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So many kinds of dog food – I agree. Seems to me it's about money. I was wondering the other day if those breed-specific dog foods were still around. That trend struck me as pretty laughable.
I see the commercials on tv that say a lab digests food differently from a golden and require a different food. I hope consumers are researching and finally catching onto this type of marketing!
It doesn’t tell you what is added to or taken from these foods to make it appropriate for a specific breed.
I hate marketing of dog foods playing consumers for a fool.
 
Just had our boy Yago to his Cardiologist for his 6mo Echo. He was diagnosed in Dec. 2015 with Occult DCM.
I laughed when his Cardiologist ask Please tell me Yago is not on a Grain Free Diet? I said no Doc he has been fed a Raw Diet for years!
Needless to say she was thrilled about his Echo!

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This what his Cardiologist wrote about Grain Free Foods

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New info!! November 29, 2018

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It’s Not Just Grain-Free: An Update on Diet-Associated Dilated Cardiomyopathy
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by Lisa M. Freeman, DVM, PhD, DACVN
November 29, 2018
in Petfoodology Blog, Pets with Health Conditions, Trending Topics in Pet Nutrition


You may have read my June 4 post, “A broken heart: Risk of heart disease in boutique or grain-free diets and exotic ingredients.” This post had more than 180,000 page views in the first week and continues to get more than 2000 page views a day. So, I’m pleased that people are interested in this important issue and trying to learn about it. But I’ve also found a tremendous amount of confusion and misinformation in the past 5 months including people who doubt that this is a real issue, some who still haven’t heard about it, and people who mistakenly think it’s just grain-free diets or that it’s only related to taurine.

As a result of the continued confusion, some of my cardiologist colleagues and I wrote an article which was published in the latest issue of the Journal of the American Veterinary Medical Association. This article provides a summary of our current understanding of diet-associated dilated cardiomyopathy (DCM), how to recognize it, and a recommended protocol for veterinarians to follow when they see dogs with DCM.

To be sure this information reaches as wide an audience as possible and to clear up confusion, I thought I’d provide some updates to address the most common misconceptions I’m hearing:

  1. It’s not just grain-free. This does not appear to be just an issue with grain-free diets. I am calling the suspected diets, “BEG” diets – boutique companies, exotic ingredients, or grain-free diets. The apparent link between BEG diets and DCM may be due to ingredients used to replace grains in grain-free diets, such as lentils or chickpeas, but also may be due to other common ingredients commonly found in BEG diets, such as exotic meats, vegetables, and fruits. In addition, not all pet food manufacturers have the same level of nutritional expertise and quality control, and this variability could introduce potential issues with some products.
  1. Most dogs being diagnosed with DCM do not have low taurine levels. Some owners continue to feed a BEG diet but supplement taurine thinking that this will reduce their risk for heart disease. In our hospital, we currently measure taurine in all dogs with DCM, but more than 90% of our patients with DCM in which taurine has been measured have normal levels (and the majority are eating BEG diets). Yet some of these dogs with DCM and normal taurine levels improve when their diets are changed. This suggests that there’s something else playing a role in most cases – either a deficiency of a different nutrient or even a toxicity that may be associated with BEG diets. Giving taurine is unlikely to prevent DCM unless your dog has taurine deficiency. And given the lack of quality control for dietary supplements, you can introduce new risks to your dog if you give a supplement without evidence that she needs it.
  1. Raw diets and homemade diets are not safe alternatives. Out of concern, some owners are switching from BEG diets to a raw or home-cooked diet. However, we have diagnosed DCM in dogs eating these diets too. And raw and home-cooked diets increase your dog’s risk for many other health problems. So, forego the raw or home-cooked diets and stick with a commercial pet food made by a well-established manufacturer that contains common ingredients, including grains. If your dog requires a home-prepared diet for a medical condition or you feel strongly about feeding one, I strongly recommend you consult with a Board-Certified Veterinary NutritionistTM (acvn.org). However, because home-cooked diets are not tested for safety and nutritional adequacy like good quality commercial diets, deficiencies could still develop.
Current thoughts on DCM

Currently, it appears that there may be three separate groups of dogs with DCM (although this may change as we learn more). I am listing them in the approximate frequency that we are currently seeing them in our hospital:

  1. Diet-associated DCM with normal taurine levels. While this form of the disease was first identified in dogs of breeds not predisposed to DCM that are eating BEG diets, it appears to also occur in dogs of typical DCM breeds that are eating a BEG diet.
  2. Primary DCM in predisposed breeds that is unrelated to diet. This is the traditional, genetically-related DCM in typical breeds, such as the Doberman Pinscher, Boxer, Irish Wolfhound, and Great Dane.
  3. Diet-associated DCM with taurine deficiency: This is the least common form we are seeing in our hospital. This appears to happen both in breeds predisposed to DCM and breeds that are not predisposed to DCM.
Common questions

We still have a great deal to learn about diet-associated DCM. However, I’m providing answers to some common questions I’ve been getting based on what is currently known:

