Feeding your EPI pet the right diet can make a HUGE difference in it's health- however finding the right diet may be tricky. The most important dietary fact when feeding an EPI animal is that most times it needs to be a low fiber diet......but that is where the simple ends and the difficult begins.....
Dogs and cats have shorter digestive tracts than humans and are basically carnivorous meaning that their nutritional requirements overall are better served with meat vs. plant materials. However, much of the food we purchase for our pets does have some fiber in it, so it would be better for us (and our pets) if we understood the various types of fibers and how they function.... and why so many of the grains/fiber in various pet food can be detrimental to our EPI pets and yet why "some" EPI pets do better with some grain while others do horribly on the same product.
Usually finding the right diet for the EPI pet is the last cornerstone of effectively managing EPI.
My hope with this FIBER page is that if we understand the various types of fiber and their functions that this will better help us understand why some of our EPI pets do fine on one food, while another EPI pet might do horribly on the exact same food...
According to extensive research by dog food companies such as Eukanuba and IAMs, dogs and cats maximized nutrient digestibility with optimal crude fiber levels from a range of 1.4 to 3.5%.
However… we know we cannot apply this to EPI dogs and cats simply because:
So, not only do "most" EPI pets do better on low fiber food.... if possible it would be even better if we could understand what type of fiber is being used in a particular product.
There are different types of fiber such as “SOLUBLE” and “INSOLUBLE” fiber and within these two fiber classifications is another consideration, and that is how “FERMENTABLE” the different fibers are.
Previously the focus was on soluble vs. insoluble fiber..... but more recently.....the veterinary nutritionists are now focusing more on how fermentable a fiber is and whether a highly fermentable or poorly fermentable fiber is better for which dog. They are beginning to suspect that which fiber better agrees with which dog depends on a multitude of factors, such as underlying health issues, gut flora and the metabolic response of that particular dog.
Complicating things further is that both types of fibers Soluble/Insoluble + Fermentable/Poorly Fermentable are usually found together in the same plant, but classification is often made by which fiber type is more predominant and/or the different fiber types are attributed to different portions of the plant.
On commercial dog foods.... a label may claim that there is only 6% fiber content.... but... with an EPI pet it makes a HUGE difference if that 6% fiber is composed mainly of soluble fiber such as sweet potato or insoluble fiber such as sweet potato skins (discussed below)
Both soluble and insoluble fiber are called “Dietary” fiber. Dietary is known to influence bowel habit and gastrointestinal mucosal cell morphology and function.
Chemically speaking, dietary fiber consists of non-starch polysaccharides such as arabinoxylans, cellulose AND other plant components that are resistant dextrins, inulin, lignin, waxes, chitin, pectins, beta-glucans and oligosaccharides.
Dietary fiber inhibits enzymatic activity but in varying degrees according to experiments using both soluble and insoluble fibers such as wheat bran, cellulose, guar gum, pectin, psyllium and lignin. Inhibition seems to also be dependent on incubation time; proportional to fiber concentration and inversely related to enzyme level.
• Soluble fiber dissolves easily in water. Think “gel”. Some foods rich in soluble fiber are fruits, oats, some beans, barley, and vegetables. Such foods result in an increased absorption of nutrients. This type of soluble fiber actually slows digestion down. Because of this, it has a tendency to stabilize blood glucose, and permit better absorption of nutrients. It tends to reduce blood cholesterol. It also increases satiety, so individuals aren’t inclined to eat as much. Sources of soluble fiber include flax, beans, peas, oatmeal, berries, apples, and some nuts and seeds.
• Insoluble fiber doesn’t dissolve in water- -however retains water. Some foods rich in insoluble fiber are vegetables, whole grains, and wheat bran. It is tough, and it doesn’t easily break down. Insoluble fiber tends to increase the “speed of transit” through digestive systems, and increases regularity of bowel movements.
What is “fermentable” fiber ? Some fiber will ferment in the colon, producing compounds that help support colon health, and possibly have other benefits. Most soluble fiber is highly fermentable. Pectins (found in apples and berries) and the fiber in oats are examples of fiber with a large fermentable component. Inulin and oligofructose are also highly fermentable, as is resistant starch. But this also is not cut and dry... although fermentable fiber might be beneficial... too much fermentable fiber may cause inflammation in the colon. SO.... how much is too much... it all depends on how each individual dog processes the fiber!
