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"Research Update on Diet Associated DCM" by cardiologist Sarah M Cavanaugh

Rits

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Felt like this deserved its own thread outside of the big thread...

TL;DR - The assertion dog food with “grain-free” labeling will cause dilated cardiomyopathy or other heart disease has no scientific merit at this time.


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Research updates on diet-associated dilated cardiomyopathy
Now more than ever, it is imperative we discuss diet and nutrition with our colleagues, our clients, and members of the pet food industry
August 15, 2019


By Sarah M. Cavanaugh, DVM, MS, DACVIM (cardiology)

As veterinarians, our mission to identify curable conditions is everlasting, but like many of our human colleagues, we too may be overlooking the most logical etiology of all—food. Recently, the work of a handful of observant veterinary cardiologists raised concerns that certain diets may cause or exacerbate dilated cardiomyopathy (DCM) in some dogs. The collaborations with other veterinarians, pet owners, researchers, and government officials that followed have already begun to produce results invaluable to canine cardiac health, such as those recently reported by Kaplan and colleagues.2 Although we have more questions than answers right now, we must continue the diet and nutrition conversation with each other, with pet owners, and—importantly—with members of the pet food industry.

Factually speaking
We cannot ignore the economic implications of the pet food industry, which grossed more than $30 billion in the U.S. in 2018.1We also cannot ignore that we, as veterinarians, are very much a part of this industry. We have a responsibility to help ensure science—not marketing or profits—drives pet owners’ decisions regarding pet food. To achieve this goal, we have to not only support scientific research, we also have to dig deep and listen to the results no matter how in line or divergent from our own beliefs they may be. A story I hope I never forget is that of my father-in-law, who suffers from heart disease, asking his cardiologist whether he should change his current diet to a different diet (one which has been scientifically proven to reduce heart disease) and his cardiologist replying: “Yes, [that] diet would probably help you very much, but I don’t recommend it to most of my patients because I can’t even eat that way.” My father-in-law’s cardiologist did what is known as being human, but when it’s you that’s sick, or your partner, parent, sister, or best friend, you just wish the doctor would give you the facts so you and your family can make an informed decision.

Here are the facts about diet-associated dilated cardiomyopathy (DADCM) in dogs that we have so far.

Suspicions raised
In 2017, several veterinary cardiologists from various locations in North America began suspecting the ventricular systolic dysfunction they were seeing in some of their canine patients was diet-related and because of two main factors:

1) A subjective assessment that a greater number of dogs from breeds that do not typically develop DCM were being diagnosed with this condition and many of these dogs were consuming foods made by the same company and/or consuming diets with similar ingredients (e.g. atypical meat source, grain-free, legume-rich).

2) Many of the affected dogs experienced improvement or resolution of their DCM when pharmacologic therapy was coupled with diet change. The aforementioned observations and discussions prompted research efforts aimed at studying the potential relationship between some of the diets of concern and canine DCM. Highlights from those studies and related information are discussed later on in this article.


The taurine factor
Kaplan and colleagues2 prospectively studied 24 golden retrievers that had both taurine deficiency and dilated cardiomyopathy and 52 apparently healthy golden retrievers. All 24 golden retrievers with taurine deficiency and DCM were receiving at least one of nine different brands of commercial dog food. Eight of nine brands were labeled as grain-free, and all food labels indicated they were formulated to meet the American Association of Feed Control Officials (AAFCO) Dog Food Nutrient Profiles. Fifteen of 24 dogs (63 percent) were fed the same brand of food, and 10 of those 15 dogs were consuming the same variety of food.

Researchers found a statistically significant association between a low taurine concentration and the brand of diet that was being consumed by 15 of 24 golden retrievers. The authors classified any diet with a legume (e.g. beans, peas, lentils) as one of the first five ingredients as “legume-rich.” Using this classification scheme, all but three varieties of food consumed by dogs with taurine deficiency and DCM were legume-rich. Interestingly, the other four ingredients in the variety of food that was consumed by 10 of 15 affected dogs were deboned pork, pork meal, pork liver, and pork fat (whole lentils were the third ingredient).


At this point, what we can say with confidence is there is a dietary factor that is harming the hearts of some of our canine patients.
All 24 dogs were treated with taurine, and 21 of 24 dogs were switched to a new diet. Over half of the dogs also were treated with at least one cardiac medication (e.g. pimobendan, benazepril). Nine dogs with congestive heart failure (CHF) also received furosemide. Follow-up taurine levels were performed at a mean of 143 +/- 93 days and were normal in all but one dog. At a median follow-up time of 250 days (range: 26 to 860 days), a statistically significant improvement in echocardiographic parameters was observed in all but one dog. It is worth noting that while most affected dogs (17 of 21) were switched to a diet containing grains at the time of diagnosis, four dogs were switched to a different grain-free diet and three of those dogs improved.

Another relevant finding was the discovery that most of the affected dogs were consuming fewer calories than predicted by calculated maintenance energy requirements (MER) and also less than the amount recommended by the pet food manufacturer. This suggests daily caloric intake could be a contributing factor to these conditions. Lastly, it seems golden retrievers may be genetically predisposed to taurine deficiency, and the low end of normal limits for taurine levels is higher in golden retrievers than other breeds.

Is grain-free the cause of DCM?
A retrospective study by Adin et al.3 evaluated 48 dogs of various breeds with DCM; 36 dogs were being fed a grain-free diet and 12 dogs were receiving a diet that included grains. Fourteen of 36 dogs (39 percent) were consuming the same brand of grain-free food. A notable difference in the results of this study compared to the one by Kaplan et al. is that, of the dogs on grain-free diets whose taurine level was measured, none had taurine deficiency. An initial principal finding in this study was that the echocardiographic abnormalities in the 14 dogs receiving the same brand of grain-free food were more severe than the echocardiographic abnormalities in the dogs receiving diets that included grains. Seven of the 36 dogs with follow-up information were switched to a new diet at the time of DCM diagnosis and six of seven dogs also were prescribed taurine. All dogs were treated with cardiac medications according to their stage of DCM. Most dogs had improvement in their echocardiographic parameters at three months, and all dogs showed improvement by nine months. A remarkable similarity between the findings in this study and the golden retriever study is that two of seven dogs were switched from one grain-free diet to a different grain-free diet and their hearts improved, further emphasizing a lack of grains alone is probably not the cause of diet-associated DCM in all of the dogs studied thus far.


Legume-rich diets
Legumes are a valuable source of protein and other nutrients, and they have been used in pet foods since the 1990s. When grains are excluded from pet food, some manufacturers increase the amount of legumes in an attempt to offset nutrient and density losses. When legumes or other ingredients are provided in excess, a diet can become unbalanced. If the pet food formulator does not account for the potential imbalance by adjusting the type and/or amount of other nutrients in the diet, a deficiency of one or more nutrients may occur. An in-depth analysis of legumes and taurine is beyond the scope of this article, but interested readers can refer to the recent publication by Mansilla et al.4 for a detailed discussion on the subject. At Ross University School of Veterinary Medicine, we recently completed a comprehensive feeding trial of a legume-rich diet (dried peas and pea protein were the first and second ingredients, respectively) and found no evidence of taurine deficiency or DCM in any of the dogs (unpublished data).5 These findings suggest legume-rich diets can be formulated to be safe and nutritionally adequate for dogs.

The value of educating pet owners
The assertion dog food with “grain-free” labeling will cause dilated cardiomyopathy or other heart disease has no scientific merit at this time. Propagation of this and other non-evidence-based claims has the potential to misguide pet owners and jeopardize patient health. As veterinarians, we can help shift the focus to nutritional science and away from trend- and emotion-based marketing by helping our clients understand the complexities of pet food formulation and animal physiology. We also can connect with AAFCO, the Global Nutrition Committee of the World Small Animal Veterinary Association (WSAVA), and pet food companies to express our support of the development of pet food labels containing complete and accurate nutrient information. In addition, we can enhance the quality of pet foods by supporting our veterinary nutritionist colleagues and by encouraging members of pet food companies to employ the expertise of nutritionists when formulating their products.


