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.

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).

Thursday, June 2, 2011

a new fountain for cats

A colleague turned me on to this new drinking fountain - it's mostly ceramic which is a big improvement over the plastic fountains that hold onto contaminants, bacteria and leach things like BPA.

See it here:

Saturday, April 16, 2011

Preventing Weight Loss During Chemotherapy

Chemotherapy sometimes makes a patient sick. Unfortunately, it is in the nature of the treatment to maim and kill cells, hopefully more cancer cells than normal ones. But cells of the GI tract are often sensitive to the effects of chemotherapy, and cancer patients sometimes experience nausea, vomiting and diarrhea.

Weight loss during cancer therapy is extremely common because patients either feel ill, cannot keep their food down, or cannot smell or taste it well. Significant weight loss is a poor prognostic indicator, at least in people, and presumably in pets as well. If you were to check out the web pages of major cancer centers such as M.D. Anderson in Texas, you'd find multiple references on how to maintain your weight during chemotherapy and radiation treatment. My personal belief is that we need to try just as hard in canine and feline cancer patients.

Recently, one of my favorite patients developed cancer and his owner, an animal behaviorist, decided to start chemo. We discussed the challenges of maintaining his appetite and body weight, and using her comprehensive knowledge of animal behavior, she made certain he lost very little weight indeed.

It involved alot of thought, and use of principles that most of us may not be familiar with or just don't consider putting into practice. I was so encouraged by her success that I asked her to share her methods. If your dog or cat has cancer, whether undergoingg treatment or not, you may want to check it out:

Thanks a million to Allison Martin for sharing her insights, and to Brody for inspiring her!

Wednesday, July 7, 2010

Cancer Diet Redux: When is the "Cancer Diet" not recommended?

When should the "cancer diet" not be fed to veterinary cancer patients?

We should begin by determining when the "cancer diet" *should* be fed to cancer patients. It is fairly universally recognized now that cancer cells exhibit increased glucose utilization compared to normal cells, and this metabolic defect is the basis for research to determine whether lowering glucose concentrations (by limiting simple carbohydrates in the diet) can improve cancer survival.

Clinical proof that a low carbohydrate diet is clinically beneficial remains a little lean. A single clinical trial in dogs suggested that a low carbohydrate, high fat diet containing fish oil and arginine accelerated time to remission in lymphoma patients and may extend the disease-free interval. Every cancer is different, and test tube studies on human cancer cells suggest that different cancers respond differently to various nutritional profiles in their media.

While a few million dollars has likely been spent on canine research in this area, billions have been spent in human nutritional oncology. And we still don't have definitive proof as to the best diet for cancer patients. In dogs and the cats, the usual recommendation is to feed a low carb diet simply because there is a physiologic rationale for it. In people, it is recommended that they eat the diet that helps prevent cancer - low in animal fat, high in vegetables, full of variety - and people should continue to get exercise. And while there is plenty of evidence in people that excess weight *loss* during cancer treatment worsens the prognosis, there is now emerging evidence that being obese while undergoing cancer treatment also worsens prognosis.

The dietary key to influencing cancer proliferation is that the diet be high in fat - tumor cells are unable to use fat as an energy source, whereas dogs and cats can do this very efficiently. So the "low carb diet" for cancer patients is usually quite high in meat (which contains a lot of fat), low in starches and sugars, and contains added fat. A logical conclusion is that for pets with cancer only - no pancreatitis, no advanced renal disease, no obesity, etc - a low carb, moderate protein, high fat food makes sense. But for patients with these other disorders, the diet can not only worsen the prognosis but even make death from the other disease more imminent than death from cancer.

I'd like to focus here on managing obesity in a cancer patient. Here's the thing - obesity leads to hyperglycemia - high blood glucose - and insulin resistance. This hyperglycemia is much more persistent than the elevated glucose load that occurs after any meal of any composition. In addition, surgery, radiation and chemotherapy can cause changes in endocrine functions that could increase the likelihood of development of metabolic syndrome (de Haas, 2010).Cancer itself is commonly associated with hyperglycemia (Heber, 2006). Whether this persistent hyperglycemia and insulin resistance leads to worse outcomes in veterinary patients is unknown, but glycemic control is routinely recommended in human patients when hyperglycemia is identified (Heber, 2006). This is both to control episodes of infection (made more likely through the use of immunesuppressive therapies) but also to prevent progression to metabolic syndrome and diabetes which is a risk factor for the development of other cancers.

Obesity is also an 'inflammatory disease', as is cancer. Fat is now considered an organ that releases excess infl ammatory cytokines, such as tumor-necrosis-factor-α (TNFα) and interleukin 6 (IL-6) (de Haas, 2010). These cytokines are considered growth factors that can activate genes that control angiogenesis, invasion and metastasis of cancer cells.