• Highly fermentable fiber results in poor stool quality. Foods rich in highly fermentable fiber are cabbage, pectin and guar gum.
• Moderately fermentable fiber results in adequate production of short-chain fatty acids and maintains excellent stool quality. Examples of foods rich in moderately fermentable fiber are beet pulp and rice bran.
• Slow fermentable fiber doesn’t result in adequate production of short-chain fatty acids and is found in plant hull cellulose. This type of fiber is helpful in weight management as it increases bulk and thus the dog feels full even though he has consumed lesser amounts of food.
Too much fiber can cause problems as can too little fiber. Just the very nature of EPI and the relationship of fiber with enzymes require that “most” EPI cat and dog patients need to consume lower fiber content in their diet….but depending on the individual animal and what is going on in their gut, some may need a little bit of fiber. And here in lies the conundrum.
Which type of fiber should be avoided ???
Which type of fiber might be needed ???
How much how little ???
What do they need it to do ???
Needless to say, this explains why finding the right diet can be so tricky and why veterinarian nutritionists are concerned when we say “grain-free”. It really is not necessarily grain-free but rather low fiber that we should consider for a diet for most (not all) and then even what will depend on the individual animal is which type of fiber (if any) it can tolerate or needs to avoid or include at a low dose.
The overall consensus is that for "most" EPI animal patients do best with a LOW FIBER diet.... What was thought was that some EPI dogs do better with
“Soluble” (highly digestible) fiber that is also low in "poorly-fermentable" fiber.....
BUT.... there are others that do better with "poorly-fermentable" fiber......
There is another take on Nutrition that does cover certain fibers (and other food types) that is now generating lots of interest, call FODMAPs.....FODMAPs is an acronym for Fermentable, Oligo-, Di- and Mono-saccharides and Polyols, used to describe a group of fermentable short-chain carbohydrates. Some evidence suggests that reducing global intake of FODMAPs to manage functional gut symptoms provides symptom relief for about 75% of patients with FGDs.2
If your dog appears to be one of those whose gut agree with the "acceptable" foods on the FODMAP list of ingredients.... then be careful of commercial dog foods... as many are packed with the very FODMAP ingredients to avoid....these SCFA may be healthy in small doses, but commercially packaged, may be just too much for your dog's system and hence encourage colonic inflammation.
I am including FODMAPs research and the list of acceptable and avoidable FODMAPs foods here because i personally have always had trouble feeding my EPI gal, Izzy with "too many carbs" and even the recommended "highly fermentable fiber" automatically gave her SID/SIBO.... and yet.... there are certain vegetables that she can eat and not have any issues with. I noticed that the all the veggies/fruits and foods that my EPI gal tolerates and can tolerate in large quantities are all listed on the acceptable FODMAPs list .. and those that she has major issues with are listed on the unacceptable FODMAPs list.
FODMAPs List of (human) foods: https://stanfordhealthcare.org/content/dam/SHC/for-patients-component/programs-services/clinical-nutrition-services/docs/pdf-lowfodmapdiet.pdf http://www.ibsdiets.org/fodmap-diet/fodmap-food-list/
FODMAPs (human) Article: http://www.todaysdietitian.com/newarchives/072710p30.shtml
FODMAPs 2010 research http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2010.04237.x/full
The role of short-chain fatty acids in the interplay between diet, gut microbiota, and host energy metabolism
Short-chain fatty acid formation at fermentation of indigestible carbohydrates
So.... which type of fiber and how much can your dog digest...... YOU need to be the judge!
This is why it is HIGHLY advisable to do trial and error with food, start with a low 4% or less fiber content food first... and adjust more or less fiber from there. Record what fiber types are included in diets that work and the diets that don't work..... ALWAYS watch the diet output (the poo!), the volume, color, texture and frequency for 3-5 days before implementing the next change. This will help you determine which ingredients appear to agree or not agree with your individual EPI patient.
