Monday, March 19, 2018

The “Myth” Of Complete And Balanced Nutrition

A common theme heard from those who believe in paleolithic feeding claim that the “complete and balanced diet” is unnecessary. Their reasoning goes like this –
  • ·         Humans don’t eat a complete and balanced food every day. We even raise children without a daily complete and balanced, all-in-one food like pets eat, and they do just fine, don’t they?
  • ·         Wolves and wild cats don’t eat complete and balanced foods every day.  Not only does their native diet supply all they need, but the foods that they can hunt or forage varies on a day to day or week to week basis – this variety in the diet leads to a complete/balanced nutrient profile over time.
  • ·         Complete and balanced nutrition has not resulted in pets living longer lives – my childhood dog lived to be 20 years old!
  • ·         ONE complete and balanced food is not, by itself, able to provide complete and balanced nutrition over months to years.
Let’s look at these claims one by one.

Humans don’t eat a complete and balanced food every day. We even raise children without bothering to balance every meal, and they do just fine, don’t they?

Actually, no.  Both young and aging humans experience different kinds of illnesses than dogs and cats, particularly atherosclerosis, hypertension and metabolic syndrome, which are rampant in developed countries.  And humans could be considered a sentinel population for the increasing problem of obesity, childhood diabetes, and preventable cancers.  No, humans are not doing just fine.

Wolves and wild cats don’t eat complete and balanced foods every day.  Not only does their native diet supply all they need, but the foods that they can hunt or forage varies on a day to day or week to week basis – this variety in the diet leads to a complete/balanced nutrient profile over time.

The natural diet of wolves and African wild cats are perfect for repeated reproduction, not longevity.  Wild animals eat diets that are high in protein and energy to support repeated production of offspring - as many and as much as possible. Repeated reproduction is associated with shorter life expectancy, and the body is worn out from optimal reproduction, there is no further use for that individual in the population, so they die from exhaustion and inability to fend for themselves. 

We have different plans for our pets - we want them around for 15 or more years, and we know that neutering them and keeping them thin adds many years to their lives in comparison to their wild ancestors We also know that preventing nutrient deficiencies through development of complete and balanced diets has been associated with an increase in life expectancy. Paleolithic diets are too high in fat for many of our pets whose most intense exercise is a few 30 minute walks or play sessions a day.  In order to achieve our goals for our pets, we may not always be able to feed a paleolithic diet, and balancing that diet appears to optimize an animal’s life expectancy..

Complete and balanced nutrition has not resulted in pets living longer lives – my childhood dog lived to be 20 years old!

If you don’t believe that pets are living longer, just look at the surge in old age diseases in the last 50 years. Veterinarians now treat more degenerative issues like osteoarthritis and kidney disease than ever before.  And cancer!  Yes, it’s possible cancer is on the rise due to environmental or other exposure issues, but pets are also living long enough to contract cancer.  We just did not see as much cancer to treat 50 years ago.

In addition, we now have evidence for certain interventions that increase life expectancy – a great example is that of keeping dogs and cats thin -the increase in lifespan is up to 2 years.

There is evidence that life expectancy is greater in pet or domesticated dogs and cats than in feral or ‘wild’ dog and cat populations. The average life expectancy in pet cats (12–14 years) is considerably higher than the reported median lifespan in feral cats (4·7 years). It is not known what factors contribute to this difference between feral and pet cat populations, however, accidents, diseases, parasites, food availability and stress due multiple and frequent pregnancies may contribute. 

A study from Banfield showed that, over the past decade, average lifespan has increased by 1 and 0·5 years in cats and dogs. 

Results from a yearly survey of UK households over a 34 year period, totaling 233,461 households, showed that the average age of dogs and cats increased by about 13% from 1960 - 1994. The percentage of both dogs and cats over the age of 8 years also increased. During this same time period, the feeding of "prepared pet food" increased from 49 - 69% for dogs, and from 64 - 90% for cats.  Veterinary databases from academic sources also show greater longevity in dogs

And those 20 year old beloved family pets?  These are the pets who made it past deadly infectious diseases (for which there were no vaccines) and traumas (such as fights, vehicular accidents, etc). Those pets that died early were not remembered later in the owners’ lives, but the few who did lived on as beloved memories.

ONE complete and balanced food is not, by itself, able to provide complete and balanced nutrition  over months to years.

I don’t completely disagree with point 4 – feeding a single brand of complete and balanced food may indeed reveal some shortcomings of that diet over months to years.  Or more precisely, reveal that the pet eating the diet has requirements that the diet cannot fulfill.  These diets are formulated to supply complete nutrition for 99% of normal animals.  However, even normal animals have individual nutrient requirements that may vary widely from “average”.  Pet owners and veterinarians frequently note how a pet’s haircoat declines on one diet over time, and immediately improves after a switch to another over the counter diet.  That pet just received missing nutrients of some sort, or conversely, got relief from an overdose of a nutrient that he or she couldn’t tolerate well.  There might well be a perfect diet out there for every individual pet, but with thousands of brands available, finding that one diet is challenging if it exists at all!

