Finding the right diet for an EPI dog is usually the final piece of the puzzle to getting your EPI dog healthy..... however.... sometimes this is easier said then done! Unfortunately not all EPI dogs respond equally to the same food. What we DO know is that fiber content NEEDS to be kept at a minimum. The variance from one dog to another may be due to the fact that each dog's gut condition varies from one to another probably causing different levels of need. Just to give you an example of how confusing this can be... but that you CAN find the right food.... after some trial and error, is the following post from one of our EPI FORUM members, Alan and his EPI dog "Brandy":
Update - success!
As I said above, by dropping the enzyme to 1/2tsp I had semi-success with the stool trying to firm up. But the real answer was in fact the FOOD!
Received the Single Protein (Fish) Earthborn Coastal Catch Grain Free on 6/4/12 and within one day the poop went from semi-good to perfectly formed! So, we are back in Business!
So, the problems were.....
1. Bad TOTW started the problem.
2. Earthborn Primitive Nature (3 Protein) did not work with her.
3. Started Tylan to be sure.
4. Reduced Enzymes from 1tsp to 1/2tsp and helped a bit.
5. Got her on Earthborn Coastal Catch (single Protein - fish).
6. Finally complete success....poop back to normal, continuing to gain weight.
Next thing is to let the Tylan complete it's course and see if all remains good.
"I believe the inputs & results just confirm that all variables have to be re-considered when a problem arises."
Feeding less food but more often helps...
If possible with your human family "schedule", when first diagnosed with EPI, it seems to help if the EPI dog can be fed 2-3 times a day, sometimes 4 temporarily. Depending on the breed and size of dog, feed (an example) 1 cup of food each time…with 1 tsp of powdered enzyme, or equal amount of enzyme potency in another form. After the EPI comes under control, usually the feedings can be reduced back to twice a day to accommodate the human’s “life-stye”.
What an EPI dog responds best to depends on the individual EPI dog. Some respond best to raw food diets, However, many EPI dogs do just well on dry kibble, especially if the kibble or canned food is low fiber (dog food companies have coined some of these foods as "grain free" although you do have to be careful, read the ingredients and variation in response is often because of what "type" of fiber the manufacturer is including in the food. OR.... some dogs do just fine on the food they always were on now that enzymes are included. Most however do respond best to low fiber...but some only do well once a tiny amount of fiber is added (this is where what type of fiber comes into play).
PRETTY CONFUSING, EH?!!!!!!!!!!!!!!!
BUT.....since fiber(for and explanation why, see below) is most difficult for an EPI dog to digest we strongly recommend starting with foods that have 4% or less fiber content in them. The fiber that appears to be most tolerated by an EPI dog, is usually a highly digestible food that is low in poorly-fermentable fiber (to understand the difference in fibers (please read the section on fiber types on the fiber page) http://www.epi4dogs.com/fiberinthediet.htm. So, although not the only solution, it is usually most effective to start first with a low fiber food (coined "grain-free" by dog food companies) ... although PLEASE read the label and try to start with a food that has 4% or less fiber content in it..
When using replacement enzymes, the enzymes need to be "room temperature". Make sure the food is room temperature too. Cold makes the enzymes inactive and heat destroys it. Many folks start with cold refrigerated meat and put a little hot water in a bowl with the cold meat and mix until the meat becomes room temperature. AFTER this "sauce" is room temperature or lukewarm, THEN add the powdered enzymes or serve with enteric coated enzymes. If you are using just water with kibble be careful of the water temperature - - warm water anywhere between 86-130 degrees F temperature is a good range, but temperatures any higher than 130 degrees will destroy the enzymes.
My personal opinion is to just say use "room-temperature" water... which avoids any mis-communication of too warm or too cold.
If you are using enteric coated capsule enzymes the recommended preparation is to give the capsule whole with the food. Some do open the capsule and sprinkle on top of the food but DO NOT mix these tiny pellets in the food and DO NOT let the food incubate with the enteric capsule.
If you are using the powdered form of enzymes, the rule of thumb is to start off with 1 tsp of powdered enzymes to approx 1 cup of “room temperature” food, mix and let sit for a minimum of 20 minutes or more. Many vets and publications state that it is not necessary to let the enzymes sit on the food, but unfortunately, some dogs develop mouth sores or mouth bleeds from the enzymes unless the food is allowed to sit and soften giving the enzymes more food volume to cover - -consequently diluting the caustic properties of the enzymes eliminating mouth sores. Usually mouth sores can be corrected by reducing the amount of enzymes given, but it has also been noted that when mixed very well and allowed to "incubate" (sit and soften) , the mouth sores also go away http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1461413 . Another reason for "incubating" is because some dogs just do not do well until the owners prepare their meal this way (discussed further down). No matter how you decide to prepare the food, it is imperative to thoroughly mix powdered enzymes in the food.
