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Taurine Interview about Study and DCM Herbsmith Inc.

Discussion in 'Doberman Health and News Articles' started by strykerdobe, Jun 10, 2018.

  1. strykerdobe

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  2. strykerdobe

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    A broken heart: Risk of heart disease in boutique or grain-free diets and exotic ingredients


    A broken heart: Risk of heart disease in boutique or grain-free diets and exotic ingredients
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    by Lisa M. Freeman, DVM, PhD, DACVN
    June 04, 2018
    in Finding the Best Food for Your Pet, Petfoodology Blog

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    Earlier this year, Peanut, a 4-year-old male Beagle/Lab mix was diagnosed with a life-threatening heart disease at our hospital. Peanut had been lethargic, not eating well, and occasionally coughing. The veterinary cardiologist seeing him asked what he was eating and found that his owner, in a desire to do the best thing for Peanut, was feeding a boutique, grain-free diet containing kangaroo and chickpeas. Peanut required several medications to treat his heart failure but the owner also changed his diet. And today, now 5 months later, Peanut’s heart is nearly normal!

    Heart disease is common in our companion animals, affecting 10-15% of all dogs and cats, with even higher rates in Cavalier King Charles Spaniels, Doberman Pinschers, and Boxer dogs. Most nutritional recommendations focus on treating dogs and cats with heart disease and there is much less information on the role of diet in causing heart disease. However, a recent increase in heart disease in dogs eating certain types of diets may shed light on the role of diet in causing heart disease. It appears that diet may be increasing dogs’ risk for heart disease because owners have fallen victim to the many myths and misperceptions about pet food. If diet proves to be the cause, this truly is heart-breaking to me.

    In my 20 years as a veterinary nutritionist, I’ve seen vast improvements in our knowledge about pet nutrition, in the quality of commercial pet foods, and in our pets’ nutritional health (other than the unfortunate rise in obesity). However, in the last few years I’ve seen more cases of nutritional deficiencies due to people feeding unconventional diets, such as unbalanced home-prepared diets, raw diets, vegetarian diets, and boutique commercial pet foods. The pet food industry is a competitive one, with more and more companies joining the market every year. Marketing is a powerful tool for selling pet foods and has initiated and expanded fads, that are unsupported by nutritional science, including grain-free and exotic ingredient diets. All this makes it difficult for pet owners to know what is truly the best food for their pet (as opposed to the one with the loudest or most attractive marketing). Because of the thousands of diet choices, the creative and persuasive advertising, and the vocal opinions on the internet, pet owners aren’t able to know if the diets they’re feeding have nutritional deficiencies or toxicities – or could potentially even cause heart disease.

    Dilated cardiomyopathy

    Dilated cardiomyopathy or DCM occurs in cats where it is associated with a nutritional deficiency (see below). DCM is a serious disease of the heart muscle which causes the heart to beat more weakly and to enlarge. DCM can result in abnormal heart rhythms, congestive heart failure (a build-up of fluid in the lungs or abdomen), or sudden death. In dogs, it typically occurs in large- and giant-breeds, such as Doberman pinschers, Boxers, Irish Wolfhounds, and Great Danes, where it is thought to have a genetic component. Recently, some veterinary cardiologists have been reporting increased rates of DCM in dogs – in both the typical breeds and in breeds not usually associated with DCM, such as Miniature Schnauzers or French Bulldogs. There is suspicion that the disease is associated with eating boutique or grain-free diets, with some of the dogs improving when their diets are changed. The US Food and Drug Administration (FDA) Center for Veterinary Medicine and veterinary cardiologists are currently investigating this issue.

    Is diet the cause?

    It’s not yet clear if diet is causing this issue. The first thought was a deficiency of an amino acid called taurine. DCM used to be one of the most common heart diseases in cats but in 1987, it was discovered that feline DCM was caused by insufficient taurine in the diet. It was shown that DCM in cats could be reversed with taurine supplementation, and now all reputable commercial cat foods contain enough taurine to prevent the development of this lethal disease. We still occasionally see taurine deficiency-induced DCM in cats but it is usually when owners are feeding a vegetarian or home-prepared diet, supplemental diets, or a diet made by a manufacturer with inadequate nutritional expertise or quality control.