The obese cancer patient then gets a double dose of simple sugar in the blood, and more inflammatory chemicals already being produced by the tumor itself. These patients just have to be 'sicker' - whether or not they show it - than patients of normal weight. Hence the new evidence that some obese human cancer patients have worse outcomes than people of normal weight. This has been shown most frequently in breast, prostate and colon cancer (Ramos 2010, Sinicrope 2010, Komaru 2010, Siegel 2010, de Azambuja 2010, Lange 2008, Nitori 2009). Additionally, some recent trials suggest that overweight patients undergoing controlled weight loss during cancer treatment experienced improved prognosis (Freedland 2009).

A diet that is low in simple carbohydrates and higher in meat protein will be fairly calorie-dense, depending on the proportion of meat to other ingredients. A homemade version of the low carb diet can be made to resemble an Atkins-style diet. This can work for weight loss in some patients but not necessarily for others, because meat comes with fat - even the lower fat meats. If I formulate a diet for an obese patient, I use a lower fat protein, such as tofu, often along with a small amount of a starch, and plenty of vegetables. These proportions are customized to the individual dog, and the vitamin/mineral levels are also changed as needed. The starch and sugar content is still quite low, and weight loss can be facilitated.

I see many people who request the 'cancer diet' for their pet with cancer, and a few who refuse to believe that it is inappropriate for their particular pet. We have an increasing number of studies in people to suggest that customizing the diet for an obese patient improves survival, and only 1 study in dogs suggesting that the high fat low carb diet makes a difference in survival. The veterinary oncologist that investigated the low carbohydrate diet for veterinary cancer patients has repeatedly written "no one diet is right for every cancer patient". You can't believe that his research is right 100% of the time but that this opinion of his is wrong 100% of the time.


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de Haas EC, Oosting SF, Lefrandt JD, Wolffenbuttel BH, Sleijfer DT, Gietema JA. The metabolic syndrome in cancer survivors. Lancet Oncol. 2010 Feb;11(2):193-203.

Freedland SJ, Aronson WJ. Dietary intervention strategies to modulate prostate cancer risk and prognosis. Curr Opin Urol. 2009 May;19(3):263-7.

Heber, D. Assessing Endocrine Effects of Cancer and Ectopic Hormone Syndromes. Nutritional oncology. Elsevier, St Louis, 2006; p. 695

Komaru A, Kamiya N, Suzuki H, Endo T, Takano M, Yano M, Kawamura K, Imamoto T, Ichikawa T. Implications of body mass index in Japanese patients with prostate cancer who had undergone radical prostatectomy. Jpn J Clin Oncol. 2010 Apr;40(4):353-9. Epub 2010 Jan 10.

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Wednesday, June 9, 2010

How to choose a pet food

As a nutritionist and integrative practitioner, I’m asked almost every day what pet food I recommend. It’s an interesting thought – that I recommend one pet food.

At the same time, my nutrition training has led me to question authority. While the holistic folks like to vilify the big over the counter and prescription brands of food, my training has shown me that they employ some of the best – and some of the worst- company philosophies. And this is what I’m about today – choosing a company, and not a food.

Before I tell you what personal philosophies drive *my* company choices, I’ll paint a picture of the problem for you.

Over the past decade, I’ve had occasion to ask for more detailed information about a food based on my patients’ needs. You see, the guaranteed analysis on the food label provides only the barest guide as to the nutrient profile of the food. And while I care about *ingredients*, I also care that my patients are being provided with essential *nutrients* they require for continued normal functioning.

I’ve needed to know if the protein content was able to meet the minimum needs for animals who required caloric restriction of a high fat diet. I’ve needed to know if amino acid profiles were adequate in a vegetarian diet with a suspicious ingredient listing. And I’ve been disturbed by the digital equivalent of a blank stare I got when asking for this information from some of the most popular makers of ‘holistic’ and ‘natural’ diets. The ones you are feeding your pets right now, and the ones your local pet store employee is pushing as new and improved.