There is another aspect to this observation that pets may respond very decisively to diet changes.  Depending on how the food is formulated, there may be ingredients and nutrients present which are not considered essential but that do confer some benefit. Phytonutrients from fruits and vegetables are one example.  Nutritionists formulate complete and balanced foods to supply optimal (not minimal) amounts of all the essential nutrients, but a food containing more biochemical complexity may benefit an animal’s metabolism in ways that are not obvious or easy to study.

One of the most common areas for a nutrient deficiency or imbalance to show up is in the skin.  I see sparse hair growth and flaky or greasy skin pretty commonly in animals that are eating deficient diets. However, we generally do not see classical nutrient deficiencies if a pet is eating a diet that is deficient in 1 or 2 micronutrients but contains plenty of protein, fat, calcium, etc.  What we see instead is that if the pet becomes ill with another problem, that illness may be worse, or require more treatment or hospitalization than if the pet had been eating a complete and balanced diet. Those subclinical nutrient deficiencies leaves the patient wanting and without metabolic reserves when the system is stressed. The other relatively common situation is the sudden “appearance” of a nutrient deficiency that was developing for months to years while the animal seemed perfectly healthy.  A particularly dangerous example is taurine deficiency in dogs* – a dog can motor along seeming perfectly healthy, but behind the scenes, the heart is proceeding into heart failure, and the owner doesn’t notice anything wrong until failure has occurred.

Can you measure blood levels to determine whether a vitamin or mineral deficiency is present? In many cases, the test is either not very accurate or difficult to run so we don't typically do those tests unless special circumstances exist.  On the other hand, if a pet is chronically malnourished or has been starved, we do see indirect indicators such as w protein and other laboratory values.  But the physical condition often tells us what we need to know. 

To summarize, there are many good reasons to feed a complete and balanced diet, and no good reasons to avoid doing so.  It’s easy to find foods of all types – complete/balanced homemade recipes, raw foods, grain-free foods, paleo foods, kibbles, cans, prescription diets -why take chances when it just isn’t necessary?

*Taurine is not considered an essential nutrient in dogs, and yet some dogs develop heart failure due to taurine deficiency from certain diet formulations, including diets very high in fiber (we believe), or those composed of meats that are low in taurine. 

Watson D.  Longevity and diet (letter). Vet Rec 1996 (138) 3: 71
Butterwick RF. Impact of nutrition on ageing the process. Bridging the gap: the animal perspective. The British journal of nutrition. , 2015, Vol.113 Suppl, p.S23-S
 EJ Taylor , C Adams & R Neville (1995) Some nutritional aspects of ageing in dogs and cats. Proc Nutr Soc 54, 645–656.
 Banfield Pet Hospital (2013) State of pet health 2013 report.
J Levy , D Gale & L Gale (2003) Evaluation of a long-term trap-neuter-return and adoption program on a free-roaming cat population. J Am Vet Med Assoc 222, 42–46.

Tuesday, March 13, 2018

Paleo for all?

Recently many pet owners have become interested in the idea of paleolithic feeding - that is, feeding the paleolithic diet of cat or dog's ancestor. Paleolithic feeding does not mean the same thing to everyone, so some definitions are in order:

·         Paleolithic diets are high in meat and fat, and low in starches and sugars - they theoretically mimic the ancestral diet of dogs (the wolf) and cats (the African wild cat).

·         Low carb diets are theoretically low in *digestible* carbohydrates such as starches and sugars, and high in meats.  They should also be low in another type of carbohydrate - fiber - but this varies diet to diet.

·        Grain-free diets contain no grains (such as wheat, corn, oats, rice, millet, amaranth, quinoa, barley, etc).  Grain-free diets are not necessarily low in carbohydrates, which are instead found as potato, tapioca, or pulses in these diet formulations.

Raw diets contain raw meat, and are typically high in protein and fat.  They may or may not contain starches, sugars, fiber from vegetables and fruits, nutraceutical additives, or vitamins and minerals.

In general, the increasingly popular trend is to feed a paleolithic diet.  These high meat, high fat diets usually consist of muscle and organ meat, ground bone, and may or may not contain vegetables, or be complete and balanced.  It is important to note that these homemade and commercial combinations are not really paleolithic at all, as wolves and feral cats would typically eat almost all parts of their prey including the toughest, least digestible parts containing primarily connective tissue*, nervous system; organs not available for consumer purchase like trachea, lymph nodes, spleen, etc; GI tract contents, etc.  Commercially available meat has also been exsanguinated - blood was drained at slaughter, and blood is a very rich source of nutrients. 

Also, prey animals have generally eaten wild foods, which give their flesh a very different nutrient profile than that of store-bought meats. Wild grains (and therefore wild prey animals) contain higher levels of healthy omega-3 fatty acids and other types of plant compounds as well. Conventional meat used in raw diets come from intensively raised cattle and chickens with unhealthy fat (that causes atherosclerosis and heart disease in people!).

(*These poorly digestible, high connective tissue parts are known as by-products when found on a pet food label.  Note that many pet owners consider “by-products” unhealthy, when they are, in fact, part of the natural diet.)