  1. What’s causing diet-associated DCM in dogs? For the vast majority of dogs, we do not yet know what is causing this disease. There are definitely some dogs with DCM that have low taurine levels, many of which will improve with taurine supplementation and change of diet. For dogs that have normal taurine levels, however, other nutritional deficiencies may be present. Some nutritional deficiencies can affect the heart’s normal function, so an insufficient amount of these nutrients (or reduced bioavailability) in the diet could cause heart disease. Diet-associated DCM could also be due to an ingredient in the food that is toxic to the heart. The FDA and many researchers are actively studying this issue so that it can be solved as quickly as possible.
  1. My dog was diagnosed with DCM. What should I do? Ask your veterinarian to measure taurine levels and give heart medications as directed by your veterinarian. If your dog is eating a BEG diet or other unconventional diet (including vegetarian, vegan, or home-prepared diets), I recommend following the steps outlined in my previous post, including switching to a non-BEG diet. Three updates to my previous post are:
    • Taurine supplements: Consumer Lab is expected to release a report on independent quality control testing of taurine supplements in late 2018. Given the lack of quality control for dietary supplements (human and pet), having these results will be very useful to find good quality products for dogs that require taurine supplementation. Your veterinarian or veterinary cardiologist can help you determine an optimal dose for your dog.
    • Other dogs in the household: We are now recommending that other dogs in the household of dogs with DCM that are eating the same BEG diet be screened by their veterinarian since their hearts could also be affected (even if they are showing no symptoms).
    • Outcome: Not all dogs with DCM will improve and improvements in the echocardiogram, when they do occur, can take a long time (often more than 6 months).
  1. If my dog is eating a BEG diet but has no symptoms, should I test for DCM or switch to a different diet? It’s unlikely that most dogs eating a BEG diet will develop DCM. However, given the fact that we don’t yet understand why BEG diets are affecting some dogs and because DCM is a life-threatening disease, I recommend you reconsider your dog’s diet until we know more. Contrary to popular belief, there are no health benefits of grain-free or exotic ingredient diets except in the rare case of food allergy. If your dog is a part of your family and you want to feed him the very best, be sure to base this important decision on more objective factors than marketing and the ingredient list (see our post). Be sure to watch for early signs of heart disease – weakness, slowing down, less able to exercise, shortness of breath, coughing, or fainting. If you notice any of these, get your dog checked out by your veterinarian who will listen for a heart murmur or abnormal heart rhythm (although not all dogs with DCM have any changes that can be heard with a stethoscope). Your veterinarian (or a veterinary cardiologist) may do additional tests, such as x-rays, blood tests, electrocardiogram, and ultrasound of the heart (echocardiogram – the test of choice to diagnose DCM).Tell your veterinarian what you’re feeding your dog. You can help your veterinarian by bringing a list of everything your dog eats to every appointment. If your dog has no symptoms, additional testing is really up to you. Some owners have measured plasma and whole blood taurine levels or scheduled an echocardiogram to check their dog’s heart size and function. However, given the cost of an echocardiogram, other owners have elected to have their veterinarian do a blood test called NT-proBNP, which goes up when the heart is enlarged. While a normal value doesn’t guarantee your dog has no heart disease, a high level suggests your dog’s heart should be evaluated further.
  2. Has diet-associated DCM been seen in cats? The association between BEG diets and heart disease has only been reported in dogs so far. However, that doesn’t mean cats are immune. If your cat is diagnosed with DCM and is eating a BEG, vegetarian, vegan, or home-prepared diet, I recommend following the same protocol as described for dogs with DCM.
Lastly, if your dog has been eating a BEG diet and has been diagnosed with DCM, please don’t feel guilty. I’ve talked to owners who feel terrible because they wanted to provide the finest care for their dog by feeding them the best diet possible. They often spent a lot of money buying an expensive boutique diet and now that same diet may be associated with their dog’s heart disease. Trying to decide what is really the best food is confusing and difficult because of the many different products available, nutrition fads, and compelling marketing. My hope is that the one bright side of this serious situation is that it will shine a light on the complexities of making safe and nutritious pet food and the importance of nutritional expertise and quality control, rather than just what is new and trendy.

Lisa M. Freeman, DVM, PhD, DACVN
Dr. Freeman is a veterinary nutritionist and a professor at Cummings School of Veterinary Medicine at Tufts University. She is on the cutting-edge of science, with hundreds of articles in prestigious journals, speaking engagements at national and international conferences, and awards for her scientific achievements. However, she also is passionate about providing objective and accurate information on pet nutrition to veterinarians, pet owners, and other animal enthusiasts.
 
Doc called me with taurine results for the twins. I am NOT happy.
Bacall is borderline deficient at 207
Bogie is 245.

My friend’s Porty was 415 and she feeds raw in morning and a non grain free at night. Geez, I am upset. Have increased their taurine supplement and L-Carnitine.
Will recheck in 6 mos.
What a worry!!!
 
What the :censored: am I supposed to make of this!

This bit makes me think this vet is anti raw feeding anyway:
"And raw and home-cooked diets increase your dog’s risk for many other health problems."

I read the BEG link too:
"do not switch between multiple diets containing different exotic meats."

But different proteins have different nutritional profiles. And chicken and pork have too much omega 6 so you need to offset that with other proteins.

This is pretty much saying that bad quality kibble is best and your vet knows best :scratch:
 
What the :censored: am I supposed to make of this!

This bit makes me think this vet is anti raw feeding anyway:
"And raw and home-cooked diets increase your dog’s risk for many other health problems."

I read the BEG link too:
"do not switch between multiple diets containing different exotic meats."

But different proteins have different nutritional profiles. And chicken and pork have too much omega 6 so you need to offset that with other proteins.

This is pretty much saying that bad quality kibble is best and your vet knows best :scratch:



I wasn't surprised about the Anti Raw feeding stuff in the It’s Not Just Grain-Free: An Update on Diet-Associated Dilated Cardiomyopathy.

We feed multiple meat proteins including chicken and pork. Not all the time. Maybe 2x's a week sometimes.
 
Doc called me with taurine results for the twins. I am NOT happy.
Bacall is borderline deficient at 207
Bogie is 245.

My friend’s Porty was 415 and she feeds raw in morning and a non grain free at night. Geez, I am upset. Have increased their taurine supplement and L-Carnitine.
Will recheck in 6 mos.
What a worry!!!

You feed Bacall & Bogie the exact same diet?????
What brand of supplements do you use???
 
Both eat the same thing. I give different proteins every few days.

