Successful management of pancreatitis in canine patients is often due to early diagnosis and prompt medical treatment.
While there are several factors involved in the creation of a treatment plan for pancreatitis patients, perhaps one of the most important considerations is diet and nutrition.
This report will discuss nutritional care for canine patients who are being treated in a veterinary hospital for pancreatitis. Topics to be covered include: a general description of the disease, nutritional requirements of the patient, a comparison between homemade and commercial dog foods including ingredients in the foods and costs, potential adverse reactions with diet, and advice given to owners upon discharge of their pet.
1. WHAT IS PANCREATITIS:
Pancreatitis is inflammation of the pancreas. The pancreas is an organ that is made up of two types of tissues: 1. exocrine tissue, which is responsible for producing and storing digestive enzymes such as amylase and lipase, and 2. endocrine tissue, which is where hormones such as insulin and glucagon are produced.
The digestive enzymes produced in the exocrine tissue are stored in an inactive form and only become active after they are released into the small intestine. When the mechanisms that keep these enzymes inactive fail, then the enzymes become active while still in the exocrine tissue, causing self digestion of the pancreas. In severe cases these enzymes can enter the blood circulation.
There are many factors that can contribute to the development of pancreatitis. They include: certain medications, infections, hypothyroidism, diabetes, Cushings disease, metabolic disorders, obesity, and even trauma and shock. Pancreatitis can have a sudden onset, which is referred to as ‘acute pancreatitis’ or happen over the course of time, which is referred to as ‘chronic pancreatitis.’ Both forms are serious and can be life threatening. In veterinary practice we see a lot of dogs presenting with acute pancreatitis from diets high in fat. A classic example occurs after the Christmas holiday when there usually is an increase in the occurrence of pancreatitis. Owners have given their dogs the left over ham etc and treats from ‘lunch’, overloading their poor dog’s system with fat!
Patients who have pancreatitis may exhibit several clinical signs which include persistent vomiting, anorexia, dehydration and shock, cranial abdominal pain (evidenced by assuming a ‘prayer’ or ‘bowing’ position), diarrhoea, peritonitis or ascites.
Dogs with acute pancreatitis are usually treated on an in-patient basis with IV fluid therapy and medications to control pain and vomiting. Patients with chronic pancreatitis are often less ill and can be placed on a special low fat diet for life. It is possible for patients with chronic pancreatitis to experience an acute flare up requiring hospitalization.
2. NUTRITIONAL REQUIRMENTS:
The nutritional quality of a dog’s food directly affects every aspect of their life. There are several factors in determining nutritional requirement of a patient. They include the body condition scoring of the patient, the life stage of the patient and their health status. For patients diagnosed with pancreatitis, and particularly those who are admitted to hospital with acute pancreatitis, the protocol for meeting nutritional needs is compounded by the need to reduce pancreatic secretions and allow the pancreas to recover. Patients are placed on IV fluids, given anti-emetic and pain medications and fed small amounts of bland low fat food. The most important consideration in diet is that food provided is low in fat, and for the first few days they are given only about 25% of the amount they are normally fed.
Body Condition Scoring
All patients are weighed when they are admitted to hospital. This particular measurement is important because medicine doses and IV fluid rates are based on a patient’s weight. In addition to a measurement in kilograms, however, an important indicator of healthy weight is the Body Score. Body score is measured on a scale of 1 to 9. Body score charts shows diagrams of five different body types, ranging from a 1/9, which is severely underweight, to a 9/9 which is obese.
In general, the body condition scoring of an otherwise healthy patient will help determine whether or not that particular animal requires fewer or more calories (and other nutrients such as protein) in their diet (ie if they are severely underweight or severely overweight). Pancreatitis is more likely to occur in overweight dogs. In addition to choosing an appropriate food to control the pancreatitis, the veterinarian may suggest a diet which also limits calories. This will help to control excessive weight which can exacerbate the condition.
The Life Stage of the Patient
A dog’s dietary needs change over the course of its life. Young puppies require almost four times the energy that adult dogs require and will also benefit from increased protein which helps build new tissues.
At the age of 2 years (or even 1 year in the case of very small dogs) the dietary needs change and it is recommended that these dogs are given a high quality diet with:
- High quality, animal-based protein for muscle maintenance
- Fibre for a healthy digestive tract
- Essential vitamins and minerals for the immune system
- Vitamin rich fish oils for a healthy coat and skin and for overall health
- Healthy grains for energy (taken from pet Nutrition Life Stages, VPI)
Senior dogs (those who are in the last third of their life expectancy) are typically less active and so require a diet which is lower in calories, protein and fat. This is important to help prevent obesity, a common problem for older dogs. The diet for senior dogs should also be higher in fibre to enhance gastrointestinal health. As older dogs can tend to develop health problems, there are many specialized foods that can address various conditions.