    In dogs, Golden Retrievers and Cocker Spaniels were found to be at risk for DCM caused by taurine deficiency, and one study showed that Cocker Spaniels with DCM improved when given taurine supplementation. Since then, additional studies have shown associations between dietary factors and taurine deficiency in dogs, such as lamb, rice bran, high fiber diets, and very low protein diets. And certain other breeds were found to be at increased risk for taurine deficiency and DCM, including Newfoundlands, St. Bernards, English Setters, Irish Wolfhounds, and Portuguese Water Dogs. The reasons for taurine deficiency in dogs are not completely understood but could be reduced production of taurine due to dietary deficiency or reduced bioavailability of taurine or its building blocks, increased losses of taurine in the feces, or altered metabolism of taurine in the body.

    No matter what the reason, the number of dogs with taurine deficiency and DCM subjectively appeared to decrease since the early 2000’s. However, recently, some astute cardiologists noticed higher rates of DCM including Golden retrievers and in some atypical dog breeds. They also noticed that both the typical and atypical breeds were more likely to be eating boutique or grain-free diets, and diets with exotic ingredients – kangaroo, lentils, duck, pea, fava bean, buffalo, tapioca, salmon, lamb, barley, bison, venison, and chickpeas. Even some vegan diets have been associated. It has even been seen in dogs eating raw or home-prepared diets.

    So, is this latest rash of DCM caused by taurine deficiency? Most of these affected dogs were eating boutique, grain-free, or exotic ingredient diets. Some of the dogs had low taurine levels and improved with taurine supplementation. But even some of those dogs that were not taurine deficient improved with taurine supplementation and diet change. Fortunately, cardiologists reported the issue to the FDA which is currently investigating this issue. [Note: Dr. Joshua Stern from the University of California Davis is conducting research on taurine deficiency and DCM in Golden Retrievers.

    It’s not so simple

    Currently, it seems that there may be two separate problems occurring – one related to taurine deficiency and a separate and yet unknown problem (with a third group of dogs likely having DCM completely unrelated to diet). Identifying the potential dietary factors contributing to DCM in the non-taurine deficient dogs is more difficult, but the FDA and cardiologists are hard at work trying to solve it. What seems to be consistent is that it does appear to be more likely to occur in dogs eating boutique, grain-free, or exotic ingredient diets.

    Exotic ingredients are on the rise

    Why are pet owners feeding these exotic ingredients? I think is it primarily because pet owners are falling victim to marketing which portrays exotic ingredients as more natural or healthier than typical ingredients. There is no truth to this marketing – and there is no evidence that these ingredients are any more natural or healthier than more typical ingredients. This is just good marketing that preys on our desire to do the best for our pets.

    There is no proof that grain-free is better!

    Many pet owners have, unfortunately, also bought into the grain-free myth. The fact is that food allergies are very uncommon, so there’s no benefit of feeding pet foods containing exotic ingredients. And while grains have been accused on the internet of causing nearly every disease known to dogs, grains do not contribute to any health problems and are used in pet food as a nutritious source of protein, vitamins, and minerals.

    Exotic ingredients are more difficult to use

    Not only are the more exotic ingredients unnecessary, they also require the manufacturer to have much more nutritional expertise to be nutritious and healthy. Exotic ingredients have different nutritional profiles and different digestibility than typical ingredients, and also have the potential to affect the metabolism of other nutrients. For example, the bioavailability and metabolism of taurine is different in a lamb-based diet compared to a chicken-based diet or can be affected by the amount and types of fiber in the diet.

