Another word from our site’s sponsor…Me

I know that I will have detractors, especially as I reach more readers, but before getting back to my regularly programmed topic [The Good (and Bad) of Home-Cooked Diets] there are a few things I wanted to clear up.

#1: No One is Paying Me to Recommend Diets

I realize that my moderate, consider-the-facts approach to feeding dogs and cats is less sexy than making inflammatory statements about commercial pet foods. Statements like Big Pet Food are “big money recycling companys [sic] who don’t give a damn about the health of your pet” (real comment I received from a reader) really do catch the eye and imagination. Clickbait headlines like “Low Grain and Carbohydrates Treat ALL Chronic Illness” (Spoiler Alert: they don’t and depending on the disease can actually make your dog or cat much, much worse) are more exciting than an article that advocates for putting the patient first and then finding the diet strategy that fits their needs.

As a practicing Veterinary Nutrition Specialist I have worked with patients that have eaten a variety of different pet food brands as well as home-prepared foods; I have toured pet food manufacturing facilities large and small to see how pet food is made and what kind of safety and quality control standards are (or are not) in place; and have been invited to speak at local, state and national veterinary conferences. Sometimes my speaker’s fees and travel expenses have been sponsored by a pet food company, sometimes it comes from the conference organizers, and sometimes if it is close to home for an organization that I support I’ve paid my own travel expenses and waved a speakers fee. Whichever way, it hasn’t changed my patient-first approach to nutritional therapy. There is there is no one-size-feeds-all diet and to quote one of my favorite movies The Princess Bride: “Anyone who says differently is selling something.”

Who doesn’t love The Princess Bride?

So for the record, I have never been an employee of anyone other than a veterinary hospital or clinic (or myself) and no one is paying me to promote a particular food or a particular feeding philosophy. I have served as a paid consultant for a few pet food and treat companies, but you won’t find me promoting any one food strategy or brand as better than all others. I did not go into veterinary medicine or Veterinary Nutrition to become wealthy, I chose these fields because I want to help animals and their families. If my primary goal was financial gain, I would have a website selling my own brand of supplements and foods or at the very least I would include a link to an online retailer that sent me a “fee” for funneling sales to them. Instead I have a site dedicated to sharing the knowledge that I’ve accumulated over my years in practice and it is yours to read or dismiss for free. No membership fee required.

#2: No One Else Paid for My Education

There are a few online veterinary “experts” that like to stir up conspiracy theories about Veterinary Nutrition Specialists. They make claims like Big Pet Food “might be encouraging veterinary nutritionists to speak out in defense of mass-marketed commercial pet food formulas” or that there are problems with “veterinary nutritionists and their ties to the pet food industry”. I’ve even heard the accusation that Big Pet Food pays for veterinary education and the education of Veterinary Nutrition Specialist. Unfortunately for me and my personal finances, no one has paid for my veterinary education other than me (and I still have the student loan debt to prove it!) and my residents salary (all $30K a year) was funded by the University of California, Davis.

Lifetime of Aggie Pride!

Everyone loves a good conspiracy. Yes, there are Veterinary Nutrition Specialists that work for pet food companies, but the majority of ACVN members (>60%) are at universities teaching and conducting research that benefits animal health. Some of this research is funded by their individual universities, some by government organizations like the National Institutes of Health (NIH), and some of this research is funded by pet food or supplement companies. Research funding for animal health and nutrition studies is limited and sometimes beggars can’t be choosers. Outside of industry and academia there are a few ACVN members like me who are scattered in private practice settings (<10%). We work directly with caregivers and primary care veterinarians and our relationships with pet food companies are limited to what we use to treat our patients. No matter where we are, every member of ACVN that I know (and I know all of them) loves animals; we all have our own furry family members large and small; and we all want dogs, cats, horses, etc. to live long happy lives irrespective of what type of food caregivers decide to feed.

# 3: Pet Food Safety is a Priority for Me

I am anti-raw animal products for reasons that have nothing to do with the nutritional aspects of feeding a less processed food and everything to do with the increased health risk to caregivers and other animals in the household. Yes, dry pet foods have been recalled for Salmonella contamination, too. The Centers for Disease Control and Prevention (CDC) reported that 70 people were diagnosed with salmonellosis after coming in contact with contaminated dry pet foods between 2006-2008. The CDC also reports an estimated 1.2 million cases (i.e., people) acquiring Salmonella infections each year associated with eating raw or undercooked meat and eggs, though contaminated fresh fruits and vegetables are a close second. When you compare cases of Salmonella from dry pet foods (70 between 2006-2008, plus an additional 22 from 2011-2012) with exposure from people foods (1.2 million/year), dry food contamination represented 0.0009%-0.003% of all human Salmonella cases during the years of these outbreaks. So yes, I am much more worried about raw meats and other people foods carrying Salmonella than I am about dry pet foods.