Dogs that are middle aged or older, or who are overweight, or who have a history of gastrointestinal disturbances or endocrinopathies, are considered to be at a higher risk of developing pancreatitis. There are a variety of foods available to help control a wide range of health problems. Hill’s brand, for example, offers prescription diets such as z/d, u/d, t/d, and w/d to assist in the treatment of adverse food reaction, bladder health, oral health and weight control (respectively).
This report, however, will only address those foods that are appropriate for pancreatitis patients. The goal in feeding these patients is to minimize the triggering of the enzymes that cause the inflammation.
As the dog begins to recover from the attack of pancreatitis small amounts of low fat, highly digestible (usually bland) foods may be introduced. For some cases, a liquid food might be the first oral food introduced.
Once the patient is tolerating the liquid food, dogs can be placed on a low fat, high fibre diet. “…moderate fiber diets, containing 10–15% dry matter, and moderate fat contents (10–15%)….” can be fed. Carbohydrates have a weak effect on the hormones which trigger pancreatic enzymes and they aid digestion. Rice is a commonly used ingredient in both commercial and homemade diets for pancreatic patients. Boiled chicken, low fat beef, egg whites, yogurt, barley and cooked vegetables are also considered safe foods for pancreatitis patients.
3. FOOD COMPARISONS
Owners have several choices of types of foods when feeding a pet with pancreatitis. A wide range of commercial foods are available, from budget supermarket brands to premium foods to prescription foods. Alternatively, owners might choose to make their own food at home. Homemade foods may fall within the category of raw food (ie: the BARF diet) or cooked food.
Commercial Foods (Supermarket and Premium)
While many manufacturers advertise their product as being complete and balanced, there is a clear difference in the content of foods across the broad range of what is available to purchase. Premium brands contain a higher quality of food and so will have a higher nutrient content.
Prescription foods that veterinarians might recommend specifically for dogs with gastrointestinal problems such as pancreatitis are: Hill’s Prescription Diet i/d or Royal Canin Gastrointestinal Low Fat. It is generally recommended that the food for pancreatitis patients should contain less than 18% fat. Some veterinarians recommend that the fat content be less than 8%. Hill’s i/d contains 14.9% fat while the Royal Canin contains 7% fat.
Another alternative available to pet owners is to make their pet’s food themselves. While a drawback to this choice is that the process is time consuming, some pet owners are happier with this as they feel they know exactly what their pet is eating, that they can provide a safer, more natural diet and, in some cases, create a diet more suited to their philosophical views, choosing vegetarian, organic or raw diets.
“A recent survey reports that 10% of owners feed a non-commercial diet to provide 50% or more of their pet’s intake.”
(from Home Cooked vs Commercial diets, Dr. Natalie Langer)
While the internet abounds with websites offering recipes for homemade dog food, most cannot guarantee the percentage of protein, fat or vitamins contained in the food. If an owner is keen to prepare their own food, we recommend seeking the services of a veterinary nutritionist. Massey University in New Zealand has an excellent service.
Typically, the cost for ‘special’ foods is higher than the cost for ‘normal’ foods. This is true whether you choose commercial, prescription or homemade foods and supplements. The table below outlines the cost comparisons between two premium brands available at most veterinary practices, and the cheaper, supermarket brands. Included as well are costs for both animal grade and human grade meats that can make up a homemade diet.
|COST PER BAG||COST PER KG||PREMIUM/|
|Hill’s Adult Fit Food||Normal||$91.50 for 7.5kg||$12.20/kg||Premium|
|Hill’s I/D Dry||Prescription||$126.00 for 8kg||$15.75/kg||Premium|
|Royal Canin – Canine Gastro Intestinal Low Fat||Prescription||$156.00 for 12 kg||$13.00/kg||Premium|
|Pedigree Dog Food Dry Mince & Vegetable||Normal||$23.45 for 8kg||$2.93/kg||Supermarket|
|Optimum Dog Food Dry Chicken Vegetable & Rice||Normal||$34.40 for 6.2kg||$5.54/kg||Supermarket, (considered a higher quality supermarket food)|
|Fresh Pet Food Co Dog Food Chilled Mince (no fat content noted)||Normal, animal grade||$5.50/1kg||$5.50/kg||Supermarket, animal grade|
|Beef Mince Premium min. 1 kg (no fat content noted)*||Normal, human grade||$16.00 for 1 kg||$16/1kg||Supermarket, human grade|
|Woolworths Chicken Mince 500g (no fat content noted)*||Normal, human grade||$12 for 1 kg||$12.00/1kg||Supermarket, human grade|
|Lamb Offal Liver min. 470g (no fat content noted)*||Normal, human grade||Beef liver $3.99/kg|
Lamb liver $4.99/kg
| $3.99/kg to|
|Butcher, human grade|
*the fact that no fat content is noted can be of concern when determining the best ingredients for a homemade diet.