Many EPI owners observed that when enzymes are mixed into the food and allowed to "incubate" stool elimination was less voluminous, which led pet owners to assume that the enzymes were breaking down the food in the bowl...if allowed to incubate. In reality, enzymes outside the body cannot sufficiently break down the food (as previously thought by many) without being ingested- -too many other "things" need to interact with the replacement enzymes during the digestion process in order to fully break down the food. Bio-chemicals, sustained gut temperature, bile salts, proper PH & micellar lipids (both of which are much lower than normal in the EPI dog than a normal dog), and additional enzymatic catalysts are also needed to aid in the breakdown. Although digestion of most nutrients in the small intestine is extensively carried out by enzymes secreted by the pancreas which are lacking in the EPI dog, there are also enzymes located at the brush border membrane of the enterocytes which are responsible for the completion of this nutrient process. In addition, there are complex pathways utilized in breakdown and absorption. Enzyme activation is very complicated, dependent on a multitude of biological and chemical interactions. Even today much still remains to be learned about enzyme activity. FOR AN IN-DEPTH EXPLANATION OF THE DOG'S DIGESTIVE SYSTEM - -VISIT THE "ROLE OF NUTRITION" page.
A study by Dr. Guy Pidgeon http://www.vetmed.ucdavis.edu/executive/council/pidgeon.cfm designed to determine if pancreatic replacement enzymes needed to be incubated on food prior ingesting. There was no difference in either the "incubated food" and the "non-incubated food" fat content output in the dog's stool elimination. Conclusion from this particular study was that incubation is not necessary.
So according to research, it is not absolutely necessary to incubate the enzymes (powdered enzymes) on the food, HOWEVER many EPI owners claim differently. Incubation has been the turning point for some "problematic" EPI dogs and it does help alleviate mouth sores if the dog is prone to this.
So does one incubate or not???? You, the EPI owner ultimately needs to determine which method works best for your individual dog.....
Regarding grinding the food or softening the food is sometimes also said not be necessary, (for example, when feeding hard kibble) by grinding the food you do allow more surface area of the food to be covered (touched) by the enzymes. Again, although not a requirement, it has been noted that this technique has benefited "problematic" EPI dogs especially when first embarking on the EPI journey, but many owners have found that shortly afterwards it does not seem to make any difference whether the food is ground or not. So, once again, how you prepare the food will depend on the individual EPI dog. Use the technique that works best for your dog.
Personally, when I first started enzyme treatment for my EPI dog, I did not see results for two weeks until after (1) I served everything room temperature
(2) l mixed the enzymes well in the food and let sit for 20 minutes
(3) I added 20% raw food to the serving
(4) my dog was on antibiotics already for two weeks to combat SIBO.
It took two weeks before all these things to took effect and my dog started showing improvement.... For others, sometimes it only takes a few days for any noticeable improvement, and for yet others it may take months. Don't be discouraged!!! Things should work out once you find the right balance for your dog. It will be 6 years since my dog was first diagnosed with EPI. She achieved stabilization 3 months after diagnosis. I no longer let the enzymes "incubate" for 20+ minutes BUT I do mix the enzymes in the room temperature food very well, off-and-on for 10-20 minutes... this has worked well for my dog. Everyone needs to make their own decision on how to feed their dog....do what works for you and your dog!
Why FIBER should be limited in an EPI dog's diet (EPI: Diagnosis & Treatment by J Enrique Domínguez-Muñoz, pub Feb 16, 2011)
A fibre-rich diet appears to increase pancreatic lipase secretion, but also inhibits pancreatic lipase activity by more than 50%,11 so its use is under discussion and cannot be considered as adequate.
11.Effect of dietary fiber on pancreatic enzyme activity in vitro. Gastroenterology 1982; 82: 918–24. , , .
Why FAT should not be limited in an EPI dog's diet: (EPI: Diagnosis & Treatment by J Enrique Domínguez-Muñoz, pub Feb 16, 2011)
Classically, the initial approach to patients with pancreatic exocrine insufficiency is to restrict fat intake in an attempt to reduce steatorrhea. A diet containing less than 20 g fat daily is thus generally recommended in this context. Nevertheless, restriction of fat intake is linked to insufficient intake of fat-soluble vitamins, which are already malabsorbed in patients with pancreatic exocrine insufficiency.6 In addition, studies on the metabolism of both endogenous and exogenous enzymes during small intestinal transit show that the half-life of enzyme activity is enhanced by the presence of their respective substrates.9 That means that maintenance of lipase activity during intestinal transit requires the presence of dietary triglycerides. Actually, it was demonstrated in an experimental model of pancreatic exocrine insufficiency in dogs that fat digestion and absorption was higher when enzyme supplements were taken together with a high-fat diet compared with a low-fat diet.10 As a consequence, fat restriction should no longer be considered as a rule in the management of patients with pancreatic exocrine insufficiency.
6. 13C-mixed triglyceride breath test to assess oral enzyme substitution therapy in patients with chronic pancreatitis. Clin. Gastroenterol. Hepatol. 2007; 5: 484–8. , , , .
