V11I2 (Spring 2021) by Redstone Media Group

IVC Spring 2021

SPRING 2021

EDITORIAL DEPARTMENT Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor IVC: Laurin Cooke, DVM Senior Content Editor: Emily Watson Senior Graphic Designer: Dawn Cumby-Dallin Senior Graphic Designer: Alyssa Dow Web Design & Development: Lace Imson Digital Media Specialist: Cole McCall Digital Media Specialist: Jamie McClure

COLUMNISTS & CONTRIBUTING WRITERS Amanda Ardente, DVM, PhD Zach Bush, MD Julie Buzby, DVM, CVA, CAC Christina Chambreau, DVM, CVH Oscar Chavez, BVetMed, MRCVS, MBA Carmen Colitz, PhD, DACVO Todd Cooney, DVM, CVH Katherine E. Dahlhausen, PhD Brad Ewankiw, BSc Agriculture Lionel Fabries, DVM Holly H. Ganz, PhD Karen Gellman, DVM, PhD John J. Gildea, PhD Barbara Fox, DVM Joyce Harman, DVM, MRCVS Jiqian Huang, MD, PhD Melissa Kellagher, AHVMA Director of Operations Dawn D. Kingsbury, DVM, PhD, DIP. ACVIM (SAIM) Cynthia Lankenau, DVM Julie Anne Lee, DCH, RCHom Terri McCalla, MS, DACVO Margo Roman, DVM, CVA, COT, CPT Barbara Royal, DVM, CVA Marlene Siegel, DVM Gary Tashjian Valarie V. Tynes, DVM, DACVB, DACAW

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IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyright© 2021. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: March 2021.

improving the lives of animals... one reader at a time.

IVC Spring 2021

contents FEATURES

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THE LATEST ON THE LINK BETWEEN CANINE DILATED CARDIOMYOPATHY AND NUTRITION

By Dr. Barbara Royal, DVM, CVA Misinformation about the causes of DCM in dogs is still being spread. In this article, we will examine the current body of evidence for hearthealthy nutritional decision-making.

NUTRITION NOOK PET FOOD MATH

By Dr. Karen Gellman, DVM, PhD

TREATING LYME DISEASE IN THE HORSE

INCORPORATING WHOLE FOOD NUTRITION INTO YOUR VETERINARY PRACTICE

How to decipher pet food labels and why it’s so important.

CLINICAL UTILITY OF C-REACTIVE PROTEIN AND THE C-REACTIVE PROTEIN/ALBUMIN RATIO (CAR) IN CANINE PATIENTS By Marlene Siegel, DVM, ALT, CNHP

A NEW FRAMEWORK FOR CHRONIC GI DISEASE IN DOGS AND CATS

By Katherine E. Dahlhausen, PhD, Dawn D. Kingsbury, DVM, PhD, DIP. ACVIM (SAIM), and Holly H. Ganz, PhD Chronic enteropathy (CE) is the term now used to describe long-term gastrointestinal disease that lacks a specific diagnosis in canine and feline patients.

LIMITED INGREDIENT DOG FOOD

49 50 58

by Gary Tashjian

NUTRITIONAL SUPPORT FOR THE AGING CANINE BRAIN By Valarie V. Tynes, DVM, DACVB, DACAW

Dogs are living longer than ever. However, this increases their risk of developing cognitive dysfunction syndrome (CDS). Here’s how nutritional support can help.

THE BENEFITS OF BOTANICALS IN CANINE BEHAVIOR MANAGEMENT

By Joyce Harman, DVM, MRCVS While treating Lyme disease in horses is complex, a wide variety of alternative therapies can be helpful for different stages and manifestations of the illness.

By Oscar Chavez, BVetMed, MRCVS, MBA

Published research supports the health benefits of human-grade, whole food nutrition for dogs and cats.

MICROBIOME RESTORATIVE THERAPY (MBRT) FOR PANCREATITIS AND OTHER GI ISSUES

By Margo Roman, DVM, CVA, COT, CPT

PHARMACY VS. FARMACY By Marlene Siegel, DVM

How nutrient deficiency, toxicity, and lifestyle are making veterinary patients more dependent on the pharmacy medical model.

INNOVATIVE PRACTICE

TEACHING CLIENTS TO SHINE THE LIGHT OF BEAM ON THEIR PETS’HEALTH

By Christina Chambreau, DVM, CVH Short for Behavior, Energy, Appetite, and Mood, BEAM shifts the client’s focus from current symptoms to a more comprehensive view of the pet’s quality of life.

DEER VELVET ANTLER — APPLICATIONS IN THE VETERINARY SETTING

By Julie Buzby, DVM, CVA, CAC Studies are demonstrating that deer velvet antler has a long, impressive, and rapidly-growing list of positive benefits.

By Amanda Ardente, DVM, PhD

THE EVOLUTION OF GUT HEALTH — PART 1 By Julie Anne Lee, DCH, RCHom

FOR AN ANIMAL’S HEALTH AND HOMEOSTASIS, LOOK TO THE RENAL PROXIMAL TUBULE

By John J. Gildea, PhD, Jiqian Huang, MD, PhD, and Zach Bush, MD

advisory board Dr. Richard Palmquist, DVM GDipVCHM(CIVT) CVCHM (IVAS), graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California, former president and research chair of the AHVMA, and an international speaker in integrative veterinary medicine. Dr. Palmquist is a consultant for the Veterinary Information Network (VIN) and a past president of the AHVM Foundation. He has published two books, one for conventional veterinarians and a second for clients discussing how integrative thinking works. Michelle J. Rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate educational institution offering state-approved programs. She is co-owner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.

29 COLUMNS & DEPARTMENTS

6 Editorial 36 Industry innovations 38 From the VBMA 55 From the AHVMA 56 From the NASC 61 From the AVH 65 From the VMAA 66 News bites

Dr. Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. Her practice is 100% holistic, using acupuncture, chiropractic, herbal medicine and homeopathy to treat horses to enhance performance and those with a variety of chronic conditions, with an emphasis on Lyme Disease. Her publications include the Pain Free Back and Saddle Fit Books, and numerous articles in lay and professional magazines. She maintains an informative website: www.harmanyequine.com. Dr. Steve Marsden, DVM, ND, MSOM, Lac. Dipl.CH, CVA, AHG lectures for IVAS, the AHVMA, the AVMA, and numerous other organizations. He is co-founder of the College of Integrative Veterinary Therapies and is a director emeritus of the National University of Natural Medicine in Portland OR. He authored the Manual of Natural Veterinary Medicine (Mosby); and Essential Guide to Chinese Herbal Formulas (CIVT). Dr. Marsden is extensively trained in alternative medicine, including Chinese herbology, acupuncture and naturopathic medicine. He has holistic veterinary and naturopathic medical practices in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the AHVMA; and Small Animal Veterinarian of the year by the CVMA in 2009. Dr. Jean Dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994.

Dr. Barbara Fougere, DVM, CVAA graduated in 1986, and was named the American Holistic Veterinary Medical Association Educator for 2011. Dr. Fougere is the principal and one of the founders of the College of Integrative Veterinary Therapies. She has continued studying over the last 26 years, and has three Bachelor degrees, two Masters degrees, three post Graduate Diplomas, several Certifications and numerous other courses under her belt.

Dr. Christina Chambreau, DVM, CVH, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program and is the former Associate Editor of IVC Journal. Dr. Chambreau teaches classes in homeopathy for animals, lectures on many topics, speaks on Radio and TV, and is the author of the Healthy Animal’s Journal among other titles. She is now on the faculty of the Holistic Actions Academy, which empowers members to keep their animals healthy with weekly live webinars.

IVC Winter 2020/2021

contributors 1

1. JULIE BUZBY, DVM, CVA, CAC

Dr. Julie Buzby is an integrative veterinarian and founder of Dr. Buzby’s: The Senior Dog Company, which provides products and client education to improve quality of life for dogs as they age. She developed Dr. Buzby’s ToeGrips® for dogs and also markets Dr. Buzby’s Encore Mobility™ hip and joint supplement containing New Zealand Deer Velvet. After graduating from Kansas State University College of Veterinary Medicine (1997), she earned certifications from the AVCA (1998) and the IVAS (2002). She is a long-time member of the advisory board for the Grey Muzzle Organization. P. 62

2. CHRISTINA CHAMBREAU, DVM, CVH

Dr. Christina Chambreau (ChristinaChambreau.com) has been teaching holistic approaches to health since she began using homeopathy in her practice 39 years ago. She now has a Pet Health Coaching phone consulting practice, and is also the author of the Healthy Animal’s Journal series, including e-books for cats and dogs, and Fleas Be Gone (a Kindle book). Dr. Chambeau is one of the founders of the Academy of Veterinary Homeopathy, and is on the faculty of the Holistic Actions Academy. P. 54

3. OSCAR CHAVEZ, BVETMED, MRCVS, MBA

Dr. Oscar E. Chavez is a veterinarian and business executive whose career is founded on a solid commitment to pet advocacy, integrity, education, and sound veterinary principles. He is the Chief Medical Officer and founding executive at JustFoodForDogs LLC and co-Author of Big Kibble. He has served as adjunct faculty, researcher, and professor of veterinary clinical nutrition in the Department of Animal and Veterinary Sciences at California State Polytechnic University. In 2012, Dr. Chavez completed an MBA from the University of California Irvine. P. 34

4. KAREN GELLMAN, DVM, PHD

Dr. Karen Gellman holds DVM and PhD degrees from Cornell University in animal locomotion biomechanics. She has advanced training and certification in veterinary acupuncture and chiropractic, and has practiced these and other modalities since 1995. She teaches about posture, biomechanics and holistic therapies to veterinarians, is research director of Maximum Horsepower Research, and practices holistic veterinary medicine in New York State. Dr. Gellman founded Plena Curae Botanical Solutions, a company making novel botanical pain solutions for pets and horses. P. 10

5. JOYCE HARMAN, DVM, MRCVS

Dr. Joyce Harman graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. She is certified in veterinary acupuncture and chiropractic and has completed advanced training in homeopathy and herbal medicine. Her practice in Virginia uses holistic medicine to treat horses. Her publications include The Horse’s Pain-Free Back and Saddle-Fit Book — the most complete source of information about English saddles. P. 41

6. DAWN KINGSBURY, DVM, PHD, DIP. ACVIM (SAIM)

Dr. Dawn Kingsbury has practiced general and specialty companion animal medicine around the world. She met Holly Ganz while studying for her PhD. Being chief veterinary officer at AnimalBiome aligns with Dr. Kingsbury’s interests — host-microbe interactions, precision medicine, and One Health — while allowing her to promote microbiome analysis as a non-invasive, clinically actionable tool, and to cultivate evolving microbiome restoration strategies. P. 58

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7. BARBARA ROYAL, DVM, CVA

Dr. Barbara Royal is a Chicago veterinarian, IVAS certified acupuncturist, author, and lecturer with extensive experience in veterinary care, including nutrition, acupuncture, emergency medicine, pathology, conventional practices, herbal remedies, physical rehabilitation techniques, and more. Dr. Royal was past president of the AHVMA. Author of The Royal Treatment: A Natural Approach to Wildly Healthy Pets and several other books, she is also the founder and owner of The Royal Treatment Veterinary Center in Chicago, the Royal Animal Health University, and co-owner of the Animal Diet Formulator. P. 46

8. MARLENE SIEGEL, DVM, CNHP

Dr. Marlene Siegel is an international speaker and innovator in integrative veterinary medicine. Her practice, Pasco Veterinary Medical Center, offers the widest array of alternative therapies and detoxification services in the country. She developed her own raw pet food and supplements company, EvoLoveRaw.com. Passionate about education, Dr. Siegel has online integrative veterinary medicine programs for pet parents and veterinarians. This year, she is launching S’Paws Family Wellness, detox centers for pets and their parents. P. 28

9. VALARIE TYNES, DVM, DACVB, DACAW

Dr. Valarie Tynes received her DVM from Texas A&M University, and worked in private practice for 14 years before pursuing a residency in clinical animal behavior at the University of California at Davis in 2000. She has been a diplomate of the American College of Veterinary Behaviorists since 2003 and is Board Certified in Animal Welfare. Dr. Tynes’ special interests are the behavior and welfare of pet pigs, exotic pets and zoo animals. She has been actively involved in the Fear Free initiative since its inception and serves on the Fear Free Speakers Bureau. She joined Ceva Animal Health in 2014 as a veterinary services specialist. P. 20

10. KATHERINE E. DAHLHAUSEN, PHD

Katerine Dahlhausen is a science writer for AnimalBiome. She was mentored by Holly Ganz during the beginning of her PhD at the University of California Davis and helped with the beginning of the KittyBiome project. Katherine has worked on a wide variety of microbiome-related projects to date, including ones about koalas, buildings, pollinators, and coral reefs. P. 58

11. HOLLY H. GANZ, PHD

Holly Ganz is Chief Science Officer and co-founder of AnimalBiome. As a successful citizen scientist, she has translated her academic research into solutions for pets: firstly by assessing thousands of microbiomes to reveal common imbalances, and secondly by providing better approaches to maintain and restore gut health, including screened Fecal Microbiota Transplantation material via oral capsules. P. 58

editorial

NOURISHMENT AND RENEWAL I have a slim, dog-eared booklet called Salad-Ideas in my cookbook collection. It’s one of the few things I inherited from my grandmother. Published in 1929, it is full of recipes on how to make perfect, tempting salads, all based on a magic ingredient — one full cup of Hellmann’s Blue Ribbon Mayonnaise. Apparently, any salad worth serving at the time could be enhanced with a generous helping of mayo, and making this ingredient from scratch was a fickle endeavor. Prepared mayo, jarred and sold commercially, offered an innovative solution to inconsistent results and imperfect salads. Around the same time, in 1926, near Gray Summit, Missouri, Purina Farms created the first center for pet nutrition to validate both the palpability and nutrition of its pet foods. According to the historical timeline on the Purina website, dogs on Admiral Richard Byrd’s expedition to the Antarctic in 1933 thrived on Purina Dog Chow, with an endorsement from the Massachusetts General Hospital. Mass-produced, shelf-stable products were indeed an innovation of the time. They offered simple, easy-to-use, consistent solutions. Too much of a good thing, however, is rarely the healthiest choice, and eating in 2021 is anything but simple. Our supermarkets are flooded with endless and overwhelming varieties of processed foods for us, our pets and patients. The science of what to eat seems more complex than ever, and there is growing consumer demand for a return to simple, fresh, whole foods that haven't been broken into myriad chemical components, heavily processed, and then reassembled into new forms.

The same consumer demand applies to pet food. Clients know that nutrition is fundamental to health. While they still need easy-to-feed options, they are eager to learn ways to incorporate healing foods into the diets of their animal companions. We hope this issue of IVC Journal offers you a taste of what a whole food approach to nutrition can bring to your patients. Included is an update on the research into canine dilated cardiomyopathy and its supposed link to grain-free foods. We also explore supplements to help with the aging canine brain, and discover a new way to look at the ever-so-common problem of “chronic enteropathies” or CEs. Learn about an innovative acronym to teach your clients to recognize subtle imbalances in their animals before major problems arise. We also include articles on how modern agricultural practices have led to nutrient deficiency and toxicity, and how to incorporate whole food nutrition into your practice. On another topic, as you welcome the warmer months ahead, be prepared for equine Lyme disease with a piece on innovative treatment strategies. This has been a trying year and a long winter. May we all be nourished by the promise of spring!

Laurin Cooke, DVM Associate Editor, drlaurin@ivcjournal.com

IVC Spring 2021

Misinformation about the causes of DCM in dogs is still being spread at the expense of our patients. In this article, we will examine the current body of evidence for heart-healthy nutritional decision-making.

THE LATEST ON THE LINK BETWEEN

canine dilated cardiomyopathy and nutrition

BY BARBARA ROYAL, DVM, CVA

Over two years ago, veterinarians embarked on a turbulent journey in search of an explanation for the higher incidence of dilated cardiomyopathy (DCM) in dogs. Widespread confusion and assumptions that grain-free diets were the culprit influenced both pet owners and veterinarians. Even cardiology specialists began touting the unproven conclusion that diets with grains are protective and “hearthealthy.” The truth is very different, as we will discover in this article.

Pet parents of dogs, both with and without a significant risk of DCM, have changed foods to increase the grain content, believing that the simple addition of grain will prevent any future heart disease. This misguided and simplistic strategy should be discontinued if we value the health of our dogs and are availing ourselves of accurate, informed, nutritional data.

GRAINS ARE NOT CONNECTED TO HEART HEALTH

NUTRITION EDUCATION IS LIMITED IN VET SCHOOLS

Research conducted by Dr. Joshua Stern, DVM, PhD, DACVIM, Chair of the Department of Veterinary Cardiology at UC-Davis,1 erroneously purported to conclude that grain diets or just adding grain to food is nutritionally protective against DCM in dogs. As a result, misinformation about grains, kibble foods, and raw diets continues to be propagated. While the research was interesting, the conclusions drawn from this limited study are rife with

We know that heart disease can be devastatingly lifethreatening for a dog, and veterinarians take this very seriously. The sudden onset and swift progression of DCM tragically shortens lifespans and devastates families.

IVC Spring 2021

erroneous assumptions (see https://ivcjournal.com/grain-freediets-heart-disease, IVC Journal, Volume 9:1, Winter 20182).

Sadly, veterinary school nutrition education is limited, and once we graduate, most of us work long hours. We don’t have time to do research ourselves, so we rely on the medical research

CHECKLIST FOR A

HEALTHY HEART Breed predisposed to DCM? n No — make sure nutrition choices don’t affect a healthy dog n Yes — make sure nutrition choices don’t trigger the dog’s DCM predisposition Feed a complete and balanced species-appropriate diet created with fresh ingredients and quality fresh meat protein, minimally processed to ensure balanced macro- and micronutrients are not degraded by heat or other processing. Important components: n Taurine n Carnitine n Copper n Iron n Diverse microbiota (bacteria play a role in absorption of important nutrients) n Proper Omega-6 to Omega-3 ratio (4:1)

Additionally: n Avoid anti-nutrients found in legumes and binding agents in kibble foods (soy, lentil, peas, chickpeas, etc) n Avoid over-supplementing with fiber n Monitor proper vitamin levels, especially vitamin D n Support healthy and regulated endocrine function; endocrine issues have been associated with DCM (monitor stressors and test for thyroid/adrenal/pituitary function) n Regular activity and exercise — the heart is a muscle n Maintain healthy weight (especially avoid obesity, a factor in DCM)

community to provide data to support our arsenal of treatments. When the industry uses limited data research and inaccurate assumptions to create overreaching general recommendations that may not be fully helpful for our patients, we are at risk of doing the same. This seems to be the case in the DCM debacle.

HOW DO WE NAVIGATE CONFLICTING INFORMATION? Our best approach is to evaluate basic physiology and biology ourselves to find the “grain” of truth in this situation, which can lead us to a better conclusion for our patients and pets. We must focus on what we know, not what we have assumed. We need to allow the genetics, biology, and nature of the canine species to inform our conclusions. We have access to good information about the pathways of important compounds that help heart function. We have evidence in dogs and other animals regarding possible genetic links, nutrient deficiency issues, microbiome challenges, anti-nutrient damage, and infectious agents that can all be implicated in heart disease. 3 We know metabolic pathways require specific minerals and nutrients to produce important compounds for heart function and health. It is clear that while there is still no research to prove specific ingredients have a direct link to most DCM cases, it is also clear that IVC Spring 2021

there is no definitive research proving that nutrition is not a cause of DCM.4

taurine production. Without the proper natural precursors, can dogs make enough taurine for heart health?

DO KIBBLE INGREDIENTS AND NUTRIENTS CONTRIBUTE TO DCM?

It seems likely that a taurine deficiency in a breed prone to DCM might be doubly devastating to the heart. Perhaps this calls for heightened diligence in feeding fresh nutrient-dense foods to all DCM breeds. There is evidence that increasing levels of taurine and carnitine in the diet provides improvement for many cases of DCM. 5

Biological, ancestral, and physiologic data suggest that feeding a steady diet of highly processed and heated pet foods could create a perfect storm that could contribute to DCM in dogs. But veterinarians are encouraged to believe the opposite is true. Processed foods are still recommended to patients with DCM while fresh foods are maligned. It’s also worth noting that the grain-free trend in pet food production was likely a response to market demands for lower carbohydrate levels in foods, and not an actual need for the type of grain-free foods that resulted.

IS NUTRITION RELEVANT IN BREEDS MORE LIKELY TO HAVE DCM? Even though some breeds are typically considered at risk for DCM, the relationship between diet and the genetic expression of DCM may still be relevant. It is possible that DCM breeds are more sensitive to the nutritional and other conditions that can create the disease in non-affected breeds. Because we know the function of taurine in heart health is important, we can focus our attention on that nutrient. We know that, unlike cats, dogs can make their own taurine. We also know that without enough copper, iron, methionine or cysteine, dogs can’t make taurine. If a dog is missing certain microbiota that make cysteine in the GI tract, he can become deficient in cysteine, which would consequently affect his

PREVALENCE OF

HEART DISEASE IN DOGS •A pproximately 0.5% to 1.3% of all dogs

suffer from some form of heart disease. •M ost of these (75%) have chronic degenerative

valve disease (not DCM). •L ess than 25% of dogs with heart disease (under

0.125% to 0.325% of all dogs) have some form of DCM.¹ •T hough the data is not complete, it may be true that

more dogs have been diagnosed with DCM in recent years. •H eart disease is more prevalent in males than females. •H eart disease is more likely in older dogs than

young dogs.

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SIZE ALSO MATTERS Compared to smaller dogs, large breeds synthesize 50% less taurine per unit of metabolic body weight.6 Large breed dogs are at higher risk of becoming taurine deficient. Obesity is also associated with lower concentration of taurine in animals.7 These physiological factors that increase taurine utilization in some dogs may make the endogenous synthesis of taurine insufficient to meet requirements. Dietary supplementation or fortification may be required, even though there is no minimum dietary taurine concentration according to current AAFCO recommendations.

DO OTHER ISSUES AFFECT THE TAURINE PRODUCTION LINE? We know that taurine is lost through bile salt conjugation, especially if the dog is eating a high volume of starchy fibers, like beet pulp or rice bran. Studies show that the newly popular pet food ingredient, beet pulp, is even more closely associated with taurine deficiency than rice bran.4 The quantity of these fiber ingredients in the food is relevant. While low fiber amounts can be healthful, too much will overly bind and remove taurine in bile salt conjugation, not allowing it to be recycled. Dogs will have an increased need for taurine if their diet is heavy in fibrous ingredients, especially beet pulp. Highly processed kibble foods using poor quality meats, plant proteins, and excessive fiber are creating multiple areas of deficiency. However, grain-free kibble food does not categorize all grain-free pet foods. The deleterious cardiac effects of grainfree kibble foods are likely caused by the ingredients included in place of the missing grain and meat protein. This does not support the erroneous claims that just by adding grains, dogs can be protected from DCM. Nor does it support the claim that because fresh raw food diets have no grain, they are also implicated as likely to cause DCM. In fact, the ingredients in fresh raw foods support healthy heart function and are not likely to contribute to DCM. In the two years since the Stern research, raw foods have not been implicated in increases in DCM. Given the research on relevant nutrients for healthy heart function, we are very lucky that there are more pet food options than just kibble diets, as both grain and grain-free kibble foods have been implicated in DCM cases. Continued on page 12.

Continued from page 10.