Taurine 1000mg 2xday
L-Carnitine 2x day 900mg
The they get a scoop (4tsps) each of Dogzymes Complete which a blend of all the vitamins, algae, coconut, pre and probiotics, phytoplankton, green lipped mussels, a bunch of minerals and amino acids. I will post a picture of ingredients.
They get raw eggs with shell and sardines 3x wk.
All treats are natural. Dehydrated lamb lung, dehydrated liver. They don’t get bagged treats or any cooked treats (table scraps.)
I do feed more turkey than chicken, but they get bison, beef, emu, rabbit, duck and fish. Green tripe, chicken and beef and pig hearts, liver, pancreas, beef tongue, gizzards. It’s a blend of the different proteins.
 
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Thank you, I would really appreciate it. !!!


It is vitamin B12 but like I said, Drake's Cardiologist recommends giving a B complex.

What a worry!!!


I do understand your concern. I was talking with our Cardi at our last visit about food and low taurine. She said their phone has been ringing off the wall with questions. The good news is not one dobie that has been diagnosed DCM has had low taurine in all the the studies they are doing. Hope that little tid bit helps take some worry away.
 
What the :censored: am I supposed to make of this!


The thing about studies is you always get different interpretations. Leaves the lay people wondering who's right. I'm going to just leave it at we are studying and learning. That's GREAT news.
I lost a beautiful red boy to DCM at 6 1/2 in 2010. The amount we have learned since then is just mind blowing. So if you think about that for just a minute, you could consider that a lifespan. If we keep learning at that rate it could mean we have the horrible disease solved in a single life span. :shock: So what this means to me is we have the attention of the researchers and they are trying and making headway! That's fantastic news with numbers as high as 60% of dobies being diagnosed with the disease.
 
Very good read!

The Heart of the Matter

The Science Dog

By Linda P. Case
The Heart of the Matter
August 30, 2018 The Science Dog

In mid-July, the U.S. Food and Drug Administration (FDA) released an alert to veterinarians and pet owners regarding reports of increased incidence of a heart disease called canine dilated cardiomyopathy (DCM). This disorder is characterized by weakening of the heart muscle, which leads to a decreased ability of the heart to pump, and if untreated, to cardiac failure. The reported cases occurred in breeds that are not considered to be genetically predisposed to this disorder.

Further, a significant number of the dogs were found to have reduced levels of circulating taurine in their blood and have responded positively to taurine supplementation. It is speculated that these cases are related to the consumption of foods that negatively affect taurine status, leading to taurine-deficiency DCM. Foods containing high levels of peas, lentils, other legume seeds, or potatoes were identified by the FDA as potential risk factors. These ingredients are found commonly in foods that are formulated and promoted as “grain-free.”

As these things go, there followed a lot of hype and a fair bit of hysteria in response. Let us avoid this type of reaction and instead look at the evidence – what do we currently know about the role of diet and taurine in the development of DCM in dogs and how is it that “grain-free” foods have been recently targeted as a possible dietary cause?

What is Taurine? The nutrient taurine is a unique type of amino acid, called a beta-amino sulfonic acid. It is not incorporated into proteins but rather is found primarily as a free amino acid in body tissues and circulating in the blood. Taurine has many functions, but two that are important for this discussion involve its role in normal heart function and its presence as a component of bile acids, which are needed for fat digestion. Most animals obtain adequate taurine to meet their needs by producing it endogenously (in the body) from two other amino acids, methionine and cysteine.


This means that while animals require taurine physiologically, most do not have a dietary requirement for taurine. The exception to this rule is the cat. Cats (but not dogs) always require a source of taurine in their food. If they do not have it, one of the diseases that they can develop (and possibly die from) is……you guessed it…..DCM.

Taurine-deficiency DCM is well documented in cats. We also know quite a lot about the dietary factors that contribute to this disease in that species. In contrast, dogs (usually) do not require a source of dietary taurine. However, we know that some dogs still develop taurine-deficiency DCM. Why does this happen? The history of DCM in cats can help in untangling what may be occurring in dogs.

Taurine-deficiency DCM in Cats: Looking back, I cannot avoid a sense of déjà vu. In the early 1980s veterinarians began reporting increased incidences of DCM in pet cats. By 1987, a role for dietary taurine was suspected. In a seminal study, a veterinary researcher at UC Davis reported low plasma (blood) taurine levels in 21 cats with clinical signs of DCM (1). When the cats were supplemented with taurine, all 21 completely recovered from the disease. This discovery led to a series of controlled studies that supported the existence of taurine-deficiency DCM developing in cats, despite being fed diets that contained sufficient concentrations of taurine.

What was going on?

It has to do with Bile Acids: Another role of taurine is the body is that it is necessary for normal bile acid function. Taurine is linked to bile acids in the liver to form bile salts. These compounds are secreted into the small intestine during digestion where they function to aid in fat digestion. Animals are very efficient at conserving the taurine that is secreted into the intestine by reabsorbing the bile salts back into the body further down the intestinal tract. This occurs through a process called “enterohepatic reutilization” and prevents a daily loss of taurine in the feces.

Herein lies the problem for cats with DCM: If anything happens during digestion that causes the degradation of the bile salt taurine or that inhibits its reabsorption into the body, more is lost in the feces. If this happens consistently, the cat will experience an increase in his or her daily need for dietary taurine. Simply put – if anything causes the cat to poop out more taurine-bile acid complexes (or their degraded by-products), the cat will be in danger of a taurine deficiency if a higher level is not provided in the diet.

This is exactly what was happening in the cats with taurine-deficiency DCM – and is possibly what we are seeing today in dogs. The difference is that we know what diet factors caused taurine deficiency in cats during the late 1980s. These factors are not yet fully understood for dogs (but we can make a few guesses).