More important is the question of whether domestic dogs and cats should eat a paleolithic diet at all.  First, domestic pets are genetically different from their wild ancestors.  Even the tiny amount of DNA that   differs between dogs and wolves, or domestic and wild cats accounts for major variations in some visible traits, like the differences in size between a Great Dane and a Chihuahua, or the leg length of a munchkin cat, the ears of a Scottish fold, or the nose and haircoat of a Persian cat.  The traits we cannot see, such as those regulating metabolic enzymes, differ just as greatly from those of wild animals.

Next, evolution has different plans for wild animals than we do for our pets. Wild animals eat diets that are high in protein and energy to support repeated production of offspring - as many and as much as possible. Repeated reproduction is associated with shorter life expectancy, and when the body is worn out from optimal reproduction, there is no further use for that individual in the population, so they die from exhaustion and inability to fend for themselves. 

We have different plans for our pets - we want them around for 15 or more years, and we know that neutering them and keeping them thin adds many years to their lives in comparison to their wild ancestors We also know that preventing nutrient deficiencies through development of complete and balanced diets has been associated with an increase in life expectancy. Paleolithic diets are too high in fat for many of our pets whose most intense exercise is a few 30 minute walks or play sessions a day.  In order to achieve our goals for our pets, we may not always be able to feed a paleolithic diet.

Formulated diets that are lower in fat may be appropriate, and they may contain sources of carbohydrates (such as corn, lentils, rice, sweet potato, etc).  These are not just fillers -  they can contain low-fat sources of protein, as well as vitamins, minerals and good fiber types.

Finally, while raw and paleolithic diets can occasionally be used to feed sick animals, this is just as often not true, as we need to intensively manage some nutrients such as phosphorus or copper or fat.  These ill animals have progressive illness that, without nutritional management, would kill them.  In fact, in the wild, animals with these conditions indeed die an early death.  We are able to keep our sick pets happy and well for much longer with controlled nutrition, whereas in the wild, they wouldn't have a chance, even if they were well enough to find food. Geriatric, ill pets who live for months to years happily represent a very, very artificial situation, and a natural diet is likely the worst thing that could happen to some of them!

Raw and homemade fresh diets can be formulated to provide just about any nutrient profile required by your pet, and pets are individuals – some will do well on raw and paleolithic diets, and some will not.  The ideal diet for your dog or cat is the one that produces the best long term (not just short term) results.  I recommend that your pet's diet be balanced in calories, protein and other nutrients to maintain your pet's optimum condition, rather than conform to some standard that doesn't apply to his or her lifestyle.

Saturday, June 24, 2017

What is a Novel Protein Anyway, Or, Why is Chicken Bad for My Pet?

 Recently I've had a spate of owners claiming that they've been told that chicken is bad for their dog or cat. Well……yes and no.

Like the game we played in grade school – Rumor – the real story has been lost in the re-telling, such that when it reaches me from the owner in my hospital, chicken has become the enemy.

It is not.  So let’s talk about food allergy.

Food allergy is believed by many to be a common cause of allergic skin disease.  It is not – environmental  allergies are by far the most cause of skin allergy.  However, changing dietary ingredients may help  improve the itching from environmental allergy.

Food allergy is more likely to cause GI problems – intermittent or persistent loose stool, diarrhea, reflux, vomiting, gas, and noisy stomach.  And just to return to skin allergy for a second, I usually expect that GI signs will accompany skin signs if food allergy is the cause.

Food allergy is a problem for animals who are genetically predisposed to it, or for animals who have had an insult to the gut resulting in inflammation.  That inflammation can lead to a breakdown in the normal gut barrier, leading to absorption of substances into the body that would otherwise be kept safely inside the gut ultimately to be eliminated. This situation has a name – Leaky Gut.

When a leaky gut is present, the immune system gains abnormal access to food molecules, bacteria, and other protein-containing substances that lead to the development of immune response to “fight” this “foreign invader” that the immune system has never  seen before.

The good news is that leaky gut is often treatable using a combination of diet changes, probiotics, and anti-inflammatory herbs, nutraceuticals or drugs. For even more good news, some of these food allergy cases turn out not to be permanent.

Food allergy, if the conditions are right, develops because of exposure to that particular food ingredient.  Chicken just happens to be the most common meat ingredient in the pet food industry, so…..

So, if an animal does in fact develop a sensitivity* to chicken, a change in dietary ingredients is certainly warranted, but that doesn’t mean that chicken is forbidden forever.  In fact, it is not possible to definitively diagnose a food allergy in any way except for elimination and then challenging with that food ingredient.  If a challenge test using chicken meat results in a reaction (GI OR skin), well, food allergy is usually the answer.  But what we usually find is that on challenge testing, chicken is no longer a problem (or never was).

By the way, this reminds me of the whole corn story from 10 or 15 years ago.  Many dog owners were claiming that their pets were allergic to corn simply because they changed from corn-containing diets to diets that had none. There are many great reasons for significant clinical improvements to occur when we change diets, so I believed these owners. However, a true allergy to corn is even less rare than a true allergy to chicken.  There was something else at work there.    