ADDITIONAL FACTORS THAT MAY AFFECT TAURINE BIOAVAILABILITY Negative factors: • Binder ingredients in kibbles, such as lectins, phytic acid, fibers, and polysaccharides, may inhibit taurine absorption, recycling or conversion. Phytic acid is found in beans, grains, nuts and seeds, and reduces the absorption of minerals. Lectins, found in beans, grains, nuts, seeds, potatoes and some dairy, mediate attachment and binding.4 • Cassava (tapioca) accumulates cyanide, causing increased demand for sulfur-containing amino acids during its detoxification, limiting the availability of amino acids used in the biosynthesis of taurine and carnitine. Peanuts, soybeans, sweet potatoes, broccoli and other cruciferous vegetables are also implicated. • Heavy metals can negatively affect heart function. • Tofu/soy based diets are low in sulfur-containing amino acids and devoid of taurine; they can contribute significantly to taurine deficiency and DCM.

BREEDS AT

INCREASED RISK OF DCM

• Doberman Pinscher

•G olden Retriever

• Irish Wolfhound

•S aint Bernard

• Great Dane

•A iredale Terrier

• Boxer

• Newfoundland

• American and English Cocker Spaniel

•S cottish Deerhound

• Bulldog

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•G erman Shorthair Pointer

Positive factors: • Methionine/cysteine are needed for taurine production. •C holine is used to make homocysteine, a precursor for methionine. • C arnitine is important; deficiency can cause mitochondrial dysfunction in the heart muscle. • Copper is needed for taurine creation. • Vitamin E affects heart function. • Selenium, not detectable in most kibble foods tested, is important for immune function.

TESTING FOR TAURINE Taurine, the nutrient most discussed in relation to DCM, may not be accurately measured using serum samples. Whole blood is likely to be the better measure of taurine levels, as platelets have been shown to contain taurine in measurable amounts. However, even measuring taurine with whole blood samples may not create an accurate picture in terms of the body’s needs. We do not know how the blood taurine value corresponds to the actual amount of taurine doing its work intracellularly. Measuring intracellular taurine amounts would require biopsy and is unlikely to be popular or practical. Taurine is the most abundant intracellular free amino acid. One would expect most of the body’s taurine to be in the cells, which perhaps explains why in many DCM cases we have found taurine levels in blood to be adequate, when perhaps the cellular levels may be deficient.8 To avoid deficiency, it seems sensible to rely on practical diet information based on the nature and biology of the breed. Dogs would naturally obtain a good deal of taurine and its precursors from fresh meat diets. Even though they can make taurine, and AAFCO6 does not list it as an essential amino acid, dog food should likely still contain ingredients with taurine to seamlessly maintain cellular concentrations and decrease our concerns about DCM.

DOGS WITH IBD HAVE LOW CARNITINE LEVELS Animals with IBD have been shown to have low carnitine levels from poor absorption. When owners choose a grain-free kibble diet high in vegetable protein sources to help treat IBD, they are likely exacerbating an already low carnitine condition as well as creating a taurine deficiency in their dogs, which could contribute to the development of DCM. Fresh raw food diets or homemade recipes created with a professional formulator are more effective options. They can help reflorinate the microbiota lost in IBD cases, and provide high quality digestible proteins with plenty of the sulfur amino acids, taurine and carnitine (and other nutrients), a low inflammatory carb percentage, moderate fiber, and healthy non-rancid fats.

FRESH, BALANCED, SPECIESAPPROPRIATE RAW FOODS VERY UNLIKELY TO CAUSE DCM The fact that raw foods don’t have grains does not equate them to the DCM-related issues in dry kibble grain-free

foods. Don’t focus on choosing between a dry kibble food that either has grains or is grain-free (two bad choices) — choose balance and freshness wherever possible: • Taurine and carnitine are plentiful in meat-based diets. • T hese diets contain copper and iron in appropriate forms for absorption. • Increased plentiful microbiota are found in fresh raw foods. • Recipes can vary in terms of Omega-6:3 ratios. • Very few anti-nutrients will be found in fresh raw foods. • Fiber and carbs are low in these diets.

CONSIDER HOMEMADE DIETS The most important decision we can make for our dogs is what we put in their food bowls. Dog food formulators should have a deep knowledge of processing methodologies and nutrient interactions that go beyond meeting AAFCO nutrient profiles, and should not carelessly follow unsubstantiated market trends.9 Make sure your recipes provide nutrition for all aspects of canine health. Not all available recipes are fully balanced and complete, and most will not include nutrient data, especially

FACTS ABOUT TAURINE AND CARNITINE Taurine • This amino acid is not used to create proteins. Rather, it is used as a mediator in many biologic processes.

• Without enough taurine, the heart muscle may not properly contract, which can result in DCM.

• Vegetable protein sources in pet foods do not contain taurine.

Carnitine

• Taurine is not considered an essential nutrient for dogs (it is for cats). • Foods with low or even no taurine are still considered balanced. • Taurine is needed for proper heart function. Its high concentration in heart muscle is thought to contribute to calcium reabsorption and sensitivity of the myofilaments to calcium.

• Carnitine is not considered an essential nutrient for dogs or cats. • It is needed for proper heart function. • Vegetable sources of protein do not contain carnitine. • Foods with low or even no carnitine are still considered balanced. • DCM cases have been shown to be associated with low carnitine levels.

IVC Spring 2021

SUPPLEMENTATION

FOR DCM

If an animal has a heart condition, and taurine or carnitine might be a factor, consider suggesting a supplement. Taurine: For dogs, the levels are typically extrapolated, but it is difficult to overdose (taurine is excreted rather than stored in the body). Give 250 mg for a small dog, 500 mg for a medium dog, 750 mg for a large dog, twice a day. Carnitine: Give up to 500 mg for a small dog, up to 1,000 mg for a medium dog, and up to 2,000 mg for a large dog, twice a day. CoEnzyme Q10 and B vitamins: Also good supplements for heart disease. It can take several months to see cardiac improvement, but if a taurine deficiency was at the heart of the problem, it may fully resolve with supplementation. Use organic and well-known sources. Consider using freeze-dried heart treats to help increase amino acids, including taurine.

References available at IVCJournal.com

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for taurine and carnitine. Many recipes are general guidelines with room for big mistakes. Many people in the pet food industry are recognizing that the future of pet food is moving towards functional nutrition — ingredients designed and combined for optimizing the individual’s health needs. Using software tools like the Animal Diet Formulator™ (ADF) software has helped veterinarians, professionals, and even pet owners find and remedy deficiencies or excesses in recipes to improve pet health. Royal Animal Health University uses the ADF to teach veterinarians and technicians to evaluate and create recipes and diet plans. It is an unusually complete and useful nutrition tool with continually-updated data on nutrients like taurine and many others. Veterinarians should not just be looking at minimums; we should also be looking at the research for optimal levels of nutrients to keep up with current health concerns. The ADF performs important calculations to determine Omega ratios, and typical values for basic ingredients; it can even estimate nutrient values for many ingredients. Creating recipes that accurately evaluate the nutrient levels of a cooked diet can be difficult. Cooking can cause nutrient degradation, loss, or even increases in some cases. The nutritional changes that occur when ingredients are cooked are included in the ADF data. If the final product is to be cooked before feeding, the recipe and nutrient data will reflect those nutrient changes. This may be critical as we consider the fragility of taurine in cooked diets for our DCM cases. Always remember that food is medicine. While a good diet cannot cure all ills, a poor diet will always create problems. With proper nutrition, there is a strong tendency for health.

ADVERTORIAL

Hemp products what does strain (cultivar) specificity mean?

Not all cannabis (hemp) is created equal. There are hundreds, if not thousands of different cannabis (hemp) cultivars in the world. Cannabis itself is made up of thousands of compounds, including terpenes and cannabinoids. These two compounds, along with flavonoids and tocopherols, work together synergistically in what is known as the “entourage effect”. The entourage effect changes with each genetic strain because the profile of the terpenes and cannabinoids differs in each strain. Certain strains will produce certain benefits from the profile of its compounds; if the profile changes, the results may change as well.

HOW DO YOU KNOW IF A PRODUCT IS STRAIN SPECIFIC?

1 2

Make sure the company is vertically integrated, meaning they handle everything from farming to the final product. Ensure they are using a full spectrum oil. Otherwise, the oil will be void of certain compounds such as terpenes, flavonoids, tocopherols, and tetrahydrocannabinol. Look for the strain name on the product — for example, Cherry Abacus or Charlotte’s Web. These are names of actual strains used in the product.

Cultivar specificity ensures you will receive the same product time after time, and pets will have consistency in the way their bodies respond to the pharmacokinetics and pharmacodynamics of hemp. If you are using hemp that is not cultivar specific, you could be doing a trial-and-error experiment every time you order a new bottle.

TERPENE AND CANNABINOID PROFILES Terpenes not only make up the smell and flavor of the plant but also contain many health-related beneficial properties.1 Thousands of terpenes have been documented thus far, existing in a range of plants from citrus fruits to pine trees. Terpenes contain antimicrobial, antioxidant, and anti-inflammatory properties. They play a role in offering “relevant protection under oxidative stress conditions in different diseases, including liver, renal, neurodegenerative and cardiovascular diseases, cancer, diabetes, as well as in aging processes”. 2 Another aspect of hemp products that needs to be considered is the cannabinoid profile. Both the cannabinoid and terpene

BY ELISHA LEHRHOFF, MS TOXICOLOGY

profile make up the genomic fingerprint of the hemp plant. 3 The cannabinoid profile represents the active cannabinoids in that specific strain, as well as the concentration between cannabidiol and tetrahydrocannabinol. Hemp strains can vary from a few cannabinoids to hundreds, depending upon the purpose of the product.

THE ENTOURAGE EFFECT The entourage effect comes into play when a myriad of ingredients are combined to exert a synergistic effect, including cannabinoids, endocannabinoids, terpenes, phytocnanabinoids, and tetrahydrocannabinol. 5 When all these ingredients are combined, they have a much stronger effect on the body than isolated cannabinoids do on their own. 5 HempMy Pet™ utilizes their own genetic line of Cherry Abacus™ hemp that is bred and produced at our local farm in Colorado. Our full-spectrum hemp extract combines CBD, CBG, CBC, terpenes, flavonoids, tocopherols, and under 0.03% THC to create a cultivar specific product full of bioactive, human-grade, and vegan ingredients that are beneficial for animals. We are incredibly proud to be cultivar specific so we can ensure every customer receives the same product every single time they purchase from us. Each batch is third party analyzed and tested to ensure purity, potency and safety for every pet. Elisha is originally from Los Angeles, California. She graduated from Colorado State University in 2015 with a BA in Animal Science and a minor in Business Administration. Throughout her undergraduate career, she fell in love with research and working with animals. She completed her Master of Science in Toxicology in 2017 and hopes to return to school in the fall of 2021 to pursue her PhD in Public Health. She is currently working for HempMy Pet™ as Head of Research, Toxicologist. Elisha thrives in a scientific writing environment and is specifically interested in holistic preventative health and the endocannabinoid system. Elisha has two adopted dogs, Bailey and Dudley, who accompany her on backpacking, camping, and hiking trips. Bergman, M. E., Davis, B., & Phillips, M. A. (2019). Medically Useful Plant Terpenoids: Biosynthesis, Occurrence, and Mechanism of Action. Molecules (Basel, Switzerland), 24(21), 3961. https://doi.org/ 10.3390/molecules24213961. 2 González-Burgos, E., & Gómez-Serranillos, M. P. (2012). Terpene compounds in nature: a review of their potential antioxidant activity. Current medicinal chemistry, 19(31), 5319–5341. https://doi.org/ 10.2174/092986712803833335. 3 Project CBD. CBD-Rich Strains. Project CBD: How to Use CBD & Cannabis. https://www.projectcbd.org/ medicine/cbd-rich-strains. 4 Valastro, C., Campanile, D., Marinaro, M., Franchini, D., Piscitelli, F., Verde, R., Di Marzo, V., & Di Bello, A. (2017). Characterization of endocannabinoids and related acylethanolamides in the synovial fluid of dogs with osteoarthritis: a pilot study. BMC veterinary research, 13(1), 309. https://doi.org/10.1186/s12917-017-1245-7. 5 Russo E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British journal of pharmacology, 163(7), 1344–1364. https://doi.org/10.1111/j.1476-5381.2011.01238.x. 1

IVC Spring 2021

nutrition nook

PET FOOD

MATH

How to decipher pet food labels and why it’s so important. BY KAREN GELLMAN, DVM, PHD

As veterinarians, we are often asked to recommend specific pet foods. This involves treading the line between our knowledge of canine and feline physiology, clinical studies sponsored by the pet food industry, and common sense; between an ancestral carnivore diet of small prey, and a convenient, economical diet of highly processed remnants from the human food industry. But convenience comes with a cost! The enormous increase in chronic disease, autoimmune problems, and cancer in pets over the past 60 or so years parallels the growth of the commercial pet food industry into a multi-billion-dollar business. A recent study from Finland compared inflammatory bowel disease (IBD) incidence in a population of over 7,000 adult dogs, looking at the variable of how the dogs were fed in the first six months of life. A high-fat, low-carbohydrate non-processed meat diet fed during early life, and a normal

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PEER-REVIEWED

body condition in puppyhood, were significantly associated with less IBD in adult dogs compared with those fed an ultra-processed carbohydrate based diet.1 What is an “ultraprocessed carbohydrate based diet”? Well, it turns out those terms describe almost every dry pet food, from supermarket to ultra-premium brands, and many canned foods as well. To evaluate how a commercial pet food stacks up to what a carnivore’s nutritional and physiologic needs are, we need to both understand carnivore nutrition, and interpret the actual nutritional content of a pet food beyond the often incomplete truths on the label.

LESSONS FROM UNBIASED NUTRITIONAL RESEARCH As scientists, we like to base decisions on evidence. Unfortunately, most vet school nutrition research and boarded nutritionist specialty training depends on support from large pet food manufacturers, which creates a conflict of interest and potential bias. However, zoologists with no ties to veterinary medicine have also studied the nutrient profiles of wild canids and feral cats (“ancestral” diet) in comparison with those of domestic dogs and cats when given free choice (“instinctual” diet). 2,3 The studies cited here are each meta analyses of 40 to 50 individual studies, analyzing both scat and stomach/gut contents in captured/deceased animals. While the canine study tracked the diet of wolves only, it is recognized that some other wild canids, such as foxes and jackals, do eat more plant-based foods, such as berries, which will increase the carbohydrate portion of their diets. For wolves, the nutrient profile consumed (see Table 1) in terms of energy (percentage kcal) was found to be 54% protein, 45% fat, and 1% carbohydrate. Feral cats were found to eat 52% protein, 46% fat and 2% carbohydrate. Interestingly, the researchers found that the consumed nutrient profile did not align perfectly with the actual

nutrient content of the cats’ prey, which was, on average 62% protein, 11% fat, and 13% carbohydrate. This implies that feral cats choose which body parts to eat in order to maximize the fat content.

TABLE 1: Dog and cat ancestral and instinctual diets Diet/species

Energy ratio – % P : F : C

Ancestral diet (wolves)

54 : 45 : 1

Instinctual diet (dogs)

30 : 63 : 9

Ancestral diet (feral cats)

52 : 46 : 2

Instinctual diet (cats)

52 : 36 : 12

Ketogenic diet

30 : 69 : 1

To tease out the difference between “ancestral” and “instinctual”, several studies have been performed to assess what nutrient profile domestic dogs and cats will select in a free choice situation.4,5,6 Across a variety of breeds, dogs self-selected a macronutrient profile of 30% protein, 63% fat, and 9% carbohydrates, which is a much higher fat content than the selection consumed by wild canids. Two separate studies in cats, performed by different groups six years apart, both found remarkably similar results: 52% to 53% protein, 36% fat, and 11% to 12% carbohydrates. The nutrient selections in cats were not influenced by texture or moisture content, and the authors observed that domestic cats refused to eat more than 12% carbohydrate content free choice — in fact, they would shortchange their protein to avoid more than 12% carbs. Interestingly, the “ketogenic” diet promoted by some to help fight cancer in pets and humans is remarkably close to the nutrient/energy ratio of an “instinctual” diet that dogs eat when given free choice. Here is the bottom line: the carbohydrate share in most commercial pet foods is four to 20 times what either feral or domestic dogs and cats would choose to consume.

BRIEF HISTORY OF THE PET FOOD INDUSTRY In traditional societies, dogs hunted vermin as part of their jobs, and in the city, dogs were fed waste left over from turning full animal carcasses into meat — most butchers provided inexpensive “dog meat” from scraps. Cats, of course,

IVC Spring 2021

had a domestic contract to hunt mice and rats in the home and barn. Commercial pet food has its origins with a mid-19th century entrepreneur, James Spratt, who made grain-based biscuits for dogs based on sea-going hard biscuits for sailors, and marketed them to the wealthy aristocracy — the only demographic that might actually spend good money on dog food. Around the time of WWI and the demise of horses as the engine of commerce, Ken-L-Ration began canning horse meat as a diet for dogs. Post-WWII, the nascent food industry discovered it could use the waste products and technology of the cereal industry to make shelf-stable extruded pet foods that could be sold in a bag. In the 1960s, a comprehensive marketing campaign was effective at convincing Americans that commercial pet food was healthier than the traditional way of feeding dogs with family leftovers. Today, there are not only pet food divisions in all the major food manufacturers, but dozens of smaller specialty pet food companies. All are competing for the vast market of US pet lovers, and the truth about their products is not nearly as appetizing as the pictures on their bags.

DECIPHERING THE LABELS As with all commercial foods, the FDA requires that the contents (ingredients) are listed in order of weight, from large to small, on pet food labels. The guaranteed analysis (GA) is required to tell the percentage by dry weight of the food’s protein, fat, and indigestible fiber. What is not listed are carbohydrates, which are the principal component of most commercial dry pet food.

Ingredient splitting Consumers know that the first few ingredients represent the largest components of a food, so commercial manufacturers are sure to list recognizable meats, such as chicken, beef or lamb, as the first ingredient. But a tactic called “ingredient splitting” is also being employed. For instance, in one popular premium pet food, the ingredient list starts with: Chicken, Cracked Pearl Barley, Whole Grain Wheat, Whole Grain Corn, Whole Grain Sorghum, Corn Gluten Meal, Soybean Meal, Chicken Fat, Brewer’s Rice… The GA on this product states it contains 21% protein, but the unstated percentage of carbohydrates is calculated to be 53.5% to 61.5% (depending upon whether you use weight or energetic value for your calculations — see below). Even though “chicken” comes first on this list, the next four ingredients are all grains, which are primarily carbohydrates.

IVC Spring 2021

After these are two “meals” of processed plant proteins. So, it is likely that there is a vanishingly small amount of chicken in this food, after which comes a “just smaller than” amount of four grains, adding up to half the nutritional content of the food. Next comes two plant protein “meals”, which have an incomplete amino acid profile for carnivores. All the ingredients are treated with high heat, extruded and dried, and preservatives are added. Without the “loophole” of ingredient splitting, the ingredient list by weight would read: Grain (Barley, Wheat, Corn, Sorghum), Protein Meal, Chicken… Not even the advertising geniuses could convince pet owners that food described in this manner would be healthy for domestic carnivores.

What about grain-free pet foods? Somehow, “grain-free” pet food evolved alongside the “gluten-free” processed food movement for humans. While there is no evidence that pets are sensitive to wheat gluten, pet owners picked up on the industry’s intention for them to infer “grain-free” as “carbohydrate-free.” This is not true in the least. Grain-free pet foods substitute legumes for grains, and use the same “splitting” techniques. Legumes contain both carbohydrates and vegetable protein, so a long list of “splits” means that the amount of animal protein in the guaranteed analysis becomes smaller and smaller. For instance, a popular super-premium grain-free dog food lists the following ingredients: Chicken, Chicken Meal, Sweet Potatoes, Pea Protein, Pea Flour, Whole Dried Potatoes, Dried Beet Pulp, Tapioca, Flaxseed, Chicken Fat, Turkey Meal, Peas, Fish Meal… Chicken and chicken meal are both animal protein, and are probably present in similar amounts. Next in weight are five ingredients containing carbohydrates along with plant proteins. So, if this food’s protein content is listed as 26%, it may be only 10% chicken or less. The remaining protein portion will be made up of highly-processed protein meals and plant-based protein. The rest of the top listed ingredients add up to a total of 41% carbohydrates. While this is an improvement on the 54% carbs in the example above, it is nowhere near either the ancestral nor the instinctual diet carbohydrate content of less than 10%.

Protein meals are a popular ingredient in pet foods. They are products rendered from the subpar scraps left over from meat packing — rendered, concentrated, and heat-treated. Protein meals are an inexpensive source of concentrated protein, so are a favorite in the pet food industry to keep costs down while providing necessary protein for carnivores. While most bags of kibble feature photographs of beautiful cuts of meat to entice the buyer, in reality, most of the meat inside would not look like something you would be willing to eat for dinner.

What’s wrong with plant-source protein? Each biological protein is made up of an individual profile of amino acids. “Essential” amino acids in any species are those required for health but cannot be generated in the animal’s body. Carnivores, like dogs and especially cats, have evolved over millions of years to get their essential amino acids from the bodies of their mammalian or avian prey. High heat processing denatures proteins and reduces their bioavailability. It was discovered in the 1970s that feline dilative cardiomyopathy was due to a nutritional deficiency in taurine, an essential amino acid for cats. Cats who hunted and ate rodents or birds would get a complete and balanced diet from their prey, but those eating dried kibble were deficient until the pet food industry began dressing the kibble with extra taurine. More recently, the exaggerated scare of grain-free kibble being associated with dilative cardiomyopathy in dogs was, upon deeper examination, more likely due to the poor bioavailability of taurine, an essential canine amino acid, possibly triggered by interactions with legumes in processing. This makes more sense than thinking that grain is an essential nutrient for carnivores.

What about canned food? Isn’t that better? Some canned foods have a better nutrient profile than dry, but sometimes the only difference between canned and dried commercial pet food is the moisture content — usually 10% in dry food and 78% in canned. When you remove the water, indigestible fiber, and mineral ingredients from the guaranteed analysis, the nutritional content of what is left becomes clearer. Many commercial canned cat foods have an acceptable nutritional profile — see catinfo.org for a spreadsheet of the actual nutritional content of many canned cat foods. However, canned pet foods are, by definition, processed with high heat, and come with other risks associated with their packaging. We now know that the plastic liners in the cans contain many toxins that can leach into the food and IVC Spring 2021

CALCULATING THE MISSING VALUES ON A PET FOOD LABEL

There are many other factors to consider when interpreting pet food labels. Every small nuance of wording conveys a legal meaning! For example, a label of “Turkey Dog Food” requires 95% meat or more of the total weight of all ingredients. “Turkey Recipe Dog Food” requires at least 25% percent meat, but not more than 95%; and “Turkey Flavor Dog Food” contains less than 3% percent total meat. Darwin’s Natural Pet Food has a great educational page that is well worth a perusal: darwinspet.com/resources/comparing-petfoods/how-to-read-dog-food-labels.html.

The US pet food industry has a powerful lobby with the FDA, which has allowed them to label processed pet food differently than food for human consumption. So you won’t see the carbohydrate content of pet food on the label guaranteed analysis. The only way to know the actual macronutrient profile of a commercial food is to pull out your calculator, or as Dr. Lisa Pierson does for catinfo.org, call the manufacturer’s customer service and insist that they supply the full information to you.