Here is What We Know: The studies with cats found that several dietary factors influenced taurine status (2,3,4). These were the level and type of dietary protein, the amount and type of dietary fiber, and the degree of heat treatment that was used during food processing. These factors could affect taurine status in three ways:

  1. Bile Acid Binding: Certain fibers and peptides (small protein chains) in the food can bind with bile salts the small intestine and make them unavailable for reabsorption into the body. This results in an increased daily loss of taurine in the feces and a subsequent increase in daily taurine requirement to replace that loss.
  2. Increased Microbial Degradation: Thermal processing of protein (extrusion or canning) can lead to the production of Maillard products – complexes of sugars and amino acids and are poorly digested in the small intestine. The undigested complexes travel to the large intestine and provide an intestinal environment that favors increased numbers of taurine-degrading bacteria. An increase in these bacterial populations reduces the proportion of taurine that is available for reabsorption and reuse by the body.
  3. Reduced Taurine Availability: Taurine is found naturally in animal-based proteins but is not found in plant-based protein sources. Therefore, providing diets that include a sufficient level of high-quality animal proteins (that are not heat damaged) should ensure adequate taurine intake. However, protein that is of low quality or that has been excessively heat-treated will be poorly digested, reducing the availability of taurine and of its precursor amino acids, cysteine and methionine. (Note: Cats produce small amounts of taurine from these precursors, while dogs can produce all of their needs from them, if adequate levels are available).
In response to new information regarding the interaction of dietary factors and taurine status in cats (and their relationship to DCM in cats), the Association of American Feed Control Officials (AAFCO) increased the recommendations for dietary taurine in extruded and canned cat foods in the early 1990s. The current recommendations are 1000 mg taurine/kg (0.1 %) in dry (extruded) cat foods and 2000 mg taurine/kg (0.2 %) in canned cat foods.

So, What about Dogs? Unlike the cat, dogs that are fed diets containing adequate levels of protein should be capable of synthesizing enough taurine from the two amino acid precursors, cysteine and methionine, to meet their needs. Therefore, a requirement for dietary taurine has not been generally recognized in dogs.

Breed Predispositions: However, there is evidence – evidence that we have had for at least 15 years – that certain breeds of dogs, and possibly particular lines within breeds, exhibit a high prevalence of taurine-deficiency DCM. Genetically predisposed breeds include the American Cocker Spaniel, Golden Retriever, Labrador Retriever, Saint Bernard, Newfoundland and English Setter (5,6). Although the exact underlying cause is not known, it appears that some breeds have either a naturally occurring higher requirement for taurine or a metabolic abnormality that affects their taurine synthesis or utilization.

Size: A second factor that affects taurine status in dogs is size. There is evidence that a large adult size and a relatively slow metabolic rate influences the rate of taurine production in the body and may subsequently lead to a dietary taurine requirement. It is theorized that increased body size in dogs is associated with an enhanced risk for developing taurine deficiency and that this risk may be exacerbated by a breed-specific genetic predisposition. For example, when compared metabolically, Newfoundlands have a significantly lower rate of taurine synthesis than Beagles (7).

There is additional evidence that large and giant breed dogs have lower rates of taurine production compared with small dogs. Ultimately, studies suggest that certain dogs possess a genetic predisposition to taurine depletion and increased susceptibility to taurine-deficiency DCM and that this susceptibility may be related to the combined factors of breed, size and metabolic rate.

What is the Role of Diet? The recent spate of cases and media attention to taurine-deficiency DCM in dogs suggests that this is a very new problem in dogs. However, it is not new. A connection between diet and DCM in dogs was first described in a paper published in the Journal of the American Veterinary Medical Association in 2001 (8). What is new is the sudden focus on certain pet food ingredients and the target that appears to have been placed upon the backs of all “grain-free” pet food brands by some bloggers and veterinarians. Not to put too fine a point on this, but the 12 cases of taurine-deficiency DCM described in the 2001 paper were collected between 1997 and 2001, years before grain-free dog foods had arrived on the pet food scene. Rather than disparage one class or type of dog food (or pet food company), it is more important to look at specific dietary factors that may be involved in DCM in dogs.

Generally speaking, these are expected to be the same as those identified for cats, including low protein levels, poorly processed or heat-damaged proteins (leading to Maillard products), and the inclusion of a high proportion of plant-based protein sources such as peas and legumes.

Over the past 15 years, reduced taurine status in dogs has also been alternately associated with feeding lamb meal and rice diets, soybean-based diets, rice bran, beet pulp, and high fiber diets (9,10,11). As with cats, there appear to be multiple dietary (and genetic) factors involved. For example, it was theorized that the perceived (not proven) association between lamb meal and taurine status was due to low levels of available amino acids present in the lamb meal, or to excessive heat damage of the protein, or to the confounding factor of the inclusion of rice bran in many lamb meal-containing foods. To date, none of these factors have been conclusively proven or disproven. Although, the most recent study showed that three types of fiber source – rice bran, cellulose, and beet pulp – all caused reduced plasma taurine levels in dogs when included in a marginally low protein diet, with beet pulp causing the most pronounced decrease (11).

Complicated? You bet. This is why it is important to avoid making unsupported claims about certain foods and brands. Taurine-deficiency DCM has been around for a while in dogs and continues to need study before making definitive conclusions about one or more specific dietary causes.

What DO we know? We know that any dietary factor that reduces the availability of taurine precursors, binds taurine bile salts in the intestine, or causes an increase in the bacteria populations that degrade taurine can reduce a dog’s ability to synthesize taurine or will increase taurine degradation and/or loss in the feces. These changes could ultimately compromise a dog’s taurine status (especially if the dog was genetically predisposed) and affect heart health. In extreme cases, as we are seeing, this can lead to taurine-deficiency DCM (see diagram below).