Bottom line – if your pet is itchy or has ear problems, it’s usually fair to try and change the dietary ingredients.  But if your pet improves, we just can’t conclude that food allergy was the reason.  Food changes are powerful for many reasons.

Wednesday, May 31, 2017

When a Vitamin isn't a Vitamin At All

Pet owners ask me every day about supplementing a nutraceutical* for their pet's chronic condition.  Some common examples are:

Heart disease - magnesium, Vitamin E, B vitamins, taurine, thiamin
Wound healing - zinc 
Immunedeficiency - Vitamin A
Anemia - Vitamins B2, B6,  iron, etc
Oxalate bladder stones - Vitamin B6
Asthma - Vitamin B6
Diabetes - magnesium
Immune-mediated diseases - Vitamin D

The difference between most people and most pets is that most pets are eating complete and balanced diets, and people do not.  In fact, the majority of chronic problems experienced in the human population are likely due to some form of malnutrition, which may be why humans have a different set of common disorders than dogs and cats (such as atherosclerosis, diabetes, and hypertension). Every one of the conditions with suggested nutraceuticals listed above are used in people to correct a dietary deficiency. 

Generally, supplementing dogs and cats with nutrients doesn't make much sense if they are eating a complete and balanced diet - at least if that nutrient is used in the human conditions to treat a deficiency.  Yes, you need to know a bit of physiology to evaluate these compounds for use as medication.

On the other hand, I've seen a rise in the number of people feeding unbalanced homemade diets, so perhaps veterinarians should give these kinds of supplements a closer look in pets eating unbalanced diets.  Or just encourage the owner to get them properly balanced.

But nutrients can have other effects, activities that show up only when pharmaceutical doses are used.  When nutrients are used at doses beyond what is necessary for nutritional maintenance, they are being used as nutraceuticals. And some do have interesting potential. One well known example is the use of Vitamins A, E, C, and pyridoxine as antioxidants.  Another is the use of fish oil in higher than nutritional doses to suppress chronic inflammation.

Moral of the story - it's hard to decide if a nutraceutical will help a pet with a chronic problem without direct evidence, like a study involving that nutrient, for that condition, in a group of similar patients, compared to patients taking a placebo.  But studies are expernsive, and we can't usually count on getting all of the studies we need.  If the scientific support is lacking but the supplement seems safe and the mechanism makes sense, a veterinarian may choose to use a nutraceutical. But it's just not as simple as searching the web and picking the most common recommendations that can be found. 

*A nutraceutical is a nutrient used at supra-nutritional doses. Herbs are not nutraceuticals. 

Friday, May 19, 2017

Inflammatory Bowel Disease and Plant Medicines

A variety of plants, plant extracts,  and complex herbal formulas have  been studied in the treatment of IBD.  Central to the problem of studying this condition  is the lack of understanding about the cause.  Bowel inflammation is believed to involve the following: 1
  • ·         multiple genetic variations
  • ·         alterations in the composition of the intestinal microbiota
  • ·         changes in the surrounding environment
  • ·         overreactivity of the intestinal mucosal immune response

Herbal treatments have been identified based on ancient traditional treatments for chronic diarrhea, vomiting and other GI complaints, while more scientifically based testing has been done based on the content of anti-inflammatory compounds contained in plants.
Experimental animal studies have indicated that a variety of herbs and herbal formulas may quell gut mucosal inflammation. These are established models for the human diseases known as IBD, irritable bowel disease, ulcerative colitis, and Crohn's disease.   Most recently, cannabidiol from the hemp plant has been shown to suppress mucosal inflammation as well as hypermotility.2  A very small sampling of other plants shown in recent experimental animal studies  to have benefit include:
  • ·         Zanthoxylum myriacanthum var. pubescens 3
  • ·         A formula of Quebracho, Conker tree and M. balsamea Willd extracts 4
  • ·         Zataria multiflora Boiss 5
  • ·         Daucus carota (carrot)  6
  • ·         Boswellia serrata (conflicting results) 7,8
  • ·         Zingiber officinale (ginger)  9
  • ·         Cordia dichotoma 10
  • ·         Patrinia scabiosaefolia 11
  • ·         Vitex negundo 12
  • ·         Pistacia lentiscus 13
  • ·         Mastic 14,15,16
  • ·         Plantago ovata (psyllium) 17

Human clinical trials are naturally fewer, and there were virtually no clinical trials found in dogs and cats at the time of this review.  A systematic review 1 from 2015 highlighted the following herbs.  In all cases where adverse effects of treatment were tracked,  herbs were deemed very safe.