Do the math to learn the full nutrient profile of any pet food from the guaranteed analysis on the label (see sidebar on page 22 for an example of the calculations required). Compare the results in the example to the ancestral energetic ratio of wolves at 54 : 45 : 1 and the free choice instinctual canine diet energetic ratio of 30 : 63 : 9 across breeds (Table 1). See Table 2 below for a comparison of some popular commercial dry and canned pet foods with

disrupt endocrine function. Some of the thickeners used, especially in “cuts with gravy”, are suspected to stimulate inflammatory bowel disease. (Those “meaty cuts”? They contain exactly the same ingredient mash as the paté style, but the slurry is dried and sliced in the factory. That style difference is all marketing, to make it seem more appealing to the purchaser!)

TABLE 2: Commercial dry and canned pet food nutrient analysis Moisture, fiber, protein and fat % by weight from label Guaranteed Analysis

Product

Moisture Fiber Protein

Fat

Calculated CHO

Energy ratio % P : F : C

Hill’s Science Diet, large breed

12.5

53.5

21 : 27 : 52

IAMS large breed

22.5

14.5

46.4

22 : 32 : 46

Nutro large breed

3.5

15.2

50.3

20 : 32 : 48

Nutrish Zero Grain

16.3

40.5

25 : 36 : 39

Taste of the Wild Sierra Mountain

17.7

42.3

23 : 37 : 40

Orijen Original

22.1

21.8

35 : 45 : 20

Blue Chicken Dinner canned for dogs

4.6

26.5

41.9

24 : 35 : 41

Meow Mix

40.2

32 : 26 : 42

Nature’s Logic

36 : 34 : 31

9 Lives tender morsels for cats — beef, canned

28 : 54 : 18

TABLE 3: Commercial raw food diets (beef formulas only were used for comparison) Moisture, fiber, protein and fat % by weight from label Guaranteed Analysis

Product

Moisture Fiber Protein

Fat

Calculated CHO

Energy ratio % P : F : C

Darwin’s Natural Selections (frozen)

38.7 : 45 : 16.3

Bravo (frozen)

12.5

1.5

34.7 : 61.8 : 3.5

Instinct (frozen)

36.1 : 44.4 : 19.5

Nature’s Logic (frozen)

38.3 : 45.7 : 16.0

Primal (freeze-dried)

35.8 : 56.7 : 7.4

Stella & Chewy’s (freeze-dried)

30.5 : 59.4 : 10.1

Bravo (freeze-dried)

43.2 : 29.5 : 27.3

IVC Spring 2021

their actual macronutrient ratios. As you can see, none of the kibbles, even the super-premium brands, come close to either ancestral or instinctual nutrition ratios. The very lowest carbohydrate content dry food is still over two times what may be considered a physiologically appropriate diet for canine carnivores. And none of the cat foods have anywhere near the amount of protein cats need.

WHAT ARE THE SOLUTIONS? We have lots of options! I tell my clients that there is a wide range of what we can feed our pets — from the ideal (sending them out to catch their own dinner) to the awful (the rancid, dusty bag of kibble that has been sitting on the shelf at the local convenience store for five years). Every family has to find the compromise that works for their lifestyle, their pet’s health, and their wallet. The family with three large dogs may choose to feed the economic dry food, but the increased risk of chronic metabolic diseases and their complications may not save money in the long run, considering vet bills. The calculation may be quite different for a small dog or cat, that literally eats less, and different again for the pet that suffers from chronic skin or GI problems, which will hugely benefit from a fresh food diet lower in carbohydrates. Homemade pet food can be a great option — if the client has the time, the motivation, and your professional support for nutrition balancing.

For clients with limited financial resources, “diluting” the high carbohydrate proportions of dry dog food with inexpensive high-fat ground beef (65/35% or 70/30% lean) can be a brilliant solution. I recommend lightly cooking such a beef product, because mass-produced ground beef as found in supermarkets commonly has Salmonella or E. coli recalls. Chicken can be a great inexpensive protein, but comes with a higher risk of Salmonella in the commercial food stream, plus many dogs with chronic inflammatory conditions may find that the warming qualities of chicken worsen their skin or GI problems. At the very least, you can ask clients to give their dogs a portion of whatever

Beware of “home-made diet” recipes that include grains or other high glycemic index carbs as a major ingredient. Some of our older, beloved integrative textbooks have recipes that don’t stand up to modern thinking and research. Another great option can be commercially-prepared raw food diets, either frozen or freeze-dried for convenience (Table 3). The nutrient profiles on many of these are far closer to the ancestral and instinctual ones. They tend to be available at super-premium prices, however, which limits the demographic that can take advantage of them.

IVC Spring 2021

How to assess the

nutritional balance of a pet food

Guaranteed Analysis

STEP 1: Calculate the carbs

Crude Protein

21.0% min

The pet food guaranteed analysis lists, by percentage, the constituent nutrients of the food. But it omits carbohydrates. To calculate the carbs, subtract the other percentages from 100.

Crude Fat

12.5% min

Crude Fiber

3.0% max

Moisture

10.0% max

Vitamin C

85 mg/kg min

Vitamin E

400 IU/kg min

Glucosamine

300 mg/kg min

Chondroitin Sulfate

550 mg/kg min

Take this example of a popular national brand of premium kibble (see Figure 1): 100% - 21% protein - 12.5% fat - 3% fiber - 10% water = 53.5% carbohydrates

STEP 2: Calculate the percentages of macronutrients based on dry nutritive matter To make an even more accurate assessment of the nutritional balance, you must subtract the water and indigestible fiber from the total, as they have no nutritional value. So we arrive at 87% dry nutritive matter (100% less 10% water and 3% fiber). We can then divide each percentage of protein, fat, and carbs by 87 to get its true percentage in the diet. 21/87 = 24.1% protein 12.5/87= 14.4% fat 53.5/87= 61.5% carbs

STEP 3: Calculate the energy ratios What about energy ratios from this diet? After all, fat has twice the energy of protein or carbohydrates. If we imagine our food sample weighs 100 grams, and multiply each percentage by the energy value, we get:

Figure 1: Guaranteed Analysis label for pet food analyzed in the sidebar example at left.

they are having, minus the starch (rice, pasta, potatoes). They could feed a couple of eggs for breakfast and some meat and vegetables for dinner. The dogs will love it and it minimizes the time commitment. Of course, obesity is a huge health factor in a lot of our dogs and cats. Just reducing the carb ratio of their food will help normalize their metabolism and get their weight under control. When shifting the diet away from kibble, remember that dry food has at least twice the nutritional density by volume as fresh foods that are not dehydrated. So if a dog is eating two cups of kibble twice a day and maintaining a good weight, you could advise substituting one cup of dry with two cups of meat/eggs/sardines and vegetables at each meal. Fresh food is much more digestible than dry food, so you will have to monitor weight through this transition, and if the dog is gaining, take away even more kibble. Knowledge is power! Give your clients the tools to help them choose their pets’ diets based on nutrition, not marketing!

24.1 x 4.5 kcal/g = 108.5 kcal 14.4 x 9 kcal/g = 129.6 kcal 61.5 x 4.5 kcal/g = 276.8 kcal 100 grams of food contains: 108.5 + 129.6 + 276.8 = 514.9 kcal

Hemida M, Vuori KA, Moore R, Anturaniemi J, Hielm-Björkman A: Early life modifiable exposures and their association with owner reported inflammatory bowel disease symptoms in adult dogs. Front Vet Sci. 2021 Feb 1;8:552350.

Bosch G, Hagen-Plantinga EA, Hendriks WH. Dietary nutrient profiles of wild wolves: insights for optimal dog nutrition? British Journal of Nutrition.2015;113:S40–S54.

To calculate the nutrient ratio, divide each nutrient energy total by the total calories: 108.5/514.9 = 21.1% protein 129.6/514.9 = 25.1% fat 276.8/514.9 = 53.8% carbohydrate This food has a true nutrient energetic ratio of: 21.1 : 25.1 : 53.8.

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Hagen-Plantinga EA, Bosch G, Hendriks WH. Estimation of the dietary nutrient profile of freeroaming feral cats: possible implications for nutrition of domestic cats. British Journal of Nutrition.2011;106:S35–S48.

Hewson-Hughs AK, Hewson-Hughs VL, Colyer A, et al.Geometric analysis of macronutrient selection in breeds of the domestic dog, Canis lupus familiaris. Behav Ecol.2013;24(1):293-304.

Hewson-Hughs AK, Hewson-Hughs VL, Colyer A, et al.Geometric analysis of macronutrient selection in the adult domestic cat, Felis catus. Journal of Experimental Biology. 2011; 214: 1039-1051.

Saloun F, Blanchard G, Le Paih L, Robert F, Niceron C. Impact of macronutrient composition and palatability in wet diets on food selection in cats. J Anim Physiol Anim Nutr (Berl). 2017;101(2):320-328.

Clinical utility of

C-reactive protein and the C-reactive protein/albumin ratio (CAR)

in canine patients BY MARLENE SIEGEL, DVM, ALT, CNHP

The inflammatory response is an important innate immune process that protects the body when tissues are injured by pathogens, trauma, toxic compounds, heat, etc. When it works properly, the acute inflammatory response quickly activates, complements, and promotes phagocytic activity, and then returns to a steady state, ready to respond when injury occurs again. This return to a low inflammatory state is vital for proper response. Even with simple vaccinations, a study found that “inflammation, even subclinical, can result in the development of an immunological risk group, in which vaccination fails to provide sufficient immunity.”1 It is generally recognized that the best marker for measuring the inflammatory response are the acute phase proteins. The major positive acute phase protein in dogs is C-reactive protein. CRP concentrations can increase 100-fold and rise quickly; typically, within 24 to 48 hours. Measuring CRP can be clinically useful in these situations: • Screening the apparently healthy dog. By definition, a healthy dog should not have any inflammation, and if inflammation is present, it is likely to be chronic. Detecting inflammation in the “normal” dog may be an early sign of emerging occult disease. A high-sensitivity CRP test is necessary to screen for inflammation. • Disease activity and progression. CRP is a useful tool to gauge disease activity in chronic enteropathies for dogs with GI disease, 2 and is helpful for differentiating asymptomatic mitral valve disease (MVD) from congestive heart failure. 3 • Therapy efficacy. CRP rises and falls rapidly. If a therapy is effective, the CRP should fall quickly, within two to four days. For instance, IMHA patients showing a positive response to therapy should see a rapid reduction

in CRP. If medication is having a positive impact on IBD patients, their CRP should stay low. CRP and albumin, independently, have long been used as markers for prognosis. Patients with either high inflammation or low albumin tend to have worse outcomes. Now, use of the C-reactive protein/albumin ratio (CAR) is growing in human medicine. Combining these two well-recognized, independent markers into a single metric can offer greater prognostic insight. High CAR values, where the body is in a high inflammatory state with low albumin, has demonstrated poor outcomes in cancer survival, post-surgical complications, sepsis mortality, and other serious disorders. New studies in canines show CAR to be a better metric than CRP or albumin alone for estimating length of hospital stay, time of recovery in a variety of serious diseases, and relative risk of death in dogs with acute pancreatitis.4,5 Canine CRP does not share common antigenicity with human CRP, so testing methods do matter.6 Many labs use a human CRP assay that does not recognize canine CRP consistently, leading to poor precision and low accuracy. A high-sensitivity canine-specific CRP assay is strongly recommended.

Povey RC. Distemper vaccination of dogs: factors which could cause vaccine failure. Can Vet J 1986;27(9):321-3.

2 Jergens AE, Schreiner CA, Frank DE, et al. A scoring index for disease activity in canine inflammatory bowel disease. J Vet Intern Med 2003;17(3):291-7. 3 Reimann MJ, Ljungvall I, Hillström A, et al. Increased serum C-reactive protein concentrations in dogs with congestive heart failure due to myxomatous mitral valve disease. Vet J 2016;209:113-8. 4 Gori E, Pierini A, Lippi I, Ceccherini G, Perondi F, Marchetti V. Evaluation of C-reactive protein/albumin ratio and its relationship with survival in dogs with acute pancreatitis. N Z Vet J 2020;68(6):345-348. 6 Fabretti K, Siqueira R, Amaral H, Kemper D, Chaves R, Pereira P. Determination of the reference interval of the C-reactive protein/albumin ratio and its efficiency, CRP and albumin as prognostic markers in dogs. Presq. Vet. Bras 2020;40(3):202-209.

Yamamoto S, Miyaji S, Abe N, Otabe K, Furukawa E, Naiki M. Canine C-reactive protein (CRP) does not share common antigenicity with human CRP. Vet Res Commun 1993;17(4):259-66.

IVC Spring 2021

A new framework for

CHRONIC GI DISEASE

in dogs and cats

BY KATHERINE E. DAHLHAUSEN, PHD, DAWN D. KINGSBURY, DVM, PHD, DIP. ACVIM (SAIM), AND HOLLY H. GANZ, PHD

Chronic enteropathy (CE) is the term now used to describe long-term gastrointestinal disease that lacks a specific diagnosis in canine and feline patients. Gastrointestinal complaints are common in clinical practice, with acute patients typically resolving with symptomatic and supportive treatment. However, a small subset (1% to 3% of the total caseload) have relapsing or chronic signs in the absence of the usual suspects (such as repeated dietary indiscretion, foreign body ingestion with intermittent partial obstruction, parasites, or enteropathogens).1 Chronic enteropathy (CE) is an umbrella term now used to describe such gastrointestinal (GI) disease in dogs and cats that lasts longer than three weeks and lacks a more specific diagnosis. The causes of canine and feline chronic enteropathies are multifactorial, and include breed predisposition, environmental factors (e.g. dietary antigens), and intestinal microbiota. While breed specific factors are important and may be useful, such as gluten-sensitive enteropathy in Irish setters7 and antibioticresponsive enteropathy in German shepherds,4 the genetic makeup of the patient in the exam room is unalterable. A change of diet is a leading action generally associated with positive, sometimes long-term, outcomes. Chronic enteropathies can be defined by treatment response according to four general categories: food-responsive, antimicrobial-responsive, immunomodulation-responsive, and non-responsive.

FOOD-RESPONSIVE ENTEROPATHY (FRE) Similar to food protein-induced enteropathy in people (e.g. gluten sensitivity), about 50% of dogs and cats with CE respond to diet change alone. FRE is more common in younger cats and dogs, whose signs arise from an adverse food reaction, food allergy, and/or food intolerance. It is common for CE patients to have an allergic reaction to certain types of dietary protein. In contrast, food ingredients most likely to cause food intolerances are much more varied and do not require prior exposure. These include carbohydrates (e.g. disaccharides: milk lactose, sucrose and dextrins), pharmacologically active products (e.g. histamine/histidine in certain cheeses and fish), food additives (e.g. food color dyes), and food toxin contamination or overconsumption (e.g. phytohaemagglutinin aka PHA lectin in beans, among many

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other naturally-occurring plant toxins through to mycotoxins). Improvement can take up to 14 days after switching diets, and several diets may need to be tested. An elimination diet can be effective at identifying allergies or food sensitivities but can be challenging for clients to implement. Some studies report that a hydrolyzed protein diet8 or an easily digestible diet9 are successful at mitigating signs of CE in dogs. As is the case for elimination diets, these special diets can provide short term benefit; however, reducing the diversity of foods provided in the diet in the long run will lead to reduced bacterial diversity in the gut microbiome. Bacterial dysbiosis is associated with CE and can often be modified by diet. Changes in macronutrient ratios and nutrient bioavailability contribute to shifts in bacterial composition in the digestive tract. Remission in patients with CE induced by a hydrolyzed protein diet was accompanied by decreased abundances of the pathobionts Escherichia coli and Clostridium perfringens, reduced bacterial dysbiosis, and increased levels of the secondary bile acids, lithocholic and deoxycholic acid.10 Improvements in clinical signs are also reported after switching from a high carbohydrate, low protein diet to a low carbohydrate, high protein diet, including raw diets. Likewise, the addition of prebiotic fibers can help firm up stool while also feeding beneficial bacterial populations. Early life events can influence the likelihood of developing a CE. In a new study, exposure to a high fat, low carbohydrate, non-processed, meat-based diet during early life, and a normal body condition in puppyhood, were significantly associated with less IBD in adult dogs.11 The opposite trend was found with early life exposure to ultra-processed carbohydrate-based diets.

ANTIMICROBIAL-RESPONSIVE ENTEROPATHY (ARE) Some forms of CE may be alleviated by using antimicrobial treatment to treat a known or suspected bacterial pathogen, to alter the bacterial composition of the gut microbiome,

and/or to allow for lower doses of anti-inflammatory medication (immunomodulation). Why such cases respond to antibiotics is often unclear, and an imbalance of the gut microbiome is strongly implicated. Common antibiotics used to treat CE are tylosin, tetracycline, doxycycline, azithromycin, enrofloxacin, rifaximin, and metronidazole. Menozzi et al12 reports that antibiotics can be effective, at least temporarily, at resolving CE signs. However, relapse rates are high. Tylosin has a relapse rate of 86% in 30 days13,14 and 88% within two months,14 and metronidazole has a relapse rate of 100% within six to 12 months.15 In addition to high relapse rates and contributing to antibiotic resistance, the use of antibiotics can produce unhealthy, long term changes in a pet’s gut microbiome. A recent study found that metronidazole had lasting effects on the fecal microbiomes of healthy dogs.16 In our research, we find that prior antibiotic exposure is significantly associated with elevated levels of Escherichia, diarrhea, and bacterial dysbiosis in both cats and dogs (presented at the 2020 ACVIM Forum). Targeted bacteriophage cocktails, such as those designed to target problematic strains of Escherichia coli, provide an alternative to the use of broad spectrum antibiotics.

IMMUNOMODULATION-RESPONSIVE ENTEROPATHY (IRE) Medications that suppress the immune response in order to reduce inflammation of the gastrointestinal tract lining are the defining treatment for IRE, which is more commonly found in older cats and dogs. Several types of anti-inflammatory drugs are available, some of which are used in combination with antibiotics in more severe cases. Prednisone, prednisolone (preferred for cats over prednisone), chlorambucil (preferred for diabetic cats), mycophenolate, and budesonide have been reported as effective treatments for reducing inflammation

The role of the GUT MICROBIOME The gut microbiome is defined as the community of all microorganisms living inside the gastrointestinal tract, including bacteria, fungi, viruses, and protozoa. The presence and diversity of microbes that make up the gut microbiome are strong indicators of health, as they have a complex and direct link to the immune system, metabolism, endocrine system, and even mental health. The health of the gut microbiome can be easily connected to every type of CE response category. For example, imbalances in the gut microbiome (e.g. overgrowth of harmful bacteria, lack of diversity, absence of beneficial bacteria, etc.) are correlated with signs of chronic CE of both cats27 and dogs.28 Hundreds of studies now highlight the negative impact of antibiotics on the gut microbiome, as they can disrupt the balance and diversity of the bacterial community in the intestines. Therefore, it may be beneficial to the overall health of your feline and canine patients to assess their gut microbiome composition in detail before treating for ARE. Based on a particular patient’s results, treatment recommendations can be prioritized to supplementing fiber or making other dietary adjustments before resorting to antibiotics. In some cases, antibiotics can be used to alleviate signs before performing microbiome restoration with diet or fecal transplantation.

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Why do specialists now prefer the term “CHRONIC ENTEROPATHY”? Historically, CE was referred to as inflammatory bowel disease (IBD), once histopathological evidence of inflammation was reported via gastrointestinal mucosal biopsies. Specialists now prefer CE as the term for diagnosis because the predominant inflammatory infiltrate in animal IBD (lymphocytic plasmacytic) is very different from human IBD (neutrophilic and monocytic). Furthermore, the diagnosis of CE provides a useful framework that can be used early on in the diagnostic journey, and encompasses many conditions, making CE very common in cats and dogs.2 While a lack of consensus on specific inclusion criteria makes it hard to know just how prevalent CE is, a recent review estimated that biopsy diagnosed IBD prevalence is at least 1% to 2% in dogs,1 with all enteropathic disorders reported at a prevalence of 17.8%.3,4 In cats, the prevalence of enteropathic disorders is estimated at 20%.5,6

within two weeks, with remission rates as high as 78%.17 Reported data is limited, but one study published a relapse rate of 22.7% following immunosuppressant treatment.18 While important and useful, these medications are associated with significant side effects, including negative behavioral shifts and gastrointestinal ulceration. Notari et al19 reported that dogs on corticosteroids were less playful, more nervous, fearful and/or aggressive in the presence of food, and more prone to barking or to startle, to reacting aggressively when disturbed, and to avoiding people or unusual situations. Healthy dogs administered prednisone exhibited gastrointestinal bleeding and ulceration, even in the absence of clinical signs.20 Mycophenolate has recently been reported to produce gut dysbiosis21, 22 but was also reported to reduce gut dysbiosis in spontaneously hypertensive rats. 23 Approximately a quarter of canine recipients of mycophenolate experience GI signs.24 While mycophenolic acid acyl glucuronide metabolites, produced by enterocytes and excreted into bile with hepatic metabolism, contribute to osmotic diarrhea by a local irritative effect, 25 the gut microbiota play a prominent role in GI toxicity.22 The exact players and mechanisms have yet to be determined.

NON-RESPONSIVE ENTEROPATHY (NRE) Because CE is a broad term with numerous causes, it’s not surprising that 15% to 40% of cases do not respond to treatment in the short term.26 If a patient is non-responsive to treatment, it is possible that another disease or condition could be contributing to signs. For example, pets can still

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have a cobalamin deficiency, despite an adequate diet, due to malabsorption as a result of an unbalanced gut microbiome and mucosal inflammation. That said, not all the causes of CE are understood, let alone known. Altering the gut microbiome is an emerging and promising treatment for clinical signs of a gastrointestinal condition, even when the cause is unknown.

FECAL TRANSPLANTATION TO RESTORE KEY BENEFICIAL MICROBES Should an imbalance in the gut microbiome be suspected or detected in a chronic CE patient, it is possible to augment the intestinal community with probiotics. However, numerous studies report that supplementing with probiotics is unlikely to make a noticeable permanent difference to the gut microbiome. Instead, a fecal microbial transplantation 29 (also known as Microbiome Restoration Therapy or MBRT) is the best known practice for restoring a balanced gut microbiota, and contains native gut microbes not found in today’s probiotics. FMT has proven to be effective in both animals 30 and humans 31 for a number of conditions, such as gut microbiome recovery after antibiotic treatment, 32 and to resolve IBD and Clostridioides difficile infections. 31 Fecal transplants may be administered a number of ways, including via upper and/or lower endoscopy, enema, or oral delivery. 33 Of course, microbiome restoration is most effective when supported by a diet that also feeds these beneficial gut bacteria. References available at IVCJournal.com

LIMITED INGREDIENT DOG FOOD BY GARY TASHJIAN

You’ve heard of limited ingredient dog food — but what is it exactly, and is it right for your canine patients? Limited ingredient dog foods are made with a minimal number of ingredients to reduce allergic reactions and food intolerances while still providing complete and balanced nutrition. Also called limited antigen dog foods, these diets have one to a few high quality proteins, and one to a few carbohydrates from vegetables, fruits, or starches, though some veterinarians consider limited ingredient foods to be those containing only one protein and one carb.