    Small pet food manufacturers might be better at marketing than at nutrition and quality control

    Making high quality, nutritious pet food is not easy! It’s more than using a bunch of tasty-sounding ingredients. The right nutrients in the right proportions have to be in the diet, the effects of processing (or not processing) the food need to be considered, and the effects of all the other ingredients in the food need to be addressed, in addition to ensuring rigorous quality control and extensive testing. Not every manufacturer can do this.

    How could diet be increasing the risk for DCM?

    What is the consistent factor between the diets being implicated in diet-related DCM? It may be related to companies’ inadequate nutritional expertise or rigorous quality control. We published a study several years ago in which we measured a single nutrient in 90 canned cat foods that all claimed to be nutritionally complete and balanced. We found that 15% of the diets were deficient in that nutrient (all of those diets were made by small companies). If companies don’t have the quality control to ensure all nutrients are at the minimum levels, deficiencies could occur and could contribute to DCM. However, these problems could also be related to problems with bioavailability or interaction with other ingredients in the diet (especially the more exotic ingredients, which are not as well studied or understood). And DCM could even be the result of an ingredient in the diet that is toxic to the heart. The FDA is investigating this potential association between diet and DCM but, in the meantime, there are some things you can do.

    What should you do?

    • Reconsider your dog’s diet. If you’re feeding a boutique, grain-free, or exotic ingredient diets, I would reassess whether you could change to a diet with more typical ingredients made by a company with a long track record of producing good quality diets. And do yourself a favor – stop reading the ingredient list! Although this is the most common way owners select their pets’ food, it is the least reliable way to do so. And be careful about currently available pet food rating websites that rank pet foods either on opinion or on based on myths and subjective information. It’s important to use more objective criteria (e.g., research, nutritional expertise, quality control in judging a pet food). The best way to select what is really the best food for your pet is to ensure the manufacturer has excellent nutritional expertise and rigorous quality control standards (see our “Questions you should be asking about your pet’s food” post).
    • If you’re feeding your dog a boutique, grain-free, or exotic ingredient diet, watch for early signs of heart disease – weakness, slowing down, less able to exercise, short of breath, coughing, or fainting. Your veterinarian will listen for a heart murmur or abnormal heart rhythm and may do additional tests (or send you to see a veterinary cardiologist), such as x-rays, blood tests, electrocardiogram, or ultrasound of the heart (echocardiogram).
    • If your dog is diagnosed with DCM and eating one of these diets, I’d recommend the following steps:
      • Ask your veterinarian to test whole blood and plasma taurine levels (I recommend the University of California Davis Amino Acid Laboratory
      • Report it to the FDA. This can be done either online or by telephone. The FDA may be able to help with testing costs for your dog. Reporting it will also help us to identify and solve this current problem.
      • Change your dog’s diet to one made by a well-known reputable company and containing standard ingredients (e.g., chicken, beef, rice, corn, wheat). Changing to a raw or homecooked diet will not protect your dog from this issue (and may increase the risk for other nutritional deficiencies). If your dog requires a homecooked diet or has other medical conditions that require special considerations, be sure to talk to a veterinarian or a veterinary nutritionist (acvn.org) before making a dietary change. You can contact the Cummings Nutrition Service to schedule an appointment (vetnutrition@tufts.edu)
      • Start taurine supplementation. Your veterinarian or veterinary cardiologist can recommend an appropriate dose for your dog. Be sure to use a brand of taurine with good quality control.
      • Any improvements in your dog’s DCM can take 3-6 months. Your dog will need regular monitoring and may require heart medications during this time. There’s no guarantee she’ll improve but is certainly worth a try.
      • Make sure your dog is getting the best combination of medications to treat his heart disease, as this can make a difference in his outcome. You can find a board-certified veterinary cardiologist near you on this website: Veterinary Specialist Directory - Find Veterinary Specialist - VetSpecialists.com
    Sometimes, the changes we make in pet nutrition advance our knowledge and the health of our pets. In other cases, we can take a step in the wrong direction when the marketing outpaces the science. Hopefully, identifying this current issue will allow us to set a new, more science-based approach to the optimal nutrition of our pets.