The following is from the: New Paradigms in Dietary Management of GI Diseases - V.C. Biourge, C. Kirk – 2006 North American Veterinary Conference
FAT: Traditionally, diets low in fat have been recommended for patients with GI disease . The postulate behind this recommendation is that lipid digestion and absorption is a complex process easily disturbed in pathological condition. Moreover, bacteria in the intestinal tract can metabolize undigested fat to hydroxy-fatty acids which leads to secretory diarrhea in the large intestine . Bacteria also deconjugate bile acids further impairing fat digestion and absorption .
Several field observations and studies disagree with the postulate that pets with GI disease do not tolerate high level of fat (>40 % of their calories from fat) in their diet. Firstly the GI tract of dogs and cats is very well suited for the digestion of fat, and fat in those species is the most digestible nutrient (>90 % digestibility). Secondly, since the mid-1980s, veterinarians and owners have observed that the quality of the feces of GI-sensitive pets was dramatically improved on so-called "premium" rather than "super-premium" diets. A specificity of those diets is their high fat content (> 17 % fat on a dry matter basis). In a canine model of pancreatic insufficiency, dogs better tolerated a diet with 20% than 8% fat . The authors concluded that a better conservation of pancreatic enzymes during gastric transit could explain this observation. Forty-nine dogs with a confirmed diagnosis of chronic intestinal disease (exocrine pancreatic insufficiency, inflammatory bowel disease, bacterial overgrowth, acute or chronic gastritis) were fed a diet containing a high concentration of fat (> 20 % on a dry matter basis) [12,13,15,17]. The benefits of the high fat diet were readily apparent with improvements in appetite, weight gain, and resolution of clinical signs of vomiting and diarrhea noted at 15 and 30 days following institution of dietary therapy.
High fat diet are energy dense and thus might be of interest in many patients with GI diseases, especially in chronic disease and exocrine pancreatic insufficiency when patients have a hard time to maintain their body condition. Not all pets with GI diseases will benefit from a high fat, highly digestible diet. Those diets are contraindicated in pancreatitis or a history of pancreatitis, lymphangiectasia, exudative enteropathy as well as in cases of steatorhea . To maximize tolerance, a transition of 3 to 5 days is recommended when changing from a low to a high fat diet.
The following EPI paper is by Edward J. Hall presented in 2003 to the World Small Animal Veterinary Association. For complete article, please go to the following link: http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2003&PID=6553&O=Generic
Pathophysiology of malabsorption - The lack of pancreatic amylase, lipase and proteases results in maldigestion and hence malabsorption. The effect on fat digestion is the most profound as the majority of lipase is derived from the pancreas whereas there are brush border peptidases and saccharidases. The faeces are often voluminous and putty-like as the osmotic effect of undigested food is not high. The occurrence of watery diarrhoea suggests secondary bacterial overgrowth. A lack of enzymes and enriched environment allow bacterial proliferation, resulting in bile salt deconjugation and fatty acid hydroxylation, both causing colonic secretion. In addition, there may be concurrent inflammatory bowel disease.
The mainstay of treatment of EPI is replacement of pancreatic enzymes by oral enzyme extracts. Fresh (frozen) pancreas is an excellent source of enzymes but there is often limited availability. Approximately 100-150 g of fresh bovine or porcine pancreas is fed per meal. Of the commercial enzyme preparations available, uncoated powders have been shown to work best. Enteric-coated preparations may not dissolve because the duodenal pH is not sufficiently alkaline to dissolve the coating. However, the uncoated powders are unpleasant to handle, and may cause dermatitis of the lips as well as give the patient an unpleasant odour. The powder should be mixed with food, but pre-incubation before feeding is unnecessary.
Diet - A highly digestible food that is high in non-complex carbohydrate and protein is ideal. Historically, a fat restricted diet has been recommended. However, studies have shown that this is of no benefit, and indeed may prevent the patient gaining weight. For there is experimental evidence to show that the percentage fat absorption increases the higher the percentage of fat that is fed. Therefore, current recommendations are merely to give a good quality food. Frequent small meals are also often recommended. However, as enzyme must be given with each, it becomes counter-productive to feed more than three meals per day. In order to gain weight the patient should be fed up to 150% of the maintenance requirements of its ideal body weight in three divided meals. The third meal is dropped when the target weight is reached.
Enzymes - Most commonly, the owner tries to save money by giving inadequate amounts of enzyme. It should be explained that this is a false economy, especially in the early stages of treatment, but that ultimately the dosage may be reduced with continuing clinical efficacy. Secondary bacterial overgrowth must also be addressed. Finally, concurrent inflammatory bowel disease may prevent treatment success, but as immunosuppression more commonly causes the signs of EPI to worsen, it is prudent to obtain histological proof before commencing glucocorticoids.
My biggest piece of advice for new EPI owners when first embarking on this EPI journey is to start with the basic rules of treatment and Keep a Journal! Find what produces normal looking poops for YOUR dog by trial and error with one change at a time. Once the dog is stable on enzymes do not forever restrict your dog by these rules, slowly try increasing a little more fat in the diet, slowly try not having to soften the food so much for such a long time, slowly try to reduce the amount of enzymes you give your dog once he/she is stable.... slowly try different foods/brands, etc. if it works for your dog, great!