RECOGNIZING LIMITED INGREDIENT DOG FOOD Although commercially-available limited ingredient recipes have improved over the years, no official definition exists for limited ingredient foods. Originally, limited ingredient diets were not available commercially, but manufacturers started producing them at the request of vets implementing elimination diets. Look for these characteristics in limited ingredient dog food: • Simple, high quality ingredients • Single protein • No fillers from animal by-products, beet pulp, corn, and wheat

WHAT IS THE BEST LIMITED INGREDIENT DOG FOOD FOR ALLERGIES? Examine the label’s guaranteed analysis, which provides maximum percentages of crude fiber and moisture and minimum percentages of crude protein and crude fat, to ensure the food is balanced. It’s also important to find a food that’s minimally processed to ensure the bioavailability and preservation of nutrients. Raw or gently cooked diets are usually less processed than conventional canned or kibble diets. Next, look for these characteristics: • T he food should contain only one protein. • Look for novel whole proteins such as game meat, buffalo, kangaroo, pheasant, venison, and duck. • Look for novel carbs such as squash, amaranth, millet, and quinoa. • T he food should include zinc, copper, and selenium, as well as vitamins A, C, E, and B6 to support the immune system in the gut.

• Often grain-free

IS LIMITED INGREDIENT DOG FOOD RIGHT FOR YOUR PATIENTS?

• No preservatives or additives A few things to avoid include: • General descriptions such as “poultry”, which can mean turkey, chicken, or any other fowl • Food dyes, artificial flavors, and preservatives • By-products or vague ingredients like “chicken meal”

Keep in mind that foods cause less than 10% of dog allergies, yet are frequently the first source held responsible for skin and other issues. However, a limited ingredient diet of sustainably raised protein and carbs can often soothe skin and digestive irritations and possibly pre-empt some health problems.

• Fillers like tapioca, soy, and corn

Gary Tashjian is the owner and founder of Darwin’s Natural Pet Products. Gary spotted the opportunity to help more pets live longer lives with healthier diets and founded Darwin’s Natural Pet Products in 2004, the first raw pet food company in the Pacific Northwest. Over the past 17 years, Darwin’s has served more than 80 million nutritious meals to dogs and cats, helping tens of thousands of pets live healthier lives.

What problems can LIMITED INGREDIENT FOODS help solve?

• Bladder stones

• Poor hair growth

• Obesity

• Ear infections

• Diabetes

• Weight loss or weight gain

• I tchy or flaky skin and other skin issues

• Hot spots

• Dull coat

•V omiting, diarrhea, or other digestive problems IVC Spring 2021 27

Our growing knowledge of canine health and nutrition, combined with other advances in medical science and technology, means dogs are living longer than ever. However, this longevity increases their risk of developing cognitive dysfunction syndrome (CDS). Here’s how nutritional support can help.

Nutritional support FOR THE

aging canine brain Cognitive decline, or cognitive dysfunction syndrome (CDS), is a neurodegenerative condition resulting from brain pathology, so is different from what is considered the normal aging process. The condition is progressive and irreversible, and will eventually result in behavioral changes related to learning, memory, perception, awareness, social interactions and activity level.1 Changes in sleep-wake cycles and feeding and drinking behavior, as well as altered responses to stimuli, often result.1 CDS has been shown to be an excellent model of the aging process associated with Alzheimer’s disease in humans.2

AGING CHANGES THE BRAIN Several gross anatomical changes can be seen as the brain ages; total brain volume decreases and ventricular volume increases.2-5 Specifically, frontal cortex volume decreases and hippocampal volume can be seen to decrease as well.2-5 Since the hippocampus is associated with memory storage, one can see why memory deficits are associated with this condition. Changes that can be seen at the histopathological

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BY VALARIE V. TYNES, DVM, DACVB, DACAW

level include reduced numbers of neurons and an increased presence of free radicals.2,4 Free radicals are the normal by-products of cellular metabolism; under normal conditions, free radical scavengers remove these by-products. With age, the levels of free radical scavengers decrease, allowing free radical numbers to increase. The brain is extremely sensitive to the toxic effects of free radicals. Several other conditions associated with aging, such as heart disease and hypertension, result in decreased oxygen to the brain and contribute to the overall decline in brain tissue health. Other circulatory changes, including the increased presence of micro-hemorrhages and infarcts, further contribute to the clinical signs. 2,4 A reduction in glucose metabolism in the aging brain can lead to energy deprivation, which subsequently contributes to a further decrease in neuronal function.6 A reduction in cholinergic function has also been documented in the aging brain, and is suspected to contribute to the declining cognitive and motor functions seen in many aging individuals.7

Possibly one of the most notable changes is the increased presence of lipofuscin and beta amyloid plaques in the brain.2-5 Beta amyloid is also known to be neurotoxic and is a hallmark of Alzheimer’s disease in humans. The degree of accumulation of these plaques has clearly been associated with the degree of cognitive impairment in both humans and dogs.8

DIAGNOSING CDS CDS can be challenging to diagnose but the clinician should start by using the acronym DISHAA to evaluate the patient for signs of CDS.1 DISHAA stands for Disorientation, Interactions, Sleepwake cycle, House-soiling, Activity and Anxiety. See Table 1 for details regarding the DISHAA signs. Many of the signs commonly seen with CDS, such as house-soiling, nighttime waking and vocalization, and increased anxiety can be due to other medical conditions. For example, sleep-wake cycles are often altered in patients with chronic pain. The presence of osteoarthritis can make it difficult to lie down and stand up. Alternatively, lying

down for an extended period of time may lead to increased discomfort due to joint disease. Osteoarthritis can also lead to house-soiling if accessing the appropriate elimination site is painful for the dog. Any medical condition leading to increased frequency or urgency of elimination can result in house-soiling. Chronic pain can also lead to increased anxiety. As you can see, many signs of CDS can overlap, and many can be similar to those seen with other physical conditions. This means a good history, physical exam, and appropriate diagnostics are also important to rule out the presence of concurrent medical conditions. To some extent, CDS is a diagnosis of exclusion, but it is also likely to occur alongside many other medical conditions. All the pet’s medical conditions will need to be managed at the same time as the CDS is addressed, in order to maintain the best quality of life for the patient. Unfortunately, many pet owners may see these signs and just think their dogs are “getting old”, when in fact, if diagnosed early, many of these conditions can either be treated or managed so the Continued on page 31.

TABLE 1 – The signs of Cognitive Dysfunction Syndrome DISORIENTATION

• Acts as if they do not recognize familiar individuals • Stares blankly into space • Acts lost in home or yard • Gets stuck — can't figure out how to move around objects; stands at the hinge side of the door

INTERACTIONS

• Less interested in interacting with familiar individuals • More irritable • Increased attention seeking

(Changes in social interactions)

SLEEP-WAKE CYCLE • Sleeping more or less than usual •P acing, vocalization at night DISTURBANCES HOUSE-SOILING (Learning and memory problems)

ACTIVITY (Changes in level or frequency of activity)

ANXIETY

• Indoor elimination; decreased signaling to go outside • Failure to respond to previously learned cues • Less interest in play or walks • Increase in repetitive behaviors or aimless behaviors such as circling, pacing, etc. • Increased reactivity to stimuli • Increased anxiety when separated from owners • Increased fear or anxiety associated with new places or things

What the studies show Both the severity and prevalence of CDS increase with age in dogs. In one study of 180 dogs, 10% of 11-12-yearold dogs had two or more signs of CDS, while 36% of 15-16-year-old dogs had two or more.9 In another study of 479 dogs, using a newly validated questionnaire, 41% of dogs over 14 were affected.10 In a more recent study that involved prospective screening, prevalence ranged from 13% to 16% in dogs 8-11 years of age while almost all dogs over 13 showed some signs of CDS.11 The prospective study also found that over the course of six months, 42% of dogs with no impairment progressed to mild impairment, and 24% with mild impairment progressed to moderate.11 Over a year’s time, 71% progressed from having no signs to mild signs, and 50% progressed from moderate to severe signs.11 This suggests that twice-yearly screening could be extremely valuable, since most of the interventions that have been studied are most effective when used before signs of CDS become severe.

DISHAA: Recognizing signs of CDS

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TABLE 2 – The Role of Specific Nutrients in the Aging Brain INGREDIENT / SUPPLEMENT PURPORTED MECHANISM OF ACTION Arginine

• Precursor to nitrous oxide (NO)-enhanced nitrous oxide synthesis for maintaining normal blood pressure, circulation and cognition • Antioxidant • Regulation of glucose metabolism • Supports neurogenesis

Alpha lipoic acid

• Improves mitochondrial function — cofactor for mitochondrial respiratory chain enzymes • Reduces production of reactive oxygen species (antioxidant) • Increases intracellular glutathione levels • Neuroprotective • Improves nerve blood flow and nerve conduction • May attenuate the decrease in neurotransmitter levels that occur with age

16-19

B6, B12 and folic acid

12, 20-23

• All three are essential to the health of the CNS •D eficiencies of Vitamin B12 and folic acid lead to impaired methylation and increased plasma homocysteine. •C orrect for B vitamin deficiency and minimize risk of elevated homocysteine •E levated homocysteine associated with renal and heart disease in dogs • L ow concentrations of B vitamins and increased homocysteine associated with cardiovascular disease and risk of cognitive impairment in humans • I mprovements in cognitive impairment with good Omega-3 fatty acid status • Pyridoxine (Vitamin B6) • Normal brain development, function and neuronal health; neuroprotective • Cofactor in the synthesis of serotonin, noradrenaline and dopamine. • Vitamin B12 • Required to form methionine which undergoes methylation to SAMe.

Beta-carotene

• Antioxidant • Improves immune function

Ginkgo biloba

25-26

• Scavenges free radicals • Inhibits nitric oxide production

L- carnitine 16-17,21-22,27

• Mitochondrial lipid metabolism and required for the maintenance of normal mitochondrial functioning • Transport of long chain fatty acids through inner mitochondrial membrane • Regulates ketogenesis • Neuroprotective • Increases levels of antioxidants

Medium Chain Triglycerides (MCTs) 28-29

• May increase ketone levels in brain providing alternate energy source • Has been shown to improve memory in humans with cognitive deficits

Omega-3 Fatty acids (DHA and EPA)17,20,30-32

• Neuronal cell membrane plasticity and health • Neuroprotective • Anti-inflammatory • Correct for age related DHA deficiencies contributing to cognitive decline • DHA increased BDNF • DHA enhanced neurogenesis

Phosphatidylserine (PS)

• Plays a role in key signaling pathways in the cortex • Modulates the release of certain neurotransmitters

S-adenosyl–L-methionine (SAMe) 34

• Plays a role in maintaining cellular membranes in the CNS • Required for synthesis and inactivation of several neurotransmitters

Selenium

• Antioxidant • Helps to mediate levels of other free radical scavengers

Vitamin E

16-17, 19-20,36

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• Antioxidant — protects cell membranes from oxidative damage • Anti-inflammatory • Neuroprotective

Continued from page 29. dog not only lives longer but has a better quality of life in his senior years. While CDS cannot be cured, appropriate management can slow the progress and onset of signs.

RISK FACTORS FOR CDS Multiple risk factors have been identified that appear to predispose both humans and dogs to cognitive decline. These include a deficiency of docosahexaenoic acid (DHA), high homocysteine levels (homocysteine is an amino acid also associated with heart disease in people), and low levels of vitamins B6, B12 and folic acid.12,13 In addition, high blood pressure, chronic oxidative stress (another way of saying “high levels of free radicals”), and chronic low-grade inflammation are also risk factors.12,13 Therefore, nutrients that reduce these risk factors may enhance brain function and retard cognitive decline.

EVIDENCE FOR NUTRITIONAL SUPPORT Currently available treatment modalities, which some research supports, include those that improve brain metabolism, reduce oxidative damage, enhance neuronal transmission, and maintain neuronal integrity.14 These modalities can be used alone or in some combination. Table 2 lists some of the molecules or ingredients that have been shown to help in maintaining brain health, along with some information regarding their purported mode of action. • Hills® Prescription diet ® b/d® is supplemented with fatty acids, antioxidants (vitamins C and E, beta carotene, selenium, flavonoids, carotenoids), dl-alpha-lipoic acid and l-carnitine. This diet has multiple studies associated with it, involving both laboratory beagles and client-owned dogs. Most trials were blinded and placebo-controlled. In the laboratory studies, all dogs receiving the diet demonstrated better learning ability.15 In a clinical trial that included 125 family-owned dogs, those fed the diet showed improvement in five DISHAA categories. They also demonstrated significantly higher activity levels, and increased interactions with their families.16 It is noteworthy that in one of the laboratory studies, the diet alone was compared to placebo, and the diet plus environmental enrichment was compared to placebo. The study demonstrated that the dogs receiving b/d and environmental enrichment performed even better on cognitive tests than dogs that received b/d with no enrichment.15 • Purina Pro Care NeuroCare® is supplemented with 6.5% medium chain triglycerides (MCTs) as well as a combination of arginine, antioxidants including vitamins IVC Spring 2021

C, E and selenium, B vitamins, and fish oil containing DHA and EPA. In a double-blinded placebo-controlled trial of dogs identified as having CDS using a DISHAA screening tool, significant improvement was seen in five categories of DISHAA after eating the diet for just 30 days.17 After 90 days, a significant number showed improvement in all six DISHAA categories, whereas the dogs fed the control diet only showed some improvement in three categories.17 • Senilife® (Ceva Sante Animale) is a supplement containing phosphatidylserine, ginkgo biloba, antioxidants, and vitamin B6. In a double-blinded crossover study in nine laboratory beagles, aged 7-12.7 years, dogs receiving the supplement for 70 days showed significant improvement in a visuospatial memory task over baseline.18 In addition, there was a significant effect of phase; the subjects receiving the supplement during the first phase of the trial, and acting as controls during the second phase, did not show a significant difference in their performance between the two test periods, indicating that their level of performance was maintained in spite of the supplementation being discontinued. The collective results of this study suggest that the treatment also has some long-term benefits.18 In an open clinical trial including eight dogs that had been diagnosed with cognitive dysfunction syndrome by a veterinary behaviorist, the subjects were administered Senilife once daily for three months.19 The dogs were evaluated at three separate visits at approximately monthly intervals, and owners were asked to rank the frequency of clinical signs that had been identified at the initial visit. All eight dogs showed a highly significant improvement in all categories evaluated at the third visit when compared to the start of the trial.19 • Other supplements that can be given individually to support brain health include S-adenosyl–L-methionine (SAMe) and Omega-3 fatty acids (PUFAS). SAMe is a metabolite found in every living cell, where it plays a role in hundreds of different

metabolic reactions.20 It is particularly important in the central nervous system; decreased levels of SAMe have been noted in the brains of Alzheimer’s patients.21 There is evidence that SAMe crosses the blood-brain barrier intact and several studies indicate that parenteral and oral administration of SAMe can increase CSF concentrations in dogs.20 In one double-blinded placebo-controlled clinical trial, 36 dogs with CDS were given a SAMe supplement (Novifit ® by Virbac) for 60 days, and demonstrated significantly improved activity levels, awareness, and mental impairment scores compared to placebo. 22 In a blinded, placebo-controlled laboratory study of 14 aged beagles, executive function was found to be enhanced with SAMe administration.23 • Omega-3 long-chain, polyunsaturated fatty acids (PUFAs) are of fundamental importance to brain development and function, with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) considered most important. They play a vital role in maintaining cell membrane structure, fluidity, and cell-to-cell communication.24 Few studies have looked at the role of individual fatty acids on brain health, and most focus on the effects of Omega-3 fatty acids in combination with other ingredients. However, the evidence is clear that DHA and EPA together improve cognition in healthy adults and slow cognitive decline in those with mild impairment.24,25 Such clear evidence in animals has not yet been found, but due to their many potential benefits, supplementation with PUFAs should be considered in aging pets. While CDS cannot be reversed, the signs can be improved and clinical progress slowed with appropriate early intervention and nutritional support. The result can be happier clients and improved behavioral health and welfare for your patients. References available at IVCJournal.com

Supporting the human-animal bond with education and early screening Many health conditions seen more often in the aging individual, including CDS, can lead to behavior changes that can harm the human-animal bond and lead to decreased quality of life for the pet. Many of these conditions can also present risk factors for the use of certain medications. Therefore, the use of supplements to help ensure brain health in the aging animal should at least be discussed with the client as soon as any signs are noted. Educating the client about what signs to look for should begin when the pet reaches middle age, and the importance of early recognition and intervention should be emphasized.

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The benefits of

BOTANICALS in canine behavior management BY AMANDA ARDENTE, DVM, PHD

Managing canine behavioral issues often requires a multimodal approach that incorporates environmental modification, behavior training tactics, and therapeutics. For behavior issues stemming from stress and anxiety, botanical remedies can be utilized as the sole therapeutic, or strategically incorporated to provide adjunctive support to conventional therapies. Plant-derived supplements can be effective at relatively low concentrations and produce few side effects, compared to conventional drugs, making both short- and long-term use more desirable for behavior management. Many of these botanical remedies work by modulating neurotransmitters such as serotonin, dopamine, norepinephrine, and gamma-aminobutyric acid (GABA). Neurotransmitters are chemical messengers that send signals from a neuron, across a synapse, to a target cell located in the peripheral and central nervous system (PNS and CNS, respectively). Serotonin and dopamine are important neurotransmitters for modulating mood balance, behavior, and stress response. Norepinephrine encourages focus and concentration, and GABA, also known as the “inhibitor transmitter”, promotes a sense of calm. Each neurotransmitter exists in certain concentrations, relative to each other, and maintaining a proper balance is essential for achieving healthy behavior.1.2 St. John’s Wort (Hypericum perforatum) is a flowering plant that commonly grows around the U.S. and Canada. Its active constituents include hypericin, hyperforin, and flavonoids like quercetin and amentoflavone. 3 St. John’s Wort inhibits re-uptake of serotonin, dopamine, norepinephrine, and GABA, increasing their circulating availability for neural cells. Its specific effect on serotonin makes it an effective sole therapeutic for modulating a healthy mood and temperament. St. John’s Wort should not be used with pharmacologic antidepressants that have similar mechanisms of action, such as monoamine oxidase inhibitors (MAOI), because of the risk for serotonin toxicity.4

regulate mood and reduce anxiety by depressing, or calming, the CNS. 3 It likely does this by inhibiting GABAligand binding, thereby increasing circulating GABA in the CNS. 5 Another method of managing stress and anxiety is by modulating the hypothalamic-pituitary-adrenal (HPA axis) to reduce or balance nitric oxide and cortisol production. An adaptogen called Eleuthero (Eleutherococcus senticosus), also known as Siberian ginseng, works via this method.6 In veterinary medicine specifically, it has been recommended for use in shelters where stress is high, and even as a prophylaxis against stress.7 A more recent target of botanical therapeutics is balancing the endocannabinoid system, the group of specialized endogenous cannabinoid receptors CB1 and CB2 and their lipid ligands. Cannabidiol is one of approximately 60 cannabinoids present in Cannabis spp. plants that reduces anxiety, improves energy, manages the stress response, and balances mood. It likely does so by inhibiting degradation of anandamide, an endogenous cannabinoid, which binds CB1 in the brain, resulting in the desired effects.8,9 This is a rapidly evolving field of research that could prove useful for canine behavioral issues. The management of behavioral problems in dogs, caused by stress, fear/phobias, or anxiety, is challenging and often requires long-term therapy with a multimodal approach. When devising a treatment plan, the use of botanical therapeutics should be considered either as a short-term adjunct support or as a safe long-term management strategy.

References available at IVCJournal.com Dr. Amanda Ardente is a veterinarian and nutritionist, consulting for Animal Necessity, LLC. She resides in Ashland, VA, and is the owner of a nutrition consulting company, Ardente Veterinary Nutrition, LLC.

Extract of passionflower (Passiflora incarnata) is another botanical therapeutic containing flavonoids that help IVC Spring 2021

The evolution of gut health PART 1

BY JULIE ANNE LEE, DCH, RCSHom

Achieving optimal gut health in veterinary patients starts with an understanding of how important bacterial organisms are to the entire ecosystem of the planet.

Bacterial organisms are the most primal yet critical contributors to both individual and global health. Their collaborative power to sustain longevity in animals, humans, and the planet, is unparalleled by anything else.

BEGIN BY WORKING WITH NATURE — NOT AGAINST IT My life’s work is to enrich the lives of all animals, not just companion animals. To achieve this, in my view, we need to understand the framework of how energy influences matter, and immerse ourselves in what nature teaches us. We need to work with nature instead of against it. Without respecting this principle, there is no such thing as true healing. We must fully embrace the fact that we, our animals, and our planet are all part of an incredible, diverse ecosystem that has no room for hierarchy. We should celebrate the biodynamic way it functions, with everything in nature contributing to its health and longevity. It’s imperative to find a collaborative path in the labyrinth of natural health industry experts, unbiased science, regenerative soil coalitions, and our local biodynamic farmers who are giving back to the soil that keeps the earth intact. The soil is where the most diverse microbiome can be found; a microbiome that is translated

IVC Spring 2021

into the food our veterinary patients (and ourselves) need to thrive, not just survive. We have to find a way to practice and live the way nature intended, to formulate sustainable and ethical products that can create the most diverse microbial community possible.

WHY DO MANY PROBIOTICS FAIL TO WORK? With this in mind, let’s look at why so many probiotics are not achieving the desired effect in our patients. In my opinion, it’s because we are flooding the gut with simplistic strains of microbes that come from a narrow range of nonspecies-specific sources, and that are studied within the model of human health. This minimal strain overpopulation causes the gut microbiome to become unbalanced, and can lead to negative health consequences. In other words, we are compartmentalizing and researching probiotics in a conventional manner, producing products rather than working with the diverse ecosystem needed to support the very foundation of health. When we approach gut health in this way, we focus on the eradication or reduction of pathogenic bacteria instead

of supporting their symbiotic relationship. The goal should be to create a landscape that supports the ebb and flow of what we consider the enemy. Many bacteria that the healthcare system previously deemed dangerous are now understood as being responsible for regulating the balance of the microbiome. These “pathogens” include not only bacteria but fungi, parasites, and viruses. While we know that antibiotics, NSAIDs, diet, stress, and infectious disease can contribute to dysbiosis, so can the limited understanding we have of how prebiotics and probiotics affect the microbial terrain. This fundamental understanding opens the door to enlightening us in differentiating leaky gut, SIBO, EPI, IBD, and food reactivity, and supports us in choosing the most appropriate course of treatment.

FACTS TO CONSIDER Here are a few facts to digest before I present Part 2 of this article in the next issue of this journal, when I will go deeper by presenting the science behind species-specific probiotics, species-oriented prebiotics, soil contribution, and some key points in recognizing the interactive complicating factors in differentiating leaky gut, SIBO, histamine response, yeast, and “the over-cultured canine” (the over-indulgence of probiotics). • T he intestinal microbiome is a complex milieu. We are only beginning to understand its intricacies and its broad impact on a variety of body systems and organs, including, but not limited to, the central nervous system, cardiac muscle, skeletal muscle, skin, oral cavity, etc. • Intestinal microbiome dysbiosis (imbalance) has negative impacts on the host animal, irrespective of species: a broad variety of clinical presentations can manifest as a consequence of an acute or chronic insult to the microbiome. • A s animal health practitioners, we face two common scenarios and opportunities: • Diagnosing and prescribing a course of therapy for an acute or chronic health condition. And triangulating whether or not the health condition is a result of intestinal dysbiosis. • Building and improving the resiliency of the microbiome to help prevent the first scenario. An ounce of prevention is worth a pound of cure. Prevention employs a more holistic approach to overall animal health and wellness. • Science matters. Holistic animal well-being has been marginalized for too long. The value of species-specific probiotics to build the health of the microbiome is

science-based. Combining species-specific probiotics with researched prebiotic ingredients extends benefits to the animal. The inclusion of complex large molecules such as humic and fulvic acids further supports and builds animal health. Expected results from professionally formulated microbiome supplements include: • Increased production of beneficial short chain fatty acids • I nhibition of pathogenic bacterial growth • More complete digestion and better availability of dietary nutrients • I mproved cellmediated immunity •R educed inflammation associated with elevated interleukin levels •T ighter junctions between intestinal epithelial cells, reducing intestinal permeability • I mproved stool consistency with reduced flatulence. Formulating best-in-class ingredients for microbiome health is a science, supported by documented clinical experience and the lessons that nature provides, for students who are eager to learn and apply them. When we combine host-specific bacteria with diverse bacteria and add researched, soil-based carbon molecules, we are attempting to fill the gap we humans have created in nature. When I am formulating or have a question, I do not look at what is viewed as “natural”; instead, I look to nature in its entirety for the answer. I hope that my experience and research will provide a useful addition to your own toolbox for restoring animal health.