At this point, what we can say with confidence is there is a dietary factor that is harming the hearts of some of our canine patients. But is it nutrient excess or nutrient deficiency? Is it a combination of certain ingredients or nutrients? Is it the processing? Is it the quality or sourcing of ingredients or nutrients? Are dietary factors causing other chronic diseases? The questions go on and on, and in the short-term, we and our clients are bound to feel frustrated. When I look back at the “Diets and DCM” Listserv discussions among my colleagues from a year ago and compare our knowledge then to what it is today, I’m reminded just how productive and powerful collaborative research efforts can be. I expect we will know even more this summer when members of the American College of Veterinary Internal Medicine (ACVIM) and of the American Academy of Veterinary Nutrition (AAVN) convene in Phoenix, Ariz., to present scientific reports and abstracts at their annual conferences. If you’re unable to attend, you can view ACVIM abstracts in the Journal of Veterinary Internal Medicine (JVIM) (an open access journal) later this year.

References
1 American Pet Products Association. Pet Industry Market Size and Ownership Statistics. Pet Industry Market Size & Ownership Statistics. Last accessed: 5/9/19.


2 Kaplan JL, Stern JA, Fascetti AJ, et al. Taurine deficiency and dilated cardiomyopathy in golden retrievers fed commercial diets. PLoS One.

3 Original: 2018 Dec 13;13(12):e0209112. doi: 10.1371/journal.pone.0209112.

4 Correction: 2018 Dec 31;13(12):e0210233. doi: 10.1371/journal.pone.0210233.

5 Adin D, DeFrancesco TC, Keene B, et al. Echocardiographic phenotype of canine dilated cardiomyopathy differs based on diet type. J Vet Cardiol. 2019 Feb;21:1-9. doi: 10.1016/j.jvc.2018.11.002.

6 Mansilla WD, Marinangeli CPF, Ekenstedt KJ, et al. Special topic: The association between pulse ingredients and canine dilated cardiomyopathy: addressing the knowledge gaps before establishing causation. J Anim Sci. 2019 Mar 1;97(3):983-997. doi: 10.1093/jas/sky488.

7 Cavanaugh SM, Cavanaugh RP, Gilbert GE, et al. Amino acid concentrations and echocardiographic findings in dogs fed a commercial plant-based diet. Abstract will be presented at ACVIM Forum, July 2019. Phoenix, Ariz.

Sarah M. Cavanaugh, DVM, MS, DACVIM (cardiology), is assistant professor of small-animal medicine at Ross University School of Veterinary Medicine. Dr. Cavanaugh received her bachelor of science from the University of Florida and earned her DVM from Ross University. After graduation, she completed an internship in small-animal medicine and surgery at the Animal Medical Center in New York City before completing a residency in cardiology and master of science at Colorado State University. In 2010, Cavanaugh became a diplomate of the American College of Veterinary Internal Medicine Specialty (ACVIM) of cardiology. She has practiced small-animal cardiology in Denver, Colo., and Fort Myers, Fla., and joined the faculty at RUSVM in 2017. Cavanaugh can be contacted via email at scavanaugh@rossvet.edu.kn.

Source: Research updates on diet-associated dilated cardiomyopathy - Veterinary Practice News
 

strykerdobe

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Dilated Cardiomyopathy in Dogs: Study on Protein Source

DILATED CARDIOMYOPATHY IN DOGS: STUDY ON PROTEIN SOURCE

By W. Jean Dodds, DVM on September 15, 2019
Dilated-Cardiomyopathy-in-Dogs-Study-on-Protein-Source.jpg

Null Hypothesis: Animal ingredients are essential for amino acid homeostasis in dogs.

Alternative Hypothesis: Animal ingredients are notessential for amino acid homeostasis in dogs.

Homeostasis Definition: Any process that living things use to actively maintain fairly stable conditions necessary for survival.

PROSPECTIVE STUDY: AMINO ACID CONCENTRATIONS AND ECHOCARDIOGRAPHIC FINDINGS IN DOGS FED A COMMERCIAL PLANT-BASED DIET
RESEARCHERS
  • Sarah Cavanaugh, DVM, MS, DACVIM, Board Certified Cardiologist at Ross University School of Veterinary Medicine; Ryan Cavanaugh, DVM, DACVS-SA, ACVS Founding Fellow, Surgical Oncology at Ross University School of Veterinary Medicine; GE Gilbert; E Leavitt; Jennifer Ketzis, BS, MS, PHD, Associate Professor of Parasitology at Ross University School of Veterinary Medicine; Aline Vieira, DVM, MSC, PHD, Assistant Professor of Veterinary Physiology at Ross University School of Veterinary Medicine
THE STUDY
  • The proposal for this study was set in January 2018, before the Food and Drug Administration’s (FDA) announcement in July of the same year
  • 38 client-owned healthy adult dogs were enrolled
  • 34 dogs were transitioned to a commercial plant-based diet from their regular diets. Their regular diets include one or more animal ingredients, was commercially-available, was non-prescription, and was not grain-free
  • 4 dogs remained on their regular diet, which were similar to the diets described previously
  • Amino acid analysis (including plasma and whole blood taurine levels) was performed in all dogs
  • Echocardiography was performed in 37 dogs at baseline
TAURINE
  • Taurine is an amino acid
  • Amino acids are found in animal-based protein sources and plant sources like soy at varying amounts, depending on the type of meat or plant
  • Taurine deficiency can lead to heart disease in humans, cats and dogs
  • At this time, taurine is not considered an essential, food-sourced amino acid for dogs. Taurine is synthesized in the liver from the amino acids cysteine and methionine, which should provide sufficient quantities of taurine to meet dogs’ metabolic needs
  • Taurine can still be and is present in dog food. However, a pet food label does not need to reflect this presence or meet any minimum requirement per standards of the Association of American Feed Control Officials (AAFCO)
THE DIET
  • Vegan diet for dogs
  • Meets AAFCO standards
  • Company was started in 2005
  • The diet has always contained taurine and methionine. The last year the manufacturer, V-Dog, did a major reformulation was around 2007. The company maintains its food has always contained taurine in its formula since its inception in 2005
  • Manufacturer provided the food’s nutrition profile, which states the food contains 19% taurine – on an as fed basis
  • According to the pet food manufacturer, the taurine source is 100% vegan
  • Ingredients: Dried Peas, Pea Protein, Brown Rice, Oatmeal, Potato Protein, Sorghum, Canola Oil (preserved with mixed tocopherols) , Natural Flavor, Suncured Alfalfa Meal, Brewers Dried Yeast, Dicalcium Phosphate, Flaxseeds, Millet, Calcium Carbonate, Lentils, Peanut Hearts, Quinoa, Sunflower Chips, Salt, Potassium Chloride, Choline Chloride, Taurine, Dried Carrots, Minerals (Ferrous Sulfate, Zinc Sulfate, Copper Sulfate, Sodium Selenite, Manganese Sulfate, Calcium Iodate), Dl-methionine, Dried Parsley, Vitamins (Vitamin E Supplement, Vitamin A Supplement, Niacin Supplement, D-calcium Pantothenate, Riboflavin Supplement, Vitamin D2 Supplement, Thiamine Mononitrate, Vitamin B12 Supplement, Pyridoxine Hydrochloride, Biotin, Folic Acid), L-Ascorbyl-2-Polyphosphate (A Source Of Vitamin C), Preserved with Citric Acid, Preserved with mixed Tocopherols, Dried Blueberries, Dried Cranberries, Dried Celery, Yucca Schidigera Extract, Dried Lettuce, L-carnitine, Dried Watercress, Dried Spinach, Rosemary Extract.
STUDY RESULTS
  • Results suggested that dogs transitioned to the plant-based diet undergo changes to their amino acid profile
  • 75% of the amino acids – including taurine – increased after 30 days on the plant-based diet
  • Taurine (nmol/mL): pre-diet median – 107; post-diet median – 165
  • Whole Blood Taurine: pre-diet median – 247; post-diet median – 298
  • Methionine: pre-diet median – 70; post-diet median – 65
  • Cystine: pre-diet median – 1; post-diet median – 2
  • After 90 days on the plant-based diet, no dogs had echocardiographic evidence of left ventricular systolic dysfunction or dilated cardiomyopathy (DCM)
HYPOTHESIS SELECTION
Alternative Hypothesis – Animal ingredients are notessential for amino acid homeostasis in dogs

