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Broth and Enzymes

Posted: 15 Jul 2019, 13:11
by JakeyJas
Hi all, new member here.

Jakey is about 8 YO, has been getting enzymes for about 6 years, along with relevant supplements. He was recently discovered to have a small stomach ulcer, and has started with sucralfate.

Our vet also recommended L-glutamine for gut healing, which we are giving with a bit of diluted broth between meals. Should I be adding a little enzymes to that?

Also, I’ve been seeing statements elsewhere that say it’s been found that the enzymes don’t need to incubate for 30 minutes for most dogs. My question is does incubation time affect the acidity, and, if so, how?

Re: Broth and Enzymes

Posted: 16 Jul 2019, 03:39
by Jean
Hello and welcome from UK ... y-in-dogs/

Our founder Olesia Kennedy wrote this some time ago but it doesnt answer your question, and as we in UK dont incubate enzymes, I will need to refer this upwards


Re: Broth and Enzymes

Posted: 16 Jul 2019, 08:06
by JakeyJas
Seems the article isn’t available to me. I did get a glimpse of it before the blocker came up, and I already know what EPI is, so a basic article about it isn’t helpful. Thanks anyway. :^)

Re: Broth and Enzymes

Posted: 16 Jul 2019, 09:03
by jilbert57
How are your dogs poops?
I would say if your dogs poops are great you should stay the course.
Broth does contain protein, fat and some carbs so I would normally say yes add some enzyme. But if you are happy with his poops.....
What enzymes are you using? If powdered they are usually incubated to discourage mouth sores. Some dogs can get away with no incubation.

Re: Broth and Enzymes

Posted: 16 Jul 2019, 10:59
by Olesia711
Gastric ulcerations in dog.pdf
(80.26 KiB) Downloaded 12 times
Hi Jakey's caregiver.

Jill gave you the correct answers, but if you are interested, i'll get a little more into the weeds.... and my apologies if i give too many deatils.details.

I agree, if the poos are okay, pretty much stay the course, but if you are adding broth... in-between meals... exactly for the reasons Jill cited, i would sprinkle just a tiny pinch of enzymes in the broth too... but i then i wouldn't bother incubating it... as it is a liquid.

You are correct... there is research that states that incubation is not necessary.... HOWEVER.....the main reason why we suggest incubating is to mostly avoid mouth sores....but there is another reason. Practical Application. IN the clinical trials, they test with xxx amount of dogs, the minimum requirement is 6 dogs and usually, from the studies i have seen, it will go up to 12 or 30 or 50 dogs in the trial. THen they assess the results and found the majority didn't show a difference for xxx amount of time the study was done.

HOWEVER (again) in practical application.... what we have discovered is that many dogs (and we are basing our "observation" on thousands of EPI dogs, not just a limited amount in a clinical trial.....and we are also basing our observations long term, not just xxx amount of days)..... that many, but not all, will start to have loose stools come back over a long period of time when the enzymes are not incubated.... Others will right away have much better (formed/solid) poos when the food is incubated..... but then the big monkey wrench in this entire premise is that even those that respond better to incubated enzymes, respond in varying incubation time.

Many of us (a while back) tested our own dog actually did fine with enzymes incubated for only 5-10 minutes. If i didn't incubate at all.... within a month her stools went south. Some others found that they could avoid incubation all together, but the majority found that their dogs did much better with some incubation... some even needed more than 20 minutes. We use 20 minutes as a general guideline.

So... what do i do personally?... just to avoid any issues, i have incubated my dog's enzymes for 20 minutes... been doing this for 13 years now.........

Also...there used to be rumors going ar9und that enzymes incubate food in the bowl.... that is incorrect. I have spoken at length to the researchers about this and for the enzymes to fully activate, they need to be in the digestive system because they need specific warmth temperature, pH levels, other digestive catalysts and they need slightly warm liquid too...... so...............when you put enzymes in a bowl of food... there is a teeny weeny little bit of activation due to the liquid in the food but no where near enough to digest the food in the bowl as some claim....

The other thing about incubation... because you are adding the enzymes to food, with a little moisture.... it will slightly decrease the caustic properties of the enzymes..... so that helps to.

Also.... just a FYI.... about 70% of the enzymes (powdered) are destroyed before they get to do their job due to the bile acids/pH in the digestive tract. this is why when enteric coated enzymes are given they are a lot less in potency BUT then you have a few other problems of the enteric coated being digested at the right time to have the enzymes be effective, and the size of the enzyme particles.... but again, EPI pet owners have learned how to work around this when there are no other options. i have a suggestion...... you might want to ask your vet if after the ulcers (rupture) subside somewhat from the Sucralafate.... if he/she would consider having you "try" slippery elm" powder as a mucilage to maintain keeping the ulcers in check. The reason why i am suggesting this is because i know Slippery Elm is indeed used for this... but..... recently, i happened upon some vet research where they are now suggesting that Sucralafate is not all that they thought it was when used on dogs and that it may even cause an issue.........i'll try to find the report so that you can share with your vet... and let your vet decide whether the research is actually valid or jsut a one time trial that may or may not hold credence. Some of the vets i know continue to recommend Sucralafate.... but.... i personally have requested them not to on my dogs and have instead successfully used SLippery ELm ... one time was to avoid stomach bleed from strong meds..... when my gal battled IMHA..... BUT...she did not have existing ulcers, we used it to prevent them from developing.... so i am not sure if what i am suggesting is appropriate or not, and should be discussed with your vet, don't go by jsut what i am saying.