Julie Anne Lee, DCH, has over 25 years of clinical practice, and opened the first licensed holistic veterinary hospital in Canada. A primary focus for Julie has always been the microbiome. She regularly lectures at veterinary conferences and universities worldwide. Julie is the owner and formulator of Adored Beast Apothecary. IVC Spring 2021

industry innovations

Client communication tool A new text-message-based client communication tool integrates with most practice management software platforms. Fur Baby Tracker provides real-time pet status updates via text messages and optional app updates when pets are visiting the veterinary clinic for curbside drop-offs, surgery, boarding, and more. Streamline internal workflow, enhance staff communication, and increase pet owner satisfaction with proactive, real-time communication. Visit www.FurBabyTracker.com for workflow tips, access to free webinars, and further information.

Species-specific probiotics for your patients The revolutionary species-derived probiotic formula, Fido’s Flora, from Adored Beast Apothecary, is proven through research to survive the canine gastric digestive system and support a diverse ecosystem in the gut. Combined with prebiotic larch and ancient minerals, humic and fulvic acid, Fido’s Flora improves cell-mediated immunity, has a positive impact on interleukin production, creates tighter junctions between intestinal epithelial cells, and is not affected by antibiotics commonly prescribed to treat intestinal upset. adoredbeast.com

Supporting the endocannabinoid system The endocannabinoid system (ECS) governs a number of critical functions in the body that include neuronal, gastrointestinal, endocrine, immune, bone, and muscular systems. VF Hemp Oil from Standard Process helps support the ECS in dogs and cats. It comes in liquid form, which provides convenient, flexible dosing with a graduated dropper. It’s also gluten-free, and contains nongenetically engineered hemp. standardprocess.com/Veterinary-Formulas

Learn medical acupuncture at home The recognized leader in scientific acupuncture education for over two decades, CuraCore VET now provides the same rigorous curricular content and certification without the need for travel. Through expertly-designed, highly interactive, and readily accessible content, Dr. Narda Robinson and her faculty provide personalized instruction for those choosing to study medical acupuncture from the safety of their home. For more information, email info@curacore.org or visit CuraCore.org/vet/emav and start your course today.

IVC Spring 2021

news bites CAN HORSE ANTIBODIES POTENTIALLY TREAT COVID? New research by scientists in India shows that horses immunized with inactivated SARS-CoV-2 can quickly produce enough antibodies to potentially neutralize the COVID-19 virus and its variants.

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New hemp products for dogs and cats The healing benefits of CBD are becoming more mainstream. Rascal’s Better Buddy is premiering two new hemp-infused, THC-free tablets for cats and dogs. Easy Bud contains a mix of CBD and CBG (cannabigerol) designed for calming, while Run Around, featuring CBD, the anti-inflammatory properties of CBG, and CBN (cannabinol) helps improve mobility. Run Around comes in two doses specifically formulated for small to large breeds. crappysfeelbetter.com

According to the preliminary paper, the team used inactivated Indian SARS-CoV-2 cultures mixed with Freund’s Complete Adjuvant — a solution that promotes cell-mediated immunity — to inoculate the horses. They subsequently tested plasma samples to measure antibody response and found the highest immunoglobulin titer occurred just 42 days postimmunization, at 1:51,200 dilutions. Other results indicate this strategy could potentially treat severe COVID-19 cases with high titers, as well as defuse COVID variants, since it demonstrated cross neutralization of another SARS-CoV-2 strain. With COVID-19 still wreaking havoc worldwide, this type of passive immunotherapy, using large animals, is just another tool being considered to combat the virus. Biorxiv.org

WOMEN VETERINARIANS EARN $100K/YEAR LESS THAN MEN Women veterinarians make less than their male counterparts, new research from Cornell University’s College of Veterinary Medicine has found — with an annual difference of around $100,000 among the top quarter of earners. The disparity predominantly affects recent graduates and the top half of earners, according to the research.

Vegan pet foods that offer complete nutrition Feeding a dog or cat a vegan diet is problematic if the food isn’t providing the animal with all the nutrients he needs to stay healthy. Internationally-awarded Evolution Diet has been providing plant-based dog and cat foods since 1989. Their products are the only 100% complete plant protein pet foods made in the US and Canada that meet or exceed Nutrition Research Council (NRC) and American Association of Feed Control Officials (AAFCO) Certification Standards for nutritional completeness. Made from organic, non-GMO, and toxic chemical-free ingredients. petfoodshop.com

Dr. Clinton Neill, assistant professor in the Department of Population Medicine and Diagnostic Sciences, and his collaborators, examined practice ownership income, experience and specialty certification. The reasons for the earning inequality are challenging to identify but include unconscious bias, size of practices, less external financing and societal expectations as potential factors. Practice ownership and type of ownership also play a role. Partnerships, for example, are more beneficial for women’s income earning potential than sole proprietorships, while any form of ownership benefits men’s incomes. When it comes to the number of years worked, the study found that men move into higher income brackets at lower levels of experience than women. IVC Spring 2021

From the VBMA

The Veterinary Botanical Medicine Association is a group of veterinarians and herbalists dedicated to developing responsible herbal practice by encouraging research and education, strengthening industry relations, keeping herbal tradition alive as a valid information source, and increasing professional acceptance of herbal medicine for animals. Submitted by Cynthia Lankenau, DVM

DID YOU GUESS LAST ISSUE’S MEDICINAL HERB? Chaga (Inonotus obliquus) is a clinker polypore that grows in the circumpolar regions of the northern US, Canada, Russia, and Scandinavia. Be certain to select chagas found growing on birch trees, as only these have the important betulin flanosterols phytochemicals critical for the mushroom’s medicinal effects on cancer. Clinical research validates chaga’s use for cancer of the breast, lip, lung, skin, rectum, and cervix. It enhances immune function and has a long history in the treatment of leukemia. It also relieves cancer pain. Other validated uses include inflammatory conditions of the GI tract, such as gastritis, gastric and duodenal ulcers, hepato cholecystitis, and colitis. Chaga has proven antiviral effects as well as immune-potentiating properties, and has been used to treat immunodeficiency diseases, colds, influenza, and bronchitis. It has pancreatic restorative effects and can inhibit pancreatitis.

CASE REPORT Cinnamon is a nine-year-old spayed Vizsla who suffered from an episode of paraduodenal pancreatitis in 2018. Out of concern for the potential of secondary pancreatic cancer/ fibrosis/damage to pancreatic cells, Cinnamon has been taking chaga and milk thistle as part of a triune formula. She is in good health.

Virtual International Herbal Symposium Registration for this virtual event will open in March. Please sign up for the vet track to support the VBMA and receive CE. Our speakers this year include: •C onstance DiNatale, DVM — presenting a four-hour intensive on incorporating herbs in the small animal diet, and lectures on Chinese food therapy •C ynthia Lankenau, DVM, RH (AHG) — discussing metabolic syndromes and the interaction of Liver and Spleen, as well as what feline infectious peritonitis (FIP) can tell us about COVID-19 •G ary Richter, DVM — lecturing on herbs and mushrooms for the cancer patient, and herb-drug and herb-herb interactions, and also offering an intensive on cannabis in veterinary medicine •A lexia Tsakiris, BVetMed, RH (AHG) — speaking about grief, covering a materia medica of herbal medicine useful for both chronic and acute grief, as well as lecturing on alpacas and exhausted adrenals.

Please join us! Visit vbma.org for more information.

GUESS THIS HERB!

VBMA EVENTS

Upcoming webinars •A practitioner panel discussion will discuss how to integrate herbal medicine into your practice. The panel features Drs. Cynthia Lankenau, Ihor Basko, and Rona Sherebrin, with special guest Dr. Jamie Moran. •A n EPM discussion will be presented by Dr. Huisheng Xie.

IVC Spring 2021

Join the VBMA at vbma.org to find out. The answer will also be published in the next issue of IVC Journal.

ADVERTORIAL

For an animal’s health and homeostasis, look to the

renal proximal tubule BY JOHN J. GILDEA, PHD, JIQIAN HUANG, MD, PHD, AND ZACH BUSH, MD

Maintaining the healthy differentiated state of the renal proximal tubule should be the goal of every pet caregiver.

In all mammals, the renal proximal tubule is necessary for reclaiming vital nutrients, regulating the body’s pH homeostasis, and stimulating red blood cell production. A correctly formed barrier in the kidneys results from wellfunctioning proximal tubules. This barrier is essential for both electrical and concentration gradients. These gradients allow for active and passive pumping across the barrier, which is vital for the kidneys to carry out their essential functions. In our research, we measured these electrical gradients and examined the effects of ION*Gut Health For Pets on these critical barriers.

MATERIALS AND METHODS Cell culture

As starting material, primary renal proximal tubule cells were isolated and grown from approximately one gram of fresh renal cortex from mouse, rat, cow, dog, and cat. Primary human renal proximal tubule cells were purchased and grown according to manufacturer’s instructions (Lifeline Cell Technology).

Trans-Epithelial Electrical Resistance (TEER) Cells were plated in the apical compartment of 24 collagen coated Transwell Inserts (Corning, Sigma Aldrich) at 90% confluence, and incubated for three days when the TEER values stabilized. TEER values were measured with an EVOM2 (World Precision Instruments). Briefly, electrodes were sterilized by soaking in 70% ethanol for ten minutes then conditioned by soaking in cell culture media for one hour. A background reading of an empty Transwell Insert without cells was subtracted from all values and recorded as Ohms x CM^2. Six Transwell Inserts were used for either vehicle treatment, phosphate buffered saline (VEH), or ION*Gut Health For Pets treatment added to 20% ION by adding to both apical and basolateral media for four hours.

DISCUSSION The integrity of epithelial barriers is now considered a major component of longevity. One of the features of a disrupted epithelium is the concept of epithelial to mesenchymal transition, where cells of the confluent cell layer lose close association with their neighbors. This disruption of barrier function causes the cells to progressively become more similar to mesenchymal cells, which are then responsible for the fibrotic conversion of a tissue toward a less resilient condition. Tight junctions are among the structures within the cells that are disrupted as cells lose their identity and are the feature of an epithelial layer that mediates the TEER measured in this paper. The ability of ION*Gut Health For Pets to increase TEER and inhibit the reduced differentiation observed in these proximal tubule cell cultures may be an important component supporting overall kidney health, whole body homeostasis, and lifetime wellness. Zach Bush, MD is a physician specializing in internal medicine, endocrinology, and hospice care. He is an internationally recognized educator and thought leader on the microbiome as it relates to human health, soil health, food systems, and a regenerative future. John Gildea, PhD is a Cell Pathophysiologist and Molecular Geneticist with 27 years of scientific research experience in both industrial and academic labs. A guiding principle of his work is to establish innovative optimized model systems and assays to robustly investigate both normal and pathological states. Jiqian Huang, MD, PhD is a clinically trained physician and published scientific researcher with expertise in biomedical research on cancer, endocrinology and metabolism and reproductive biology, and in medical education on cellular and molecular biology. Through his profession of medical education and research he has gained extensive experience in animal studies, morphology, cell and molecular biology, has authored multiple peer-reviewed publications, and has earned national and international awards for his research.

Impact of ION* on the Barrier Integrity Across Renal Proximal Tubules for Multiple Species

RESULTS A proximal tubule cell is known to be a leaky epithelium, meaning that it is characterized as having a relatively low TEER value compared to other epithelial layers. In growth media, the TEER value was found to be barely over background for all six species tested (VEH in graph). However, in all six species, a dramatic and significant increase in TEER was observed when treated for only four hours with ION*Gut Health For Pets (*p<0.01 ION vs VEH, n=6 per group). IVC Spring 2021

ADVERTORIAL

BY LIONEL FA BRIES, DVM

Addressing

kerato-seborrheic disorders (KSD) in canine and feline patients

Kerato-seborrheic disorders (KSDs) are an increasingly common diagnosis seen in the veterinary setting. The key to combating these disorders involves first pinpointing and targeting the cause, then selecting an effective topical treatment that reduces symptoms by protecting and maintaining a healthy skin barrier.

KERATO-SEBORRHEIC DISORDERS: A REFRESHER In animals affected with KSDs, there is always an anomaly of keratinization characterized by abnormal exfoliation of corneocytes and/or an anomaly of sebum production. Seborrhea can come in two forms: dry seborrhea (dry skin and coat and dull hair that easily fractures) and oily seborrhea (greasiness). Both are often accompanied by keratinization disorders that are visible through dandruff.

CONSIDERING THE CAUSES Kerato-seborrheic disorders can be primary or secondary to many skin diseases. Primary seborrhea is inherited and usually occurs in certain breeds where gene mutations have been identified. Secondary KSD can usually be traced back to many other underlying disorders such as hormonal imbalances, allergies, parasites, etc.

With an ada pted topical app roach, you can ma intain a healthy sk in barrier and alleviate kerato-sebo rrheic disorders .

Evidence-based dermo-cosmetic products can help moisturize and regulate keratinization and sebum production. They help reduce dandruff, shedding and bad odors.

MAINTAINING A HEALTHY SKIN BARRIER The skin barrier is composed of the stratum corneum, the hydrolipidic film, and the microbiota. When these elements are fully functional, the skin is healthy and protected. If the cutaneous barrier is impaired, it leads to several disorders, including KSD.

ESSENTIAL 6® SPOT-ON (DERMOSCENT®, LDCA) IS A MUST-HAVE • Its innovative formula contains only natural active ingredients: a synergy of essential oils that provide sebo-regulating, deodorizing and anti-dandruff properties; hemp and neem seed oils rich in essential fatty acids to support the skin barrier; and anti-oxidizing vitamin E. • T he single-dose format enables optimal user compliance: one pipette applied on one spot of the skin between the shoulders once a week. It helps decrease shampoo frequency and substitutes for daily intake of essential fatty acids.

Bensignor E., Nagata M., Toomet T. Preliminary multicentric open study for dermocosmetic evaluation of a spot-on formulation composed of polyunsaturated fatty acids and essential oils. PMCAC (2010) 45, 53-57.

• Its ability to help redress kerato-seborrheic disorders has been proven in several peer-reviewed publications. A largescale study on 210 dogs and 79 cats conducted by veterinary dermatologists demonstrated its efficacy in sebo-regulating skin and coat, diminishing dandruff, bad odors and hair loss.1 In another blinded study carried out by Prof. Hoffman and her team at Texas A&M University, Essential 6® spot-on improved odor in dogs with direct action on the cutaneous microbiota shift. Moreover, a novel association between cutaneous malodor and two bacterial genera, Psychrobacter and Pseudomonas, was highlighted for the first time. 2

Meason-Smith C., Older C., Ocana R., Dominguez B., Lawhon S., Wu J., Patterson A., Rodrigues Hoffmann A. Novel association of Psychrobacter and Pseudomonas with malodour in bloodhound dogs, and the effects of a topical product composed of essential oils and plant-derived essential fatty acids […] Veterinary Dermatology (Dec. 2018); 29(6) p.465-475. Short Communication NAVDF 2018 in Hawaii.

Dr. Lionel Fabries graduated from Ecole Nationale Veterinaire de Toulouse in France in 1981 and completed a veterinary ophthalmology degree in 1982 prior to becoming a visiting scholar in the University of Florida as one of Prof. Kirk Gelatt’s staff during 1982-83. For over 30 years, he has been practicing medicine and surgery on small animals, mainly in ophthalmology and cardiology. He has played an active role as a member of the Board in the French Association of Small Animals Veterinarians and has given regularly lectures in the above mentioned two disciplines. As a member of the European Society of Veterinary Dermatology since 2004, Lionel attended numerous congresses and workshops, and has since developed his practice in dermatology. In 2003, he founded with two associates LDCA to offer a comprehensive range of dermo-cares for companion animals under the brand Dermoscent® to enrich veterinarians’ arsenal in addressing skin disorders.

TREATMENT Treatment must be adapted to the case, but in general, keratomodulating shampoos, rehydrating lotions, topical or oral essential fatty acid supplementation, and immunomodulators all play a role in restoring healthy skin. 1

IVC Spring 2021

BY JOYCE HARMAN, DVM, MRCVS

THE LYME DISEASE ORGANISM

TREATING

Lyme disease IN THE HORSE

While treating Lyme disease in horses is complex, a wide variety of alternative therapies can be helpful for different stages and manifestations of the illness. Lyme disease (LD) has been recognized for 40 to 50 years, and is now the most commonly reported tick-borne illness in the US and Europe. It is also found in Asia and increasingly in Australia. Since LD occurs in so many locations, it should be considered part of a rule-out list when a diagnosis is not clear. While the technology used to diagnose Lyme disease in horses has not changed much over the last ten years, our understanding of the symptoms is becoming part of mainstream medicine. Additionally, although treating LD in equine patients is complex, we are finding that a wide range of alternative and natural therapies are effective at treating and managing it.

SYMPTOMS OF LYME IN HORSES One of the most common signs of Lyme in horses is lameness or arthritis that is difficult to identify and may change locations. Other symptoms are anterior uveitis, neurologic signs, low grade fever, sensitivity to touch, weight loss, tremors, neck pain, lethargy and laminitis. The key is that there is usually some degree of behavior change. About 10% to 15% of the horses in my practice area become dangerously spooky when infected with Lyme. The exact reason for this is unknown, but it may be due to one of the different strains. Sometimes Lyme appears along with or before/after cases of equine protozoal myelitis (EPM), particularly in older horses. And sometimes Lyme presents with neurological symptoms that look like EPM, but are negative to the EPM test, and positive for Lyme. The characteristic bull’s-eye skin lesion is not seen, most likely due to the horse’s hair coat.

LABORATORY DIAGNOSIS Laboratory diagnosis of LD can be very difficult, partly due to the cleverness and changeability of the spirochete, and partly because the tests are not good enough yet. The main test is performed by Cornell University and is called the

The Lyme spirochete (Borrelia burgdorferi) is a very mobile, corkscrew-shaped bacteria. Its life cycle involves the deer tick or blacklegged tick on the East Coast, with other tick species involved in other regions. Contrary to popular belief, deer are far from the only hosts for infected ticks, since different tick species prefer different hosts. Many small mammals are part of the host cycle, from white-footed mice (the main host in the Northeast) to chipmunks, hedgehogs, squirrels and rats, along with humans and dogs. Birds are now identified as carriers, and since they travel a long way, Lyme can easily appear in areas where it was never identified before. Birds also carry another similar spirochete, Borrelia bissettii, which is a common cause of Lyme-like disease among people in Europe. Fleas, spiders, mosquitoes, and mites are also possible parts of the life cycle, though the available research has not defined their exact roles. The tiny nymph stage ticks are the source of most infections, while the adult tick, which is a little larger and easier to see, may be less important but still potentially infective. The difficulty with this organism is that it is incredibly smart (it talks to other spirochetes) and very adaptable. It can change shape and evade the immune system, as well as become dormant, waiting for an opportunity to reactivate. It has outer surface protein coats, called Osp, which change as the tick attaches and begins to suck the host's blood. This and many other adaptations allow it to become resistant to antibiotics, herbs, and the host's own immune system.

IVC Spring 2021

THE ROLE OF HEMP, CANNABIS, AND CBD IN TREATING LD The use of hemp with cannabinoids (CBD) in horses with LD is new, but early clinical use in this author’s practice is showing excellent results. In humans, CBDs are being used successfully for LD. The effects of cannabinoids on the immune system, arthritis, and for pain and inflammation are some of the reasons they are useful in LD cases. CBD is usually available as an oil extract. This can be an expensive way to give it to horses, since the dose that seems to have the best clinical effect is about 25 mg a day of a high quality product. Poor quality CBD is a common problem, and products with a low concentration likely have less effect. Some equine CBD is being sold inexpensively with claims of very high concentrations; these products are likely to be of poor quality, not organically grown, or are sourced from China. Hemp will grow anywhere, and will extract toxins from the soil, so it's important to use organic, traceable products. A powdered CBD extract of hemp leaf is currently being used in my practice. Cannabis with a THC component is not legal in most states, so has not been researched for use in horses. It would likely have too sedating an effect in horses, making them unsafe to ride.

ADDITIONAL TREATMENT SUGGESTIONS Other compounds can be helpful depending on the signs the horse is showing. • Magnesium is frequently deficient in human LD patients; it is easy to supplement horses with magnesium citrate (1 g to 3 g per day). Topical preparations of magnesium are beneficial if the oral route causes any intestinal upset; however, the actual dose absorbed is difficult to calculate. • Herbs to support general gut health can be beneficial, especially after prolonged courses of antibiotics. • Marshmallow leaf (Althaea officinalis) and meadowsweet (Filipendula ulmaria) are examples. • Turmeric root (Curcuma longa) shows excellent antiinflammatory effects on joints and offers supportive properties to the liver. • Garlic (Allium sativum) may be beneficial; it may also help keep some ticks away and is a good tonic herb. • Coenzyme Q-10 is a fat-soluble antioxidant that may be helpful. Resveratrol is another antioxidant that can be used in LD cases. • Joint supplements are also important for any horse that has shown signs of joint-related discomfort. These include glucosamine-based supplements, hyaluronic acid, glycosaminoglycans, and green-lipped mussel products, as well as Western and Chinese herbal preparations.

IVC Spring 2021

Lyme Disease Multiplex Test. It measures different stages of the disease but still does not correlate closely with the clinical signs. The test can be negative, yet a horse can still respond to treatment and behave like he has LD. It’s possible that we are actually treating other Borrelia species, or other tick-borne diseases for which we cannot yet test.

CANINE LD VACCINES BEING USED FOR HORSES There are no LD vaccines approved for the horse, so canine vaccines are used. Vaccination can be stressful to the immune system and has led to relapses. A recent study showed that all current canine vaccines produced only short-term responses in horses. It is important to note that many, but not all, of these horses have negative responses to other vaccines, such as rabies, West Nile virus, and others, once they have had LD.

TREATMENT APPROACH — NO QUICK FIX There is no magic bullet for treating chronic LD cases. The best approach is a multisystemic one, using a combination of conventional, complementary, and alternative medicine. Successful treatment includes support for the immune system, not just during the immediate treatment period but over the long term. Due to the Lyme spirochete’s ability to “recur,” the immune system must be prepared to respond at a moment’s notice.

ANTIBIOTICS MAY BE NEEDED Antibiotics can be useful, especially in freshly diagnosed horses. Repeated rounds of antibiotics, or usage for two to three months or more, usually produces resistance but is detrimental. It is better to change to herbs and keep the spirochete guessing. The use of antibiotics suppresses the immune system in the gut, so the rest of the plan needs to support the horse’s immunity.