  • ·         Aloe vera (1 trial) - significant maintenance of remission as compared to placebo
  • ·         Andrographis paniculata (1 trial) - clinical efficancy similar to mesalamine though recurrence rate was higher
  • ·         Artemisia absinthum (2 trials) significant improvement over placebo in 1 trial but not anotherj smaller trial
  • ·         Boswellia serrata (3 trials) - treatment efficacy similar to sulfasalazine in 2 trials but not different  from  placebo in a third trial
  • ·         Cannabis sativa (THC extract, 2 trials, one not controlled)  - significantly better results over  placebo 
  • ·         Curcuma longa (turmeric, 3 trials, only 1 controlled) - reduced clinical signs and relapses as compared to placebo group.
A modern Chinese herbal formula significantly improved symptoms of irritable bowel syndrome in a randomized controlled trial in human patients 18. This trial compared patients given placebo, individualized Chinese herbal prescriptions, and standard formula. Initially, both treatment groups improved significantly compared to the placebo group; at follow-up 14 weeks later, only those receiving individualized prescriptions maintained improvement.
Standard Chinese herbal formula in Bensoussan trial
Dang Shen            Codonopsis pilosulae               7gm
Huo Xiang             Agastaches seu pogostemi      4.5gm
Fang Feng            Ledebouriella sesiloidis            3gm
Yi Yi Ren              Coicis lacryma-jobi                      7gm
Chai Hu                 Bupleurum Chinense                4.5gm
Yin Chen               Artemisia capillaris                    13gm
Bai zhu                 Atractylodes macrocephalae    9gm
Hou Po                 Magnolia officinalis                    4.5gm
Chen Pi                 Citrus reticulata                          3gm
Pao Jiang             Zingiber officinalis                     4.5gm
Qin Pi                   Fraxinus rhynchophylla             4.5gm
Fu Ling                 Poria cocos                                 4.5gm
Bai Zhi                  Angelica daihurica                    2gm
Che Qian Zi           Plantago asiatica                     4.5gm
Huang Bai             Phellodendron amurense      4.5gm
Zhi Gan Cao          Glycyrrhiza uralensis             4.5gm
Bai Shao               Paeonia lactiflora                     3gm
Mu Xiang              Aucklandia lappa                     3gm
Huang Lian            Coptis sinensis                       3gm

Wu Wei Zi             Schisandra chinensis              7gm

How might herbal medicines work to improve the clinical signs of, or even resolve, IBD?  There are a variety of potential active compound classes contained in herbs, including proteins, carbohydrates, lipids, alkaloids, glycosides, flavonoids, saponins, terpenoids, tannins and essential oils. Importantly to the practice of herbal medicine, it may be the combination of components that is most effective as opposed the singular effect of one compound.  Herbal medicines may exert anti-inflammatory, antiphlogistic, astringent, and mucosal protective effects, and may also alter the microbiome.  Botanical medicines have also been used in IBD for their psychological effects, as the pain secondary to inflammation of the bowel may alter circulation and other functions of the gut.19

Veterinarians who use integrative therapies will choose from a variety of approaches to treat this potentially deadly disease.  A change in diet is a reasonable first step, and herbal therapies often come next, sometimes along with acupuncture. Many veterinary herbalists are consulted after conventional therapies including steroids  (prednisone, budesonide) or stronger immunesuppressive therapies (cyclosporine, azathioprine, chlorambucil and even mycophenylate, leflunomide, etc ) are already on board and see an improvement when natural therapies are instituted. Patients can die of this disease, and herbal therapies are a reasonable addition at any stage in order to mitigate side effects and perhaps increase the chance of a remission.


1 Algieri F, Rodriguez-Nogales A, Rodriguez-Cabezas ME, Risco S, Ocete MA, Galvez J..  Botanical Drugs as an Emerging Strategy in Inflammatory Bowel Disease: A Review. Mediators Inflamm. 2015;2015:179616. doi: 10.1155/2015/179616. Epub 2015 Oct 20.

2 Pagano E, Capasso R, Piscitelli F, Romano B, Parisi OA, Finizio S, Lauritano A, Marzo VD, Izzo AA, Borrelli F. An Orally Active Cannabis Extract with High Content in Cannabidiol attenuates Chemically-induced Intestinal Inflammation and Hypermotility in the Mouse.  Front Pharmacol. 2016 Oct 4;7:341.

3 Ji KL, Gan XQ, Xu YK, Li XF, Guo J, Dahab MM, Zhang P.  Protective effect of the essential oil of Zanthoxylum myriacanthum var. pubescens against dextran sulfate sodium-induced intestinal inflammation in mice.Phytomedicine. 2016 Aug 15;23(9):883-90

4 Brown K, Scott-Hoy B, Jennings LW.  Response of irritable bowel syndrome with constipation patients administered a combined quebracho/conker tree/M. balsamea Willd extract.  World J Gastrointest Pharmacol Ther. 2016 Aug 6;7(3):463-8. doi: 10.4292/wjgpt.v7.i3.463.

5 Nakhai LA, Mohammadirad A, Yasa N, Minaie B, Nikfar S, Ghazanfari G, Zamani MJ, Dehghan G, Jamshidi H, Boushehri VS, Khorasani R, Abdollahi M.. Benefits of Zataria multiflora Boiss in Experimental Model of Mouse Inflammatory Bowel Disease.  eCAM 2007;4(1)43–50 doi:10.1093/ecam/nel051

6 Patil MVK , Kandhare AD,  Bhise SD.  Anti-Inflammatory Effect Of Daucus Carota Root On Experimental Colitis In Rats. Int J Pharm Pharm Sci, Vol 4, Issue 1, 337-343

7 Madisch, A.; Miehlke, S.; Eichele, O.; Mrwa, J.; Bethke, B.; Kuhlisch, E.; Bästlein, E.; Wilhelms, G.; Morgner, A.; Wigginghaus, B. & Stolte, M. (2007). Boswellia serrata
extract for the treatment of collagenous colitis. A double-blind, randomized,  placebo-controlled, multicenter trial. International journal of colorectal disease, Vol.22,
No.12 (December 2007), pp.1445-14451.