Caveat: Additional studies are needed to determine whether the significant changes in amino acid concentrations observed in this study are due to normal day-to-day variation or due to differences in type, quality, and/or quantity of nutrients in plant-based diets compared to traditional diets

DISCUSSION
We have been following the U.S. Food and Drug Administration’s (FDA) investigation into the potential link between certain diets and DCM in dogs, which has sparked fervent concern nationwide among pet companion caregivers for the past year. As this has carried on, all of us have been subjected to:

  • Speculation that the lack of grain in certain pet food diets is contributing to DCM without any scientific proof
  • Speculation that ingredients that replace grains plus-or-minus exotic meats is the problem
  • Warnings issued by the FDA based on frequency of reports they have received, that dog companion caregivers should not purchase certain brands – simply because they were mentioned ten or more times by pet companion parents or veterinarians that submitted case reports of dogs diagnosed with DCM. Remember that we’re talking about 524 reported cases from January 2014 through April 30, 2019, among the millions of pets fed in the country!
A lot of this speculation is being fueled by only a few veterinary cardiologists and veterinary nutritionists. Bear in mind, we have deliberately distinguished between these two specialties based on their lanes of research.

The DCM studies conducted by the veterinary cardiologists on this team have been weak in our opinion.

According to the researchers on the nutritional side of things, “Inclusion of exotic ingredients, such as kangaroo, alligator, fava beans, and lentils, adds another level of complexity to ensuring the diet is nutritious and healthy. Exotic ingredients have different nutritional profiles and different digestibility than typical ingredients and have the potential to affect the metabolism of other nutrients. For example, the bioavailability of taurine is different when included in a lamb-based diet, compared with a chicken-based diet, and can be affected by the amount and types of fiber in the diet.”

We do not disagree with the researchers on these points, but just stating them does not prove any causality. However, they are not actually conducting nutritional research and coming up with solutions for the right pet food formulations. In fact, the research could prove their assumptions to be incorrect.

They are also not considering food sensitivities to certain proteins, which can also cause health problems.

All in all, they are simply speculating, and alarming dog companion caregivers nationwide.

At Hemopet, we refer back to Sean Delaney, a board-certified veterinary nutritionist, who is not a part of this group of researchers. He and his team’s 2003 often cited study of taurine concluded, “The lowest whole blood concentrations were seen in dogs fed lamb or lamb meal and rice diets. Plasma methionine and cysteine concentrations were lower in dogs fed diets with animal meals or turkey, and whole grain rice, rice bran or barley.”

We also remember Ko and Fascetti’s study from 2016 about beet pulp, “Dietary beet pulp showed the most significant effect in lowering plasma and whole taurine concentrations, in part, by decreasing the protein digestibility (sulfur amino acid bioavailability), by enhancing fecal excretion of bile acids and possibly, by enhancing degradation of taurine by the gut microflora in dogs.”

We aren’t too sure about you, but our heads feel somewhat like the ping pong ball at a ping pong match!

THE CAVANAUGH STUDY
That is the beauty of Cavanaugh and her team’s study that we detailed above.

  • It eliminates one of the multiple variables under debate – meat proteins
  • It also eliminates the variability/bioavailability of taurine, cyst(e)ine and methionine between the various meat sources. In essence, it suggests dogs are not dependent on meat-based meals for adequate taurine supplementation if they are given the right amount of taurine supplementation, regardless of the source of taurine.
  • The study also suggests that peas are not inhibiting the absorption of taurine. However, we do not know if peas inhibit cyst(e)ine and canine dilated cardiomyopathy Archives - Hemopet.

    Cavanaugh, SM, et al. “Amino Acid Concentrations and Echocardiographic Findings in Dogs Fed a Commercial Plant-Based Diet.” Ross University School of Veterinary Medicine, 2019.

    Delaney, SJ, et al. “Plasma and Whole Blood Taurine in Normal Dogs of Varying Size Fed Commercially Prepared Food.” Journal of Animal Physiology and Animal Nutrition, vol. 87, no. 5-6, June 2003, pp. 236–244., http://www.ncbi.nlm.nih.gov/pubmed/12752830.

    Dodds, WJ. “Food Sensitivity and Intolerances Associated with Diet Type in Golden Retrievers: A Retrospective Study.” Journal of the American Holistic Veterinary Medical Association, vol 56, Fall, 2019, pp.52-57.

    “FDA Investigation into Potential Link between Certain Diets and Canine Dilated Cardiomyopathy.” U.S. Food and Drug Administration, 27 June 2019, FDA Investigates Potential Link Between Diet & Heart Disease in Dogs.

    Freeman, LM, et al. “Diet-Associated Dilated Cardiomyopathy in Dogs: What Do We Know?” Journal of the American Veterinary Medical Association, vol. 253, no. 11, 1 Dec. 2018, pp.1390–1394., doi:10.2460/javma.253.11.1390. An Error Occurred Setting Your User Cookie.

    Ko, KS, and Fascetti, A. “Dietary Beet Pulp Decreases Taurine Status in Dogs Fed Low Protein Diet.” Journal of Animal Science and Technology, vol. 58, Aug. 2016, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971673.
 

Kay Shaw

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Found these on the website of a Dobie breeder. Not sure where they’re from or if this information is accurate. But I thought it would be worth sharing.
 

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strykerdobe

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Until the FDA finds out what’s going on. I would try and stay away from lentils, peas and potatoes of any kind! Especially if they are way up on the ingredient list.
Or at least be supplementing with Taurine, CoQ10 and L-Carnitine.
 

strykerdobe

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Researchers Find No Definitive Link Between DCM and Grain-Free Diets
BY PET PRODUCT NEWS STAFF
Published: 2020.06.17 12:29 PM

Researchers Find No Definitive Link Between DCM and Grain-Free Diets

great-dane-DCM-6fbd9fec.jpeg

IMAGE BY UTE STUDBERG-WIRTH FROM PIXABAY

A group of researchers found no definitive relationship between grain-free and legume-rich diets and dilated cardiomyopathy (DCM) in dogs, according to the authors of a new article published in the Journal of Animal Science. Additionally, the U.S. Food and Drug Administration’s (FDA) reported cases of DCM include incomplete information, making it impossible to draw any sound conclusions from this data, the authors noted.

The research group included veterinarians, veterinary cardiologists and animal nutritionists from BSM Partners, a pet care research and consulting firm, who analyzed more than 150 studies for the peer-reviewed article.

The article, which can be accessed here, is an exhaustive literature review regarding the causes of DCM, and the first research resulting from BSM Partners’ long-term DCM research effort, said BSM officials.

“We wanted to gain the best understanding of this issue, so we examined the results of more than 150 studies, which taken together did not support a link between grain-free and legume-rich diets, and DCM,” said Dr. Sydney McCauley, an animal nutritionist and the article’s lead author. “What the science does make clear is that DCM is largely an inherited disease.”

The article also details published research highlighting a number of other factors that could contribute to the presence of DCM. These include nutrient deficiencies, myocarditis, chronic tachycardia and hypothyroid disease.