NATURAL TREATMENTS FOR SUPPORTING THE IMMUNE SYSTEM • The microbiome is the DNA of the microbes living in the gut. Probiotics are an absolute necessity and should continue for many months after antibiotic therapy is finished. The purpose of giving probiotics over the long term is to restore the health of the microbiome. Since soilbased microbes make up most of the natural population of the gut, supplements that use soil origin microbes will more effectively colonize the gut. • Vitamin C is well known for its action in the immune system and on collagen (4 g to 6 g twice a day). • Noni (Morinda citrifolia) is an herb that supports the immune system and has excellent anti-inflammatory

properties. In fruit leather form, it is relatively inexpensive and concentrated, while the juice can be quite expensive, more dilute, and contains a significant amount of sugar. • Omega-3 fatty acids are anti-inflammatory and support the immune system. They can be obtained through feeding whole flaxseed (inexpensive), naturally stabilized ground flax, hemp seeds, or chia seeds (a very stable Omega-3 source). Flax or hemp oils can be used, but they must be refrigerated during warm or hot weather. Three to six ounces twice a day is the usual dose for seeds; less volume is needed with the oils. Blue-green algae also contains significant amounts of Omega-3 fatty acids. • Medicinal mushrooms have excellent research showing their positive effects on the immune system, and are beneficial to various arthritic conditions. They are safe and can be used over the long term in a tincture or powder. I usually use a combination product unless I need to target a specific symptom.

PRIMARY ALTERNATIVE LD THERAPIES

Homeopathics should be prescribed constitutionally, based on the presenting signs. Several medicines fit many LD symptoms quite well. Ledum palustre is one of the major homeopathics for LD; its symptoms include effects from toxic puncture wounds as well as insect bites — a tick

bite is both. Rhododendron and Kalmia latifolia are also worth considering. Based on the constitution, other medicines have helped individual cases, including, but not limited to, Sulphur, Arsenicum album and Rhus toxicodendron.

Western herbal protocols have also been used successfully. In general, the same herbal formulas should not be used on a continuous basis, since the spirochete is capable of developing a tolerance to the herbs. A rotation of formulas every month is best.

Acupuncture is excellent for pain control, immune stimulation, and tonifying Qi or energy. There is no one point prescription since each horse is an individual. Some present as Qi deficient, some as Liver Blood or Yin deficient, and some as stagnation with pain in the muscles and joints.

Chinese herbal medicines are effective in both early and late stage LD cases depending on the pattern presented. Current thinking is again to change formulas on a regular basis while actively treating the infection. Once past the acute or early chronic stage, long-term tonifying formulas are often needed. Herbs should be prescribed by trained Chinese herbalists, since the choice of herbs is based on a correct Chinese diagnosis. Continued on page 44.

IVC Spring 2021

Continued from page 43.

CONSIDER EXERCISE AND STRESS LEVELS Exercise at the level the horse is comfortable with is an important part of recovery. It is good for the immune system and mentally helpful for the horse. There is no benefit to pushing the horse beyond what is comfortable, so if he is having a bad day, a short walk will suffice. Stress is an important factor in recovery from LD. It is beneficial to maintain horses under stress on adaptogenic, stress-relieving herbs such as Siberian ginseng root (Eleutherococcus senticosus) once they have recovered and returned to competition. It is also important to observe the amount of rest horses get at a barn. It has been shown that at many busy barns, horses actually get very little rest and sleep. This adds to stress, which suppresses the immune system.

PREVENTING LYME DISEASE Prevention is difficult if you live in a LD endemic area. Topical antiparasitics are toxic to the horse and the environment (if they are washed off in the rain and get into waterways). In some cases, it is easier to support the horse’s system to deal with the drugs than to treat chronic LD. In other cases, it is beneficial to use a more natural approach. For example, Guinea hens are effective at removing ticks from the environment, though they are noisy and may not fit in with the farm environment. Keeping grass mowed in the pasture is also helpful. Topical essential oils and various insect repellant sprays can be useful but need to be applied frequently. Japanese knotweed root appears to be helpful in endemic areas but cannot be said to guarantee protection. A new topical spray is available that prevents ticks from adhering to the hair (Ticks-Off ®). This is an exciting addition to Lyme prevention protocols. It is non-toxic and therefore safe to add to a prevention program.

CONCLUSION The treatment of LD in horses is complex and requires a willingness to keep reevaluating progress and make changes based on current symptoms. To prevent relapses and maintain optimal health, stress needs to be managed, the immune system needs support, and attention needs to be paid to how the horse feels. Tick and insect control is always a challenge, but must be an important part of managing the disease. Most horses can be returned to full performance, even with chronic LD, but many will require ongoing maintenance.

IVC Spring 2021

ADVERTORIAL

Black soldier fly-based dog food BY BRAD EWANKIW, B.SC. AGRICULTURE

— a novel protein that’s both nutritious and sustainable Conducted in 2020 in the United States, the study indicated impressive digestibility rates of 85.4% and 93.7% for the BSF protein and oil, respectively, for dry extruded dog food containing 20% EnterraProtein and 6.8% EnterraOil.

Animal-based protein isn’t the only way to give dogs the nutrition they need. Pet food manufacturers are starting to include new ingredients that are not only effective sources of easily-digested and immune-supportive protein, but that also meet the market demand for sustainable, natural food. A novel ingredient that is generating interest in the pet food industry is protein made from black soldier fly (BSF) larvae.

In terms of palatability, multiple studies in recent years have also shown that dogs and cats equally prefer foods that include BSF ingredients, especially once they become used to the smell and flavor profile of this novel ingredient.

Insects are a natural dietary component for many wild animals. Even wolves and wild cats will turn to insects when sources of larger prey are scarce. According to an article published by the Cambridge University Press, “Other types of animals consumed [by wolves] were birds, insects, intertidal organisms and fish.”1 While BSF larvae are not on the usual list for these close cousins of domesticated dogs and cats, they do provide a high quality source of protein and are rich in beneficial nutrients.

This is a new ingredient option to keep an eye out for this year as the U.S. Food and Drug Administration has completed its utility and safety review for the use of BSF meal in adult dog food. In addition, the Ingredients Definition Committee (IDC) of the Association of American Feed Control Officials (AAFCO) has voted to propose to the Board of Directors a new tentative ingredient* that includes the use of whole dried black soldier fly larvae and black soldier fly larvae meal in adult dog food. This proposal will go to the AAFCO Board of Directors in April before being passed on for voting by the full AAFCO Membership in August.

BSF larvae are dried, heat treated, and processed into a granular meal with 50% to 54% crude protein, and an oil product, that can both then be added to a pet food recipe alongside other ingredients. • T he powder created from BSF larvae is filled with essential amino acids, digestible lipids and antimicrobial components. As noted in the table, black soldier fly has a comparable level of the ten essential amino acids that dogs need.

*New Tentative Definitions remain in a tentative status for one year. If neither the IDC nor the FDA receives objections during this interim period, the IDC will recommend that the tentative definition be moved to official status. During the tentative status, states are unlikely to object to the use of the ingredient in the finished product as the FDA and IDC have both signed off on the product being safe and efficacious.

• BSF oil is not only rich in lauric acid, but also has significant levels of unsaturated fats, with a profile of 21% monounsaturated and 19% polyunsaturated.

As the product line manager for feed ingredients at Enterra, Brad Ewankiw is responsible for all aspects of product management for the current portfolio of black soldier fly larvae-based products and ingredients. As well, he manages the product development process, focusing on new products that will provide value in the pet food and feed markets.

Enterra, a North American ingredient manufacturing company that focuses on insect-based feed, recently funded and completed a study on the digestibility and health benefits in adult dogs of its BSF meal and oil products (EnterraProtein™ and EnterraOil™ ), with some notable results. Essential amino acid (mg/g protein)

Bosch, G et al. Dietary nutrient profiles of wild wolves: insights for optimal dog nutrition? British Journal of Nutrition. 2014;113(S1).

Adult Dog Maintenance Minimum (AAFCO)*

Beef**

Pork**

Chicken**

Soybean**

Cereal Grains**

Brown Rice**

Black Soldier Fly Larvae***

Arginine

57 65

Lysine

Histidine

Isoleucine

Leucine

Valine

Methionine + Cysteine

Phenylalanine + Tyrosine

100

112

Threonine

Tryptophan

261

516

531

500

588

445

501

544

Total essential amino acids

* The Association of American Feed Control Officials guidelines

** nutritiondata.self.com

*** Evaluation of Black Soldier Fly (Hermetia illucens) Larvae and Pre-Pupae Raised on Household Organic Waste, as Potential Ingredients for Poultry Feed, March 2019

Incorporating

whole food nutrition into your veterinary practice BY OSCAR CHAVEZ, BVETMED, MRCVS, MBA

Published research supports the health benefits of human-grade, whole food nutrition for dogs and cats.

Minimally processed pet foods made with human-edible produce, USDA inspected and approved meats, and cooked in a kitchen, have been available for over a decade. Yet, some veterinarians are still not entirely comfortable with the concept. In this article, we review both past and recently published research on human-grade, whole food nutrition, and dive into the benefits of embracing it as a foundation of health in your practice.

REAL FOOD IS HEALTHIER FOR US; WHY WOULD IT BE ANY DIFFERENT FOR PETS? If you ask almost any human health practitioner today, or simply refer to public health officials, recommendations surrounding human nutrition are usually pretty clear: limit consumption of ultraprocessed foods (UPFs), especially meats, and eat real whole foods: minimally processed (or simply cooked) vegetables, meats, whole grains, and fruits with all their original natural color and integrity.2 Most recently, several reviews of human nutrition research have highlighted the link between UPFs and chronic human disease, including all-cause mortality, cardiovascular diseases, renal disease, metabolic syndrome, overweight and obesity, depression, irritable bowel syndrome, cancer, and asthma. 3,4,5

IVC Spring 2021

Still, not all vets are convinced that real food impacts pet health. A recent article challenged any parallel made between ultraprocessed human foods and ultra-processed pet food, saying it is not a fair comparison because human ultra-processed foods are “junk” food and snacks, and pet food is designed to be complete and balanced nutrition.6 Recent research looking into the mechanism of why ultra-processed foods may be harmful suggests this analysis may be too rudimentary. In 2018 and 2019, a research team in the Netherlands published a series of papers in the journals Clinical Nutrition and the American Journal of Clinical Nutrition based on data from the CODAM study (Cohort on Diabetes and Atherosclerosis Maastricht) in people. Their work focused on the accumulation of advanced glycation end products (AGEs) from diet. AGEs are Maillard reaction products (between proteins, fats, and sugars) that can occur naturally, but are formed at exponential levels during high temperature processing as a function of time. As such, most processed foods are rich in AGEs.7,8 These AGEs are then consumed, transported in plasma, and accumulate in tissues including the blood, heart, kidney, and liver. Researchers believe this may be

the mechanism behind the well-documented correlation of UPFs and disease in humans. In June 2020, an abstract presented at the 20th annual American Academy of Veterinary Nutrition symposium, “Influence of Dietary Advanced Glycation End-products on Plasma Advanced Glycation End-Products in Dogs”, confirmed that dry pet food contained the highest concentration of the specific AGEs carboxymethyllysine (CML) and carboxyethyllysine (CEL) when compared to levels found in canned pet food, dehydrated pet food, and raw pet food. These are the same AGEs tracked in the CODAM study on people. The research team from the University of Georgia was also able to show that AGE plasma concentrations in dogs increased with consumption of these foods.9 Additional work in this area is currently being investigated.

IS THERE OTHER RESEARCH THAT SUGGESTS REAL FOOD MAY BE HEALTHIER THAN KIBBLE? According to some vets and nutritionists, no evidence exists that fresh whole foods are healthier for pets than processed commercial kibble. In fact, Tufts’ Clinical Nutrition Service outrightly warns against feeding real food,10 and challenges the notion that human-grade is any better.11 An article published in JAVMA’s “Timely Topics in Nutrition” as early as 2013 gave many veterinarians anxiety about anything that comes from a home-cooked recipe.12 However, there is evidence of the potential beneficial effects of fresh whole foods, specifically in dogs, dating back as early as 2005. A study in Scottish Terriers showed that dogs who ate fresh fruits and veggies at least three times a week had a reduced risk of bladder cancer.13 Another study that year showed that aged Beagles fed antioxidant-fortified diets experienced better cognition scores.14 In 2014, the first abstract published on complete and balanced whole food diets in the Journal of Animal Physiology and Animal Nutrition showed that some markers of health improved in the bloodwork of dogs fed JustFoodForDogs versus kibble.15 In 2019, the first study on human-grade dog food (also JustFoodForDogs) concluded that it’s highly digestible.16

PRACTICAL APPLICATIONS When switching a patient to a fresh diet, a gradual and slow transition is recommended, especially if the pet is moving from an extruded diet, since a period of detoxification can occur. Most transition just fine, although rarely, a short course of metronidazole and/or probiotics can help ease any difficulty. Once transitioned, pets being fed real food IVC Spring 2021

New study shows human-grade foods mean

less fecal waste

In February 2021, a study published in the Journal of Animal Science titled “Nutrient digestibility and fecal characteristics, microbiota, and metabolites in dogs fed human-grade foods” found that dogs eating JustFoodForDogs whole food human grade (HG) diets produced 2.0 to 2.9 times (up to 66%) less feces than dogs eating Blue Buffalo kibble. When compared to a Freshpet variety, the results were still substantial: 1.5 to 1.7 times less fecal volume (up to 41%).1 This research supports mounting evidence of the potential benefits of feeding fresh whole food diets. It was led by Dr. Kelly Swanson, PhD, the Kraft Heinz Company Endowed Professor in Human Nutrition in the Department of Animal Sciences and the Division of Nutritional Sciences at the University of Illinois. Dr. Swanson’s team fed beagles four commercially available diets: Blue Buffalo Chicken and Brown Rice Recipe (extruded dry kibble); Freshpet Roasted Meals Tender Chicken Recipe (fresh); JustFoodForDogs Beef & Russet Potato Recipe (HG beef); and JustFoodForDogs Chicken & White Rice Recipe (HG chicken). Each diet was fed for 28 days, with a six-day diet transition phase and 16 days of consuming 100% of the diet. Feces were collected for five days and blood was collected on a single day. The outcomes measured were the effects of the HG food on apparent total tract digestibility, fecal characteristics and volume, metabolites, microbiota, serum metabolites, and hematology. In short, the researchers found that not all calories and nutrients are created equal, and more waste going in means more waste coming out. Where energy and nutrients are sourced and how they are processed affects their integrity and digestibility. The researchers attributed the observed differences to multiple factors, including the inherent nutrient and energy digestibility of the HG diets versus the other diets, processing methods used to prepare the food, ingredient profile, and dietary fiber. Dr. Swanson’s team also noted marked differences in gut microbiota based on the diets fed.

IVC Spring 2021

seem to do better with variety overall (with other whole foods) than with a variety of processed foods. When evaluating fresh food companies, look for those who have completed feeding trials, employ full-time veterinarians, and are committed to funding research in these types of diets. After a decade of working with these diets, and based on the collective experience of thousands of veterinarians, this author advocates that incorporating the highest available quality nutrition is the foundation for health and wellness. Most pet parents appreciate this approach. Veterinarians report that increasing numbers of clients are demanding diets superior to typical processed pet food. Many veterinarians have completely transformed their standard of practice using a “nutrition first” focus, leading with fresh whole foods as their first and best recommendation. As Dr. Julie Stegeman DVM, DACVIM, puts it, “Every patient can benefit from a diet upgrade.” The best way for veterinarians to familiarize themselves with fresh whole foods is to adopt it for their own pets.

Disclosure: Dr. Chavez is the Chief Medical Officer for JustFoodForDogs. Founded in 2010, JustFoodForDogs is the first company to offer commercially-prepared whole food diets and has grown to become the number one vet-recommended fresh whole food brand, based on a 2019 national independent survey of 16,000 veterinarians.17 The JustFoodForDogs product line consists of six daily diets for healthy dogs, one adult feline recipe, and eight prescription recipes that can be used by vets to manage common conditions such as renal disease, liver disease, GI disease, dermatological conditions, PLE, lymphangiectasia, and many others. A custom formulation service is available for more complex cases, led by staff nutritionist Dr. Dan Su, DVM, MS. Full veterinary resources are available at JustFoodForDogs.com. References available at IVCJournal.com

Microbiome Restorative Therapy

(MBRT) for pancreatitis

and other GI issues For patients with GI problems, MBRT therapy is more beneficial than Fecal Microbiota Transplantation.

Since the gut has over 500 species and 1,000 subspecies of microbes, it is crucial that we try to balance that relationship when animals have a gastrointestinal illness. We have had dozens of cases of pancreatitis at my clinic, Main Street Animal Services of Hopkinton (MASH), and have been able to turn these patients around within a day of introducing medical ozone and Microbiome Restorative Therapy (MBRT). We have treated animals with severe hemorrhagic gastroenteritis with MBRT and have seen them produce normal stools the following day. Within the feces that we are transferring, there are millions of bacteria, mycoplasma, yeast, and bacteriophages that are needed for an animal to thrive and be healthy. By introducing a healthy microbiome into an animal suffering with severe GI issues, we can transfer DNA, RNA, and communication skills of the microbes to the rest of the animal’s body. We know that the vagus nerve communicates with the gut-brain axis, meaning the brain can retrieve nutrients it needs from metabolism of the microbiome. Not only is the body healthier, but the brain is as well.

MBRT VS. FMT MBRT does not just involve giving a fecal transplant — it is a supportive restorative combination of nutraceuticals, medical ozone, and quality donor material. That is why we need MBRT as opposed to just a Fecal Microbiota Transplantation (FMT). MBRT is more beneficial than FMT for the following reasons:

By giving a combination of colostrum, probiotics, digestive enzymes, Omega-3 and Omega-6 fatty acids, dimethylglycine, phytonutrients and vitamins, fresh raw food that can include tripe or an intestinal glandular, and Ion Gut, we can start building a stronger terrain. A healthier gut

BY MARGO ROMAN, DVM, CVA, COT, CPT

terrain makes it easier for the new microbes to find a place to repopulate.

The success of MBRT is enhanced by the use of medical ozone. The use of rectal medical ozone as a gas insufflation at about 40 to 50 µg per milliliter, placed through a catheter and reaching near the transverse colon, helps reduce the biofilm that hinders the transplant. Medical ozone also stimulates the stem cells in the crypts of the colon and activates the mitochondria. Additionally, it is picked up by the caudal rectal vein and goes through the portal system, helping the liver as well as the pancreas.

DONORS: AN IMPORTANT COMPONENT The donor is crucial to success; finding a vibrant, healthy, well-protected donor can make a real difference. We are proud of the donor quality at MASH. Our dogs come from five generations (27 years), and have been naturally reared, much loved, and holistically cared for. They have lived in a “green” home and yard, have never had antibiotics, NSAIDs, or topical chemicals for parasites. Their food is homemade, organic, raw, and fresh. The fifth generation eats a predominantly plantbased diet and is raised with sustainability and compassion. When an organ is inflamed, my suspicion is that the normal symbiotic balance of the millions of microbes in the gut has been disturbed. MBRT therapy can help restore this balance and return the animal to a state of better health. Dr. Margo Roman graduated from the Veterinary College at Tuskegee Institute of Alabama. She interned at Angell Memorial and was on the faculty of Tufts University, teaching anatomy, physiology and acupuncture. She consulted as veterinarian in an IACUC for Creature Biomolecule in Hopkinton, Massachusetts, studying osteogenic proteins. She created the Dr. DoMore documentary preview and is a national and international speaker on integrative topics. Dr. Roman’s integrative practice, Main Street Animal Services of Hopkinton (MASH), offers functional nutrition, Microbiome Restorative Therapy, homeopathy, medical ozone, ultraviolet blood therapy, acupuncture, herbs, conventional medicine and more (mashvet.com). IVC Spring 2021

Pharmacy vs. Farmacy We have reached a pivotal period in the history of our planet. During this time, we are clearly failing to provide a platform of “health” for our pets and veterinary patients (and ourselves) with our current lifestyle choices and agricultural practices. In order to create a paradigm shift, we need to understand how and why we got to this point. Only then can we address the question of “what to do” to improve patient nutrition and health.

WHAT ARE ESSENTIAL NUTRIENTS? First of all, let’s look more closely at what nutrients are and why our bodies need them in order to thrive. A nutrient is a substance in food that provides structural/ functional components or energy to the body. An essential nutrient is one the body cannot manufacture in adequate amounts; it must be consumed in the diet. Essential nutrients act as cofactors in many metabolic pathways, and include vitamins, minerals, fatty acids, and amino acids (humans have nine essential amino acids; dogs have ten; cats have 11). Essential vitamins that are often deficient in animal patients include A, D, E, K, B1 (thiamin), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folate), and B12 (cyanocobalamin). Choline, a vitamin-like factor, is needed as well. Vitamins A, D, E and K are fat-soluble and stored in the body’s fatty tissue. The other vitamins are water-soluble;

IVC Spring 2021

BY MARLENE SIEGEL, DVM

How nutrient deficiency, toxicity, and lifestyle are making veterinary patients more dependent on the pharmacy medical model.

any excess is excreted in the urine (hence they need to be replenished in the diet) with the exception of vitamin B12, which can be stored in the liver for years. Macro-minerals that may be deficient in animal patients include calcium, phosphorus, magnesium, sodium, potassium, chloride, and sulphur. Micro-minerals that can be deficient include iron, copper, zinc, manganese, selenium, iodine, molybdenum, cobalt, fluorine, chromium, and boron.

TOP 10 CONTRIBUTORS TO “DIS-EASE” PROBLEM #1: Nutrient depletion in soil and from farming practices

Many of today’s health challenges are in part due to nutrient deficiencies. Non-sustainable commercial monoculture farming practices have resulted in foods grown on nutrient depleted soils.1 The result is food deficient in essential nutrients. It is estimated that there has been a 70% loss of nutrients in the soil since 1965.2 Additionally, animal farming practices contribute to vitamin D deficiency. Herbivores synthesize vitamin D from sunlight. Carnivores (dogs and cats) get their vitamin D from the protein sources in their diet (the animals they are eating). When herbivores are raised in conditions where they are indoors, they are vitamin D deficient, which leads to a deficiency in animals consuming their meat.

PROBLEM #2: Deficiencies in essential amino acids Dogs require valine, leucine, isoleucine, arginine, histidine, lysine, methionine, phenylalanine, tryptophan, and threonine. Cats need all these plus taurine. Taurine and arginine are naturally found in animal proteins, so feeding a meat and organ meat based diet provides adequate quantities to cats. 3 Proper digestion and absorption of a species-appropriate protein diet would provide these essential amino acids; however, many animals have poor digestion and absorption, leading to deficiencies. We have all heard that excess protein is bad for cats and can contribute to kidney failure. In actuality, protein is a critically important nutrient, comprising half of every cell’s membrane. More important than the volume of protein in a diet is the biological value of the protein. High biological value (HBV) proteins are those that are readily absorbed and

utilized efficiently by the body. HBV proteins come from meats and contain the essential amino acids. The only way protein can pass through the kidneys into the urine, contributing to renal damage, is if there is excessive sugar in the diet. The sugar undergoes glycosylation (it surrounds and becomes chemically attached to the protein), and this damaging structure is excreted in the urine. The damage therefore comes from the carbohydrates, not the protein. Interestingly, almost all commercial processed cat and dog foods contain between 40% and 60% sugar. The prevalence of chronic kidney disease (CKD) has been estimated to be 0.5% to 1% in dogs and 1% to 3% in cats, but it increases with age, especially in cats, with reported prevalence of 80% in the geriatric cat population.4

PROBLEM #3: Using the wrong essential fatty acids Polyunsaturated fats, parent Omega-6 (linoleic acid) and parent Omega-3 (alpha-linolenic acid), also called parent essential oils (PEOs), are the only essential fats the body can’t make. All other fatty acids are derivatives of these, and the body can make them in the quantity needed. Muscle and organ meats contain ample amounts of the required long-chain fatty acids. Cats do not have the delta 6 desaturase enzyme needed to convert linoleic acid (Omega-6) or alpha linolenic acid (Omega-3) to their metabolites gamma-linolenic acid and stearidonic acid respectively. The importance of feeding grass-fed/grass-finished meat to our cats and dogs cannot be over emphasized. Aside from the reduced levels of pesticides and GMOs, grass-fed animals contain plenty of parent Omega-3 oils. 5 These PEOs are fundamental in that they constitute onefourth to one-third the entire lipid (fat) portion of all 100 trillion cell membranes — plus all cellular mitochondria.6

PROBLEM #4: Toxic and “dead” water Water is the second most critical nutrient (oxygen being the first). But all water is not equal in today's world. Since 1942, there have been over 85,000 synthetic toxins developed and released into the water supply. Many of these toxins are carcinogenic. The ideal water to drink, cook with, or give to pets should be highly filtered through a system capable of removing heavy metals and glyphosate; structured (denser and more organized, allowing faster absorption and more bio-availability); and have the proper minerals and living “energy”. Scientist Dr Gerald Pollack revolutionized our understanding of water when he discovered the fourth phase of water he IVC Spring 2021

PROTEIN FACTS

➊ ➋

ver half the body is composed of muscle, which O means at least half the body is protein-based.