Here is a sampling of the problems I’ve encountered when trying to obtain nutrition information from the ‘holistic’ pet food companies:

  1. Labels with egregious mistakes showing either inaccurate information or terrible formulating errors.
  2. Company leaders who do not know what a nutrient profile* is, much less how to provide one to a nutritionist.
  3. Refusal by a company to provide nutrient profiles, stating that it is proprietary information (ok, but you will never hear me recommending your diet, especially if it is a certain new vegetarian diet). Honestly, the largest companies post their profiles on the web – do you really think it has cut into their profits?
  4. Diets (raw and processed) that are not complete or balanced when nutrient profiles are submitted to detailed analysis.
  5. A company that refuses to deal fairly with a veterinarian who discovers a major problem with its food.
  6. Companies that refuse to provide the names or credentials of their food formulators
  7. Naïve representatives making dangerous claims because they don’t understand the simplest feed concepts, such as dry matter conversions
  8. Company heads that misuse their meager knowledge of nutritional biochemistry and microbiology to make unfounded health claims and spread misinformation across the web.
  9. Advertising claims that tout health benefits that were disproven years before.
  10. Companies that for decades refuse to acknowledge new information and adjust their formulas, simply because people continue to buy their foods.

So how do you choose a pet food?

You don’t- you choose a company. So here are my criteria for recommending a food manufacturer:
  1. The company needs a track record. Even if it’s your best friend whom you consider knowledgeable, the company she owns or recommends needs to prove its ability to produce consistently safe formulations, hold onto the best employees, and is using profits to improve (and not just expand) the company.
  2. There should be a board certified veterinary nutritionist on staff. Not just a veterinarian – a veterinary nutritionist. I’ve seen some very questionable formulations even from companies owned by veterinarians. The only way the formulations can improve over time is if a nutritionist is constantly feeding updated knowledge into those formulations.
  3. The company philosophy fits with my clients’ standards** and my patients needs.

Once we settle on a few companies, I have these additional recommendations for my clients:
  1. Choose foods that carry an AAFCO feeding claim to be complete and balanced for the appropriate life stage of your pet. Some smaller pet food companies do not produce balanced diets, and others produce pure meat diets “intended for supplemental or intermittent feeding”. Nutritional deficiencies could result if any of these are fed long term.
  2. Rotate between various companies (i.e. use various flavors , but also from different companies)
  3. Avoid exotic ingredients like duck, rabbit, emu, pheasant, and venison. They aren’t necessary for healthy pets and we may need for them to be completely new to your pet when diagnosing or treating certain conditions later. There is plenty of variety to be had with chicken, lamb, beef, pork, turkey, fish, egg and vegetarian foods. It’s also easier to find organic versions of these ingredients.
  4. Feed your dog veggies and fruits as snacks or to beef up the amount of food in his bowl. It is may help prevent cancer, and they are low in fat. Avoid grapes, raisins and onions, which can be toxic to pets. Choose all colors, including carrots, broccoli, cauliflower, bell peppers, squash, apples, melon, berries, etc). Feeding more meats and starches is rarely necessarily, especially if you are already feeding a premium or Paleolithic diet.
  5. Don’t buy large bags of food for small animals- food should be used up within a month, especially if it is stabilized with natural preservatives instead of chemical preservatives.
  6. Avoid dry foods in cats and if your cat is currently eating dry, make an appointment to talk to a nutritionist about why this may no longer be recommended and how to switch stubborn kitties to canned or homemade food. At the very least, for heavens’ sake, do not leave free choice dry food down – for dogs OR cats. Most just get fat on it!
Seems like a lot to remember, but here is the simple version: feed balanced foods, with healthy ingredients, from different companies. Give veggies and fruits instead of junky treats, and maintain a lean body weight. If you prefer homemade, get the recipe balanced, and stick to the plan. And of course, check in with your vet for regular physical and biochemical exams to find emerging problems early.


*A nutrient profile shows the levels or concentrations of all essential nutrients in a food . This profile is compared to the nutrient requirements of a dog or cat to determine whether it is marginal, deficient, or replete for a particular life stage or condition.

**Philosophies and standards are unique to each pet owner. Some won’t tolerate commercial diets at all, while others don’t care if they are commercial as long as they are (pick one – raw, natural, organic, made of human grade ingredients, etc). Some trust larger companies and care only that the correct *nutrients* are provided, while others don’t care about nutrients and consider *ingredients* most important, absolutely prohibiting by-products. A few clients believe that locally sourced ingredients are best (necessitating a homemade diet unless you happen to live near a company that uses ingredients local to *you*). If you really want to know, my philosophy necessitates a complete and balanced nutrient profile, identifiable ingredients (although by-products of some types are just fine with me considering the true natural diet of dogs and cats), a veterinary nutritionist on staff, and a company that balances the need for economy with the need to document the safety of their raw ingredients (usually requiring domestically sourced ingredients). The company should be transparent in its operations (some have allowed the WDJ editor to visit their plants, and some regularly invite veterinarians for tours, while others won’t answer phone calls). And of course, I think homemade diets are superior as long as they are balanced. I’ve seen some awful sick animals eating weird homemade recipes, and I’ve seen so many improve if we just balance while incorporating the owners’ preferences!