“We believe that further research is needed in order to reach sound conclusions with respect to the relationship between diet and DCM,” said Dr. Eva Oxford, a veterinary cardiologist and an article co-author. “This is why BSM Partners has initiated multiple original research projects that will shed additional light on this topic.”

BSM researchers also noted that while the FDA has referenced many reported cases of DCM in dogs eating grain-free or legume-rich diets, the majority of these cases contained incomplete information. For example, integral data such as the dog’s complete diet history, age or the presence of concurrent conditions were often missing. Additionally, some of the reported cases were of dog breeds with a known genetic predisposition to DCM, which further confounds the claim of a dietary role.

BSM Partners is a full-service pet care research, consulting, and strategy-to-shelf product innovation firm. BSM Partners’ research professionals collaborate with hundreds of clients to formulate, validate and process roughly 800 new products each year.
 

Rits

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I heard about this recently. You should see one of the DCM FB groups though. They refuse to believe it and continue to tout the big three companies. You know, the ones that fund the research that started this.
Additionally, some of the reported cases were of dog breeds with a known genetic predisposition to DCM, which further confounds the claim of a dietary role.

What the science does make clear is that DCM is largely an inherited disease
 

strykerdobe

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I heard about this recently. You should see one of the DCM FB groups though. They refuse to believe it and continue to tout the big three companies. You know, the ones that fund the research that started this.

Yes this debate will go back and forth I'm sure.

BUT BIG Question! Who is PAYING to Fund these studies??????? The research group included veterinarians, veterinary cardiologists and animal nutritionists from BSM Partners, a pet care research and consulting firm, who analyzed more than 150 studies for the peer-reviewed article. Who helped with Funding is the big question???????????? I always like to follow the $$$$$$$$$
 

strykerdobe

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Grain free diets and DCM

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Grain free diets and DCM
This article was updated to reflect the most current studies as of January 2019.
This article was updated again to include information about the newest FDA report in June 2019. See bottom of article for more information.

Diet-related dilated cardiomyopathy (DCM) in dogs: an update

Dietary dilated cardiomyopathy (DCM) has been documented in dogs fed “complete and balanced” commercial kibble diets since the early 2000s [1] with a focus on lamb meal and rice kibble [2], high fiber/low protein kibble [3], and recently, legume-heavy grain free kibble [4].

Considering DCM is presenting in dogs being fed “complete and balanced” diets and is resolved after a diet change, this indicates that the most likely potential causes may be one or more of the following:
1. the bioavailability or digestibility of essential taurine precursors is too low;
2. antinutrient effects, such as blocking absorption or promoting extraordinary loss of involved amino acids or other nutrients; and/or
3. the existence of a genetic predisposition to inhibited taurine synthesis, transport, or metabolism in some dogs.

What’s the big deal?
DCM is what happens when degeneration of the heart muscle leads to thinner muscular walls of the heart, particularly the left ventricle. When these walls get too thin, the pressure of the blood inside the heart begins to stretch the walls. This results in an enlarged heart characteristic of DCM. The left ventricle is responsible for pumping oxygenated blood out of the heart to tissues all throughout the body. When the walls of the left ventricle get thinner and weaker, the heart’s ability to pump blood out is less efficient, eventually leading to heart failure.

The most sinister part of DCM is the lack of clinical signs. In many dogs, this condition can go completely unnoticed until they develop congestive heart failure. Overall prognosis for dogs whose DCM has progressed to congestive heart failure is extremely poor [5]. A seemingly perfectly healthy dog can succumb to heart failure in a matter of hours, even though there was no indication that the dog had DCM until it was too late.

Genetic pathways associated with dietary DCM
Dietary DCM may involve genetic factors. These would differ from the genetic factors that cause non-dietary DCM in breeds like Dobermans, Great Danes, or Boxers. Genetic factors involved in non-dietary DCM may involve mutations affecting cytoskeletal proteins, resulting in weakened heart muscle or impaired muscle contraction. In contrast, genetic factors involved in dietary DCM may involve mutations affecting proteins or enzymes involved in the metabolic pathways of taurine synthesis or transport, resulting in taurine deficiency. Taurine is involved in the development and structure of cardiac muscle, so taurine deficiency can result in weakened heart muscle or impaired muscle contraction. In this way, dietary DCM can be reversed by correcting the deficiency, while non-dietary DCM cannot be reversed by a diet change.

Genetic pathways relating to taurine transportation have been discovered. The knockdown of one of these genes in mice results in taurine deficient cardiomyopathy [6]. Strong evidence exists of a genetic factor in Portuguese Water Dogs associated with abnormal taurine metabolism leading to DCM [7].

Breed-specific predispositions to dietary DCM have been identified, involving American Cocker Spaniels [8,9], Golden Retrievers [10,11], Portuguese Water Dogs [12], and Newfoundlands [1], among others.

Sulfur amino acid requirements in dogs
Taurine is not considered an essential nutrient in dogs because normal dogs on an adequate diet are able to synthesize taurine from two other amino acids, methionine and cysteine. Previous studies have hypothesized that taurine deficiency may be caused by low methionine and/or cysteine intake or absorption rather than a direct taurine deficiency [2]. Studies have also indicated that some dogs appear to have a higher dietary methionine and/or cysteine requirement than the typical model breed used to determine nutrient requirements (Beagles) [13].

Bioavailability & digestibility
Some ingredients might have high concentrations of amino acids, but they are not completely absorbed and metabolized in the body due to low digestibility or bioavailability. This means a diet might be complete and balanced “by formulation”, or laboratory analysis, but in practice the dog isn’t actually able to utilize all of these nutrients, leading to deficiency.

Animal-based ingredients generally have higher amino acid digestibility than plant-based ingredients, and greater amounts of taurine [14,15], cysteine, and methionine [16]. Novel ingredients like lamb meal, venison meal, and duck meal may have significantly less amino acids and lower digestibility in comparison to more conventional ingredients [17] – however, considering the limited data on these ingredients, it is difficult to make conclusions about their nutritional value, which poses serious concern especially in regard to limited-ingredient dog foods in which these novel protein meals are the major source of essential amino acids.

Raw or lightly cooked meat, poultry, and fish have significantly higher amino acid bioavailability and digestibility than rendered ingredients [18,19,20]. The temperature and pressure applied to rendered ingredients during processing has been associated with decreased amino acid bioavailability [19,21]. Multiple studies have raised the concern that the current methods for measuring bioavailability estimates used by NRC and AAFCO to determine amino acid requirements in dogs may not be sufficient or accurate [22,23].

“Bioavailability estimates for Lys, Met, and Cys as calculated here require further veracity as the chemical form in which these AA are present in commercial pet foods may significantly reduce their bioavailability.” (Hendriks et al., 2015) [23]

Vitamins and minerals involved in DCM
While taurine deficient DCM has gotten the most attention as of late, taurine synthesis relies on the availability of other nutrients. For example, taurine synthesis cannot occur unless adequate vitamin B6 is present [24]. In addition, there are nutrients unrelated to taurine that have been associated with dietary cardiomyopathy, including zinc [25], selenium [26], magnesium [27], calcium [28], vitamin D [29], thiamine [30], and vitamin E [27,31]. Deficiencies of these nutrients may play a role in causing or exacerbating DCM. Diet type and the extent of processing affects absorption and metabolism of many of these nutrients [32,33].

A deficiency can also be a consequence of high levels of other nutrients. For example, beta-alanine, an amino acid, is a competitive inhibitor of taurine, and an excess of beta-alanine can contribute to taurine depletion even in animals whose diets contained adequate taurine [34].

Thus, diets can qualify as complete and balanced according to AAFCO guidelines, yet imbalanced ratios of specific nutrients in the diet can still result in deficiency. Diets developed by inexperienced individuals without backgrounds in nutritional science are at greater risk of these imbalances.