FDA Report: The FDA report identified foods that contain high amounts of peas, lentils, legume seeds, or potatoes to be of potential concern. The FDA also stated that the underlying cause of DCM in the reported cases is not known and that at this time, the diet-DCM relationship is only correlative (not causative). However, this has not stopped various bloggers and even some veterinarians from targeting small pet food companies and/or grain-free brands of food, and implying that these foods, and these foods alone, are causing taurine-deficiency DCM in dogs. Their reasoning is that peas and legumes are present in high amounts in foods that are formulated and marketed as grain-free. However, the truth is that many companies and brands of food include these ingredients. More importantly, there is no clear evidence showing that a particular dog food type, brand, or even ingredient is solely responsible for taurine-deficiency DCM in dogs.

Rather, it is more reasonable and responsible to speculate that one or more of these ingredients, their interactions, or the effects of ingredient quality, heat treatment, and food processing may play a role. Furthermore, the underlying cause could be the protein, starch, or fiber fractions of these ingredients. As plant-source proteins, peas and lentils and legumes include varying amounts of starch (both digestible and resistant forms) and dietary fiber. These protein sources are also generally less nutritionally complete and less digestible than are high quality animal source proteins – additional factors that could influence a dog’s ability to both produce and use taurine. Potatoes, on the other hand, provide a digestible source of starch in an extruded food but also contain varying levels of resistant starch, which is not digested and behaves much like dietary fiber in the intestinal tract.

The Heart of the Matter: Because any or all of these dietary factors could be risk factors for taurine-deficiency DCM in dogs and because peas, legumes, and other ingredients identified by the FDA report have not yet been fully studied, the heart of the matter is that no conclusions can yet be made about the underlying dietary cause or causes of taurine-deficiency DCM in dogs. Given what we do know, a recommendation is to feed a food that contains sufficient levels high quality, animal-source protein, does not include plant-source proteins as its primary protein source, and does not contain high levels of dietary fiber. If you are worried about your dog’s taurine status or heart health, see your veterinarian for a complete physical examination and if needed, to measure plasma levels of taurine.
Cited Studies:

  1. Pion PD, Kittleson MD, Rogers QR, et al. Myocardial failure in cats associated with low plasma taurine: A reversible cardiomyopathy. Science 1987; 237:764-768.
  2. Earl KE, Smith PM. The effect of dietary taurine content on the plasma taurine concentration of the cat. British Journal of Nutrition 1991; 66:227-235.
  3. Hickman MA, Morris JG, Rogers QR. Effect of processing on the fate of dietary taurine in cats. Journal of Nutrition 1990; 120:995-1000.
  4. Hickman HA, Morris JG, Rogers QR. Intestinal taurine and the enterohepatic circulation of taurocholic acid in the cat. Advances in Experimental Medicine and Biology 1992; 315:45-54.
  5. Freeman LM, Rush JE, Brown DJ, et al. Relationship between circulating and dietary taurine concentrations in dogs with dilated cardiomyopathy. Veterinary Therapeutics 2001; 370-378.
  6. Backus RC, Ko KS, Fascetti AJ. Low plasma taurine concentration in Newfoundland dogs is associated with low plasma methionine and cysteine concentrations and low taurine synthesis. Journal of Nutrition 2006; 136:2525-2533.
  7. Ko KS, Backus RC, Berg JR, et al. Differences in taurine synthesis rate among dogs relate to differences in their maintenance energy requirement. Journal of Nutrition 2007; 137:1171-1175.
  8. Fascetti AJ, Reed JR, Roger QR, et al. Taurine deficiency in dogs with dilated cardiomyopathy: 12 cases (1997 – 2001). Journal of the American Animal Veterinary Association 2001; 223:1137-1141.
  9. Delaney SJ, Kass PH, Rogers QR, Fascetti AJ. Plasma and whole blood taurine in normal dogs of varying size fed commercially prepared food. Journal of Animal Physiology and Animal Nutrition 2003; 87:235-244.
  10. Torres CL, Backus RC, Fascetti AJ, et al. Taurine status in normal dogs fed a commercial diet associated with taurine deficiency and dilated cardiomyopathy. Journal of Animal Physiology and Animal Nutrition 2003; 87:359-372.
  11. Ko KS, Fascetti AJ. Dietary beet pulp decreases taurine status in dogs fed low protein diet. Journal of Animal Science and Technology 2016; 58:29-39.
 
Very good read!

The Heart of the Matter

The Science Dog

By Linda P. Case
The Heart of the Matter
August 30, 2018 The Science Dog

In mid-July, the U.S. Food and Drug Administration (FDA) released an alert to veterinarians and pet owners regarding reports of increased incidence of a heart disease called canine dilated cardiomyopathy (DCM). This disorder is characterized by weakening of the heart muscle, which leads to a decreased ability of the heart to pump, and if untreated, to cardiac failure. The reported cases occurred in breeds that are not considered to be genetically predisposed to this disorder.

Further, a significant number of the dogs were found to have reduced levels of circulating taurine in their blood and have responded positively to taurine supplementation. It is speculated that these cases are related to the consumption of foods that negatively affect taurine status, leading to taurine-deficiency DCM. Foods containing high levels of peas, lentils, other legume seeds, or potatoes were identified by the FDA as potential risk factors. These ingredients are found commonly in foods that are formulated and promoted as “grain-free.”

As these things go, there followed a lot of hype and a fair bit of hysteria in response. Let us avoid this type of reaction and instead look at the evidence – what do we currently know about the role of diet and taurine in the development of DCM in dogs and how is it that “grain-free” foods have been recently targeted as a possible dietary cause?

What is Taurine? The nutrient taurine is a unique type of amino acid, called a beta-amino sulfonic acid. It is not incorporated into proteins but rather is found primarily as a free amino acid in body tissues and circulating in the blood. Taurine has many functions, but two that are important for this discussion involve its role in normal heart function and its presence as a component of bile acids, which are needed for fat digestion. Most animals obtain adequate taurine to meet their needs by producing it endogenously (in the body) from two other amino acids, methionine and cysteine.


This means that while animals require taurine physiologically, most do not have a dietary requirement for taurine. The exception to this rule is the cat. Cats (but not dogs) always require a source of taurine in their food. If they do not have it, one of the diseases that they can develop (and possibly die from) is……you guessed it…..DCM.