We, at epi4dogs, have been able to help most pet owners help their pets achieve a normal well-functioning digestive systems.... most times... the last piece of the puzzle has been finding the right diet. It may take some time, and many tweaks.. all depending on your dog's individual system's requirements.... but it can and has been done with a little bit of patience and a lot of support from others who have found the perfect diet for their EPI pet and are willing to share their experiences with others!
Summer - 2015:
This research was performed by Dr. Anne Mosseler of the University of Veterinary Medicine, Hannover, Germany, The Institute of Animal Nutrition.
Dr. Mosseler does EPI research with mini-pigs. Epi4Dogs and Dr. Mosseler have kept in touch over the years, and interestingly enough, her most recent research supports what many of our Epi4Dogs members on the FORUM have observed...that when managing an EPI patient, one must be careful of the:
A most stunning revelation with Dr. Mosseler's study was that out of the 4 carb/fibers that Dr. Mosseler tested, peas was by far the least digestible with the EPI mini-pigs.... well.....interestingly enough, members of the Epi4Dogs forum have noticed the same problem with many of our EPI dogs.
Dr. Mosseler did a limited study with 4 carbs and the pea starch had the least digestibility.
The most telling part of the research that relates directly to fiber and our EPI dogs, is the following excerpt... but please feel free to read the entire research (provided by Dr. Mosseler (THANK YOU Dr. Mosseler!!) and please share with your vet with regards to the importance of diet in optimally managing EPI.
"......... The challenge in nutrition of CF patients with PEI is therefore to enrich the diet with moderate levels of fibre (10-30 g / day) to ensure passage rate and to minimise risk of obstipation or constipation [11, 13] without negative effects like enhancing the amount of food intake needed, satiety  and forced intestinal gas production. Another side effect that might be of relevance is the reduction in enzyme activity of substituted enzymes by dietary fibre. However, this effect is strongly related to the type of dietary fibre used with 1.5g% of pure cellulose having no effect on amylase and trypsin activity and only very little effect on lipase activity . In patients with PEI a SIBO and an increased bacterial fermentation is often observed resulting in symptoms like diarrhoea, meteorism, abdominal pain, flatulence and impaired wellbeing . With modern pancreatic enzyme replacement therapy (PERT) maldigestion and malabsorption as well as SIBO can be controlled, but in some patients problems still occur . The further characterisation of fibre sources seems to be of greatest relevance as meteorism and flatulence not only affect patients’ wellbeing, but also might impair food intake. The fibre enrichment of the diet should be done deliberated as energy expenditure / requirements are increased in patients with CF and the intake of food rich in fibre raises the risk for malnutrition as diets rich in fibre are in general less digestible and have a lower energy density. The use of highly concentrated fibre sources might be way out to achieve a sufficient fibre supply to prevent DIOS (Distal Intestinal Obstruction Syndrome) without causing negative side effects like uptake of bulky food or food with a low energy density which might raise the risk of reduced energy uptake or malnutrition. There are several fibre concentrates available – differing in chemical composition. The two lignocellulose products used in this study did not cause any relevant in-vitro gas production and had positive effects on faeces quality (soft but formed faeces). Taking into account the very high fibre content of these supplements (~ 60 %) it is possible to enrich the diet with a relevant amount of fibre (10 g) without markedly increasing the amount of food. This is especially relevant when considering the recommendation of opting for a diet with high energy density for patients with PEI .
Regarding low in-vitro gas production MC, FC, OC can be recommended for a fibre enrichment of the diet. Interestingly, PF (Pea Fiber) – which is a common fibre source in human dietetics – caused the highest in-vitro gas production. Furthermore pH dropped significantly after addition of PF – also indicating a much higher fermentation rate. Taking all data into account FC and OC seem to be recommendable to increase fibre intake even in patients with PEI.