If something works, GREAT! If something does not work, that is fine also.... just go back to what does work for your dog.
Once an EPI dog is stable, the goal is to (1) reduce the amount of enzymes given to the smallest dose possible without causing a flare-up (2) feed as much of a normal balanced diet without causing a flare-up. (I personally was able to reduce 1 tsp of enzymes to 1/2 tsp of enzymes once my dog became stable)It is so hard for EPI owners to watch their dogs struggle. My hope is that by having the most recent research/advice coupled with an accumulation of EPI hands-on-experience with enzyme/diet management that it will help give new EPI owners enough of an overview of all "possibilities" allowing them to make the best decision for their individual dog.
Another suggested excellent treatment for EPI is raw bovine or porcine pancreas, however this is another perfect world scenario. It all depends on where you live ... whether or not raw pancreas is obtainable due to local agricultural laws... and whether it will agree with your dog or not. Sometimes raw pancreas can be purchased from a slaughterhouse. If you have trouble doing this, ask your state meat inspectors that if you get a letter from your vet explaining why you need the raw pancreas, would that help allow you to purchase the fresh pancreas. The suggested raw pancreas formula is 3 to 4 ounces of raw pancreas for a 44 lb dog. It can be frozen (up to 3 months), but must be thawed to room temperature. Let thaw naturally. Never heat, cook or microwave pancreatic enzymes whether fresh or manufactured.
If the dog refuses to eat the food because of the added enzymes, there are many “tricks” to camouflage the smell via green tripe, sprinkled parmesan cheese on the food, cover with a few tablespoons of BBQ sauce/tomato sauce, or add pureed chicken/beef liver, etc. The stinky (but very healthy) Green-tripe may be purchased dog food specialty stores or it may be ordered from:
(UNITED KINGDOM) http://www.butcherspetcare.com/butchers/tripe/
Powdered enzymes may be kept in tightly sealed double plastic bags and then in a sealed contained in the refrigerator to lengthen the longevity of the stored enzyme, however, it is very important to be kept dry since moisture ruins the enzymes.
Always introduce only 1 change/addition at a time... once that is tolerated well.... check the stools formation.....if they become loose with the new addition to the diet, reduce the amount given. If stools still do not firm-up, eliminate that particular protein from the diet.
If you can feed all raw meat (ground-up) most EPI dogs do best on that, not all, but most. Organ meats are excellent, trim "excessive" fat from all meat. Some people cannot or are uncomfortable with an all raw diet … because of the expense/availability/process/feel it further compromises an already compromised dog. Some just do a combination of dry and raw meat or simmered/cooked meat. This is an individual choice based on the dog's tolerance and the owner's preference.
Meats that can be used include: beef, chicken (remove all skin), pork (not cured pork!), venison, lamb, and fish such as salmon and jack mackeral. When giving fish from a can, be wary of the salt content. Other proteins that can be given, but not limited to are: cottage cheese, eggs, yogurt, etc. But once again, this is trial and error.
Organ meats should be given if preparing a home meal whether cooked or canned vs. a commercially prepared diet. Start with 10 to 15% ratio of organ meats. If this is too rich for your individual dog, reduce the amount. Some EPI dogs have been known to only be able to tolerate 1% of organ meats. Others tolerate 15% without a problem.
Again, always introduce only 1 change or addition to the diet at a time. When adding vegetables, the better digested are the very finely ground (or mashed) and thoroughly cooked. Veggies such as the "root" vegetables, like sweet potatoes (better than white potatoes), turnips, beets or carrots are "usually" well tolerated. Vegetables that grow on the ground are also good like squash or pumpkin. Broccoli, green beans, etc are also good to mix in, however, as with anything else, the percentage of any vegetable that can be tolerated by an EPI dog can range anywhere between 0% to as much as 30+% of the diet. (side note: if dog is prone to crystals... do not feed broccoli)
If you are preparing your own meals for your dog, bones need to be included. But for the EPI dog they tend not to be able to handle the commonly recommended 20 to 25% bone matter in a diet. Instead, cut this percentage in half and see how well it is tolerated. Per usual, it's all about the poop! If the stools are or have a lot of white to them, it means they are getting too much bone and cannot digest it. Cut back. Some will have loose stools. Cut back. Again this is all trial and error for your individual dog. Meaty bones can also be given occasionally, as long as you trim the fat and as long as your EPI dog can tolerate it.
NO TREATS !!! or at least not until the EPI dog is stable. Some dogs, once stable, are able to tolerate some treats …for example, freeze dried liver, baked liver, hearts, but be careful of anything with grain/heavy long-chain fats in it. On the other hand, some dogs can never have any kind of treats, even real meats unless it is treated with enzymes. Some folks just resort to a special toy as a reward/treat instead. This all depends on the individual EPI dog.
If you dog does not start to gain weight …. please have the cobalamin and folate levels checked. Actually, if you can have the B12 levels checked at the same time as the cTLI test done, all the better since they are both blood tests and this will save you money by doing the tests together. Because a lot of these dogs no longer manufacture B12… they might need B12 shots for a regular period of time until stable and then they just need to be maintained.