Homemade diets have recently increased in popularity, but the vast majority of recipes provided on websites and in books do not meet all minimum requirements for all dogs. Even when given a balanced homemade recipe, owner compliance in following preparation directions can be low [35,36]. The consequences of an unbalanced diet can easily exceed dietary DCM, especially in growing puppies [37,38]. Normal bloodwork results are not an indication that the diet a dog is eating is balanced [39]. It is essential for owners feeding homemade diets (cooked or raw) to make sure the diet they are feeding is adequate and balanced for their dog.

Restricted dietary intake
In a recent study investigating taurine deficient DCM in Golden Retrievers, all but one of the dogs were being fed less than their calculated metabolic energy requirement (MER), which indicates lower daily dietary intake [11].

One study found that energy restriction resulted in methionine/cysteine, selenium, and choline intake less than the minimum requirement (MR) and tryptophan, magnesium, and potassium less than the recommended allowance (RA), even when consuming a purpose-formulated weight loss diet [40]. Although it was stated that none of the dogs developed taurine deficiency, the methods and data relating to taurine levels were not provided, and it was also noted that the diet contained supplemental taurine. In this study, the mean daily intake was 61kcal/kg^0.75/day.

In an analysis of multiple commercially available dog foods fed at less than a dog’s MER, it was determined that all diets had multiple nutrients less than RA if they were fed at 70kcal/kg^0.75/day and at least one essential nutrient less than RA at 79kcal/kg^0.75/day [41].

Some breeds, including Golden Retrievers, tend to have lower caloric requirements than other breeds [42,43]. It has also been suggested that current MER calculations result in daily caloric intakes that are too high for most adult pet dogs regardless of breed, with new formulas proposed that may be more accurate than the current NRC formula [44].

Feeding a commercial diet at less kcal/day than a dog’s calculated MER may result in daily intake of some nutrients less than the dog’s RA and/or MR, including nutrients essential for taurine synthesis. This may be a particularly relevant concern for low-energy adult pet dogs and breeds that typically have lower caloric requirements. Changing low-energy or obese-prone dogs to a weight management diet may decrease the potential of the diet being deficient, but as mentioned previously [40], it isn’t a guarantee.

Antinutrients and nutrient interactions
Antinutrients are compounds in food that decrease the digestibility and bioavailability of particular nutrients by preventing absorption or metabolism.

High fiber can decrease protein digestion by increasing the excretion of fecal bile acids, decreasing the bioavailability of taurine precursors [3].

Many ingredients, particularly legumes, contain numerous antinutrients including phytates, lectins, saponins, trypsin inhibitors, and protease inhibitors which can significantly decrease nutrient absorption of minerals and/or amino acids if not properly processed. While cooking is an effective method of reducing some antinutrients, others are more tolerant of high temperatures and may not be significantly reduced during cooking.

Some antinutrient factors are enhanced by high temperatures, such as protein-polyphenol interactions and maillard reaction products. In addition, some food processing techniques are associated with changes in the intestinal microbiota, resulting in increased excretion of taurine [45].

Maillard reaction products, found in high levels in commercial pet food products [46], can increase microbial degradation and have been associated with significant depletion of plasma and whole blood taurine levels [47].

Polyphenols are present in many plant-based ingredients and are associated with numerous health benefits owing to their antioxidant activity . In human nutrition, regular consumption of polyphenol-rich foods is strongly associated with reduced risk of cardiovascular disease [48]. However, some polyphenol compounds can bind to proteins, affecting protein digestion and losing their antioxidant activity [49]. These interactions can inhibit or promote protein metabolism depending on the protein involved and the mechanism by which the protein’s conformation or function is modified [50]. For example, a digestive enzyme’s active site could be blocked, preventing it from assisting in protein digestion, or a protein’s shape could be modified in a way that makes it easier for that protein to bind to an enzyme’s active site, allowing it to be more easily digested.

Long story short, interactions between nutrients and other compounds in a food are highly variable and complex, driving home the point that even a seemingly well-formulated balanced diet might have unexpected consequences.

Other factors
Other factors, like increased exercise [51], increase the body’s demand for taurine. Some health conditions may increase the risk of developing taurine or carnitine deficiency, including cystinuria [52] and thyroid conditions.

Hyperthyroidism has been identified as a potential cause of DCM in dogs and other species [53]. Hyperthyroidism can be diet-related in dogs that consume excessive amounts of iodine and/or meat products that contain thyroid glands, and DCM in these dogs can be reversed by a corrected diet [54,55,56].

Hypothyroidism has also been associated with cardiomyopathy in dogs and other species [57,58], but it is thought to be relatively uncommon. Researchers have been unable to demonstrate a role of hypothyroidism in the etiology or progression of DCM in Dobermans [59,60], but in Great Danes [61] and Cocker Spaniels [62], DCM has been reversed following thyroid hormone replacement therapy.

In addition, taurine may be a conditionally essential amino acid required by dogs predisposed to or suffering from heart failure, regardless of whether or not the heart failure is induced by a dietary factor in the first place [4].

While some of these factors aren’t directly legume- or grain free-related, they could be useful to keep in mind when assessing individual cases. Multiple factors could potentially work together to exacerbate DCM. Informed owners can make decisions to mitigate risk based on their dog’s breed, health status, and lifestyle.

The grain free link to DCM
One recent study [4] analyzed the echocardiographic results from 48 dogs of various breeds and mixes that had been diagnosed with DCM and had a known diet history. The 48 dogs consisted of 12 on grain inclusive diets and 36 on grain free diets. Out of the 36 dogs on grain free diets, 14 of them were on one particular grain free diet (identified only as “the most common grain free diet”) and the other 22 were on various other grain free diets. In comparison with dogs on grain inclusive diets, dogs on the most common grain free diet had significantly larger left ventricle diameter associated with more severe cardiomyopathy. Interestingly, while all of the dogs on grain free diets whose taurine was tested had normal or high taurine levels, two dogs on grain inclusive diets had low taurine levels. One of these dogs, a German Shepherd, died in-hospital. The other, a Bouvier des Flandres, improved with a diet change and taurine supplementation, indicating that this dog’s DCM was likely associated with its grain inclusive diet. Unfortunately, this study did not identify the diets in question, so there is no way to know more about the grain inclusive diets these two dogs were on – for example, if they included legumes, were lamb meal based, were rice or rice bran based, were high fiber, and/or were low protein, which would be consistent with prior findings [1,2,3].

Another recent study [11] investigated taurine deficiency and DCM in Golden Retrievers in an effort to identify why this breed is over-represented in cases of taurine deficient DCM. This is the same study that found almost all of the affected dogs were consuming less than their calculated MER, discussed earlier in this article. In this study, the diets these dogs were on at the time of their diagnosis were identified. Of the 24 dogs diagnosed with taurine deficient DCM, 15 (62.5%) were fed Acana, 2 (8.3%) were fed 4health, 2 were fed Fromm, and 1 dog was fed each of the following brands: Taste of the Wild, Zignature, Instinct, NutriSource, Kirkland Nature’s Domain, and Orijen. 9 (37.5%) of these dogs were on a kibble that included lamb and/or lamb meal. All but 1 (95.8%) of these diets were grain free (the only grain-inclusive food was Fromm Salmon a la Veg), and all but 1 of these diets included legumes (the only one that didn’t was Fromm Salmon a la Veg, which included the following carbohydrate sources: brown rice, sweet potato, barley, potato, oatmeal, white rice, and millet). 4 (16.7%) of these dogs were on a diet that included potatoes.

Risk vs benefit: is feeding a kibble with legumes worth it?
It is highly unlikely that all grain free kibble diets carry a risk of dietary DCM and there is no evidence at this time of any characteristics specific to grains themselves that would prevent DCM.