Taurine-deficiency DCM is well documented in cats. We also know quite a lot about the dietary factors that contribute to this disease in that species. In contrast, dogs (usually) do not require a source of dietary taurine. However, we know that some dogs still develop taurine-deficiency DCM. Why does this happen? The history of DCM in cats can help in untangling what may be occurring in dogs.

Taurine-deficiency DCM in Cats: Looking back, I cannot avoid a sense of déjà vu. In the early 1980s veterinarians began reporting increased incidences of DCM in pet cats. By 1987, a role for dietary taurine was suspected. In a seminal study, a veterinary researcher at UC Davis reported low plasma (blood) taurine levels in 21 cats with clinical signs of DCM (1). When the cats were supplemented with taurine, all 21 completely recovered from the disease. This discovery led to a series of controlled studies that supported the existence of taurine-deficiency DCM developing in cats, despite being fed diets that contained sufficient concentrations of taurine.

What was going on?

It has to do with Bile Acids: Another role of taurine is the body is that it is necessary for normal bile acid function. Taurine is linked to bile acids in the liver to form bile salts. These compounds are secreted into the small intestine during digestion where they function to aid in fat digestion. Animals are very efficient at conserving the taurine that is secreted into the intestine by reabsorbing the bile salts back into the body further down the intestinal tract. This occurs through a process called “enterohepatic reutilization” and prevents a daily loss of taurine in the feces.

Herein lies the problem for cats with DCM: If anything happens during digestion that causes the degradation of the bile salt taurine or that inhibits its reabsorption into the body, more is lost in the feces. If this happens consistently, the cat will experience an increase in his or her daily need for dietary taurine. Simply put – if anything causes the cat to poop out more taurine-bile acid complexes (or their degraded by-products), the cat will be in danger of a taurine deficiency if a higher level is not provided in the diet.

This is exactly what was happening in the cats with taurine-deficiency DCM – and is possibly what we are seeing today in dogs. The difference is that we know what diet factors caused taurine deficiency in cats during the late 1980s. These factors are not yet fully understood for dogs (but we can make a few guesses).

Here is What We Know: The studies with cats found that several dietary factors influenced taurine status (2,3,4). These were the level and type of dietary protein, the amount and type of dietary fiber, and the degree of heat treatment that was used during food processing. These factors could affect taurine status in three ways:

  1. Bile Acid Binding: Certain fibers and peptides (small protein chains) in the food can bind with bile salts the small intestine and make them unavailable for reabsorption into the body. This results in an increased daily loss of taurine in the feces and a subsequent increase in daily taurine requirement to replace that loss.
  2. Increased Microbial Degradation: Thermal processing of protein (extrusion or canning) can lead to the production of Maillard products – complexes of sugars and amino acids and are poorly digested in the small intestine. The undigested complexes travel to the large intestine and provide an intestinal environment that favors increased numbers of taurine-degrading bacteria. An increase in these bacterial populations reduces the proportion of taurine that is available for reabsorption and reuse by the body.
  3. Reduced Taurine Availability: Taurine is found naturally in animal-based proteins but is not found in plant-based protein sources. Therefore, providing diets that include a sufficient level of high-quality animal proteins (that are not heat damaged) should ensure adequate taurine intake. However, protein that is of low quality or that has been excessively heat-treated will be poorly digested, reducing the availability of taurine and of its precursor amino acids, cysteine and methionine. (Note: Cats produce small amounts of taurine from these precursors, while dogs can produce all of their needs from them, if adequate levels are available).
In response to new information regarding the interaction of dietary factors and taurine status in cats (and their relationship to DCM in cats), the Association of American Feed Control Officials (AAFCO) increased the recommendations for dietary taurine in extruded and canned cat foods in the early 1990s. The current recommendations are 1000 mg taurine/kg (0.1 %) in dry (extruded) cat foods and 2000 mg taurine/kg (0.2 %) in canned cat foods.

So, What about Dogs? Unlike the cat, dogs that are fed diets containing adequate levels of protein should be capable of synthesizing enough taurine from the two amino acid precursors, cysteine and methionine, to meet their needs. Therefore, a requirement for dietary taurine has not been generally recognized in dogs.

Breed Predispositions: However, there is evidence – evidence that we have had for at least 15 years – that certain breeds of dogs, and possibly particular lines within breeds, exhibit a high prevalence of taurine-deficiency DCM. Genetically predisposed breeds include the American Cocker Spaniel, Golden Retriever, Labrador Retriever, Saint Bernard, Newfoundland and English Setter (5,6). Although the exact underlying cause is not known, it appears that some breeds have either a naturally occurring higher requirement for taurine or a metabolic abnormality that affects their taurine synthesis or utilization.

Size: A second factor that affects taurine status in dogs is size. There is evidence that a large adult size and a relatively slow metabolic rate influences the rate of taurine production in the body and may subsequently lead to a dietary taurine requirement. It is theorized that increased body size in dogs is associated with an enhanced risk for developing taurine deficiency and that this risk may be exacerbated by a breed-specific genetic predisposition. For example, when compared metabolically, Newfoundlands have a significantly lower rate of taurine synthesis than Beagles (7).

There is additional evidence that large and giant breed dogs have lower rates of taurine production compared with small dogs. Ultimately, studies suggest that certain dogs possess a genetic predisposition to taurine depletion and increased susceptibility to taurine-deficiency DCM and that this susceptibility may be related to the combined factors of breed, size and metabolic rate.