Wild Salmon Oil is used with great success by many EPI owners. Since some of these dogs may have other gastrointestinal issues (known or sometimes not known by owner of vet) and may not tolerate a lot of fat, their skin and coats become dry, itchy and brittle. Administering wild salmon oil is most often well tolerated by an EPI dog and will help alleviate these issues. In addition, since wild salmon oil is an excellent source of omega 3, it also helps reduce inflammation. * Always start off with less than the recommended dose*
Medium Chain Fats
Administer quality (cold pressed and unrefined) coconut oil. Build up to 1 tsp a day or more depending on breed and body weight. These are medium chain triglyceride fats that most EPI dogs can handle and benefit from especially since some EPI dogs are restricted from other fats. A body void of all fats can cause a whole host of other problems and conditions. Some EPI owners alternate the oils... one day wild salmon oil, the next day coconut oil.
Vitamins, Minerals and Herbs
Because of the lack of absorption, it has been observed that in humans with EPI there is a zinc depletion. For this reason, many EPI owners administer zinc supplements to their dogs. ALWAYS GIVE ZINC UNDER THE GUIDANCE OF A VET!!! In addition vitamin E, also is deficient due to the lack of absorption so many owners administer vitamin E also AGAIN, WITH VITAMIN E CHECK WITH YOUR VET FOR THE PROPER DOSE AND FREQUENCY. One herb that is commonly used among EPI'rs is slippery elm to help aid with the tender, sore intestine when first diagnosed with EPI or when a SIBO flare-up occurs http://www.umm.edu/altmed/articles/slippery-elm-000274.htm Slippery elm coats the intestines with it's mucilage properties allowing the tender area to heal. This is used for a short period or intermittently for healing. (here is another good site that talks about Slippery Elm dosage http://www.holvet.net/slippery_soup.html There are no ill side effects of slippery elm except do not give slippery elm when administering an antibiotic because the mucus properties of slippery elm will lessen the effectiveness of the antibiotic. If after treatment with enzymes, antibiotics, B12, and the dog continues to have digestive issues, some EPI people add L-Glutamine supplement to the diet regimen. L-Glutamine is often prescribed by vets to aid dogs with IBD (inflammatory bowel disorder). 50% claim that it does help the dog while the other 50% claim that there is no change. But it is well worth trying. It is also common for a dog to be battling IBD along with EPI, hence the continued intestinal issues
Getting the Weight Back
Many folks do not know how much to feed their dog when it has lost so much weight. Each dog is different, but as a starting point, try feeding the newly diagnosed EPI dog 150% of whatever percentage of food is normally required for that dog's size. As long as the Cobalamin & Folate levels and SIBO are under control ... what most often happens is that the dog will let you know when it no longer needs 150% of it's required food intake. It will start to leave food in the bowl. This is one of the ways that they let you know their body no longer requires being fed 150% .
Keep a journal!!! Record every change every addition/deletion whether it is food, new food, the amount of a protein, omega 3, vitamins, per/probiotics, minerals, medicine, vaccines, new situations/stress, etc. Even though EPI can be managed, many times a flare-up happens and only through record keeping can you make it easier on yourself finding the culprit/cause of the setback and get back on the road to recovery!
If you are interested in preparing a home-cooked meal for your dog, the following are excellent guidelines from two sources:
The Ohio State College of Veterinary Medicine:
(this site has some excellent resources)
The following tables contain some nutrient parameters of the veterinary foods available in our hospital. The diets are classified as veterinary foods because they are to be used only under veterinary supervision. Commercially available foods also may be appropriate for some of the conditions listed (as described where appropriate in the tables). The tables are based on the most commonly recognized nutrient modifications for a particular disease. This format was chosen because veterinarians commonly make the diagnosis, decide on necessary nutrient modifications, then choose the most appropriate diet for their particular patient. Some foods are used for more conditions than are mentioned in the tables.
All tables contain a title, brief introduction if necessary, a table of indications, contraindications, major nutrient modifications, and commercial substitutions if available. The nutrient tables are ordered by dog, canned and dry followed by cat, canned and dry. Table columns include:
To estimate the % of kcal as protein, or carbohydrate, multiply the grams by 4; for fat multiply by 9.
All data was obtained from manufacturer’s advertising literature available in the Autumn of 1998.
The data in the tables can be used to compare the nutrient content of different diets and, to compare nutrient content of a diet with the nutrient needs of a patient:
To compare diets:
To compare nutrient content of a diet with the nutrient needs of a patient, use the amount per unit body weight per day - because many veterinary foods contain restricted amounts of some nutrients, one must compare the number of grams of nutrient in the amount of food consumed with the needs of the animal to ensure that deficiencies are avoided. This is of practical concern for protein and sodium. For example, the minimum protein intake to sustain protein reserves in dogs is approximately 1 gram per pound per day. If a dog with advanced renal failure consumes 20 kcal per pound body weight per day, the diet would need to contain at least 5 grams per 100 kcal to provide enough protein to meet the dog’s needs. If the dog consumed 30 kcal per pound body weight per day, only 3.3 grams protein per 100 kcal diet would be necessary.