Determining the in-vitro gas production is a completely non-invasive method and allows differentiation of the extent of fermentation of different fibre sources. The screening of different foodstuffs under the aspect of minimising gas production is easy to perform and might help to improve patients’ wellbeing. It seems noteworthy that even the addition of only 1 g of PF as a “fibre source” caused a net gas production of 120 ml of gas in this study. It was previously shown  that fermentation of starch caused very high in-vitro gas production when incubated with ileal chyme of PL-pigs (up to 160 ml / g substrate). As a good nutritional status is crucial for CF patients [21,36] introducing fibre into the diet should be critically proven by a dietetic supervision and not recommended for all patients. Nonetheless, in patients with symptoms of DIOS or abdominal pain due to extensive loading of the colon with faeces the enrichment of diet with a lignocellulose fibre might be helpful to normalise gut function although [16,17] found no association between fibre intake and DIOS or constipation in CF. However, it should be taken into account that diets for CF patients are low in fibre in general according to recommendations and that this fact might mimic effects of fibre in the cohort (as all patients have a low fibre supply).  stated a lower fibre uptake in patients with DIOS, indicating that an increased fibre supply might be feasible. More precise characterisation of fibre seems to be crucial to optimise fibre supply in CF and PEI patients. Although fermentable fibre is of benefit for healthy people, in patients with maldigestion and SIBO the use of non-fermentable fibre seems to be more beneficial. Looking forward it seems necessary to do more experimental and clinical work to estimate the practical consequences of an enrichment of the diet with fibre. Aspects like effects on satiety, passage rate, water binding capacity as well as intestinal microflora should be taken into account. The use of in-vitro tests to quantify gas production might be a valuable measure to screen different fibre sources and to exclude those fibre sources that might have negative side effects like excessive gas production.
Conclusions: The use of a highly concentrated fibre source (lignocellulose) might reduce the negative side effects of fibre sources usually used while promoting passage rate and reducing the risk of DIOS. These fibre sources are neutral in flavour and taste and can be easily added to drinks or food. " ..........
... although the following relates to fiber and SID (SIBO) in humans... it is another excellent explanation of the relationship of FIBER and SID/SIBO ... many thanks to Madelon (Doc's mom) for bringing this article to my attention... although i am not 100% on board with the "absolutes" that Dr. Norm Robillard claims, i do think this article is well worth reading. I personally liked the diagram (posted below) as it is a nice and easy visual to understand...Thanks Madelon!!!
The following is taken in it's entirety from the Digestive Health Institute Organization (URL link above)
The author of the following information is by Dr. Norm Robillard
I thought long and hard about how to write about the multitude of possible interactions with fiber and the EPI animal and quite honestly, even I became overwhelmed! But while researching this topic (as I promised to the veterinarian nutritionists that I would do and encourage folks to stop using the “grain-free” term) I did discover that there were a lot of “aha!!!” moments while reading the research. I now better understand why we see so much variance in the diets with these EPI animals… why something works for one but not another…..There is a lot of excellent eye opening info that others might also find of interest. So, I have included the next section of “Interesting Tidbits” regarding this topic. There are also links below at the bottom of this page, from where I gathered much of this information. Please feel free to read the sources in their entirety.
SOME INTERESTING TIDBITS ABOUT FIBER
1. Different fibers (even those in the same category) have different fermentation rates.
2. Some research suggests adding soluble fiber to the diet can be especially beneficial for animals especially those that develop secondary bacterial overgrowth (small intestinal bacterial overgrowth or SIBO). Fibers that moderately ferment in the intestinal tract have been shown to create a therapeutic amount of short-chain fatty acids (called SCFAs). There is much exciting research evolving with regards to prebiotics in relation to this. (Prebiotic soluble fibers containing inulin or oligosaccharides are being looked at in giving relief to IBD)
On the flip side..... it appears that too much of a good thing (SCFA) might actually cause gastrointestinal discomfort. (SCFAs) act as fuel to build up healthy intestinal cells, feed “good bacteria,” and provide bulk for better movement of materials through the gut, reduce the amount of potential “fuel” available for bad bacteria to use.... but with some, these SCFAs may actually cause a problem !!!