In 2008 the Food and Drug Administration Center for Veterinary Medicine (FDA-CVM) began routinely testing dry pet foods for Salmonella, while commercial raw pet foods analyses did not begin until the end of 2012.  Lack of a recalls for a raw-meat diet before 2012 does not mean that raw meat diets are “safer”, just that no one has been looking at them. You also need to consider market shares. Dry (i.e., kibble) pet foods make up 80% of the pet food and treat market with 6.5 million metric tons of dry food produced each year. I can’t find specific data on the raw commercial market, but all wet foods (canned, pouched, refrigerated, and frozen; cooked and raw) make up only 15% of the total pet food and treat market each year.

This is not the “natural” diet of cats.

#4: Raw Meat Diets are Not Magical

Raw meat fans always like to talk about how their dog or cat’s skin allergies were “cured” when they changed from their dry food to a raw meat diet and that by recommending against raw meat I am “ignoring” the many problems that “disappear when going from ‘dry’ food, to high quality, fresh foods”.  What these raw meat advocates fail to recognize is that when they made the diet switch they also changed almost every other aspect of feeding. They also changed the ingredients, the digestibility, and the fat content. Feeding a higher fat, more digestible, limited ingredient diet can absolutely help with many skin conditions. If these same caregivers had cooked the food, they would have seen the same improvements AND they would have reduced their risk of making themselves or their animal sick. I am not opposed to caregivers feeding a fresh, less processed diet to their dogs and cats and I have definitely seen the benefits of this diet type in my patients and my personal animals. But … home-prepared foods don’t work for every dog and cat or even every family.

#5: I Want Caregivers to Be Informed Consumers

I advocate for animal health and wellness. In some cases that means feeding a balanced home-prepared diet and others that means feeding a balanced commercial dry or wet diet. As long as the diet in question provides all of the essential nutrient’s (and even a few non-essentials that may be beneficial) and does not contain anything toxic or harmful and it makes you as a caregiver happy to feed, then feed it. I don’t think there is not one diet strategy that trumps all others as long as it is balanced and safe.

Be a smart pet food shopper!

Happy Feeding!

Lisa Weeth, DVM, MRCVS, DACVN

Campylobacter, Salmonella, E. coli, oh my! Why I Don’t Recommend Raw Meat for Pets

I received an email from a concerned pet owner this week who found my contact information on the American College of Veterinary Nutrition website. She had reached out because her 14-year-old dog had recently been diagnosed with liver cancer. Her primary veterinarian had told her that the cancer seemed to be involving about 90% of the liver and there was nothing they could do to treat this condition. Being the dedicated “pet parent” that she was she won’t take this as the final answer, so looked into alternative therapies and ended up in my inbox.

I would say this was a fairly common type of “self-referral” that I saw in practice. Concerned caregiver is given bad news from their regular veterinarian and comes to see the Veterinary Nutritionist for a second opinion on treatment options. They often have seen the Veterinary Nutritionist as another type of “holistic” veterinarian and assume I am going to recommend raw meat diets and homeopathy, and are surprised when I say balanced cooked meats with carbohydrates (*gasp*) and only supplements that have (at least some) scientific evidence for use.  I would say that I am a “holistic” veterinarian in the true Oxford English Dictionary sense of the word. “Holistic: Medicine Characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease.” But taking the whole patient and family life into account is very different than recommending unproven and potentially dangerous diets and supplements.

A “whole patient” approach involves the companion animal and the family.

I look at my patients from head to tail (or if I am working remotely, physical exam notes and conversations with the managing veterinarian). I review the medical and diet history as well as the family’s lifestyle and medical goals for their dog or cat. I spend time discussing my Dietary Treatment Plans in person with caregivers (or with the managing veterinarian if it is a remote consult), then I spend additional time outside of the exam room developing and writing what I felt was the best plan for all involved (patient and caregiver). My plans consider patient and owner preferences as well as the overall medial and nutritional needs of the dog or cat.  Despite taking a whole patient approach to my practice, I would not label myself as a “holistic” veterinarian, which brings me back to my potential new client and her dog with cancer.