Because diet therapy for a number of diseases consists of restriction of nutrient intake, and because many (most?) patients with nutrient-sensitive diseases are older and don’t eat much, the risk of nutrient deficiencies must be considered. This is particularly true when the therapy is anticipated to continue for months or years. For these reasons, estimates of daily minimum intakes of some essential nutrients (amount per pound body weight) for adult, average-sized pets are presented below:
|Protein||1 gm||2 gm|
Veterinary foods often are sold as containing "high" or "low" levels of some nutrients. Currently, no generally accepted definition of these terms exists. My own definitions, many extrapolated from humans, follow:
Definition of "high" and "low" nutrient densities
|Low calorie||< 3 kcal/gm dry matter||< 3 kcal/gm dry matter|
|High calorie||>4.5 kcal/gm dry matter||>4.5 kcal/gm dry matter|
|Low protein||<5 gm/100 kcal||<7 gm/100 kcal|
|High protein||>8 gm/100 kcal||>10 gm/100 kcal|
|Low fat||<2 gm/100 kcal||<2 gm/100 kcal|
|High fat||>5 gm/100 kcal||>5 gm/100 kcal|
|Low fiber||<0.25 gm/100 kcal||<0.25 gm/100 kcal|
|High fiber||>1.5 gm/100 kcal||>1.5 gm/100 kcal|
|Low sodium||<100 mg/100 kcal||<100 mg/100 kcal|
General feeding suggestions: Remember, It is always better for a patient to eat some of the "wrong" diet than none of the "right" diet!
and the Merck Manual on Canine Nutrition:
Dogs are a biologically diverse species, with normal body weight of 4-80 kg (2-175 lb). Normal birth weight of pups depends on breed type (120 to 550 g). The first 2 wk of a puppy’s life is spent eating, seeking warmth, and sleeping. External food sources beyond bitch’s milk is rarely needed unless the bitch cannot produce enough milk or the puppy is orphaned. In these cases, the puppy must be hand-reared. Growth rates of puppies are rapid for the first 5 mo; in this period, pups gain an average of 2-4 g/day/kg of their anticipated adult weight. The growth rate begins to plateau after 6 mo, and growth may be completed by 9-12 mo of age in small breeds and by 12-18 mo in large breeds. By comparison, the average mature body weight of domestic cats is 3.2 kg (7 lb) for toms, and 2.8 kg (6 lb) for queens. Normal birth weight of kittens is 90-100 g. The growth rate is exceptionally rapid for the first 3-4 mo, and kittens gain 50-100 g/wk. The growth rate begins to plateau at 150-160 days of age, and growth is completed within 200-220 days.
|Dogs and cats require specific dietary nutrient concentrations based on their life stage. The Association of American Feed Control Officials (AAFCO) publishes dog and cat nutrient profiles for growth, maintenance, and reproduction. These are based in part on the 1974 and 1985 National Research Council (NRC) nutrient requirements for these species (Table: AAFCO Nutrient Requirements for Dogs and Table: AAFCO Nutrient Requirements for Cats). Updated NRC requirements have recently been established and will be published soon. These provide a comprehensive review of the nutrient requirements for various life stages and may be used by AAFCO to modify their profiles.|
|In developed countries, nutritional diseases are rarely seen in dogs and cats especially when they are fed good quality commercial rations or nutritionally balanced homemade diets. Dog or cat foods or homemade diets derived from a single food item are inadequate. For example, feeding predominately meat or even an exclusive hamburger and rice diet to dogs can induce calcium deficiency and secondary hypoparathyroidism. Feeding raw, freshwater fish to cats can induce a thiamine deficiency. Feeding liver can induce a vitamin A toxicity in both dogs and cats. Malnutrition has been seen in dogs and cats fed “natural,” “organic,” or “vegetarian” diets produced by owners with good intentions, and most published recipes have been only crudely balanced (by computer) using nutrient averages. Because the palatability, digestibility, and safety of these recipes have not been adequately or scientifically tested, it is difficult to characterize all of these homemade diets. Generally, most formulations contain excessive protein and phosphorus and are deficient in calcium, vitamin E, and microminerals such as copper, zinc, and potassium. Also, the energy density of these diets may be unbalanced relative to the other nutrients. Commonly used meat and carbohydrate ingredients contain more phosphorus than calcium. Homemade feline diets that are not actually deficient in fat or energy usually contain a vegetable oil that cats do not find palatable; therefore, less food is eaten causing a calorie deficiency. Rarely are homemade diets balanced for microminerals or vitamins.|
|Some nutritional diseases are seen secondary to other pathologic conditions or anorexia, or both. Owner neglect is also a frequent contributing factor in malnutrition.|
|Carbohydrates and Crude Fiber:|
The following are some examples of EPI owners and the raw and/or prepared meals... the food type percentage, ingredients used, etc. (taken from epi4dogs FORUM thread:
1. Hi everyone, i have intended to start this thread weeks ago, but am just now getting around to doing it!!!!.... anyway.... what i am looking is for folks to share the ingredients of what is in the home-made-meals that they prepare for their EPI companion (if not using kibble or other commercial food) list it here and once we have a lot of suggestions, i will copy and paste them in a special section in the "Dog Food Options" tab.