3. Large-bowel function is particularly influenced by insoluble, poorly fermentable fiber sources.
5. Mucosal function is affected by fiber sources that are more soluble and highly fermentable.
5. SOLUBLE FIBER “some” examples:
6. INSOLUBLE FIBER “some” examples:
7. POTENTIAL SOURCES OF FIBER IN A PET’S COMMERCIAL DIET
8. Lignin, an insoluble fiber, may alter the fate and metabolism of soluble fiber
9. Although most fiber sources there are carbohydrates, fiber doesn’t raise blood glucose so low carb diets don’t “count” fiber. So….. while fiber does fall under the category of carbohydrates, in comparison, it does not provide the same number of calories, nor is it processed the way that other sources of carbohydrates are.
10. If your dog has issues with the following (SHORT CHAIN CARBOHYDRATES) .... your dog (or cat) might be better served avoiding ingredients from this list:
High FODMAP (human) food (things to avoid / reduce) although this is a human list, i have noted ingredients that are often included in dog foods/products or simply fed as a "safe" food
· Garlic – avoid entirely if possible
· Onions – avoid entirely if possible
· Baked beans
· Black eyed peas
· Brussel sprouts
· Broad beans
· Butter beans
· Chick peas
· Green pepper (green bell pepper)
· Kidney beans
· Soy beans
· Scallions / spring onions (white part)
Fruit - fruits can contain high fructose
· Tinned fruit in apple / pear juice
Cereals, Grains, Breads, Biscuits, Pasta, Nuts and Cakes
· Wheat containing products such (be sure to check labels):
· Egg noodle
· Regular noodles
· Wheat bread
· Wheat cereals
· Wheat rolls
· Udon noodles
· Bran cereals
Sweets and sweeteners
· Sugar free sweets
· High fructose corn syrup (HFCS)
· The follow items can be added to yoghurts, snack bars etc:
· FOS – fructooligosaccharides
· Ice cream
· Milk – cow, goat and sheep
· Soft cheese – such as cottage cheese, ricotta and mascarpone
· Yoghurt – including greek yogurt
Acceptable FODMAP (human) food although this is a human list, i have noted ingredients that are often included in dog foods/products or simply fed as a "safe" food
· Bok choy / pak choi
· Bean sprouts
· Butternut squash
· Corn – if tolerable
· Chilli – if tolerable
· Eggplant / aubergine
· Green beans
· Red peppers (red bell pepper)
· Scallions / spring onions (green part)
· Sweet potato
· Tomato – avoid cherry tomato
· Zucchini – if tolerable
Fish and Seafood
· Canned tuna
· Fresh fish e.g.
· Seafood (ensuring nothing else is added) e.g.
Dairy Foods and Eggs
There is also more "agreeable food types listed ( breads/cereals, sweeteners, fruit, drinks, etc) that are listed here: http://www.ibsdiets.org/fodmap-diet/fodmap-food-list/
11. Various FIBER Definitions
The US Dept of Agriculture previous definition of fiber was the part of plants that were resistant to the digestive enzymes… however, the new definition of fiber is the components of plants that resist digestive enzymes including lignin and polysaccharides and resistant starches along with inulin and oligosaccharides.
The US Food and Nutrition Board assembled a panel that came up with the following definitions:
• Dietary fiber consists of nondigestible carbohydrates and lignin that are intrinsic and intact in plants. This includes plant nonstarch polysaccharides (for example, cellulose, pectin, gums, hemicellulose, and fibers contained in oat and wheat bran), oligosaccharides, lignin, and some resistant starch.
• Functional fiber consists of isolated, nondigestible carbohydrates that have beneficial physiological effects in humans. This includes nondigestible plant (for example, resistant starch, pectin, and gums), chitin, chitosan, or commercially produced (for example, resistant starch, polydextrose, inulin, and indigestible dextrins) carbohydrates.
• Total fiber is the sum of dietary fiber and functional fiber. It's not important to differentiate between which forms of each of these fibers you are getting in your diet. Your total fiber is what matters.
12. Some key components of food that "might" help you identify soluble and insoluble fiber:
Most foods containing fiber contain both soluble and insoluble fiber to certain degrees, with some having a higher degree of one fiber or the other.
• The food is a whole grain, nut, legume or seed. These foods contain both soluble and insoluble fibers..
• The food looks fibrous. Foods like sweet potatoes and carrots look very fibrous. This is good indication that the food is high in fiber.