8 Kiela, PR.; Midura, AJ.; Kuscuoglu, N.; Jolad, SD.; Sólyom, AM.; Besselsen, DG.; Timmermann, BN. & Ghishan, FK. (2005). Effects of Boswellia serrata in mouse models of chemically induced colitis. American journal of physiology. Gastrointestinal and liver physiology, Vol. 288, No.4 (April 2005), pp. G798-808. ISSN 0193-1857 

9 El-Abhar, HS.; Hammad, LN. & Gawad, HS. (2008). Modulating effect of ginger extract on rats with ulcerative colitis. Journal of ethnopharmacology, Vol.118, No.3 (August 2008), pp. 367-372. ISSN 0378-8741

10 Ganjare, AB.; Nirmal, SA.; Rub, RA.; Patil, AN. & Pattan, SR. (2011). Use of Cordia dichotoma
bark in the treatment of ulcerative colitis. Pharmaceutical biology, Vol.49, No.8 (August 2011), pp. 850-855. ISSN 1388-0209

11 Cho, EJ.; Shin, JS.; Noh, YS.; Cho, YW.; Hong, SJ.; Park, JH.; Lee, JY.; Lee, JY. & Lee, KT. (2011). Anti-inflammatory effects of methanol extract of Patrinia scabiosaefolia in mice with ulcerative colitis. Journal of ethnopharmacology, Vol.136, No.3 (July 2011), pp. 428-435. ISSN 0378-8741

12  Zaware, BB.; Nirmal, SA.; Baheti, DG.; Patil, AN. & Mandal, SC. (2011). Potential of Vitex negundo roots in the treatment of ulcerative colitis in mice. Pharmaceutical biology, Vol.49, No.8 (August 2011), pp. 874-878. ISSN 1388-0209

13 Kim, HJ. & Neophytou, C. (2009). Natural anti-inflammatory 13 compounds for the management and adjuvant therapy of inflammatory bowel disease and its drug delivery system. Archives of pharmacal research, Vol.32, No.7 (July 2009), pp. 997- 1004. ISSN 0253-6269

14 Kaliora, AC.; Stathopoulou, MG.; Triantafillidis, JK.; Dedoussis, GV. & Andrikopoulos, NK. (2007). Chios mastic treatment of patients with active Crohn's disease. World journal of gastroenterology, Vol.13, No.5 (February 2007), pp.748-753. ISSN 1007-9327

15 Kaliora, AC.; Stathopoulou, MG.; Triantafillidis, JK.; Dedoussis, GV. & Andrikopoulos NK. (2007). Alterations in the function of circulating mononuclear cells derived from
patients with Crohn's disease treated with mastic. World journal of gastroenterology, Vol.13, No.45 (December 2007), pp. 6031-6036. ISSN 1007-9327

16 Al-Habbal, MJ.; Al-Habbal, Z. & Huwez, FU. (1984). A double-blind controlled clinical trial
of mastic and placebo in the treatment of duodenal ulcer. Clinical and experimental pharmacology & physiology, Vol.11, No.5 (September 1984), pp. 541-544. ISSN 0305- 1870

17 Rodríguez-Cabezas, ME.; Gálvez, J.; Camuesco, D.; Lorente, MD.; Concha A,; MartinezAugustin, O.; Redondo, L. & Zarzuelo, A. (2003). Intestinal anti-inflammatoryactivity of dietary fiber (Plantago ovata seeds) in HLA-B27 transgenic rats. Clinicalnutrition, Vol.22, No. 5 (October 2003), pp. 463-471. ISSN 0261-5614

18 Bensoussan A; Talley NJ; Hing M; Menzies R; Guo A; Ngu M, 1998. Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial. JAMA 11;280(18):1585-1589.

19  Lauche R, Cramer H, Klose P, Kraft K, Dobos GJ, Langhorst J. Herbal medicines for the treatment of inflammatory bowel disease. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD011223. DOI: 10.1002/14651858.CD01122

Tuesday, October 23, 2012

Canola oil safety?

Recently I’ve received many questions about the safety of canola oil. The most comprehensive collection of concerns are presented on the Weston A. Price website.

I formulate a great many homemade diet recipes with organic canola oil because it has a very good balance of omega-3 and omega-6 fatty acids. I am convinced of the safety and sustainability of the oil as long as it comes from a reputable organic producer (which is admittedly harder and harder to find - see this NYT article on organic companies being controlled by Big Ag -

Below are the concerns listed on the Weston A. Price page, and the real story if you dig further. I'm open to argument and learning differently on this subject, but you had better be able to produce meaningful peer-reviewed scientific references to back up your point of view. This means large epidemiologic studies or clinical trials in people or dogs/cats.  Test tube and lab animal studies don't count.