➌ ➍ ➎

Hemoglobin is protein-based.

➏ ➐ ➑ ➒ ➓

any biochemical processes require protein-based M enzymes and hormones. Half of all the 100 trillion cells contain a membrane that is 50% protein.

Vitamins without protein are insufficient to repair damaged tissue. alcium is transported via protein. Along with the C protein, the calcium is actually going into the cell — not being taken away! lack of protein is one of the significant causes A of osteoporosis. he bone matrix itself is composed of proteinT based collagen and parent essential oils (PEOs). roteins are required to keep blood pH from P becoming too acidic. roteins are important as buffers inside the P cell (intracellularly). roteins are important in producing enzymes, P hormones, and antibodies.

calls the Exclusion Zone or EZ water. In addition to the gas, liquid, and solid phases of water, there is a gel phase that surrounds all the organelles and cells in the body. The body naturally makes EZ water. Exposure to toxins and electromagnetic pollution (EMFs) has been demonstrated to collapse the Exclusion Zone. As it collapses, the cells become sticky (this can be seen under the microscope as rouleaux) and are unable to perform their metabolic functions adequately. A healthy diet and lifestyle supports the expansion of EZ water, allowing cells to perform their metabolic functions more efficiently.7

organisms; it was never patented as a weed killer. However, 300 million pounds are poured on US soil every year; 4.5 billion pounds are used annually worldwide. A study concluded in 2007 showed glyphosate was found in 75% of rain and air samples in much of the US; today, that number may be significantly higher. Glyphosate is significantly impacting pets. Studies show significantly more glyphosate in pet food than in human food.8 Research has also found that dogs have urine glyphosate levels that are 32 times higher (16 ppb, parts per billion) than in humans (0.5 ppb).9,10 In another study, dogs that ate raw food had virtually no detectable levels of glyphosate; those that ate canned food had more, and those that ate dry kibble had the highest levels. Glyphosate is found in urine, blood, and breast milk of feed animals and humans. The amino acids methionine and glycine are also adversely impacted by glyphosate. This toxin can substitute for glycine during protein synthesis, resulting in abnormal protein folding.11 Other impacts include mineral balance disruption gut imbalances. Glycine substitution leads to mitochondrial stress and oxidative damage. Cytochrome P450 (CYP) enzymes are a particular class of enzymes that are essential for the detoxification of drugs and environmental chemicals. Glyphosate’s inhibition of these enzymes is an overlooked component of its toxicity. CYP enzymes play crucial roles in biology, one of which is to detoxify xenobiotics. Glyphosate disrupts the activities of multiple CYP enzymes. Effects of compromised CYP enzymes include the impairment of: • Cholesterol regulation and steroid hormone synthesis • Cell membrane synthesis • Normal cell metabolic function • Receptor binding and nuclear penetration • Vitamin D3 production

PROBLEM #5: Increased pesticides and other toxins Monoculture farming tends to use more pesticides and upsets the natural balance of soils.1 Though many toxins can affect nutrients, I will focus on glyphosate. This chemical is the active ingredient in RoundUp®, but there are many other toxins in the product as well. Glyphosate is both directly and indirectly responsible for a wide range of health issues, many of which are severe and degenerative. It was patented as an antibiotic, antifungal and antiparasitic against single cell

IVC Spring 2021

• Detoxification of xenobiotics • Bile synthesis, flow, and fat metabolism. Of the ten essential amino acids dogs need, three are made by the shikimate pathway. Glyphosate is known to interfere with this pathway, which exists only in plants, fungi, algae, some protozoans, archaea, and bacteria.12 These organisms use the shikimate pathway for making the essential aromatic amino acids, phenylalanine, tyrosine, and tryptophan.13 Tryptophan depletion also results in decreased serotonin

and melatonin production. It is not surprising that sleep disorders and mental problems in humans have risen exponentially in the past 20 years (since the introduction of glyphosate in agriculture), and we are seeing a dramatic rise of personality disorders in animals. Other biologically active molecules, including melatonin, serotonin, dopamine, epinephrine, thyroid hormone, coenzyme Q10, folate, vitamin K, and vitamin E, depend on the shikimate pathway metabolites as precursors for many vital functions. Though dogs and cats (as well as humans) don’t have the shikimate pathway, it is clear we rely on the organisms who do to provide many essential products and functions. Glyphosate enhances the damaging effects of other foodborne chemical residues and environmental toxins.14 It is known to drive heavy metals deeper into the brain and other nerve tissue, and interferes with detoxification pathways. Glyphosate isn’t just on the outside of plants; it is absorbed into the plants. Glyphosate contamination inside plants cannot be removed by washing, and it isn’t broken down or made less destructive by cooking or baking. Degradation products of glyphosate are just as harmful. Aminomethylphosphonic acid (AMPA) is a weak organic acid with a phosphonic acid group. It is one of the primary degradation products of glyphosate. AMPA has toxicity which is comparable to that of glyphosate and is therefore considered to be of similar toxicological concern as glyphosate itself.

PROBLEM #6: Damage to the gut microbiome There are three critical components to supporting a healthy gut microbiome: 1. I mproving the diversity of organisms (studies in humans have shown there should be 20,000 to 30,000 different bacterial species in the gut). 2. M aintaining keystone strains, bacteria that are critical for maintaining function and balance in the general microbial population. 3. Repairing intestinal permeability, “leaky gut”, which is the underpinning of all chronic disease. Feedlot animals and contained fowl are fed corn diets. Currently, up to 92% of U.S. corn is genetically engineered IVC Spring 2021

(GE), as are 94% of soybeans and 94% of cotton (cottonseed oil is often used in food products.15 Consuming animals fed these diets results in the ingestion of GMOs and resulting damage to the gut lining and microbiome. When glyphosate is consumed, the balance of the gut microbiome is disturbed. The gut microbiota’s ability to synthesize vitamins, detoxify xenobiotics (foreign substances or chemicals which the body does not recognize), participate in immune system balancing, and maintain gastrointestinal tract health is disrupted.

IMPLEMENTATION STRATEGIES

➊

top adding toxins (through food, water, S and environmental exposure). Read labels and know ingredients.

➋

Test the pet for toxins and nutrient deficiencies. •Q uicksilver Scientific offers affordable testing for eight heavy metals and eight essential nutrients at www.quicksilverscientific.com (use coupon code QSVETS2021).18 •V DI Laboratory (vdilab.com) provides veterinary blood diagnostics in the areas of cancer, inflammation, vitamin D, B12, magnesium, folate, osteoarthritis, sepsis, and wellness using a proprietary dried serum transport device.19

➌

➍

et educated on alternative care options: G www.drmarlenesiegel.com has resources for those interested in a deeper dive. Download a free PDF at www.holistichealingvet.com that covers the author’s five steps to holistic healing for pets (and their parents). This resource covers steps to stop polluting the body, to provide essential nutrients, detoxify the organs of elimination, and support the mitochondria. Include daily doses of smiles, joy and gratitude.

PROBLEM #7: Lack of hormetic stressors Hormetic stressors are intermittent stressors that humans and animals have evolved with, aiding in their ability to adapt and survive.16 Though not directly considered a nutrient, hormesis is critically important for producing internal antioxidants and triggering important metabolic functions. Hormetic stressors include fasting, high intensity exercise, and exposure to extreme temperatures. The hormetic event causes the release of cellular signaling pathways and molecular mechanisms that mediate hormetic responses, which typically involve enzymes such as kinases and deacetylases and transcription factors such as Nrf-2 and NF-kappaB. As a result, cells increase their production of cytoprotective and restorative proteins including growth factors, phase 2 and antioxidant enzymes like glutathione, and protein chaperones. Fasting activates autophagy, a process in which the body utilizes the dead and dying cells for energy and repair.

PROBLEM #8: Lack of adequate movement Movement is an essential factor for good health. Our ancestors spent most of the daylight hours outside, engaging in heavy manual labor. High intensity activities not only aided lymphatic movement, but acted as hormetic stressors. Likewise, our pets’ ancestors lived outside and had to work hard to catch their food and fight off other predators. Today, we and our companion animals are faced with a sedentary lifestyle and too little time outside, with no direct work required to access food.

PROBLEM #9: Integrative therapies often missing in medical/veterinary school curricula Before 1910, the human medical system included many therapies we consider complementary today. Practitioners viewed the body as a “whole” and focused on the root cause of disease. The landmark Flexner Report of 1910, commissioned by the Carnegie foundation, transformed the nature and process of medical education in America, resulting in the elimination of proprietary schools and the establishment of the biomedical model as the gold standard of medical training.17 American medicine profited immeasurably from the scientific advances this system allowed, particularly the pharmaceutical (pharmacy) industry, but the hyper-rational system of German science created an imbalance in the art and science of medicine. The Flexner Report resulted in the elimination of any school that didn’t follow the pharmaceutical-based medical

approach. Funding was predicated on following the mantra. Not graduating from an “accredited” institution meant no jobs, and within a short time, all alternative colleges were out of business.

PROBLEM #10: Persistent high sympathetic tone A high sympathetic tone is valuable when running from danger or fighting the enemy. However, staying in a state of high sympathetic tone is detrimental to the immune system and overall health. Parasympathetic tone is needed for the body to rest, digest and detoxify. Though being in a parasympathetic state is not a “nutrient”, there is definitely a deficiency of it in the world today, both in ourselves and the animals who share our home environments with us.

SOMETHING BETTER IS EMERGING Exciting changes are happening in the veterinary (and human) medical models. A resurgence of complementary and holistic medicine is occurring, and it is being driven by consumers! Veterinarians and their support staff are the most dedicated health providers in the world. No one wants to practice “broken care” where pets relapse, or worse, suffer from health conditions for which there is nothing else to offer. Integrative medicine offers an expanded “tool kit” and is the key to healthcare and true healing. The power to heal begins with knowledge, and succeeds when action is taken!

1 2

https://eos.com/blog/monoculture-farming/ https://drjaydavidson.com/glyphosate/ Shmalberg, J. The protein paradigm:assessing dietary protein in health and disease. Todaysveterinarypractice.com 2015;Nov/Dec: 69-75.

http://www.iris-kidney.com/education/risk_factors

https://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids

Peskin, BS, Rowen RJ. PEO Solution. Kindle Edition. 2015.

https://www.pollacklab.org

https://petsandgmos.com

https://hrilabs.org/animalstudy/ https://www.gmoscience.org/our_pets_at_risk_from_glyphosate/ Samsel A, Seneff S. Glyphosate pathways to modern diseases V: Amino acid analogue of glycine in diverse proteins. Journal of Biological Physics and Chemistry. 2016;16:9-46.

Herrmann KM, Weaver LM. The shikimate pathway. Annu Rev Plant Physiol Plant Mol Biol. 1999;50:473-503. Tzin V, Galili G. The Biosynthetic Pathways for Shikimate and Aromatic Amino Acids in Arabidopsis thaliana. Arabidopsis Book. 2010;8.

From the AHVMA The mindful leader elevating the veterinary profession through innovation, education and advocacy of integrative medicine.

The American Holistic Veterinary Medical Association is preparing to return to a physical conference this year, after going virtual in 2020 due to COVID-19. While the 2020 AHVMA Virtual Conference and Exhibition was a success, and provided over 600 attendees with educational development opportunities, we are ready to return to a physical event. The 2021 AHVMA Annual Conference and Exhibition will be held at the Peppermill Resort Spa Casino in Reno, Nevada, from October 2 to 5. The Conference Program Committee has put together a sensational line-up of speakers. Expect 80 hours of complementary and integrative sessions, hands-on labs, and special events! AHVMA will be applying for over 75 hours of AAVSB RACE approved CE. Dr. Doug Knueven will deliver the keynote address on “Holistic Renewal”, as well as introductory lectures on holistic veterinary medicine and the raw food revolution. Hands-on labs for “Manual Therapy” will be presented by Dr. Laurie McCauley; and for “TCVM Tui-Na” by Dr. Suzan Seelye. Dr. Allen Schoen will speak on “Harnessing Animals’ Healing Power” as well as on Ayurveda. There will be lectures on “Photobiomodulation” by Dr. Janet Gordon Palm and so much more! Check out the AHVMA website for a detailed schedule. With nine award-winning restaurants, an 82,000-square foot casino, boutique shopping, a 9,900-square foot fitness center, and two pools, there is sure to be something for everyone to enjoy at the Peppermill Reno! Sign up online today at https://www.ahvma.org/conference-registration/.

Samsel A, Seneff S. Glyphosate’s Suppression of Cytochrome P450 Enzymes and Amino Acid Biosynthesis by the Gut Microbiome: Pathways to Modern Diseases. Entropy. 2013; 15(4):1416-1463.

https://secretingredientsmovie.com

Mattson MP. Hormesis defined. Ageing Res Rev. 2008;7(1):1-7.

Duffy TP. The Flexner Report — 100 years later. Yale J Biol Med. 2011;84(3):269-276.

https://www.quicksilverscientific.com

https://vdilab.com

Submitted by Melissa Kellagher, AHVMA Director of Operations

IVC Spring 2021

From the NASC

Supporting pet vision—

a lifelong commitment that includes client education and antioxidant support BY TERRI MCCALLA, MS, DACVO AND CARMEN COLITZ, PHD, DACVO

In the veterinary clinic, dogs and cats are most often seen for eye problems when there is an acute injury or obvious clinical signs of a problem. Vision health probably isn’t first and foremost in a client’s mind. So it’s important to start a dialogue about lifelong vision support as early in the pet’s life as possible. Pet owners may not be aware that their dogs and cats can experience some of the same vision concerns as humans as they age. And because pets are so good at compensating for vision loss, clients may not notice early on that their pets’ vision is changing. The uncanny ability of dogs and cats to use their senses of hearing and smell to adapt to vision loss could very well trick their owners into thinking everything is fine, as most dogs and cats can get around fairly well until they have lost about 80% of the vision in both eyes. The good news is that many ocular conditions once considered hopeless are not necessarily so today. You can help put your clients on the path to supporting their pets’ vision health by: • A lerting them to any risks for ocular disease due to breed or age • Encouraging them to have their pets’ vision checked annually by a board-

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certified veterinary ophthalmologist if ocular disease is present • Explaining signs to watch for that indicate vision change •E ducating them about the benefits of antioxidants to help maintain cellular health of the eye, and protect the retina and lens against the damaging effects of oxidative stress.

ANTIOXIDANTS FOR OXIDATIVE STRESS

supplementation may help support already healthy cells while protecting pets from the effects of oxidative stress, which can lead to chronic inflammation and degenerative changes. Daily antioxidant supplements that include ingredients such as lutein, zeaxanthin, astaxanthin, grapeseed extract, and vitamins C and E may help protect the lens of the eye against a variety of oxidative stressors. Omega-3 fatty acids may complement these antioxidants in support of vision health.

Oxidative stress occurs when there is an imbalance of free radicals and antioxidants in the body. Free radicals are unstable molecules produced by the body during normal metabolic processes, and also by external factors such as dietary deficiencies, ongoing stress, or exposure to environmental toxins like pollution and pesticides. Free radicals are unstable “live wires” that can trigger a damaging chain reaction as they seek to stabilize themselves by stealing an electron from a healthy molecule.

Vision care and prevention that begins early in an animal’s life will offer the best outcome, so be sure to start the vision health conversation from day one. Keep in mind that for pets with already declining vision — especially older animals — a return to full vision is a lofty goal. Instead, focus on supportive care that will help slow vision loss and preserve remaining vision, to give these pets the best possible quality of life.

Antioxidants help keep free radicals in check by neutralizing or removing them through donation of an electron. The body produces antioxidants naturally; however, recommending antioxidant support through diet and

Terri McCalla, MS, DACVO, is a consulting veterinarian for Animal Necessity and the creator of Ocu-GLO™, co-founder of Animal HealthQuest LLC, and owner of Animal Eye Care LLC, a private referral ophthalmology practice in Bellingham, WA. Carmen Colitz, PhD, DACVO, is one of the world’s leading veterinary ophthalmologists, as well as a consulting veterinarian for Animal Necessity and co-founder of Animal HealthQuest LLC.

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innovative practice

BY CHRISTINA CHAMBREAU, DVM, CVH

Short for Behavior, Energy, Appetite, and Mood, BEAM represents the context of health for each patient. It shifts the client’s focus from current symptoms to a more comprehensive view of the pet’s quality of life.

Teaching clients to shine the light of

B EAM

Integrative veterinarians often encounter clients whose immediate goal is to quickly eliminate the current symptoms their pets are exhibiting. This is understandable with new clients, yet sometimes frustrating with those we thought had an understanding of the need to work deeply to balance the animal’s energy and restore whole and complete health, not just make symptoms disappear. We may not see these clients return to our practices until there is another acute problem, or a severe disease diagnosis such as cancer. Often, clients seek out integrative help when their animals don’t respond to conventional veterinary therapy. Clients focused solely on symptom resolution often call more frequently and need more education and reassurance. How can we increase the number of clients who come to us at the very beginning of an energy imbalance in their pets, or who schedule regular exams and energy tune-ups? There are many ways to develop this rewarding partnership between clients and our integrative practices. Educational videos, email blast reminders, blogs, and individualized “healthy pet check” reminders are all ways to emphasize quality of life indicators throughout an animal’s life, not just towards the end of it. One

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on their pets’ health

powerful tool involves teaching your clients to shine the light of BEAM on their pets. This method also helps your clients decide if an acute problem warrants an emergency visit.

BEAM REFLECTS PHYSIOLOGIC HOMEOSTASIS AND QUALITY OF LIFE Dr. Jeff Feinman, VMD, CVH of Holistic Actions for Animals Academy, created the BEAM acronym, which can easily be posted throughout the clinic, in clinic messaging, and in client discharge papers. He postulates that Behavior, Energy, Appetite, and Mood (BEAM) seem to be clinically sensitive, though not specific, reflections of physiologic homeostasis and quality of life1 (see sidebar at right). When clients and veterinarians evaluate animals with BEAM in mind, in addition to standard objective assessments, the likelihood of discovering potential problems earlier increases, allowing supportive therapies to be implemented before more serious pathologies arise. Likewise, using BEAM enhances recovery from illness and improves longevity. In my practice, clients valued having tools to not only discern the early warning signs of imbalances, but to also Continued on page 60.

BEAM in detail

BEHAVIOR could include emotional states (fears, anxiety, irritability, aggression, who they want to sit with); lifestyle changes (not using the litter box, avoiding a specific area of the yard, not wanting to walk on certain paths); sleep patterns (waking during the night, asking to go out to eliminate at different times, napping during the day); interpersonal activity (getting up to bark at noises, greet people or other animals, hiding and avoiding interactions).

ENERGY can be measured/

APPETITE could include any

noted by clients very easily as they can relate it to their own energy levels. The observable energy level probably reflects cellular energy. The obvious measure would be the length and level of activity — running, walking, performing, playing with toys. When the current state of health is very low, the energy may be measured by time spent awake, lifting head to interact, wagging tail, number of times batting at a toy, walking to the litter box, etc. Most newer clients have been trained to assume that aging decreases energy levels: “Oh, she is just old, so not as energetic.” Encourage clients to be specific to avoid this distortion, and educate them that healthy animals stay energetic as they age.

change — increased, decreased, at a different time of day or night, an aversion to normally relished foods, wanting hot or cold foods only, or craving unusual foods. Some clients become too concerned about temporary appetite changes, and will need initial coaching that even healthy animals can have some appetite variations.

MOOD is the most subjective part of BEAM, and may be combined with behavior changes. Clients do observe that their pets have become sad (maybe after lifestyle changes or deaths), withdrawn, or even angry, even though they cannot describe specific behaviors to illustrate their perceptions. IVC Spring 2021

Continued from page 58. evaluate how their pets were responding to therapies. When BEAM changed for the better, they felt confident about continuing treatment, and if it worsened, they were quick to reach out for help.

QUALITY OF LIFE IS MOST IMPORTANT TO CLIENTS The Farm Animal Welfare Council’s definition of “quality of life” applies to our companion animals as well: the ability to live a full life, free of physical, mental, and emotional restrictions, such as pain, senility, and fear.2 Why is the combination of BEAM factors an effective monitor of quality of life? BEAM assessments reflect physiologic homeostasis and can indicate organ issues even when laboratory test values are normal. Since mitochondria are the cellular energy providers, studies have related their dysfunction to lowered overall energy levels.3 When energy is low, behaviors, appetite and moods often change. In addition, reports show that these subjective measures predict response to treatment.4 Improving and conserving cellular and mitochondrial energy are important for general healing, especially for animals with cancer and end-stage diseases. Though unexplained, some human patients have spontaneous remissions. 5 As integrative practitioners, we also see this daily with our animal patients, and relate it to improving the balance of the energy pattern. Addressing BEAM, body conditioning, and symptoms commonly accepted as normal (hairballs, licking cement, pica, skin odors, etc.) rather than merely specific disease symptoms seems to increase these recoveries.

of life improved? Each day, in addition to recording how her stool is changing, be just as specific about her BEAM. Think about beaming a flashlight on her inner state of health.” • Other clients will need to be gently pushed in several visits to shift their focus. If you inquire into each of their pets’ BEAM symptoms during every visit, most clients will begin to keep their own notes at home. • Place a dollar value on tracking BEAM, such as: “You can save money on unnecessary office visits by evaluating BEAM. If the BEAM is good, especially if it is improving, then the worsening of his itching does not immediately necessitate an office visit or call. You can use some of the soothing skin treatments we discussed as long as the BEAM continues to be good.” • The most important point of using BEAM may take the longest to be appreciated in some clients. “You are building health from the inside and allowing for self-healing rather than forcing symptoms to resolve with suppressive or palliative treatments.” • Including a take-home paper with BEAM quantified at each visit gives clients a reminder of how important this tool can be for improving quality of life and longevity in their pets. Doing a Zoom class with your clients can both educate them and show how much you care. The Holistic Actions Academy founded by Dr. Feinman continually educates members about BEAM and other ways to stay the course with holistic approaches, including routine visits to maintain balance. Clients can visit www.HolisticActions.com for more information.