Clearly the Hill’s i/d or Royal Canin Gastrointestinal Low Fat foods we would encourage owners to buy would be significantly more expensive. However, it must be considered that if a special food will help control a clinical condition, the resulting savings in veterinary costs would surely offset the cost of the food.
4. POTENTIAL ADVERSE REACTIONS
It is true that commercially processed dog foods are vastly different from the foods that dogs would eat in the wild. Dogs in the wild eat not only the meat of their prey, but consume as well the bone, intestines, and organs like the liver. All these are a source of important nutrients. Diligent pet owners and manufacturers of commercial pet food are all interested in creating a food that not only replicates the wild dogs’ food, but improves upon it for domesticated dogs. We also hope to support our dog’s lives for longer than 6-8 years, the average age of a wolf. This is not an easy task.
There is much competition between manufacturers. The combination of their advertising and the increasing prevalence of on-line forums about canine diets can leave the average consumer reeling with confusion.
There is no Australian standard for dry or processed pet food. There is, however, an Australian standard for frozen and fresh pet meat, which was generated by the Primary Industry Ministerial Council’s Meat Standards Committee. It is enforced by the state’s controlling authorities. The standard covers all stages of the pet meat production process to ensure:
- It remains separate to human-grade meat.
- Is hygienically handled.
- Is free from harmful diseases.
So while owners may feel assured that the meat they purchase has met certain standards at point of sale, there are still a number of risks to take into account when they endeavor to make their pet’s food at home. “If raw animal products are included (such as meat, eggs, organs), concerns regarding contamination with pathogenic microorganisms should be discussed with the owner, particularly if vulnerable family members or others have contact with the animal or its feces (i.e., infants, elderly, immunocompromised).”
(taken from Home Cooked vs Commercial diets, Dr. Natalie Langer)
Additionally, any other potentially dangerous ingredients should be identified (i.e., grapes/raisins, garlic/onions, bones). There is the potential for whole bones to choke an animal, break teeth or cause an internal puncture. Further, there is a chance that the owner may not choose the appropriate ingredients (based on advice they may receive from a number of people, not the least of which are sources on the internet). They could inadvertently create an unbalanced diet that, if continued over a long period of time, may actually damage their dog’s health.
With regard to the claims made by commercial manufacturers about “low fat’ foods, there can be adverse reactions if a dog is fed a diet that is too low in fat. “Diets that are too low in fat can lead to deficiencies of fat-soluble vitamins and problems with the skin and coat; they can also leave your dog feeling tired and hungry all the time.”
(Taken from ‘Healthy Low-Fat Diets For Dogs With Special Dietary Needs’
Other considerations include:
– allergies or food intolerance to the protein source (e.g. chicken) Usually other options are available such as fish or beef based, but one cannot be sure of fat content.
– Processing contamination potentially causing toxicity. A possible result could be liver failure, something unlikely in commercial diets
– Poisoning in home cooked diets (eg salmonella). This is entirely possible as the owner may make up a large quality and it might go off. The owner might also have a tendency to by meat on ‘special’ which usually has a short use by date.
5. ADVICE FOR OWNERS
The best advice for owners is to discuss their pet’s dietary needs with their veterinarian. Typically a pancreatitis patient is discharged with fairly standard advice on diet: feed a low fat, high fibre diet and keep the caloric content low.
For the veterinarians who work at a general practice where premium dog food is sold, the owner can be directed to purchase a premium food, such as Hil’s i/d or Royal Canin Veterinary Diet Digestive Low Fat.
If the owner wishes to make their own dog food, then they should be advised to focus on low fat meats such as low fat chicken breast. Meats high in fat such as lamb and pork should be avoided. Rice is a commonly used ingredient in homemade diets for pancreatic patients. Other ingredients include low fat beef, beef organs (kidney, heart, liver), egg whites, yogurt, barley and cooked vegetables.
If the veterinarian advises to feed a homecooked meal, they must provide a specific diet plan so as not to inadvertently cause to owner to feed their pet a non-balance diet. We would recommend to our clients that that most convenient, accurate and economical option is to feed a commercially prepared prescription diet specifically formulated to meet their pet’s requirements.
It is also advisable to give their dog several small meals in a day rather than one large one. This is particularly important to ease the process of digestion.
Because there is no cure for Pancreatitis, owners will have to maintain ongoing attention to diet and monitor their pet’s physical state. Regardless of the diet the owner chooses, every patient should have a thorough diet history collected whenever they re-visit their veterinarian. It will be up to the veterinarian to determine other monitoring appropriate for the patient (blood tests for example). Regular contact with their veterinarian will important to assess progress, or relapses, and to decide on specific intervention that may be required. The desired outcome is improved patient condition, improved client satisfaction and improved client compliance when they see a direct cause and effect relationship with dietary management.