1. Canola oil is associated with fibrotic lesions in the heart
a. The studies cited are all lab animal studies conducted in rats artificially prone to cardiovascular disease. It is well established that these kinds of experimental studies have limited applicability to clinical patients, especially considering the fact that dogs and cats do not develop atherosclerosis and other types of heart disease typically seen in humans and these experimental animals.
b. In addition, the review of these studies specifically shows that the results are conflicting, and that the conclusion is that the critical factor in development of cardiovascular disease in these animals was the *balance* of fats in the diet, and not the mere presence of canola oil or omega-3 fatty acids. Almost all pet diets are balanced with saturated and polyunsaturated fats, containing a high level of animal fats (which are touted by Weston A Price as the healthiest of fats).

2. Canola oil causes vitamin E deficiency
a. All omega-3 fatty acids cause Vitamin E depletion in the body. A more powerful omega-3 fatty acid source - fish oil- depletes Vitamin E the even more rapidly. This is why all commercial omega-3 fatty acid supplements should be fortified with Vitamin E.

3. Canola oil causes platelet changes
a. Platelet changes are not unique to canola oil - fish oil and other omega-3 fatty acids also cause platelet and blood coagulation changes. This is actually utilized by cardiologists when they recommend fish oil for human cardiovascular patients to reduce the risk of stroke.

4. Canola oil causes shortened life spans in stroke prone rats when it is the only oil in the animals' diet.
a. Not only are these rats not in any way clinically relevant to people who develop strokes, much less dogs and cats, but the experimental situation was artificial - the sole fat in the diet was canola oil. This would be nearly impossible to replicate in any real-life management situation for dogs and cats, and certainly bears no relationship to the fat balance in normal pet foods or healthy human diets. In addition, no food formulator would attempt it as that would clearly lead to nutritional deficiencies in dogs and cats.

5. Canola oil causes growth retardation
a. This claim is not referenced and not explained in the report - they say only that experimental animals given soy and canola oil-based diets grew better when coconut oil was added to the diet. This is not the same as growth retardation and could be explained simply by supplying certain fatty acids in the coconut oil that are essential or conditionally essential in those animals.

6. That all of these issues are mitigated when saturated fats are added to the diet and that the problems seem to be related to high levels of omega-3 fatty acids.
a. Again, no food formulator would attempt to supply all dietary fat as canola oil or any other single source unless it was biologically appropriate. In dog and cat diets, a small amount of canola oil (in relation to the large amount of animal fat) supplies omega -3 fatty acid (ALA) that is essential in dogs and cats. This fatty acid is not available in the fat of animals raised by modern agricultural methods and so must be supplemented in the diet.

7. The paper reports increased rates of lung cancer in women who cook with canola oil.
The source is a Wall Street Journal article - this is not a scientific, critical look at actual epidemiologic associations and cannot be considered a credible claim.

8. Processing of canola oil leads to the introduction of trans-fatty acids.
It depends on the manufacturer – I would call them to get their trans-fatty acid analyzed levels.

9.The report implies that the original development of the commercial plant was via modern GMO methods, which is untrue.
"Seed splitting" is simply partitioning the harvested seeds so for analysis by gas liquid chromatography for certain genetic traits, and based on the results of that testing, the other half of seeds with the most desirable characteristics were selected for the breeding program. It is nothing but seed hybridization. The paper additionally claims that almost all canola oil is sourced from genetically modified plants. My understanding is that this is true, and I recommend ONLY organic canola oil for my patients.

All of this being said - we use canola oil for the nice balance of essential fatty acids.  There are other sources of these fatty acids, depending on which ones are required to balance the diet and supply the animal's requirements.  Some alternatives that may work (but you have to do the math!) are walnut oil, hemp oil, and others. On the other hand, it's problematic to use some of the more popular oils, like coconut or flax.  Some don't contain any of the essential fatty acids at all, and some in such low concentrations that it's necessary to use a combination of oils.  A nutritionist will try to tailor this essential part of a recipe to the animal's requirements and the owner's preferences.

Sunday, August 12, 2012

Leaky Gut and Intestinal Hyperpermeability are sooooo different!

“Leaky Gut Syndrome” is a diagnosis coined by alternative medicine practitioners in the 1970s.  The syndrome was especially considered in the context of a branch of alternative medicine known as “environmental medicine”.  This field developed from the 1950s and espoused the theory that many modern chronic diseases were due to a plethora of toxins in the environment and environmental allergies1.   

Leaky Gut was and is said to be caused by damage to the gut lining which allows abnormal absorption of bacteria, toxins and gut proteins, and leads to development of a very large number of chronic medical conditions.  Diseases that are said to be initiated or worsened by a Leaky gut include environmental and food allergies, arthritis of several types, eczema, chronic fatigue syndrome, inflammatory bowel disease, pancreatic disease, migraines, autism, celiac disease and gluten intolerance, and fibromyalgia.

