Making Sense of the Nutrition Noise

I promise that in the near future I will cover more current nutrition topics, like what is with this grain-free craze or how to make sense of pet food labels, but in my second post I wanted to provide you with a little more background on dog and cat nutrition.

It’s hard to miss all the sources of nutrition “advice” available to pet owners. They receive one recommendation from a friend, another from the trainer, and a third from the pet store. The breeder may have sent them home with a new puppy and a binder on everything from grooming tips to what to feed. Books and websites claim to hold the secrets to keeping dogs and cats disease free for life. With this cacophony of diet tips and nutrition recommendations, how can pet owners know whom to trust and how to make the right decisions for the animals in their care? This is where I come in. To share a few tips that I hope will make you more informed dog and cat caregivers and savvier consumers.

Tip #1: Always Check Credentials

My first tip for pet owners is to understand where recommendations can come from. Self-taught individuals may know what has worked for their own dogs and cats in the past, but enthusiasm, motivation, and even personal experience, are not the same as education and expertise. Before changing your dog or cat’s diet or adding in a supplement, look to see if that individual has a formal background in nutrition. Holding a Master’s or PhD in Animal Nutrition means that the individual has studied nutrient metabolism in detail and understands the nutritional needs of healthy dogs and cats. A Veterinarian who has completed a residency in Nutrition will have taken the same advanced nutrition classes as the Master’s or PhD students (sometimes earning that degree as well) and will understand the requirements for healthy dogs and cats and how they change with disease.  A person who loves animals, but with no additional qualifications, may not be aware of how cooking affects nutrient levels, how ingredients will interact together in the pan or in the gut, or how to identify and correct nutrient imbalances if and when things go wrong.

Which leads me to Tip #2…

Tip #2: Not Every “Nutritionist” is Created Equally

The term “Nutritionist” is relatively broad and has no legal protection or official definition. Someone with a graduate degree (Master’s or PhD) in Animal Nutrition is a Nutritionist; a Veterinarian with specialty training in Animal Nutrition (graduate degree or residency, or both) is also a Nutritionist.  Both of these groups of people have studied nutrient metabolism and biochemistry in detail, with Veterinary Nutritionist also able to put it all together for health and disease management. Then on the other side of the “Nutritionist” spectrum you have the enthusiastic animal lover who has taken an online course and was awarded a certificate of completion; the pet store clerk who attends the weekend nutrition seminar; and the person who has taken a few human nutrition classes and treats dogs and cats like small people.  There is no clear way to differentiate these people without researching their credentials and background, which I encourage every pet owner to do.

And this leads to the question, what do Veterinarians know about Nutrition?

Tip #3: Yes, Veterinarians are Taught Nutrition at School

If you are reading this blog it means you are interested in dog and cat nutrition and have likely seen and heard claims (usually by individuals pushing their own agenda) that Veterinarians lack nutrition training or have only received “product training” in school. While the depth of nutrition education varies at each veterinary school, every graduate Veterinarian leaves their school with enough basic nutrition knowledge to provide good quality patient care.

Let’s start with the basics.  There are currently 28 veterinary schools within the US that are accredited by the American Veterinary Medical Association (AVMA). All of these schools require either a basic nutrition course before school admission or a basic nutrition course during the four years of school.  After that, the breadth of training will depend on the individual University’s commitment to nutrition education. Sixteen of these 28 US vet schools have Board-Certified Veterinary Nutrition Specialists on staff teaching classes and helping to manage patient in the hospital. In the remaining 12 vet schools, nutrition education is unfortunately limited to class time. Courses are either taught by another faculty member, like an Internal Medicine Specialist or a non-veterinarian Nutritionist (typically someone with a PhD in Nutrition), or by an outside education company.

In all vet schools the concepts of nutrition for health and disease management are woven into the other required courses, especially Biochemistry, General Medicine, and Internal Medicine. Just as vet students are taught about antibiotics, vaccines, and suture materials, they are taught about which therapeutic diets to use for conditions such as kidney disease or diarrhea. I think this may be where the “product training” criticism comes from. I would argue though that therapeutic diets are just one more tool in the veterinary kit bag. This bag is full of other “products” from eye drops to syringes, ointments to x-ray equipment, and a good Veterinarian should know how to use every tool in their bag correctly.

But when that Veterinarian has exhausted all of these tools …

Tip #4: Veterinary Nutrition Specialists Do Exist

The American College of Veterinary Nutrition (ACVN) was established in 1988 and is considered a Recognized Veterinary Specialty Organization (RVSO) under the AVMA umbrella. Just like specializing in Surgery, Dermatology, or Ophthalmology, Veterinarians who wish to specialize in Nutrition have the ability to undergo additional training and certification post-vet school. The residency and examination requirements are established by the ACVN, not the AVMA (or pet food companies!), and all members are expected to have a basic nutrition knowledge and skill above that of a General Practice Veterinarian. Candidates who have successfully passed residency requirements and certification for ACVN are referred to as Diplomates and can promote themselves as such. It is a relatively small group (only 81 current members in 2014) and is comprised of both Large Animal (horses and other farm animals) and Small Animal (dogs and cats) Nutrition Specialists with very diverse backgrounds and interests. They work with other Veterinarians; they teach vet student, interns and residents; they lecture at continued education conferences; they write book chapters and articles for veterinary journals; they are on faculty at non-vet school universities; they work in industry (veterinary pharmaceuticals or pet food companies); and are in government or regulatory roles. In all of this though, very few Veterinary Nutrition Specialists work directly with pet owners or the general public, which is something that I hope will continue to change.