For all those that will be reading these raw or home-made recipes... please know that no matter how good a diet "sounds" if you are going to prepare the meal yourself from scratch.... and serve it long-term....it needs to have the proper/sufficient amount of vitamins, minerals and bone. Please share with your vet or a vet nutritionist the composition of whatever you decide to feed your dog.
My Izzy has EPI, she is 8 years old and weighs 45-48 lbs.
In the past, we were lucky, she was able to eat low fiber (grain-free foods) commercial kibble, sometimes i'd give raw, and sometimes i'd make home-made and sometimes i'd mix it all up... and she always did fine.... however recently, she developed Diabetes (we are still not sure if this is real diabetes or transient diabetes).... so.... to find our footing with the diabetes part and to still manage her EPI.... this is what i have been feeding her.
The Stew: I make a chicken stew in the crock pot... i buy raw chicken thighs, peel / cut off the fat, fill 1/2 the crock pot with the raw chicken thighs, throw in about 1/2-1 cup of whatever "organ" meats i have, peel and chop up 3 medium size sweet potatoes, then i add as much raw kale as will fit in the crock pot and pour in 1.5-2 cups of water with 1 finely chopped clove of garlic.
The Carb/Fiber: i bake 1 raw sweet potato in the microwave every couple of days, peel it..
The Home-Prepared Chicken Stew Diet for Izzy that she (for now) gets twice a day:
so far, this is working very well for us. Soon i will be trying other things. I hope this give an example to others what/how they might post their raw / home-prepared meals.
~Olesia (epi4dogs founder) & Izzy
2. Connie wrote: I always worry if I am giving her enough food if I do this. When Zoe was first diagnosed I cooked for her but I was worried she didnt get enough nutrition.
Response from epi4dogs:
Hi Connie..... well... i finally have some answers... Karen (Hondo's mom) helped me with this over the weekend (thanks Karen!)...
4. This is a really good breakdown of raw feeding and right on the button... the percentages are spot on.
I haven't fed homecooked so I will leave that to others but the raw info is good and an excellent place to start and tweak to suit the individual dog.
5. One of our members shared an actual home-prepared diet put forth by a Veterinary Nutritionist at Georgia Veterinary Specialists.... this is an AWESOME example of an diet plan for an individual dog based on age, weight, medical needs and activity level for this dog which may differ from your dog from your dog's needs that we will share here. It is a great example of what you need to think of when deciding to prepare your own food. Please feel free to contact the Georgia Veterinary Specialists http://www.gvsvet.com/ to prepare a diet specifically tailored for your individual dog .
I will include the PDF of this diet here http://www.epi4dogs.com/PDF%20Files/Isabella's_diet_PDF.pdf
6. Joyce (who's "Isabelle" will be starting the above diet: Isabella will start this diet this week. I had to wait for the "Balance IT" to arrive. I will keep you posted. If she responds well to it, I plan on scaling up and making a month supply at a time and freezing it in portion sized packages.
7. Hi Joyce.... thanks SO much for sharing this diet with us... i will be very interested in hearing how Isabella responds...i personally tried using Quinoa with my Izzy a few years ago... it did not work for us- -but we have great luck with sweet potato--and i can use some of the peas but with my Izzy she has to have less peas then what they recommend- -too much and she develops SIBO...... and i also know of someone else here who tried Quinoa in their home-made diet and the dog either kept getting SIBO or the poos were never really good... until they removed the quinoa... and yet... i have heard of other folks with EPI dogs who have used noodles, buckwheat groats, quinoa in their home-made diets and it worked just fine for their EPI dog...so..........keep really good detailed notes on this... it will be interesting to see how well Isabella's EPI condition responds to this orif she has issues with certain ingredients and if so, which ones.
I am so thankful to you for sharing this with us....i even learned some interesting information about canola oil....very interesting!
The Balance It is a fantastic product... i have used that before and once i am done with the VetriScience i have on hand now.....i will alternate and use the Balance It again.
We tried feeding Quinoa at first but she wasn't able to digest it properly no matter how long I cooked it. I can tell you though that any grain we cook for our dogs needs to be cooked longer than we would cook it for us. So I have doubts that cooking it according to package directions will work in the first place.
I switched Nikki over to Sweet Potato and the improvement in her poops was instant. The SP does provide a lot of fiber but we haven't had any issues with it so far but every dog is different. Good luck with switching her over, Nikki loves mealtime...LOL!!!
9. thanks Michaela for mentioning that.... when i tried the buckwheat groats... i cooked cooked and actually rinsed it twice too..... but Izzy still did not do so good on it......
Because i am now juggling EPI + borderline Diabetes.. i have discovered that with the EPI and her blood glucose levels... the best "filler" for Izzy is Best: cottage cheese Second best: sweet potato
10> From Karen, owned by Hondo: Hondo is doing well on the quinoa as well as I know another EPI dog doing well on it, too.