The gut is viewed as one important gateway for toxins and allergens from the environment, and constant exposure to these irritants were thought to cause gut pathology, leading to a vicious cycle of gut damage à absorption of toxins, bacteria and abnormally large intraluminal proteins directly into portal and systemic circulation à immune activation and immune-mediated diseases à àdeterioration of gut barrier,  and so on, over and over again.

The pathogenesis of leaky gut is said to include:

·         Altered GI microflora (due to repeated antibiotic therapy as well as many other drugs and a poor diet).  The intestinal microflora have many critical functions, including detoxifying some xenobiotics, maintaining an intraluminal environmental that discourages growth of pathogenic bacterial, maintaining the gut’s tight junctions and barrier function, and dialoguing with the immune tissues of the gut.
·         Overgrowth of the yeast, Candida albicans.
·         Food allergies (which if not a primary problem, becomes an associated illness once gut permeability is altered)
·         Damaged gut mucosal cells become unable to digest food normally, or to detoxify environmental xenobiotics
·         Drugs that cause direct damage to the gut mucosa, such as NSAIDs and steroids, hastened the development of a hyperpermeable gut.

Treatment involve any of the following:
·         Changing dietary components to reduce allergenicity
·         Supplementing enzymes to improve digestibility of the food.
·         Supplementing probiotics
·         Correcting possible nutrient deficiencies with a variety of vitamins and minerals
·         Treating yeast overgrowth
·         Addressing the quality of fat in the diet to emphasize less inflammatory fatty acids
·         Improving gut cell production and turnover with l-glutamine

Just as environmental medicine doctors had reported, many veterinarians using these methods noted dramatic results when pets were treated using the same principles. The problem is that “leaky gut” was never documented as a cause for these immune mediated diseases, and changes in the gut were not monitored as patients got better (although these tests are available). 

While the role of leaky gut in such a wide array of chronic diseases is still considered unproven and under the purview of alternative medicine, “ intestinal hyperpermeability” was becoming increasingly recognized by critical care specialists in the 1980s as a primary initiator of multiple organ dysfunction syndrome and death in critically ill humans 2.   And the final results are the same – invasion into the bloodstream by gut microbes and activation of the immune system – but in the case of critically ill patients, the course of the problem was more rapid and easier to recognize.

A 1998 review of “intestinal hyperpermeability” -  the approved name for the more acute condition recognized by conventional medicine – reviewed the mechanisms behind development of the condition.  They are:
·         Oxidative stress
·         Hypoxia
·         Tissue acidosis
·         Nitric oxide – an cell-signallying molecule that influences circulation, and has been shown to have deleterious effects if present in the gut in abnormally high OR low concentrations.’
·         Inflammatory cytokines – which are produced on exposure to luminal antigens and bacteria, which can happen any time the barrier is breached.
·         “Metabolic Inhibition”  - a laboratory condition that causes chemical changes in the tight junctions so critical for maintaining the intestinal barrier. 

When I look at this list, I see mechanisms that are active in chronic disease as well.  Let’s look at what I would consider a typical veterinary patient who is a candidate for management of a hyperpermeable gut.

This theoretical dog is an 11 year old Labrador with chronic osteoarthritis and a long history of allergic otitis and bad skin.  The dog has eaten the same diet for many years, and eats well.  A nonsteroidal anti-inflammatory drug has been administered daily for the past year or so.  And this dog is presented to me for acupuncture to aid in pain control for the arthritis. 

For the past 15 or so years, I’ve handled dogs like this one by delaying the acupuncture, and recommending the following:
1. Change the ingredients in the diet (making it essentially less allergenic), and make sure that it contains antioxidants in the form of vegetables and fruits.  If the dog won’t eat veggies and fruits, supplement a broad spectrum antioxidant containing Vitamins A, E, C, selenium, flavonoids, carotenoids, etc. 
2. Supplementing digestive enzymes (not just because of leaky gut, because there are those who believe that old dogs have decreased digestive function, especially in the stomach, just as geriatric people with atrophic gastritis do).
3. Possibly a probiotic supplement.
4. High doses of fish oil
5. Massage.

It’s amusing how many people attribute the improvement I see on a regular basis to the massage, because it’s just so hard to believe that dietary changes can be so effective in pain control!

I’m simply reporting my clinical experience, and I’m not saying this is right for every old arthritic pet.  But I see that conventional medicine and alternative medicine may be discovering a convergence in one very important anatomical area and organ function.  The gut is the largest immune organ in the body.  It contains more neurons than the spinal cord.  It maintains a very delicate balance between the outside environment and the critical homeostasis inside the body.  And both conventional and alternative medicine are postulating similar mechanisms for the role of the gut in all disease.  I hope this progress continues. 

1Rogers SA, 1997.  Environmental Medicine for Veterinary Practitioners in Complementary and Alternative Veterinary Medicine: Principles and Practice, Schoen A and Wynn S, Eds.  Mosby, St. Louis.

2Fink MP.  Effect of critical illness on microbial translocation and gastrointestinal mucosa permeability.  Semin Respir Infect. 1994 Dec;9(4):256-60.

3 Unno N, Fink M.  Intestinal Epithelial Hyperpermeability.  Gastroenterology Clinics of North America 1998; 27(2):289-307).