Additionally, dietary DCM isn’t exclusive to grain free kibble – as mentioned previously, DCM has been associated with grain-inclusive foods too [2,63]. In one study, rice was associated with significantly lower taurine levels [63] in comparison to corn or barley, however this study didn’t seem to involve any legume or potato ingredients for comparison.

Rather than the blame being placed 100% on grain free diets in general, it seems more likely based on current literature that this issue is multi-faceted; we may be witnessing the consequences of a “perfect storm” of factors, so to speak. But while it is important to remember that correlation is not causation, the correlation between legume-heavy grain free kibble and dietary DCM is compelling and should not be ignored.

In my opinion, the potential risks outweigh the benefits of feeding legume-heavy grain free kibble – particularly those identified as common denominators in recent dietary DCM cases (like Acana, Zignature, Fromm, 4health, and Taste of the Wild), and with breeds that tend to be susceptible to DCM (dietary or non-dietary) – until the exact cause(s) can be identified and addressed.

Although many owners may be resistant to a diet change away from grain free kibble, many of the reasons why owners want to feed grain free diets are based on myths and misunderstandings. There is no evidence that grain free is more beneficial than grain inclusive kibbles or that using grains as a source of carbohydrates is any more harmful than using alternative carbohydrate sources. Grain free diets are not inherently lower in carbohydrates than grain inclusive diets. Grain allergies are significantly less common in dogs than chicken or beef allergies [64]. Despite the pervasive myth that grains are not digestible in dogs, grains like rice, corn, and sorghum are in fact more digestible than legumes like peas and lentils [65].

A diet change may be especially important in breeds that have been overrepresented in cases of dietary DCM, like Golden Retrievers, and dogs that are known to have a non-dietary genetic predisposition to DCM, like Dobermans.

There have been reports of reversible DCM occurring in breeds that are genetically susceptible to non-dietary DCM, like Dobermans, Great Danes, and Boxers. To clarify, usually DCM in these breeds is not related to diet and therefore not reversible, yet some dogs of these breeds diagnosed with DCM have actually improved after a diet change, indicating that their condition was diet-related. As mentioned previously, taurine may be a conditionally essential amino acid required by dogs predisposed to or suffering from heart failure, regardless of whether or not the heart failure is induced by a dietary factor in the first place [4].

The association with grain free kibble and DCM seems to be particularly strong in some breeds, but it also is not limited to these breeds [4], and other breeds may have similar predispositions to dietary DCM that have yet to be identified. For this reason, even if your dog is not a breed that has been identified as at risk of DCM, feeding a grain inclusive kibble or a balanced homemade diet still may be the safer bet.

If your dog legitimately has a condition that requires a grain-free diet and you cannot feed a balanced homemade diet, it would be best to avoid legume-heavy kibbles if possible. While potatoes have been identified as a potentially risky ingredient in the recent FDA warning about grain free diets and DCM, the correlation between legumes and dietary DCM seems to be much stronger at this time. So if you must feed grain free kibble, I would still recommend avoiding legumes, and I would supplement the diet with taurine-rich fresh foods if possible.

Taurine tests and supplementation
Even if your dog has been taurine tested and came back with high taurine results on a grain free diet, I would still personally recommend a diet change away from legume-heavy kibble. In fact, very high taurine levels in dogs that aren’t given supplemental taurine may be particularly concerning because this may indicate myocardial injury [66]. In addition, taurine deficiency isn’t the only potential dietary cause of DCM, and there have been dogs diagnosed with DCM that had normal or high taurine levels [4]. For these reasons, I would not recommend relying on taurine test results as an indication that the diet you feed is safe and/or your dog is not at risk of dietary DCM – taurine test results are only one piece of the puzzle, not a definitive diagnosis one way or the other.

As more kibble manufacturers begin to add supplemental taurine to their formulas in light of recent studies and public outcry, taurine test results may be artificially higher and provide a false sense of security. The addition of taurine to certain formulas may not be enough to overcome taurine deficiency, as demonstrated by one study that found dogs on lamb and rice formulas had the lowest taurine levels, including 2 dogs on lamb and rice formulas that had been supplemented with taurine [63].

Whether or not taurine supplementation in dogs that have not been diagnosed with DCM is beneficial remains uncertain at this time. The optimal dosage of taurine for dogs is also not fully understood. However, according to Freeman et al. (2018):

“…taurine supplementation may still have some benefits owing to other effects of taurine (eg, antioxidant and positive inotropic effects).” [67]

Taurine supplementation is generally safe since excess taurine can be excreted in urine, but it is still important to avoid overdosing – too much of a good thing can easily backfire. Some commercial dog foods already contain added taurine. I would recommend talking with your vet to determine if adding a taurine supplement is right for your dog. Some owners with DCM diagnosed dogs have posted the amount of taurine their cardiologist prescribed to their dog online – DO NOT give your dog that much taurine unless you have been personally instructed to do so by your dog’s veterinary cardiologist.

I believe adding taurine-rich fresh foods would be the safest and most beneficial method of introducing more taurine to your dog’s diet. Decreasing the risk of dietary DCM will be one of many benefits of introducing more fresh foods to your dog’s diet! The following table contains a list of food items and their taurine content [15,68]. Seafoods, dark meats, and organ meats generally contain the most taurine. Each food item in this table is raw unless otherwise noted.

Taurine (mg/100g)
Tuna (albacore) 176-200
Tuna (canned) 42
Tuna (whole) 284
Salmon 60-130
Mackerel 78
Mackerel (whole) 207
Cod 31
Whiting 40
Haddock 28
Whitefish 114-151
Clam (fresh) 520
Clam (canned) 152
Shrimp 155-390
Scallops 827
Octopus 388
Mussels 655
Oysters 396-698
Herring (whole) 154
Capelin (whole) 144
Smelt (whole) 69
Chicken (light meat) 18
Chicken (dark meat) 83-170
Chicken breast 16
Chicken leg 34
Chicken liver 110
Chicken hearts & livers 118
Chicken necks & backs 58
Chicken (whole) 100
Turkey (dark meat) 306
Turkey (light meat) 30
Turkey (ground, 7% fat) 210
Duck leg (meat) 178
Duck leg (skin) 62
Rabbit (whole, ground) 37
Beef (ground, 15% fat) 40
Beef (ground, 25% fat) 28
Beef heart 65
Beef kidney 69
Beef spleen 87
Beef lung 96
Beef tongue 175
Beef gullet 80
Pork loin 50-61
Pork lung 78
Pork gullet 65
Pork liver 86
Pork kidney 77
Lamb leg 47
Lamb kidney 24
Venison 60
Veal 40
Horse 31
What should I do if my dog may be at risk?
If you are worried that your dog may be at risk, here are some steps you can take:

  • Avoid legumes and lamb based kibbles, even if it has added taurine.
  • If you feed a homemade diet (raw or cooked), make sure it is balanced. If you feed kibble, add taurine-rich fresh foods to your dog’s diet.
  • Get bloodwork done at your vet, including proBNP,– you may need to ask your vet about this, as it isn’t always included in full panel bloodwork.
  • Taurine testing can help determine if your dog is at risk of taurine deficiency, but keep in mind that high taurine doesn’t rule out DCM.
  • If necessary, get a referral to a veterinary cardiologist for an echo.
  • If you own a breed like a Doberman, ideally you should do annual 24-hour holter tests regardless of diet, but especially if they have been on a legume heavy or lamb meal based diet.
A call to action
If I may take a moment to rant…

This situation highlights the importance of pet food manufacturers’ participation in digestibility studies and feeding trials. While concerns have been raised regarding the validity of AAFCO feeding trials due to their less-than-ideal requirements, it could also be argued that something is better than nothing, and if the feeding trials are so easy to pass, then why do so few pet food companies do them? Or, even better, why don’t they go above and beyond? There is nothing that prevents pet food companies from exceeding current AAFCO feeding trial requirements and carrying out a feeding trial that involves more dogs and more tests over a longer period of time. (Look to Just Food For Dogs as an example!)