What is the Role of Diet? The recent spate of cases and media attention to taurine-deficiency DCM in dogs suggests that this is a very new problem in dogs. However, it is not new. A connection between diet and DCM in dogs was first described in a paper published in the Journal of the American Veterinary Medical Association in 2001 (8). What is new is the sudden focus on certain pet food ingredients and the target that appears to have been placed upon the backs of all “grain-free” pet food brands by some bloggers and veterinarians. Not to put too fine a point on this, but the 12 cases of taurine-deficiency DCM described in the 2001 paper were collected between 1997 and 2001, years before grain-free dog foods had arrived on the pet food scene. Rather than disparage one class or type of dog food (or pet food company), it is more important to look at specific dietary factors that may be involved in DCM in dogs.

Generally speaking, these are expected to be the same as those identified for cats, including low protein levels, poorly processed or heat-damaged proteins (leading to Maillard products), and the inclusion of a high proportion of plant-based protein sources such as peas and legumes.

Over the past 15 years, reduced taurine status in dogs has also been alternately associated with feeding lamb meal and rice diets, soybean-based diets, rice bran, beet pulp, and high fiber diets (9,10,11). As with cats, there appear to be multiple dietary (and genetic) factors involved. For example, it was theorized that the perceived (not proven) association between lamb meal and taurine status was due to low levels of available amino acids present in the lamb meal, or to excessive heat damage of the protein, or to the confounding factor of the inclusion of rice bran in many lamb meal-containing foods. To date, none of these factors have been conclusively proven or disproven. Although, the most recent study showed that three types of fiber source – rice bran, cellulose, and beet pulp – all caused reduced plasma taurine levels in dogs when included in a marginally low protein diet, with beet pulp causing the most pronounced decrease (11).

Complicated? You bet. This is why it is important to avoid making unsupported claims about certain foods and brands. Taurine-deficiency DCM has been around for a while in dogs and continues to need study before making definitive conclusions about one or more specific dietary causes.

What DO we know? We know that any dietary factor that reduces the availability of taurine precursors, binds taurine bile salts in the intestine, or causes an increase in the bacteria populations that degrade taurine can reduce a dog’s ability to synthesize taurine or will increase taurine degradation and/or loss in the feces. These changes could ultimately compromise a dog’s taurine status (especially if the dog was genetically predisposed) and affect heart health. In extreme cases, as we are seeing, this can lead to taurine-deficiency DCM (see diagram below).

FDA Report: The FDA report identified foods that contain high amounts of peas, lentils, legume seeds, or potatoes to be of potential concern. The FDA also stated that the underlying cause of DCM in the reported cases is not known and that at this time, the diet-DCM relationship is only correlative (not causative). However, this has not stopped various bloggers and even some veterinarians from targeting small pet food companies and/or grain-free brands of food, and implying that these foods, and these foods alone, are causing taurine-deficiency DCM in dogs. Their reasoning is that peas and legumes are present in high amounts in foods that are formulated and marketed as grain-free. However, the truth is that many companies and brands of food include these ingredients. More importantly, there is no clear evidence showing that a particular dog food type, brand, or even ingredient is solely responsible for taurine-deficiency DCM in dogs.

Rather, it is more reasonable and responsible to speculate that one or more of these ingredients, their interactions, or the effects of ingredient quality, heat treatment, and food processing may play a role. Furthermore, the underlying cause could be the protein, starch, or fiber fractions of these ingredients. As plant-source proteins, peas and lentils and legumes include varying amounts of starch (both digestible and resistant forms) and dietary fiber. These protein sources are also generally less nutritionally complete and less digestible than are high quality animal source proteins – additional factors that could influence a dog’s ability to both produce and use taurine. Potatoes, on the other hand, provide a digestible source of starch in an extruded food but also contain varying levels of resistant starch, which is not digested and behaves much like dietary fiber in the intestinal tract.

The Heart of the Matter: Because any or all of these dietary factors could be risk factors for taurine-deficiency DCM in dogs and because peas, legumes, and other ingredients identified by the FDA report have not yet been fully studied, the heart of the matter is that no conclusions can yet be made about the underlying dietary cause or causes of taurine-deficiency DCM in dogs. Given what we do know, a recommendation is to feed a food that contains sufficient levels high quality, animal-source protein, does not include plant-source proteins as its primary protein source, and does not contain high levels of dietary fiber. If you are worried about your dog’s taurine status or heart health, see your veterinarian for a complete physical examination and if needed, to measure plasma levels of taurine.
Cited Studies:

  1. Pion PD, Kittleson MD, Rogers QR, et al. Myocardial failure in cats associated with low plasma taurine: A reversible cardiomyopathy. Science 1987; 237:764-768.
  2. Earl KE, Smith PM. The effect of dietary taurine content on the plasma taurine concentration of the cat. British Journal of Nutrition 1991; 66:227-235.
  3. Hickman MA, Morris JG, Rogers QR. Effect of processing on the fate of dietary taurine in cats. Journal of Nutrition 1990; 120:995-1000.
  4. Hickman HA, Morris JG, Rogers QR. Intestinal taurine and the enterohepatic circulation of taurocholic acid in the cat. Advances in Experimental Medicine and Biology 1992; 315:45-54.
  5. Freeman LM, Rush JE, Brown DJ, et al. Relationship between circulating and dietary taurine concentrations in dogs with dilated cardiomyopathy. Veterinary Therapeutics 2001; 370-378.
  6. Backus RC, Ko KS, Fascetti AJ. Low plasma taurine concentration in Newfoundland dogs is associated with low plasma methionine and cysteine concentrations and low taurine synthesis. Journal of Nutrition 2006; 136:2525-2533.
  7. Ko KS, Backus RC, Berg JR, et al. Differences in taurine synthesis rate among dogs relate to differences in their maintenance energy requirement. Journal of Nutrition 2007; 137:1171-1175.
  8. Fascetti AJ, Reed JR, Roger QR, et al. Taurine deficiency in dogs with dilated cardiomyopathy: 12 cases (1997 – 2001). Journal of the American Animal Veterinary Association 2001; 223:1137-1141.
  9. Delaney SJ, Kass PH, Rogers QR, Fascetti AJ. Plasma and whole blood taurine in normal dogs of varying size fed commercially prepared food. Journal of Animal Physiology and Animal Nutrition 2003; 87:235-244.
  10. Torres CL, Backus RC, Fascetti AJ, et al. Taurine status in normal dogs fed a commercial diet associated with taurine deficiency and dilated cardiomyopathy. Journal of Animal Physiology and Animal Nutrition 2003; 87:359-372.
  11. Ko KS, Fascetti AJ. Dietary beet pulp decreases taurine status in dogs fed low protein diet. Journal of Animal Science and Technology 2016; 58:29-39.