9/2012- from Kathy (Ted's Mom)
The original thought was all enzyme activity took place in the bowl, turns out that was an assumption, people making a connection that wasn't there. This was drilled into me when I got Ted and I mean drilled, you must incubate because all activity takes place in the bowl. This was before this forum had formed but it was also said on here in the beginning, you must incubate because the activity is all in the bowl, there was initial confusion. Now we know that is untrue. A very small amount of amylase and protease activity does take place when activated with warm water but all lipase activity takes place in the dog, none in the bowl. Since fats break down with lipase there is no need to incubate fish oil, although it doesn't hurt if you do. I think under one of the tabs Olesia does talk about this original misconception.
Kathy submitted the following rule of thumb for giving supplements.... Although some of these suggestions may be considered conservative guidelines especially we have since learned thru more recent research that some of these extra steps may not be needed.... this is still an excellent rule of thumb to go by. Thanks Kathy!
If anyone is interested in understanding the chemistry of digestion/food/viability.... please feel free to check out the chemistry chapter on foods at (you will have to copy and paste this URL into your search tool- - the file was too big for me to copy the PDF here:
Thank you Nadine
Fibre and Your Dog's NutritionFibre refers to a type of carbohydrate that is not digested by enzymes in the animal's gastrointestinal tract. Fibre is important to the health of dogs, providing bulk to move food through the intestinal tract. Some types of fibre can be fermented (broken down by bacteria) in the intestinal tract. This process creates short-chain fatty acids (SCFA), which are a key energy source for the cells lining the intestinal tract.
Today people are more aware of fibre and its role in their diet. Studies showing the beneficial effects of higher fibre levels in humans influence the way many people think about their own food and the food of their pets. Some pet-food manufacturers apply the recommendations of human nutritionists and make high-fibre diets for dogs.
But dogs have a much shorter digestive tract than humans. Unlike humans, dogs are best fed as carnivores, meaning their nutritional needs are better satisfied with meat rather than plant materials.
So dietary needs of humans are not the same as dietary needs of dogs!
For more than 50 years, companion animal nutritionists at The Iams® Company have been studying diets to better meet the special nutritional needs of dogs.
Iams® research shows the optimal crude fibre level for healthy dogs ranges from 1.4 to 3.5%. At these levels, nutrient digestibility is maximised.
An important characteristic of fibre is its fermentability—how well it can be broken down by the bacteria that normally reside in the dog’s intestine. This breakdown of dietary fibre produces Short Chain Fatty Acids(SCFAs) which provide energy to the cells lining the intestines. Different types of fibre vary in fermentability. Fibre sources used in pet foods include cellulose, which is poorly fermentable; beet pulp, which is moderately fermentable; and gums and pectin, which can be highly fermentable. Research has shown that moderate levels of moderately fermentable fibre, such as beet pulp, provide the benefits of energy for the intestinal lining and bulk without the negative effects of excessive stool or gas.
High levels of poorly fermentable fibre are used in some weight-reduction pet foods to dilute the calories in a serving. Iams research shows that this is not a good practice because high fibre levels can decrease the digestibility of other nutrients in the food and, therefore, reduce the nutritional quality of the diet. Pet owners also see a marked increase in stool quantity in the garden due to the undigestible fibre.
Webs MD had a great explanation on the difference of soluble vs. insoluble fiber that we have to be cognizant when dealing with EPI patients whether canine or feline. So although this is based on human physiology, i am posting here so that EPI owners can read and have a good understanding of the difference between the two classifications of fiber.
This is the website link that this information was taken from:
Confused about fiber? You’re not alone. Dietary fiber is a misunderstood nutrient. Many people know it is important, but not much more than that. This article fills you in on the two main types of fiber – soluble and insoluble -- where to find them, and the health benefits they provide.
Dietary fibers are found naturally in the plants that we eat. They are parts of plant that do not break down in our stomachs, and instead pass through our system undigested. All dietary fibers are either soluble or insoluble. Both types of fiber are equally important for health, digestion, and preventing conditions such as heart disease, diabetes, obesity, diverticulitis, and constipation.
Soluble fiber dissolves in water. Insoluble fiber does not. To some degree these differences determine how each fiber functions in the body and benefits your health.
Soluble fibers attract water and form a gel, which slows down digestion. Soluble fiber delays the emptying of your stomach and makes you feel full, which helps control weight. Slower stomach emptying may also affect blood sugar levels and have a beneficial effect on insulin sensitivity, which may help control diabetes. Soluble fibers can also help lower LDL (“bad”) blood cholesterol by interfering with the absorption of dietary cholesterol.
Insoluble fibers are considered gut-healthy fiber because they have a laxative effect and add bulk to the diet, helping prevent constipation. These fibers do not dissolve in water, so they pass through the gastrointestinal tract relatively intact, and speed up the passage of food and waste through your gut. Insoluble fibers are mainly found in whole grains and vegetables.