Most importantly, clients are with their pets every day, and when asked about BEAM changes they become much more interested in long term treatment to maintain vitality and balance. When an animal is very ill, as with cancer, evaluating BEAM daily can prompt the client to call you to possibly alter the therapies you are recommending. They can ask every person involved with the animal’s care to note changes. The biggest challenge is for clients to quantify these measures. Some can be a direct measure and others are more qualitative, on a scale of 0 to 10 (be sure to note if 10 is good or bad).

Many clients are stressed when they notice that their animals are ill, especially during these times of COVID safety measures. Teaching clients a strategy to lower their fears about any worrisome symptom or sign can be very empowering. When you start an appointment with a brief conversation about BEAM, you are connecting with your clients’ emotions about their pets, and demonstrating how much you value their input. You also are increasing the chances of true health in your patients, as well as happy, committed clients.

IMPLEMENTING BEAM WITH YOUR CLIENTS

Ways to encourage clients to begin using BEAM are as individual as the treatments for their pets. • For some clients, just a few statements can help. For example: “I know you are worried about Fifi’s diarrhea, which is only moderately improved. Even more important, though, is how she is feeling overall. Has her general quality

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Feinman J. Significance of Signs, Symptoms, mTOR, and Quality of Life. J Am Vet Med Assoc. 2019;56:15-19.

Manteca X, Mainau E, Temple D. What is animal welfare? The farm animal welfare fact sheet. Farm animal welfare education centre. https://tinyurl.com/An-Welfare. June 2012. Accessed July 4, 2019.

3 Myhill S, Booth NE, McLaren-Howard J. Chronic fatigue syndrome and mitochondrial dysfunction. Int J Clin Exp Med. 2009;2(1):1–16. 4 Staskin DR. Age-related physiologic and pathologic changes affecting lower urinary tract function. Clin Geriatr Med. 1986;2:701–710. 5 Kleef R, Jonas WB, Knogler W, Stenzinger W. Fever, cancer incidence and spontaneous remissions. Neuroimmunomodulation. 2001;9(2):55–64.

From the AVH

The Academy of Veterinary Homeopathy is comprised of veterinarians who share a common desire to restore true health to their patients through the use of homeopathic treatment. Members of the Academy are dedicated to understanding and preserving the principles of Classical Homeopathy.

NUTRITION AND HOMEOPATHY — HOW THEY WORK TOGETHER Good nutrition forms the foundation of good health. Homeopathy and nutrition form a powerful synergistic force to bring healthy balance to individuals. Classical homeopathic treatment helps nutritional therapy, while good nutrition assists classical homeopathy. Dr. Samuel Hahnemann, the founder of classical homeopathy, realized the importance of vitamins and minerals before these nutrients had names (late 1700s to early 1800s). He realized that proper nutrition was essential for restoring balance to the body (Aphorisms 76, 77, 78 in The Organon of Medicine, 6th ed.). Chronic disease interferes with the body’s ability to extract and use essential nutrients. Additionally, for many reasons, we often deal with animals affected by poor nutrition (e.g. rescue dogs, or those with obvious diet deficiencies). The diet may be insufficient in quantity, quality, or both. In practice, it is often tricky to sort out nutritional problems from chronic disease. My approach is to improve nutrition as much as possible, and also treat the total symptom picture with the most similar homeopathic remedy, while eliminating drugs and harmful chemicals. As we see balance returning, the body begins to use nutrients better, and will thrive without a lot of supplements. There will also be fewer aggravations from certain foods, or food allergies. The “balanced” animal can eat a variety of foods without much supplementation, and without symptoms. This is the goal of homeopathy. See the table at right for some key homeopathic medicines to consider for treating animals in which nutrition may be a prominent factor, along with some of the hallmark symptoms of each remedy. As a general rule, remedies can be given in low potency (6c or 30c) with good results in chronic disease treatment. Consult a professional veterinary homeopath for further guidance in complex cases. Visit www.AVH.org for a listing of veterinary homeopaths by state.

Submitted by Todd Cooney, DVM, CVH

Arsenicum album

Illness from food poisoning, garbage ingestion, etc. Restlessness, anxiety; vomiting and diarrhea, with very foul stool odor, and often bloody stool (e.g. parvo); craves frequent small sips of cold water.

Bryonia alba

May be irritable, painful; doesn’t want to be carried or picked up. Very dry mucous membranes. Painful when moving; doesn’t want to move. Very weak.

Calcarea carbonica

Very important nutritional remedy; animals with poor growth and development; stunted; “distorted” breeds; delayed dentition, retained baby teeth; tendency toward orthopedic problems, arthritis, etc.

China

Weak and very sensitive; easily upset. Anemic; bleeding tendency; emaciation; fluid swellings (ascites, dropsy); collapsed state — sinks into bedding or furniture due to weakness. Weak from fluid loss (vomiting and diarrhea).

Ferrum

Weak, anemic, pale. Flabby muscles; restless; bones soft.

Graphites

Skin is hard and lumpy; forms cracks which ooze sticky, greasy fluid; groans; overall condition is unhealthy, but doesn’t seem too thin.

Ignatia

Violent symptoms; twitching, jerking, foaming at mouth; facial jerking, “tics”; depressed and sad. History of someone leaving — moved, or death in family.

Ipecac

Nausea and vomiting from the smell of food; no thirst; bloody stool; tends to get diarrhea easily; seizures from indigestible food may occur.

Lachesis

Advanced illnesses with tissue breakdown, fever, sepsis and necrosis; bluish discoloration of tissues, especially limbs. Foul-smelling discharges; severe pain.

Natrum muriaticum

Weakness, especially in the morning; useful in Addison’s disease, diabetes; thin, poorly nourished, very thirsty; avoids heat, wants to be outside; dry skin and mouth; hair loss; weight loss despite increased appetite.

Nux vomica

Arguably the most useful remedy for poor nutrition and digestive issues of all sorts. Treats bad effects of drugs and chemicals, poor diet, overeating; prone to seizures; sneezing; vomiting; frequent urges to pass stool; irritable and oversensitive; tends to be grumpy when ill.

Phosphorus

Tends to vomit shortly after eating or drinking (15 to 20 minutes); foreign material in stomach (plastic, rubber, wood, etc.) — will help expel without surgery. Diarrhea with bright red blood; fear of storms, fireworks, loud noises; intense thirst for large amounts of water.

Pulsatilla

Thirstless, chilly; craves open air; timid and clingy when ill; symptoms change frequently; discharges from mucous membranes are yellowish green.

Sulphur

Hungry, yet very thin; slow, lazy; unkempt appearance; looks old; anus and mouth tend to be red and inflamed; blood-tinged discharges with bad odor; swollen belly, thin legs; liver problems.

Veratrum album

Collapse, extreme weakness; cold; excessive vomiting and diarrhea; craves cold water; spasms during diarrhea.

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PEER-REVIEWED

Deer velvet antler

applications in the veterinary setting BY JULIE BUZBY, DVM, CVA, CAC

Studies are demonstrating that deer velvet antler has a long, impressive, and rapidly-growing list of positive benefits.

Integrative veterinarians owe it to their clients to be educated on the uses of deer velvet antler in practice, both to address client questions and because of the potential benefits for their patients. In 2001, an independent research study to evaluate market opportunities for the Australian deer industry concluded that although “the pet markets in Europe, North America, and Australia for velvet antler products have received little attention, there is a slowly growing recognition of the market potential, particularly for velvet antler”.1 Now, 20 years later, the future is here.

DEER VELVET ANTLER DEFINED Deer velvet antler (DVA) has been used in Chinese medical formulations for over 2,000 years for its nourishing, tonic, and hemopoietic effects. The term “velvet antler” is perhaps misleading. It does not refer to the velvety furred

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skin covering the antlers during the growth season. The term “velvet" denotes the antler’s immature stage of growth. The entire structure of the antler — which, in the velvet phase, consists of a cartilaginous core covered by connective tissue and skin — is harvested for use. 2 If not harvested, the antler will go on to harden through rapid ossification and eventually be shed after breeding season. 3 This cycle of antler development that leads to shedding occurs annually.

ETHICAL CONCERNS Antler from two species — sika deer (Cervus nippon) and red deer (Cervus elaphus) — are used in Chinese, Japanese, and Korean pharmacopoeias.4,5 Ethical concerns are often voiced about antler harvesting. It’s important for veterinarians using and recommending supplements containing DVA to understand how it is harvested. DVA is soft vascularized and innervated tissue in the velvet stage.2 But administration of lidocaine, typically in the form of a ring block, has been shown to be a reliable and effective form of analgesia for the removal,6 which takes about 30 seconds, after which the deer resume normal activity.7 New Zealand and Australia have the strictest standards governing the harvest of DVA. The velvet antler industry in New Zealand is governed by the National Velvetting Standards Body (NVSB), which is a committee of veterinarians and deer farmer representatives whose mission is to implement recommendations and standards for the welfare of deer during the removal of their antlers.8 Handling of the deer for collection is supervised and monitored by a veterinarian trained and licensed by the NVSB.

THE ORIGINS OF DVA AS A SUPPLEMENT The pedigree of deer velvet antler for medicinal use has been researched extensively by Dr. Subhuti Dharmananda, Director of the Institute for Traditional Medicine. He concludes: “The story of deer antler can be traced back to the first Chinese Materia Medica, Shennong Bencao Jing (ca. 100 A.D.), where it is described briefly. There is also reference to earlier use of deer antler in an archeological find (a set of silk scrolls named Wushier Bingfang, from a tomb dated 168 B.C.).” He states that it then fell out of favor until China’s Ming Dynasty period in the mid-16th century. Since that time, it has been used by many cultures for its purported health benefits.4 In the ancient Chinese medical commentaries, DVA was referred to as Lurong and considered a strong Yang tonic.4 Ten Lectures on the Use of Medicinals from the Personal Experience of Jiao Shude provides these insights: Lurong tonifies kidney Yang,

T Lymphocyte

strengthens sinew and bone, boosts sinew and marrow, and nourishes the blood.4 The Advanced Textbook of Traditional Chinese Medicine and Pharmacology states that Lurong is indicated for chronic diseases marked by general lassitude and lack of spirit, lumbago, cold limbs, and polyuria with clear urine, among other things.4 Extrapolating this to veterinary medicine, DVA may be appropriate for everything from senescence-related lethargy to immune modulation, although, like other entries in the Compendium of materia medica, contraindications may exist from a Traditional Chinese Veterinary Medicine (TCVM) standpoint.

Lymphoid Stem Cell

thymus

Pluripotent Stem Cell

B Lymphocyte

While velvet antler contains fatty acids, glucosamine, and chondroitin sulfate, it is a relatively expensive ingredient in nutraceutical products, so these components are often supplemented through other ingredients. For this reason, velvet antler products on the market for pets typically feature this ingredient as part of a proprietary blend or in combination with other active ingredients. For example, the author prefers to use a combination product with green lipped mussel.

PRACTICAL, PROVEN BENEFITS OF DVA In 2013, a review of the literature and research on DVA from 1980 to 2012 was conducted for a paper in the Journal of Ethnopharmacology. The information was sourced from ancient Chinese herbal classics, pharmacopoeias, formularies, scientific journals, and books via hard copy and PubMed, Google Scholar, Web of Science, Science Direct, and CNKI (in Chinese). The authors concluded: “Both in vitro and in vivo pharmacological studies have demonstrated that deer antler base possess immunomodulatory, anti-cancer, anti-fatigue, anti-osteoporosis, antiinflammatory, analgesic, anti-bacterial, anti-viral, anti-stress, antioxidant, hypoglycemic, hematopoietic modulatory activities.…”13 In several studies on the human side, and in at least one study on dogs, velvet antler was determined to be of value for patients with osteoarthritis by providing both anti-inflammatory effects and the building blocks useful for the health and healing of joints, muscle, and

Plasma Cell

Erythrocyte Megakaryocyte (blood clotting)

Myeloid Stem Cell

Macrophage

Monocyte

THE UNIQUE PROPERTIES OF VELVET ANTLER Members of the family Cervidae are the only animals with antlers, and the only mammals who fully regenerate organized tissue in an annual cycle.9 Antler regeneration is a stem cell-based process.10 It is carried out by stem cells that normally develop the bony growth from the tip of the antler, and then from the cut part after antler removal.11 Velvet antlers grow at a rate of up to 2 cm a day, completing the whole cycle from cell differentiation to mature antler development in just 90 days.12 The unique compounds that make this dynamic process possible are part of what makes DVA a unique and valuable ingredient in human and veterinary nutraceuticals (see sidebar at right).

NK Lymphocyte

Granulocytes Stem cells leading to various blood lines. The basic marrow stem cell differentiates during early fetal development into two types of stem cells, the lymphoid (which produces lymphocytes) and the myeloid (which produces all the other blood cells). Platelets (thrombocytes) are not true blood cells, but are cytoplasmic fragments of the megakaryocytes. T-cells are lymphoid cells that differentiate via action of the thymus gland. All the cell lines except erythrocytes (red blood cells) and megakaryocytes are involved with immune responses. Thus, deer antler, when used to stimulate the stem cells in patients with bone marrow depression, may improve immune responses, as indicated by laboratory animal studies.

Figure 1 ( published in (4) and used with permission from that author; original source unknown).

APPLICATIONS FOR DVA IN THE VETERINARY SETTING • Joint pain and inflammation — e.g. hip dysplasia •C onnective tissue health and healing (tendons, ligaments) — e.g. to assist the body in healing ACL tears • Stimulation of the immune system • Cognitive support • Adrenal support (stress support) • Senescence support • Red blood cell production (e.g. with Ehrlichia) • Wound healing • Fracture repair • Cardiovascular health25

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CONSTITUENTS OF VELVET ANTLER • Four types of collagens (I, II, III, and X) • Hyaluronic acid • Glycosaminoglycan (GAGs) — chondroitin sulfate is the major glycosaminoglycan present in velvet antler14 • Glucosamine • Prostaglandins A, B, E, and F

•A ntler polypeptide14,15

Much of the research on antler velvet in recent years focuses on the unique function of antler polypeptides. Wang et al’s research concluded that antler polypeptide promoted the proliferation and differentiation of bone marrow-derived mesenchymal stem cells, suggesting that antler polypeptides may be useful for promoting bone growth and regeneration.15 Zhang et al’s research suggested that pilose antler polypeptide may promote the proliferation of chondrocytes and osteoblasts.16 And Xie et al found in their study that velvet antler polypeptide could partially reverse lumbar disc osteophyte formation in mice, and improve surface area coverage of facet joint cartilage. Their research also demonstrated that velvet antler polypeptide could partially modulate extracellular matrix synthesis by inhibiting cartilage-degrading enzymes. This is relevant because articular cartilage contains extracellular matrix secreted by chondrocytes.12 The traditional use of antler to nourish the blood has been validated by recent studies which identified the active components responsible — monoacetyldiglycerides.4 Monoacetyldiglycerides are small compounds that promote the production of blood cells by marrow stem cells. One very recent in vivo study looked at the effects of methanol extracts (MEs) — a protein component — from deer velvet antler on nematode worms called Caenorhabditis elegans. While veterinarians are more often foes, not friends, to nematodes, some important conclusions can be extrapolated from this research because, just like mammals, worms are susceptible to the toxic cellular effects of reactive IVC Spring 2021

•S everal kinds of fatty acids26 •N umerous growth factors, which are responsible for stimulating antler growth, most notably insulin-like growth factor 1 (IGF-1)17

connective tissue.14 The beneficial anti-inflammatory effects of velvet antler were, in at least one study, hypothesized to be associated with pilose antler polypeptide and/or the action of pantocrin, an alcohol extract from velvet antler thought to have adaptogenic properties.14

• Minerals such as calcium, phosphorus, iron and zinc10

oxygen species (ROS). In this study, methanol extracts from DVA boosted oxidative stress resistance and extended the lifespan of the nematodes.

THE SAFETY RATING OF VELVET ANTLER “Above all do no harm” is a guiding principle for every practitioner. Velvet antler has been shown to be non-toxic. In fact, in one study, rats were fed a diet containing 10% elk velvet antler for three months, starting from birth. No negative effects were noted in health, growth, or development.17 In a separate study evaluating short and long term effects, rats were given a single mega dose of 2 g/kg DVA, and then monitored for two weeks and given a 1 g/kg dose daily for 90 days. No adverse effects were noted on observation or necropsy.18 In terms of side effects from DVA as a nutraceutical ingredient, no negative effects, including renal or hepatotoxicity, were noted in any of the studies cited in this paper. This is consistent with the author’s experience that DVA is safe to use and also to combine with other supplements and pharmaceuticals. It should be noted that DVA is thought to be a potential source of transmissible spongiform encephalopathy (TSE) prions. Chronic wasting disease (CWD) is a contagious prion disease of deer and elk. Other TSEs familiar to veterinarians are BSE, bovine spongiform encephalopathy (mad cow disease), and scrapie in sheep. These are all progressive, fatal neurologic diseases.19 At least one study has identified chronic wasting disease (CWD) prions in the velvet of elk that were affected with the disease. Because humans are susceptible to several TSEs, including Creutzfeldt-Jakob disease (CJD), this research suggests that humans who consume DVA as a nutraceutical may be at risk for prion exposure.20

Members of the Felidae family, including domestic cats, have been shown to be susceptible to feline spongiform encephalopathy, another TSE, which leads to concern about the potential for cervid-to-feline transmission.21 However, prion disease has never been described in dogs. In a recent paper evaluating why this is the case, the authors concluded that members of the Canidae family are resistant to prion infection based on a specific protein at position 163 of the canine cellular prion protein (PrPC ) — a cell-surface glycoprotein — conferring genetic protection. Reputable sourcing is essential for the responsible use of DVA in supplements for pets and humans. Along with other countries, the United States and Canada have experienced outbreaks of CWD in wild and captive cervid herds. 22 CWD has never been reported in New Zealand and Australia. 23 This is one reason for the popularity of “New Zealand Deer Velvet” in nutraceuticals.

CONCLUSION The only mention of deer velvet on the AVMA website is not a positive one: “Therapeutic benefits of velvet antler have not been well-demonstrated. A small amount of experimental research suggests potential use for improving joint function or wound healing; however, larger, independent trials have tended to produce negative results.”6 However, integrative veterinarians are accustomed to “going off the grid.” DVA is a 100% natural supplement with very unique properties. Its use in holistic health dates back at least 23 centuries, and in recent years, both in vitro and in vivo studies have demonstrated a long and impressive list of positive benefits, which (just like deer antler) is rapidly growing. Acknowledgement: The author would like to thank Subhuti Dharmananda, PhD, Director of the Institute for Traditional Medicine, for his contribution during various stages of research and editing of this article, and Doron Zur, BVSc, MRCVS. Disclosure: The author of this publication imports, distributes, and sells Encore Mobility™ — a joint supplement for dogs containing green lipped mussel and New Zealand deer velvet and has a financial interest in Dr. Buzby’s Innovations, LLC. For more information, visit toegrips.com or drbuzbyswholesale.com. References available at IVCJournal.com

From the VMAA The Veterinary Medical Aromatherapy® Association (VMAA) is an organization of veterinarians and veterinary technicians dedicated to the responsible use of aromatherapy in animal practices. Their mission is to promote standards of excellence in animal aromatherapy, to provide outreach and education to veterinarians and axillary animal practices, and to promote continual improvements in Veterinary Medical Aromatherapy®. The VMAA is elevating the veterinary profession through innovation, education, and advocacy of integrative medicine.

ESSENTIAL OILS AND THE CANINE BRAIN

Aromatherapy applications in the canine can enhance focus, cognition, and mental stimulation. They can also create calmness, peacefulness, and relaxation, depending on the individual constituents of an essential oil. A dog’s nasal canal contains approximately 100,000,000 sensory receptors, and the processing area of a dog’s brain is thought to be 40 times larger than a human’s. Once a molecule of essential oil enters the nasal canal, it is intercepted by tiny receptors, then absorbed into the bloodstream and carried to the limbic area of the brain. The limbic region is primarily composed of the hypothalamus, hippocampus, and amygdalae. It is here that emotions and memory are processed, and the regulation of autonomic or endocrine functions occurs. In addition, behaviors are reinforced by the actions of these parts of the brain. Essential oils are unique in that they can effectively cross the blood-brain barrier, unlike many synthetic drugs and medications. A pure, unadulterated essential oil also contains a distinctive vibrational frequency and is considered by many to be a living entity. These characteristics have the potential to create positive effects for dogs afflicted with various neurological disorders, cognitive dysfunction, fear aggression, separation anxiety, and training challenges. Oils high in sesquiterpene compounds have a calming and soothing effect on the canine brain when inhaled and/or applied topically. Their potential use as anxiolytic, grounding, and emotionally stabilizing agents is significant when a client desires an alternative to conventional medications for undesirable behaviors and actions. Oils high in sesquiterpenes include: • Cedarwood • Myrrh • Patchouli • Vetiver • Sandalwood • German chamomile • Ginger • Spikenard • Blue cypress • Y lang ylang

Dogs have an abundance of sensory receptors in their nasal canals.

Pure, unadulterated essential oils are safe and effective choices for creating a calmer, more peaceful dog, thanks to their positive effects on the emotional center of the brain.

Submitted by Barbara Fox, DVM IVC Spring 2021

news bites SKULL SIZE IN HORSES MAY BE LINKED TO BEHAVIORAL TRAITS In the first study of its kind, researchers at the University of Guelph and the University of Sydney discovered that the skull shape and morphology of horses and donkeys may indicate the temperaments of different horse breeds. “An unexpected discovery came up pertaining to the placement of [hair] whorls,” says Dr. Katrina Merkies, associate professor and researcher at the University of Guelph, The whorl is the point on an equine’s head where hair grows in the opposite direction from the rest, or spirals out from the center. The study revealed that whorl placement in horses almost always corresponded with the location of the olfactory bulbs, which are not only important in processing smell, but also tied to the amygdala where the brain processes learning and memory. This discovery gives some credence to anecdotal beliefs among breeders that whorl placement can indicate the temperament of a specific horse; according to folklore, a whorl located above the eye line indicates a more highstrung horse while one located below the eye line indicates a calmer animal. These new discoveries will lead researchers to investigate the relationship between behavior and breed-specific skull morphology on a deeper level, leading to a better understanding of the behavioral differences between horse breeds. https://thehorseportal.ca/2020/11/comparing-equidskulls-for-insight-into-behavioural-differences/

STUDY TO EVALUATE ESWT AS A TREATMENT FOR BACK PAIN IN DOGS Morris Animal Foundation-funded researchers at The Ohio State University (OSU) have begun a study to evaluate a non-invasive and affordable therapy for lower back pain in dogs, called extracorporeal shockwave therapy (ESWT). ESWT involves the safe delivery of sound waves to damaged soft tissue to lessen pain and speed healing. Studies in humans and horses show significant improvement in back pain after treatment. While it has been tried in dogs to stimulate bone healing and manage shoulder tendon injuries, this is the first official evaluation to assess if the therapy is effective for lower back pain. Over the next six months, researchers will enroll around 20 adult large-breed dogs with lower back pain. The dogs will receive X-rays to ensure their pain is a result of a spine or disc issue and not due to other causes. A veterinarian will perform a physical exam on each dog and evaluate their gaits as they walk over a pressure mat. Each dog will then receive three ESWT treatments administered at two-week intervals. The dogs’ improvements will be based primarily on owner questionnaires, but the team will also perform another physical exam and retest the symmetry of each dog’s gait to evaluate weight distribution patterns posttreatment. The results will be analyzed to determine treatment effectiveness. “If these results are promising, this work could provide veterinarians with another evidence-based tool to use for pain management,” says Dr. Janet Patterson-Kane, Morris Animal Foundation Chief Scientific Officer. morrisanimalfoundation.org

IVC Spring 2021