    For more information about heart disease in dogs, please see our HeartSmart website.



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    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.
     
  3. strykerdobe

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    [Note: Dr. Joshua Stern from the University of California Davis is conducting research on taurine deficiency and DCM in Golden Retrievers.

    Researchers getting closer to understanding dietary taurine and heart disease in dogs

    Link between taurine deficiency and heart disease first discovered in cats


    In 1987, a remarkable article was published in the prestigious journal, Science. Veterinarians in the School of Veterinary Medicine at University of California, Davis, reported that a deficiency of taurine, an amino acid, was responsible for the development of dilated cardiomyopathy (DCM), a form of heart muscle disease, in cats.

    The veterinary community was stunned; not only because this was a new report of a dietary nutrient and heart disease, but that the disease was reversible when taurine was added to the diet of affected cats. This makes perfect sense because taurine is an amino acid that is abundant in meat so carnivores (like cats) never developed the ability to make their own taurine and must get it from their diet. Adjustments to commercial cat diets soon followed, and since publication of the article 30 years ago, dilated cardiomyopathy in domestic cats has almost completely disappeared.

    As omnivores, the story for dogs isn’t quite so elegant.

    Soon after the Science article was published, there was a flurry of research looking for a similar link between nutrition and DCM in other species, including dogs. However, it quickly became apparent to veterinary cardiologists that DCM in dogs was not going to have a tidy resolution.

    Throughout the late 1980s and continuing through the 1990s, many veterinary cardiologists looked at a variety of nutrients, including taurine, in their canine patients with dilated cardiomyopathy. Scattered reports of taurine deficient dogs with heart disease appeared in the veterinary literature, but the vast majority of dogs with DCM had normal taurine levels. However, recent reports in golden retrievers have veterinary cardiologists revisiting taurine and DCM in this breed.

    Dilated cardiomyopathy in dogs – the basics

    The heart is a complicated organ with lots of moving parts. The heart has valves that help direct the flow of blood into and out of the heart; muscle that contracts to pump blood throughout the body; and blood vessels that supply the heart with nutrients and remove wastes. A variety of diseases can affect any of these parts. Cardiomyopathies are a group of diseases that affect the heart muscle, and DCM is one form of this type of problem.

    In DCM, the heart muscle weakens. This weakening can happen for a variety of reasons, but regardless of the underlying cause, the end result is a thinning of the walls of the heart. The heart becomes more like a flabby balloon than a powerful, muscular organ. The heart simply cannot pump blood efficiently, and lots of blood remains in the heart with each beat. At first, the body can try to compensate for poor blood flow, but eventually these mechanisms are overwhelmed, and the patient develops heart failure. Medications can help control the heart failure, but therapy can’t stop the relentless progression of the disease.

    There are many causes of DCM, While DCM is classically thought of as an inherited disease of the heart muscle, there are many causes of heart chamber dilation and reduced heart function that can mimic DCM.

    Other causes of cardiomyopathy include toxicity associated with the chemotherapeutic agent doxorubicin, and deficiencies of the nutrients taurine and carnitine.

    Taurine deficiency and DCM in dogs

    Unfortunately, many dog breeds with high incidence of DCM, such as the Doberman pinscher, didn’t have documented taurine deficiency but rather an inherited form of this disease. However, in some breeds, a link to taurine deficiency was discovered.

    In the mid-1990s, the cardiology group at University of California, Davis, spearheaded a large, multi-center study looking at DCM in American cocker spaniels. They documented low taurine levels in many of their study dogs, and they found that once taurine was supplemented in the diet, heart function improved, sometimes significantly.

    In 2003, researchers reported that some Newfoundland dogs had reversible DCM associated with taurine deficiency, and in 2005, another team published a report on a family of golden retrievers with taurine-deficiency and reversible DCM. Based on these reports, veterinary cardiologists recommended that taurine levels be tested in dogs diagnosed with cardiomyopathy, particularly if they were a breed not usually associated with the disease, or were an American cocker spaniel, Newfoundland or golden retriever.

