose DCM).Tell your veterinarian what you’re feeding
your dog. You can help your veterinarian by bringing
a list of everything your dog eats
to every appointment.

If your dog has no symptoms, additional testing is really up to you.  Some
owners have measured plasma and whole blood taurine levels or scheduled an
echocardiogram
to check their dog’s heart size and function.  However, given the cost of an
echocardiogram, other owners have elected to have their veterinarian do a
blood test called NT-proBNP, which goes up when the heart is enlarged.
While a normal value doesn’t guarantee your dog has no heart disease, a high
level
suggests your dog’s heart should be evaluated further.

4. Has diet-associated DCM been seen in cats? The association between BEG
diets and heart disease has only been reported in dogs so far. However, that
doesn’t mean cats are immune.  If your cat is diagnosed with DCM and is
eating a BEG, vegetarian, vegan, or home-prepared diet, I recommend
following the
same
protocol
as described for dogs with DCM.
list end

Lastly, if your dog has been eating a BEG diet and has been diagnosed with
DCM, please don’t feel guilty. I’ve talked to owners who feel terrible
because
they wanted to provide the finest care for their dog by feeding them the
best diet possible. They often spent a lot of money buying an expensive
boutique
diet and now that same diet may be associated with their dog’s heart
disease. Trying to decide what is really the best food is confusing and
difficult
because of the many different products available, nutrition fads, and
compelling marketing. My hope is that the one bright side of this serious
situation
is that it will shine a light on the complexities of making safe and
nutritious pet food and the importance of nutritional expertise and quality
control,
rather than just what is new and trendy.

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Author: David Diamond

David Diamond, Owner/Head Trainer: I use positive training methods and a firm, caring approach so owners and pets can learn to live together in harmony.

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