In any case, pet food manufacturers should be encouraged to prove the adequacy of their diets in some capacity beyond laboratory analysis as more and more evidence emerges that laboratory analysis isn’t a guarantee of adequacy. While funding more research like this may be expensive, pet food companies have a responsibility to thoroughly demonstrate the products they are selling are adequate, and I find it very disappointing that so few have taken the initiative to do so.

Any owner that feeds a commercial diet to their dog should be outraged at the lack of research from the vast majority of pet food manufacturers. But nothing will change if pet food companies aren’t motivated to do so. I encourage everyone to let these companies know that they need to do more to validate the adequacy of their diets. When dogs are eating the same exact thing, every single day, for every single meal, it is critical that this food is up to the task of keeping them healthy. When pet food companies claim that their products are safe, healthy, and nutritious, then they should be expected to have proof of those claims, and they shouldn’t be charging premium prices to essentially use their customer’s dogs as guinea pigs. Pet food manufacturers need to ask themselves: “do I want to be part of the problem or part of the solution?”

Conclusion
While it may be some time before researchers and veterinary cardiologists are able to get to the bottom of what exactly is causing this issue, there are some things we do know for sure as of right now:

  1. There is a significant correlation linking legume-heavy grain free diets with reversible diet-associated DCM, but the exact cause has yet to be identified
  2. In previous cases of diet-associated DCM, bioavailability/digestibility of taurine and/or taurine precursors and genetic predispositions to inhibited taurine synthesis/metabolism were identified as the most likely causes
  3. Current cases of diet-associated DCM may have similar and/or additional factors, including antinutrients, deficiencies of other nutrients, underlying health issues, unbalanced diets, or restricted dietary intake
  4. DCM has been diagnosed in breeds that have previously not been considered at risk of DCM
  5. Some dogs with high taurine levels have been diagnosed with DCM
  6. Look out for these red flags: legumes (peas, lentils, beans, etc), novel protein sources (lamb, venison, kangaroo, duck, etc), and ingredient splitting (i.e. “chicken meal, whole green peas, whole yellow peas, pea protein, pea fiber” – this food probably has more peas than chicken by weight)
FDA update – June 2019
The following information reflects the most recent findings in the FDA’s investigation into this issue.

FDADCM619-1.png


More than 90 percent of products were “grain-free”, and 93 percent of reported products had peas and/or lentils. A far smaller proportion contained potatoes.

FDADCM619-2.png



Since the July 2018 DCM Update, Vet-LIRN tested both products labeled as “grain-free” and those containing grain for the following:

  • protein, fat, moisture
  • crude fiber, total dietary fiber, soluble fiber, insoluble fiber
  • total starch, resistant starch
  • cystine, methionine, and taurine
The average percent protein, fat, total taurine, total cystine, total methionine, total methionine-cystine, and resistant starch content on a dry matter basis […] were similar for both grain-free labeled and grain-containing products. […] Additional food testing is in progress.

Click here to read the FDA’s update in full.

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strykerdobe

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New Study Adds Fuel to DCM and Grain-free Dog Food Controversy​

  • Jennifer Boncy
  • Mar 10, 2021

https://www.petproductnews.com/blog...-57e8fd4ab0c0.html?oly_enc_id=3914E8544689G1X
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Shuttersock

DCM and grain-free foods—here we go again.
A study published in the Journal of Veterinary Internal Medicine in December 2020 seems to demonstrate that dogs with dilated cardiomyopathy (DCM) that were consuming “nontraditional dog foods—namely, grain-free diets—were more likely to show signs of significant improvement in cardiac function if put back on “traditional” diets, along with being treated with heart medications.
So, it’s not an outright indictment on grain-free dog foods, but certainly not an endorsement.

The study follows the U.S. Food & Drug Administration’s (FDA) investigation of a suspected correlation between grain-free dog foods and instances of canine DCM, and adds a new wrinkle to what has become a quagmire for pet specialty retailers and pet food manufacturers who are trying to do right by their customers.

Since the FDA has raised the question of a potential link between DCM and grain-free foods—particularly diets formulated with legumes or pulses to replace the grains—others in the scientific community are also taking a closer look and adding their findings to a growing well of research on the topic.
However, it was only a few months ago that Pet Product News (PPN) reported that an FDA official acknowledged during a virtual scientific forum hosted by Kansas State University (KSU) in late September that there is no clear evidence indicating that grain-free foods with pulse ingredients are inherently dangerous for dogs and conceded that the “complex scientific messaging” was often lost in translation in the media.
And back in July, research published in the Journal of Animal Science—backed by veterinarians, veterinary cardiologists and animal nutritionists from BSM Partners, a pet care research and consulting firm—concluded that there is no definitive link between DCM and grain-free diets, a conclusion that we said came as no surprise to many industry insiders.
The news gave us perhaps a little hope—maybe false—that any concerns about the health impacts of grain-free diets would soon fall to the wayside.
So what impact will this new study have on anyone’s understanding of the issue?

It’s hard to say, and it’s probably most accurate to portend that our understanding of any potential link—or the absence thereof—will continue to evolve as more independent researchers reveal new findings and as the FDA continues its investigation. The one thing everyone seems to be in agreement on is that more research is still needed.

In the meantime, this new study may amplify concerns that, at the very least, pet foods that contain typical grains and not pulses—referred to by the researchers as traditional foods—may be better suited for dogs that have DCM or that may be predisposed to the condition than grain-free pet foods containing pulses, or nontraditional foods.
The study was funded by the Barkley Fund—a funding arm of Tuft University’s Cummings School of Veterinary Medicine, which aims to improve the care of animals with heart disease by supporting clinical investigations, teaching and learning—and was conducted by researchers from the department of clinical sciences at Cummings that included: Kimberly J. Freid, Lisa M. Freeman, John E. Rush, Suzanne M. Cunningham, Megan S. Davis, Emily T. Karlin and Vicky K. Yang.
The study reviewed the medical records of dogs diagnosed with DCM between Jan. 1, 2014, and Sept. 30, 2018, and grouped dogs into “traditional” or “nontraditional” diet categories and whether or not diet was changed after diagnosis. While the researchers did conclude that dogs with DCM that had been eating nontraditional diets improved at a greater rate when put back on traditional formulas, they also conceded that more research was needed to examine a possible link between the heart condition and diet.
Also, in their declaration of conflict of interest, two of the researchers—Freid and Rush—disclosed connections to pet food companies such as Hill’s Pet Nutrition, Nestlé Purina, Royal Canin and Mars—whether it was in the form of sponsored lectures or some sort of professional services.

Again, it’s hard to weigh the impact of this study yet, and it may be even tougher for some in the pet industry to know how to advise confused pet owners on how to feed their pets. So in essence, nothing much has changed—pet retailers and manufacturers need to stay abreast of the new research as it develops, and not necessarily make any knee-jerk responses as we all await the definitive answers we seek.

For more on PPN’s coverage of DCM, read:
 

Kaiser2016

Active Member
Interestingly, the other four ingredients in the variety of food that was consumed by 10 of 15 affected dogs were deboned pork, pork meal, pork liver, and pork fat (whole lentils were the third ingredient).
This really is an interesting detail. In the olden days people never fed their dogs pork but we now know this is safe, yet, there it is being controversial again.

I am hoping they get to the bottom of the Peas situation too. Very curious to see what’s in there that interferes with the heart. We still eat peas at home (for human meals) and everytime I see them, I always think about its role in dog food.
 

strykerdobe

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Just an updated article from Pet Products News.