I sent a brief note within 12-hours of the time on her email (she sent the first email late at night and I responded in the morning when I read it) stating that I was sorry to hear about her companion’s illness and that I would be happy to work with her and her veterinarian to develop a diet plan that supported her dog’s medical and dietary needs. I also included information about how to initiate the consult request through her regular veterinarian’s office. She replied the next day that while waiting for my reply (again my response had been less than 12-hours from her first email, but I understand that it can seem like forever when you are dealing with a sick loved one) she had consulted a “holistic” veterinarian who had put her dog on a regiment of raw meat and raw bones, but that she did have a question about a supplement she heard had anti-cancer properties. Oy. Without spending any more time than necessary on my reply to her second email I referred her back to her “holistic” veterinarian for guidance and wished her well, all the while feeling terrible for this poor dog whose new diet is likely going to hasten the end. The high protein content alone will make a dog with liver disease worse (like vomiting, diarrhea, seizures, and more rapid death worse) and this old dog with his compromised immune system is at a very high risk of becoming ill from food-borne illness, but I don’t know her or her dog so wasn’t going to offer any medical advice over an email.

For the record: I do not recommend feeding raw animal products to dogs and cats.  Yes, dogs adapted to life with human over 10,000 years ago and cats started living with humans approximately 5,000 years ago, while commercial cooked diets have only been in existence for the last 150 or so. Early dogs and cats definitely ate raw meat but they also lived 4-5 years and were not living in the home licking the children.

This is why I say “no thank you” to raw meat diets.

Knowing the essential nutrient requirements for healthy dogs and cats I could balance a raw meat based diet, but I choose not to because I am concerned about the health and welfare of my patients and their human families. Healthy animals may be more “resistant” to pathogenic bacteria, but their human family members and animals with compromised immune systems (the very young, old, or those with chronic disease) are not. There are a number of published case reports demonstrating this and a more complete scientific review of this style of diet can be found in the Journal of the American Veterinary Medicine Association (JAVMA), but I think people relate to personal experience better than published data at times so I would like to share my experiences with raw meat diets.

Why I Don’t Recommend Raw…

There were four cases I was involved over my years in practice that helped cement my anti-raw stance. The first occurred during my Residency. I worked with a veterinarian who was trying to convince her client to stop feeding a raw meat diet. The owner kept refusing because she believed that raw meat diet cleared up the dog’s skin issues (despite it causing Campylobacter-induced recurrent diarrhea and expensive emergency room visits, hence the veterinarian trying to convince her to change), but it wasn’t until the owner herself ended up in the hospital with a Campylobacter infection that she agreed as well.

The second case was one I saw as a newly minted and board-certified Veterinary Nutrition Specialist. It was a 1-year-old Soft-Coated Wheaton Terrier with food-allergic dermatitis (food allergies that made it scratch and lose fur), whose owner walked into the exam room with the dog and told me that if I recommended raw meat he was walking back out. I asked him to take a seat because I thought we would get along just fine. The owner then told me that he and his wife purchased this dog as a puppy from a breeder who fed a commercial raw meat diet. Despite changing to a dry commercial puppy food and never feeding a raw diet in their home, within one week of the new puppy joining the household he (the husband) ended up in the hospital with salmonellosis. Turns out he suffers from Crohn’s disease and the puppy brought more than joy into the new household.  And yes, the dry puppy food was tested and was cleared and the Salmonella strain was serotyped to the puppy.

The third case was a pet owner (not one of my clients, but one who came to the General Practice at my same clinic) who was feeding a commercial raw meat diet and asked the neighbor’s teenage son to feed and walk their dog while the rest of their family went on vacation. The teenage neighbor agreed (it was a paying job after all) and about the time the family returned from vacation, the same teenage neighbor was hospitalized for Salmonella. The Salmonella was very clearly linked to the raw meat diet the teenager was handling and a friendly neighborhood lawsuit ensued. Needless to say, the pet owner lost the case as well as her home owners insurance.

The fourth case was a 6-month-old puppy that had seen a ‘”holistic” veterinarian as a second opinion because he (the puppy) refused to eat any dry or canned food the owner offered. This veterinarian sold the owner a raw meat diet that was made locally for the veterinary clinic. It was expensive (but cost equals quality, right?), but the puppy loved this new food and ate it willingly. When her first batch of food ran low, the owner purchased more from the “holistic” veterinarian and things continued to go well for another month. But, one month later and within 24-hours of starting a new container of food the puppy stopped eating, developed profuse bloody diarrhea, and ended up at the emergency clinic of the hospital I worked at to be treated for fever and dehydration. Unfortunately treatment was started by the time I was brought in on the case and we didn’t have a sample of the suspected diet other than the empty and cleaned out container, so I cannot prove this was a food-borne pathogen, but highly suspicious.