    As cardiologists continued to document cases of DCM associated with low blood taurine levels, they continued to search for a common thread that tied these cases together. In many cases, diet was believed to play a major role in the disease.

    The role of diet in taurine deficiency and DCM

    It was logical for veterinary cardiologists to focus on diet as the root cause of DCM related to taurine deficiency. For many dogs with DCM, common dietary trends emerged that strongly correlated with the disease.

    “Diet plays a huge role in this condition,” said Dr. Josh Stern, a Morris Animal Foundation-funded researcher, owner of a Golden Retriever Lifetime Study participant (Lira, Hero #203), and veterinary cardiologist studying this disease. “Home-cooked diets have been implicated in this problem, as well as small batch, boutique dog foods.”

    Other studies have linked high fiber, lamb and rice meal, and very-low-protein diets to the condition.

    Dr. Stern said veterinary cardiologists were trained to measure taurine levels in dogs diagnosed with DCM if they weren’t a breed known to have a genetic link to the disease, such as Doberman pinschers or boxers. However, a recent upswing in the number of DCM cases in dogs has put veterinarians on the alert for the disease. In addition, one breed appears to have a big surge in this problem – golden retrievers.

    Taurine deficiency and DCM in golden retrievers – an emerging problem?

    A recent surge in the number of golden retrievers diagnosed with taurine deficiency and DCM has many golden retriever owners and breeders concerned. Although taurine deficiency DCM has been reported in the breed, some cardiologists are seeing more golden retrievers with the disease than normal.

    This perceived uptick in cases spurred Dr. Stern to look more closely at this phenomenon. As a veterinary cardiologist and golden retriever owner, this disease hits close to home.
    Dr. Stern has been collecting blood samples and cardiac ultrasound data from golden retrievers both with and without the disease. Although diet plays a role in the golden retrievers, Dr. Stern suspects genetic factors might be involved in increasing the risk of this conditions within the golden retrievers breed.

    “I suspect that golden retrievers might have something in their genetic make-up that makes them less efficient at making taurine,” said Dr. Stern. “Couple that with certain diets, and you’ve given them a double hit. If you feed them a diet that has fewer building blocks for taurine or a food component that inhibits this synthesis, they pop up with DCM.”

    Dr. Stern is gathering data and hopes to publish his initial findings soon. His hope is that he can offer scientifically based guidelines for golden retriever owners regarding diet and DCM in this breed. Dr. Stern will be drawing blood samples for taurine measurement at the upcoming Golden Retriever Club of America National Specialty, and hopes to add to his already impressive database.

    What’s next?

    The good news is that DCM secondary to taurine deficiency has a very good long-term prognosis. Taurine supplementation often reverses the heart muscle abnormalities, and many dogs can be completely weaned off heart medications.

    Veterinary cardiologists are spreading the word about taurine and DCM in dogs, and researchers such as Dr. Stern are piecing together data to get a clearer picture about this problem. Identifying a genetic abnormality associated with the disease could lead to a diagnostic test which might identify at risk dogs.

    Getting the word out to owners also is important. Knowing breed dispositions for disease helps both owners and their veterinary health care team make the best decisions for each patient.

    Is the Golden Retriever Lifetime Study looking at taurine-deficient dilated cardiomyopathy?

    Taurine is not currently measured routinely in enrolled dogs. However, banked samples are available to researchers, and the study team continually monitors disease information as it’s received. If you think your dog is at risk or clinically affected, please work with your family veterinarian to determine what’s best for your dog.

    Morris Animal Foundation has been a leader in canine heart disease research for more than 50 years. Beginning with our first grant to define what a normal canine electrocardiogram looks like to our most recent grants identifying genetic markers for heart disease, the Foundation has been deeply committed to advancing cardiovascular research in dogs. Read about our latest research grants as well as our history of heart disease research.

    Learn more about Dr. Stern’s research and submit samples to his laboratory for taurine measurement.
     
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