Very interesting! I like that they are looking at facts and not using scare tactics one way or another.

And the summary is perfect, "Given what we do know, a recommendation is to feed a food that contains sufficient levels high quality, animal-source protein, does not include plant-source proteins as its primary protein source, and does not contain high levels of dietary fiber. If you are worried about your dog’s taurine status or heart health, see your veterinarian for a complete physical examination and if needed, to measure plasma levels of taurine."

I wish they defined what "high levels" of dietary fiber were, though. Although, doing a quick check on the foods we've used, it's not actually stated as dietary, just crude. And as far as I can tell, there isn't really a way to calculate it but that it's typically much higher than the crude fiber stated.
 
Just out from U.C. Davis January 28, 2019

Dogs Fed Some Popular Diets Could Be at Risk of Heart Disease Study Finds Spike in Deadly Heart Disease Linked to Trendy Dog Diets
By Amy Quinton on January 28, 2019 in Human & Animal Health
fiji1.jpg

Fiji, a female golden retriever, had taurine-deficient dilated cardiomyopathy. The DCM was reversed with diet change and taurine supplementation. (Jamie Warren)

University of California, Davis, veterinarians led a team that has found a link between some popular grain-free, legume-rich dog diets and a type of nutritional deficiency and canine heart disease known as taurine-deficient dilated cardiomyopathy. The study was recently published in the journal PLOS ONE.

Researchers found dogs eating some of these boutique diets are not making or maintaining enough taurine, an amino acid important for heart health. Taurine deficiency has been known for many years to lead to dilated cardiomyopathy, or DCM, a heart muscle disorder that can lead to congestive heart failure and death.

“Given this recent surge in cases, we need to pay close attention to what we are feeding dogs,” said lead author Joshua Stern, a veterinary cardiologist and geneticist at the UC Davis School of Veterinary Medicine. “Choosing a well-researched dog food that has a healthy nutrient profile backed by expert formulation and research is of paramount importance.”

Stern said while some dog breeds are more genetically prone to a traditional form of DCM, the disease is now showing up unexpectedly in other breeds, such as the golden retriever. The common link unifying these cases is their diets. He began noticing the trend two years ago and is now treating many dogs with nutritionally mediated DCM that were all eating quite similar diets. Last year, the U.S. Food and Drug Administration issued an alert to pet owners and veterinarians about the potential association between the diets and DCM. The FDA continues to research this issue in an effort to help identify the exact dietary factor causing the problem.

Study looked at golden retrievers
suva-320x437.jpg

Suva, a female golden retriever, was treated at UC Davis. She came out of heart failure after switching diets. (Jamie Warren)
Stern’s research involved 24 golden retrievers with dilated cardiomyopathy and a documented taurine deficiency, representing the largest collection of cases with this condition that has been published. Twenty-three of the 24 dogs diagnosed with DCM had also been fed diets that were either grain-free, legume-rich or a combination.

Stern then prescribed the dogs a diet change and taurine supplementation. As a result, all but one dog improved. Nine of 11 dogs in this group with the most advanced stage of the disease, congestive heart failure, also showed dramatic improvements or no longer had congestion.

“This study helped us confirm that this condition is treatable and avoidable, something that traditional DCM of genetic origins is not,” said Stern.

Stern said consumers who are concerned about their dog’s health, should not naively switch their dog’s diet or simply add a taurine supplement. Instead, consult with your vet as dogs can develop DCM from nutritional origins and not be taurine-deficient. Taurine supplements can also mask the problem and lead to a delay of an important diagnosis.

DCM cases involve different dog food brands and formulas
Stern urged pet owners to take a second look at their dog’s diet. Cases of DCM have been reported in dogs eating multiple different brands and formulas of food.

The problem may not be that the diet is “grain-free” or “legume-heavy” but that ingredients are interacting to reduce availability of taurine or that other nutrients are missing or interacting in the formulation.

For example, while a lot of pet owners may not want to see “byproducts” in their dog’s food, often the byproducts contain organ meat like heart and kidney, which are good sources of taurine.

“Pet owners should ask themselves if they’re buying the food because it sounds good to them, or whether it’s right based on veterinary research and evidence,” said Stern. “Staying away from some of the most common marketing gimmicks may help to protect your pet.”

For more information on selecting foods for your pet, Stern recommends that clients consider using the recommendations set by the World Small Animal Veterinary Association for selecting a healthy dog food.

Click here for more information on dilated cardiomyopathy and dog food.
Nutritionally-mediated DCM
Give now to the Cardiac Genetics and Pharmacogenetics Laboratory

Dec. 2018 JAVMA Article for veterinarians: Diet-associated dilated cardiomyopathy

Dog Food & Dilated Cardiomyopathy

Golden Retriever Taurine Deficiency and Dilated Cardiomyopathy

Taurine-Deficient DCM in Golden Retriever Article 2018


Co-authors of the study include Andrea Fascetti and Jennifer Larsen, veterinary nutritionists with the UC Davis School of Veterinary Medicine, and Joanna Kaplan, a veterinary cardiology resident in the UC Davis Veterinary Medical Teaching Hospital.

Media contact(s)
Amy Quinton, News and Media Relations, 530-752-9843, cell 530-601-8077, [email protected]
 

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