We love to share with our dogs and cats, but hopefully not their bacteria.

Feed what is right for your dog or cat and safe for everyone involved…

I don’t think there is one prefect diet for every dog or cat and I don’t really care what brand or style of food people feed their companion dogs and cats as long as it is healthy and safe. I have worked with dogs and cats that did not do well on commercial dry or canned foods, but thrived on complete and balanced cooked home-prepared diets. And I have also seen animals fail home-prepared diet trials but do well on the consistent formulation and digestibility afforded by commercial dry or canned pet foods. Dogs and cats require essential nutrients not ingredients, and how those nutrients get in will depend on the needs of the individual. But please, no raw animal product.

Happy (and safe) Feeding!

Lisa P. Weeth, DVM, MRCVS, DACVN

The Importance of Peer-Review, or How to Spot a Huckster.

Hucksters are individuals who claims to have all of the answers; that “main stream” industries are corrupt profiteers out to harm you or your pet’s health for financial gain; and that only be listening to them (the Huckster) and/or by buying their products will you and your pet live long happy and healthy lives. So basically everyone else is lying/conspiring except for them. Sounds a bit to me like Kaa from the Jungle Book as he tries to wrap Mowgli up for dinner, “trussssst in me…”.

How I feel about Hucksters…

Even if you believe that large corporation (be it food or pharmaceutical companies for pets or people) are solely driven by profit, how much long-term profit is there in harming your customer?  Small corporations become large corporation because they provide a service or product that people (the ones with the wallets) want to purchase. There are numerous business books written on this very topic. Corporations with any financial and business sense want those wallet holders buying products for as long as physically possible. Their financial incentive is to prolong health and longevity not shorten it.

In the world of pet food and pet care, there is no shortage of people claiming to have all of the answers and a “study” that was recently “published” online that was too good (and by “good” I mean really bad) not to weigh in on.

Huckster Red Flag: Presenting “findings” through media outlets instead of peer-reviewed journals.

It is important to understand that anyone can write a book or develop a website on any topic they wish. There is no requirement that they need to be an expert in a particular field (or even have any training in a particular field) to voice their opinions loudly and publicly. When I started my consulting website and this blog I didn’t have to prove my credentials before I started. I paid my website registration fee (website) or filled in a registration form (blog) and off I went. I told you my credentials and experience and many people will take me at my word and never look further, but I could easily have made it all up. Fortunately, my education and experience are easily verified as are those of my Veterinary Nutrition colleagues, yet self-taught and self-proclaimed nutrition “experts” still seem to hold more sway than actual experts when it comes to matters of pet food and supplements. Forget the scientific process, these individuals want you to believe them because they say so.

This recent posting from The Spudd (thespudd.com) sums up my take on pseudosciences.

Where I think opinion starts to cross the line into pseudoscience is when experts (real or imagined) wrap their opinion in charts and science-y sounding words in an attempt elicit maximum emotional response, but without providing any actual results or following any scientific method to speak of. They use smoke and mirrors, misdirection, and misrepresentation of “findings” to tell the story they want believed instead of informing and educating the readers. I’d like to think that individuals who perpetuate this type of pseudoscience started with a genuine concern for wellness and wellbeing, be it human or animals, but have got themselves so entrenched in their beliefs that they lost sight of reality.  So how can you as the concerned pet caregiver tell fact from fiction? One way is to read everything with a healthy dose of skepticism.

In the world of true scientific publishing, the peer-review process helps act as a critical eye before studies are printed. This process is not perfect and occasionally bad or biased studies are released, but overall the peer-review process is an important step in ensuring the integrity of published science. When studies are submitted to a peer-reviewed journal, the entire materials and methods used by the researchers are outlined in detail. This allows the reviewers to examine and critique the study looking for bias in methodology or omission of important details, and whether the researchers conclusions are supported by the finding. Some journals have started requesting the raw data so that the reviewer can look for irregularities themselves or even repeat statistical analyses. If these reviewers miss key details and a paper is published with gaps in methodology or with conclusions not supported by the data, the journal’s readers can write to Letters to the Editor outlining their critique of the article in question. The researchers then have a chance to respond or even reconsider their stance. Sometimes published research papers are revised and re-published and sometimes fatal flaws are reveal and the paper is removed from reference libraries (just like the retracted and discredited “study” linking vaccines to autism).

“Scientists will hold up their research for critical evaluation while Hucksters will hold up the fact that something is printed as evidence of it being true.”