Pet Food Reformulations Increase Following DCM Debacle, But Retailers Question the Changes
  • Marissa Heflin
  • 3 hrs ago


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It’s been nearly three years since the U.S. Food & Drug Administration (FDA) released an advisory citing a potential link between canine dilated cardiomyopathy (DCM) and grain-free diets. While the FDA has since acknowledged that there is no clear evidence linking the two, and that DCM is indeed a scientifically complex, multifaceted disease, the impression of the suspected correlation has had far-reaching effects.

“Since DCM made headlines in 2018, it seems most companies changed their formulas to better meet the expectations of customers,” said Jason Ast, co-owner of Just Dog People, a pet store in Garner, N.C. “Most pet food companies have either added taurine to their existing formulas and/or added new ‘grain-in’ options to their offerings.”


Taurine supplementation, according to industry insiders, may reduce the risk of dogs developing DCM, which is why some pet food manufacturers have either added or increased the level of taurine in their products.


Nicole Cammack, owner of NorthPoint Pets & Co., a pet store in Cheshire, Conn., saw the change as well.

“The DCM debacle accelerated the pace of formulation changes, and for the first time ever, we saw manufacturers pivot and try to market these changes as positives when they really weren’t,” Cammack said. “We saw many grain-free brands, particularly the 16 brands that were in the FDA chart [of brands that were most frequently cited in DCM cases reported to the FDA], at least add taurine. Others added grains, reduced legume content, potato content or otherwise completely reformulated.”

However, some brands added taurine to grain-free options before it was ever concluded whether or not DCM was caused by taurine deficiency, Cammack said.

“Turns out, taurine deficiency was not the cause of DCM, and the FDA went as far as to analyze several foods, and all of them had sufficient taurine,” Cammack added. “This is a classic case of reacting before knowing the full details of the situation. … What we ultimately learned was not only that taurine was not the issue, but that measuring taurine itself had a lot of unknowns, including that varying breeds have different requirements and thus differing taurine status. Now we have all these formulation changes in the marketplace, and we still largely have no idea what is going on with DCM. The most glaring concern that everyone seems to miss is that nearly all of these formulations are in the marketplace without ever being validated for nutritional adequacy or digestibility. In other words, it means that these foods could potentially cause the same, or more serious issues.”


Acana, manufactured by Champion Petfoods, is one of the brands that added taurine.

Jeff Johnston, senior vice president of research, innovation and product development for Champion Petfoods, which is based in Edmonton, Alberta, Canada, explained that it was added to the food in 2018, but acknowledged that there is no proof connecting taurine levels and DCM.

“Champion has standards for the amount we require in our foods. While high levels of taurine naturally occur in many of the ingredients in our foods, including fish, meat and poultry, if our minimum standard is not met, we add more taurine to our recipes to ensure dogs who eat our foods are getting the complete nutrition they need,” Johnston said. “That said, data are currently inconclusive on whether there is a causal relationship between taurine levels in dog food and dilated cardiomyopathy. At Champion, we made the decision to add taurine to our food since some dogs may need it and it’s not harmful to dogs that don’t.”

On (and Off) the Shelf​

These changes in formulations, no matter the brand, sparked different reactions among retailers.

“In the cases where companies cited DCM as the reason for making formula changes, I actually removed most of these from our shelf because there was no—and still isn’t—any scientific reason or rationale behind these formula changes,” Cammack said.

Ast didn’t pull any products, but over time has added to his pet food shelves.

“We didn’t rush to pull foods from our shelves after the FDA’s DCM statement,” Ast said. “Mostly because it was obvious that the research simply wasn’t sufficient to draw a conclusive opinion as to the root causes of DCM. … However, we have added some new grain-in options to ensure we had options for those customers who wanted to stay away from grain-free foods. Yes, there are customers who refuse to feed grain-free foods, and for those customers, we want to ensure we have ample options for them.”


Having options is why Champion Petfoods has received positive feedback from both pet owners and retailers, Johnston said.

“When recipe updates are nutrition and science based, like they are at Champion, retailers and pet lovers appreciate knowing pets are getting the best food possible—and that’s our goal at Champion,” Johnston said. “We make both premium grain-inclusive and grain-free foods so consumers can choose what is right for their pet’s unique needs. Retailers and pet lovers appreciate that Champion will continue to offer choices that help enhance pet health and that new products are based on new findings in pet nutrition, all making it easy to work in rotational feeding with options pet lovers can trust.”

Sometimes it’s the frequency of formulation changes—whatever the reason—that may give retailers pause.


“Certain brands seem to change ingredients a little too often, in my opinion,” Ast said. “This is obviously a red flag in my book, as well as many customers’. … Currently, we are considering removing two brands from our store, simply because they change their ingredients too often, or their pricing and/or bag sizes too often. I don’t enjoy ‘selling’ around third-party vendors and their production problems, so I’d rather remove them from our store than continue to explain these changes to our customers. Consistency matters.”

And let’s not forget the one who is actually eating the food. How do dogs feel about formulation changes?

“It’s not uncommon for dogs to turn their noses up when they notice a change in their food—and this has caused dog moms and dads to look for new food options,” Ast said. “While many dogs can swap foods with no worries, others have difficulties making the change. GI [gastrointestinal] upsets and picky eaters are the main negative results we see from food swaps.”


Formula changes, according to Cammack, actually happen more frequently than one might imagine.

“I would say that most brands do go though some evolution of their formulas at some point,” Cammack said. “However, the reality is that most companies make formulation changes all the time and most people in [the] industry are largely unaware. What many retailers and consumers don’t realize is that many times companies make these changes without notification. They don’t let the retailers know, and they certainly don’t advertise it to the consumer, which really just means companies are experimenting on our pets when they don’t fully validate the new formulations—no mater how slight.”

If retailers are planning to take stock of their inventory shelves, B.C. Henschen, a partner in Platinum Paws, a pet store and grooming salon in Carmel, Ind., and columnist for Pet Product News, has some advice: “I encourage you to look beyond the label when picking which products get your shelf space,” Henschen said in his column When to Remove a Product from Your Store’s Inventory. “Is the company truly transparent? Do you know where it’s made, how it’s made and why it’s made? That’s one of the favorite questions I ask sales representatives: Why is this food made? Does it bring something special to the market that’s not available in the hundreds of other foods out there?”


Champion Petfoods Addresses Retailer Concerns over Formulation Changes​

Some retailers have expressed concerns about pet food manufacturers changing formulations in response to the U.S. Food & Drug Administration (FDA)’s initial advisory about the potential link between dilated cardiomyopathy (DCM) and grain-free diets. While the FDA has since acknowledged that there is no clear evidence linking the two, the impression has lingered.


Pet Product News (PPN) reached out to Jeff Johnston, senior vice president of research, innovation and product development for Edmonton, Alberta, Canada-based Champion Petfoods, to get his take.

Pet Product News: Some retailers have expressed concern over formulation changes related to the FDA reports, saying that such changes are based more on marketing than science. What is your response? How would you ease retailer concerns?​

Jeff Johnston: Champion’s formulations are, and have always been, science based. We have a team of pet nutrition experts to ensure any updates made to our recipes or any product introductions are done because the science is there and warrants it.

One of the many advantages about our Acana and Orijen foods and treats is that there’s a great variety for pet lovers to choose from, so whether they are looking for a grain-free or grain-inclusive option, we have what they need. What drives our innovation is that pets need variety in their foods, just like humans. We encourage pet lovers to practice rotational feeding, so pets get nutrients from a wide range of ingredient sources to support overall health, which is why we offer choice and variety using recipes that are science based.

The last update from the FDA about DCM brought more understanding to the issue, indicating that multiple factors can cause the disease, including breed, genetics, pre-existing health conditions, digestive issues and nutrition. In fact, the FDA has found no evidence that any specific pet food products are definitively linked to causing DCM. If they had found this to be the case, they would have been required by law to pull those products off the market, and they have not done so.


For related coverage, read:

 

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