• The food is a whole fruit or vegetable. Processed fruits and vegetables tend to retain soluble nutrients, but lose the fiber. The best way to get the fiber from fruits and vegetables is to eat them whole.
• The food becomes soft and creates a “sauce” when cooked. Foods like beans, oats and rice contain starch and fiber that are responsible for the creamy consistency. This is a good indication the food will be high in soluble fiber.
• The food is a fruit, vegetable or whole grain and does not dissolve readily in your mouth. A good example of this is potato skin; it is edible, but requires extra chewing. The same is true for many fruits, like pears and apples. This is a good indication the food contains fair amounts of insoluble fiber.
• Many processed foods have added fiber, either to replace what was lost during processing or add extra health benefits. If these foods do not state added fiber on the label, check the nutrition facts panel and ingredient statement to find out. The food should contain 1 or more g of dietary fiber. This can be naturally occurring or it can be added. The added fiber is considered functional fiber, but may also be classified as dietary fiber. Some of the added fibers, that are mostly soluble, are cellulose, gums (guar gum, carrageenan, etc.), inulin, and pectin. Some of the added fibers, that are mostly insoluble, are polydextrose and bran.
• Psyllium fiber, a common fiber supplement sold under the brand name Metamucil, is 70% soluble fiber and 30% insoluble fiber and has the health benefits of both types of dietary fiber.
• Too much fiber in the diet can cause bloating and gas, and it may interact with certain medications. \
• The Institute of Medicine has recommended moving away from the terms soluble and insoluble for fiber, and, instead, using fermentability and viscous to describe the different types of dietary fiber. Nutritionists feel that measuring these instead of solubility gives a more accurate portrayal of the health benefits of fiber by category.
13. Soluble and insoluble fiber are the labels most commonly used to describe fiber. However, two other properties of fiber are turning out to be important: fermentability (how easily the fiber ferments in the colon), and viscosity (the ability to gel with water) of the fiber, which may be more important than solubility.
(From Wikipedia http://en.wikipedia.org/wiki/Dietary_fiber )
14. Chemically defined as oligosaccharides occurring naturally in most plants, inulins have nutritional value as carbohydrates, or more specifically as fructans, a polymer of the natural plant sugar, fructose. Inulin is typically extracted by manufacturers from enriched plant sources such as chicory roots or Jerusalem artichokes for use in prepared foods. Subtly sweet, it can be used to replace sugar, fat, and flour, is often used to improve the flow and mixing qualities of powdered nutritional supplements, and has significant potential health value as a prebiotic fermentable fiber.
Inulin is advantageous because it contains 25–30% the food energy of sugar or other carbohydrates and 10–15% the food energy of fat. As a prebiotic fermentable fiber, its metabolism by gut flora yields short-chain fatty acids which increase absorption of calcium, magnesium, and iron, resulting from upregulation of mineral-transporting genes and their membrane transport proteins within the colon wall. Among other potential beneficial effects noted above, inulin promotes an increase in the mass and health of intestinal Lactobacillus and Bifidobacterium populations.
Vegetable gum fiber supplements are relatively new to the market. Often sold as a powder, vegetable gum fibers dissolve easily with no aftertaste. In preliminary clinical trials, they have proven effective for the treatment of irritable bowel syndrome. Examples of vegetable gum fibers are guar gum and acacia Senegal gum.
The main action of dietary fiber is to change the nature of the contents of the gastrointestinal tract, and to change how other nutrients and chemicals are absorbed. Soluble fiber binds to bile acids in the small intestine, making them less likely to enter the body; this in turn lowers cholesterol levels in the blood. Soluble fiber also attenuates the absorption of sugar, reduces sugar response after eating, normalizes blood lipid levels and, once fermented in the colon, produces short-chain fatty acids as byproducts with wide-ranging physiological activities (discussion below). Insoluble fiber is associated with reduced diabetes risk, but the mechanism by which this occurs is unknown.
.........................and now you know WHY finding the right diet can be so confusing! ...............
.... more additional research articles that support why certain fibers inhibit the effectiveness of replacement enzymes.