If a company or individual prints their study on a website, or in conference proceedings (meaning that the researcher or a representative of the researcher talked about their finding at a meeting somewhere), or in marketing materials, the critical review stage has been by-passed completely. The messy details of methodology and actual data are typically omitted and we as the reader have no knowledge of how the study was conducted or whether there are critical flaws that would invalidate the results. The reader is expected to accept the researcher’s conclusions as truth without the opportunity to review the methods or data, or even evaluate whether there are conflicts of interest between the researchers and those “publishing” the study. Scientists will hold up their research for critical evaluation while Hucksters will hold up the fact that something is printed as evidence of it being true. In my opinion true scientists are willing to admit the fact they don’t have all of the answers, which is why they keep asking questions.

Testing the hypothesis…

What do I look for in a published research study? I want to know where the tests were performed, how they were performed, how many samples were used, what they used as positive or negative control (controls are when help ensure that environmental contamination is not occurring which can bias the findings), and what statistics were used (statistics help differentiate random chance from true relationships). A well written Material and Methods section will allow another researcher to replicating the study. This is how the field of science grows, by testing hypotheses and challenging assumptions. The absence of Materials and Methods and any statistical evaluation in any study (whether submitted for peer-reviewed or “published” online) are bright red, waving flags for me.

Not that pet food manufacturers or owners should be blasé about potential problems in pet foods, but without any study details we have no way of knowing whether the researchers grabbed one dented can on the shelf, did one fungal test and then stopped testing when they found a (weak) positive result, or whether they tested multiple times or different batches of foods in each brand and repeatedly found the same result. Even if you were to trust their laboratory procedures on blind-faith, the more detailed section on bacterial contamination admits that the bacteria found were the result of improperly refrigerated food. Yet in the infographic, the reader is presented with a table outlining how almost all of the products tested positive for bacteria. Could that also be true for the fungal toxins? Everyone (hopefully) knows that if you leave any food exposed to room air at room temperature it will start to grow things, but improperly stored and handled foods by the consumer is very different than poor manufacturing practices.

“improperly stored and handled foods by the consumer is very different than poor manufacturing practices”

Let’s look more closely at the reported risk from fungal contamination. Mycotoxins (toxic compounds from fungi growing in and on foods) are a serious problem in foods and ingestion of even small amounts per pound of body weight can causing serious health effects and even death in people, dogs, and cats.  Again, if we accept the tests were done correctly and the results were not a factor of improper storage and handling, when you read the details about the fungal finding it is only when you add all of their ‘low’ risk numbers together that the ‘risk values’ get worse. I haven’t taken a statistics course in almost 20 years, but I’m pretty sure you can’t just add numbers together to provide significance.

As for the ‘nutrient’ concerns, let me start by saying that dogs and cats do not have sulfur requirements and there is no lower or upper limited in the 2006 NRC or any version of AAFCO for sulfur because it is not an essential dietary nutrient. There are requirements for the sulfur-containing amino acids (methionine, cystine, and taurine) and sulfur is found in connective tissue, which is a part of any meat, so it is not surprising that it was found in the diet. (I would be more surprised if it wasn’t.) Excess calcium intake on the other hand is a problem in growing large breed dogs, but since the foods that tested higher in calcium were either cat foods or adult dog maintenance diets, neither of which should be fed to a puppy, I’m also not worried about these nutrient values.

This “study” also compared nutrients in foods on a Dry Matter basis without providing Calorie (kcal) contents of the foods tested, but direct Dry Matter basis comparisons between foods are problematic and not used routinely by small animal (or human) nutritionists. Dogs and cats (and people) will eat to meet a particular energy requirement each day while the mineral requirements are independent of energy intake. The calcium content of an energy dense diet should be higher than the calcium content of a low energy diets to ensure that the animal received enough calcium per day despite eating less Dry Matter. To put in simple terms, if a dog needs to eat 3 cups a day of Brand X dry food to meet energy needs, but only 2 cups of Brand Y dog food to get the same Calories, then Brand Y must add 50% more calcium per cup to ensure that the dog is receiving the correct calcium intake per day despite having a lower Dry Matter intake. Providing Dry Matter values alone is meaningless.

Veterinarians and caregivers need to be advocates for their furry family-members and access to accurate, unbiased information is an important part of that. So here is what I consider my Pet Food and Supplement Red Flags:

# 1: Results promoted through media and not scientific journals.

#2: Miracle “cures” that are not supported by the larger medical or veterinary fields.

#3: Proprietary or secret formulas or methods.

#4: “Proof” that is provided by testimonials instead of facts.

Education is key, but so is checking the references

Happy Feeding!

Lisa P. Weeth, DVM, MRCVS, DACVN