Like the claim that Veterinarians “know nothing” about nutrition, Veterinary Nutrition Specialists have been accused of being shills for Big Pet Food. In my last tip I would encourage my readers to always …

Tip #5: Follow the Money Trail

Yes, some Veterinary Nutrition Specialists work for pet food companies and others are at universities and collaborate on research and clinical trials with pet food companies. These are pretty transparent relationships and it is easy to see the financial connections.  The people who I am skeptical of are those who are critical of Veterinary Nutritionists. What is their motivation in criticizing these Nutrition Specialist? What are they are trying to sell you instead? Is it an alternative diet or supplement?  Maybe they include a link on their website to make buying the “better” foods easier, or offer to sell you a subscription to a diet plan or newsletter to help you feed your dog or cat the “right” way. Invariably there will be a purchase price involved somewhere.

Even I am trying to sell you something. I am trying to sell you on the ideal that by understanding general dog and cat nutrition and the basics of the pet food industry you can improve the lives of the dogs and cats in your care. No purchase necessary.

Post #1: The Maiden Entry

Welcome gentle readers. Thank you for taking time out of your busy day to read my thoughts, insights, and occasional ramblings on dog and cat nutrition.

If you are a skeptical reader (as you should be) I thought you would like to know a bit about my background and credentials before we get started. I am a 2002 graduate of the University of California at Davis (UC Davis) School of Veterinary Medicine, with 12+ years of veterinary practice experience (if you don’t count clinical years at school and years spent as a veterinary technician before that); I also trained as a Clinical Nutritionist at UC Davis, completing my residency and becoming a Board-certified Diplomate of the American College of Veterinary Nutrition (DACVN) in 2007; and I have spent the last 7+ years (if you don’t count the 3 years of residency) working as a Clinical Nutritionist in veterinary referral hospitals.

As a Clinical Nutritionist I help caregivers and veterinarians optimize health and manage chronic disease in dogs and cats through dietary interventions. These diet changes have involved everything from developing feeding plans for hospitalized patients to formulating complete and balanced home-prepared diets, from review and selection of alternative commercial diets to simply adding supplements to the existing diet, and every combination thereof. I am also licensed to practice veterinary medicine in the United States and United Kingdom; have contributed book chapters and articles for peer-reviewed publications as well as provided content for general information articles on dog and cat nutrition; and have lectured nationally and internationally on a variety of topics related to the feeding of healthy dogs and cats and the nutritional management of diseases. I have and do work with pet food companies as an independent consultant (gives me a peak behind the pet food curtain), but have no financial interest in any pet food or treat company. This means that I know the ins and outs of how to keep dogs and cats healthy, and the ins and outs of the pet food industry.

Specializing within veterinary medicine was not something I had intended for my career path. The vision I had of my future self was always as a primary care veterinarian, keeping furry bundles of joy healthy and their families happy. Everything went as planned through undergraduate and graduate school and in 2002 I officially became a licensed veterinarian. After my first year in practice though I began to recognize that much of what I was taught in vet school was reaction driven while I was more interested in preventative care. Instead of waiting to treat the obese cat for Diabetes Mellitus, I wanted to prevent the obesity and Diabetes. When people asked me how to select the best food for their dog or cat, I too was overwhelmed by the number of different options and the often conflicting information provided by pet food companies. Diet could be both cause and cure, but how to tell which was which? At the time, continued education meetings were largely focused on the latest medications, tests, or treatments. My UC Davis training had stressed the importance of evidence-based medicine, but opportunities for continued education in nutrition seemed few and far between. So in 2004 I went back to UC Davis and started a residency in Small Animal Clinical Nutrition.

Two weeks after my residency officially ended my husband and I packed up the household and the kids (2- and 4-legged) and moved cross country to New Jersey. There I joined a large referral center and established the first of its kind Clinical Nutrition Department outside of a veterinary teaching hospital. Starting a specialty practice from scratch was no small feat, but I had a supportive hospital team (Thank you Dr. DeCarlo, the entire staff at Red Bank Veterinary Hospital, and my amazing assistant Sabrina!) who helped me build my little department into a successful and indispensable part of the veterinary community in the NJ-NY-PA area. In January 2014, my husband’s career moved us across the Atlantic to the United Kingdom. I had to say good-bye to that hospital, my patients, and their families, but I take comfort in knowing that it took two Clinical Nutritionists to take over the department that I started.

This blog is an attempt to pass along what I’ve learned over the years. The views and opinions expressed are my own based on my education, training, and years of experience managing healthy and chronically ill dogs and cats. If you are an Internet troll reading this post and are thinking about stirring up trouble either now or in future, please be warned that I am the gate-keeper of all comments. I reserve the right to be offended by and refuse to post mean spirited and derogatory statements. There is no guile or artfully crafted deceit in my posts nor is there any ulterior motive in writing this blog. I am less concerned about what you feed your companion dog or cat (within the realm of safe options), and more interested in providing the tools to navigate the sometimes tricky, sometimes truthful pet food marketplace and help keep furry family members healthy for years to come.