Regarding do enzymes increase acid.....i don't know how to correctly answer this but i am attaching a piece that i took a picture of that might shed some light on this... see below...... and attached at the top of this post is the entire research article that explains gastric ulcers in dogs

....... BUT in the digestion process i do know that they now know that all EPI dogs have skewed bile acid mechanisms.... and it is all connected primary and secondary bile acid functionality and EPI.......Some have issues to the point where they need to take acid meds, others where they do not even realize their dog's bile system is messed up because they are not seeing any physical issues........ overall the premier acid med for dogs is Omeprazole....what you want is a bile acid sequestrant. Year ago they used to automatically prescribe Cholestyramine for EPI dogs.... they might now be looking back at this. Other products have been used but tend to work only Pepcid AC, ... but then you have to stop for a while and then start up again. and some have been able to control the situation with, again, just SLippery Elm. Unfortunately it depends on the individual EPI dog.

Please feel free to read the research pages on SID, SLippery Elm, EPI...... some of this info is there and explains it much better than i can.

Hope this helps a little and that your eyes didn't glaze over.............................................

Re: Broth and Enzymes

Posted: 16 Jul 2019, 12:18
by Olesia711
Just a FYI...... here is a recent study with Texas A&M that explains that bile acid concentrations are skewed in EPI dogs:
June 2017
Epi4Dogs collaborated and co-authored with Texas A&M Gastrointestinal Lab on TWO research projects.

below is the Fecal & Bile Abstract below:

1. Dogs with Exocrine Pancreatic Insufficiency have Dysbiosis and Abnormal Fecal Lactate and Bile Acid Concentrations

A.B. Blake1, B.C. Guard1, J.B. Honneffer1, F.G. Kumro1, O.C. Kennedy2, J.A. Lidbury3, J.M. Steiner1, J.S. Suchodolski3

1Gastrointestinal Laboratory, College of Veterinary Medicine, Texas A&M University, College station, Texas, USA, College Station, TX, USA, 2Epi4Dogs Foundation, Inc., Farmville, VA, Farmville, VA, USA, 3Gastrointestinal Laboratory, Texas A&M University, College station, TX, USA

It has been reported that dogs with exocrine pancreatic insufficiency (EPI) commonly have intestinal dysbiosis. However, the effects of EPI on microbial metabolism are poorly understood. The aim of this study was to compare fecal dysbiosis as well as fecal lactate and bile acid concentrations between dogs with EPI and healthy control dogs.

Fecal samples were collected from eleven dogs with EPI that had not received antibiotics for at least 3 weeks and had been on enzyme supplementation for 0.5–10 years (median 5 years). Fecal samples from healthy dogs (n = 18), collected for three consecutive days and pooled, served as control samples. DNA was extracted and analyzed by qPCR for selected bacterial groups and data expressed as Dysbiosis Index (as previously reported). Fecal lactate was measured by enzymatic methods (D-/L-lactic acid kit, R-Biopharm) and bile acids were quantified with gas chromatography/mass spectrometry from lyophilized feces. The Mann-Whitney U test was used to compare the Dysbiosis Index and fecal lactate and bile acid concentrations between dogs with EPI and healthy control dogs. Correlations were assessed using Spearman’s correlation coefficient and significance was set at P < 0.05.

Dogs with EPI had a higher Dysbiosis Index (median [min-max]: +3.08 [−7.29 to +7.62]) than healthy control dogs (−3.81 [−7.57 to +3.32]; P = 0.0232). Total fecal lactate concentrations were increased in dogs with EPI (3.44 mM [0.71–158.30 mM]) compared to healthy control dogs (1.14 mM [0.54–6.64 mM]; P = 0.0037). The proportion of secondary bile acid was lower in dogs with EPI (70% [6–96%]) compared to healthy control dogs (93% [12–97%]; P = 0.0431). There was no correlation between any measurements and duration of enzyme therapy.

In conclusion, this study identified differences in the fecal microbiota as well as fecal lactate and bile acid concentrations between dogs with EPI and healthy control dogs.

And at the top of this page is a 2018 publication regarding Bile Acid and our dogs:

Re: Broth and Enzymes

Posted: 17 Jul 2019, 13:21
by Olesia711
Sorry it took me forever to find the research that suggests that Sucralfate for dogs, and specifically for ulcers in dogs, although a good drug, is not as good as they thought to use for dogs....problem is a lot of science was based on humans taking Sucralfate.... but dogs' body's process it slightly differently and now they think it just doesn't do as much (beneficial) that they thought it did....but rather Omeprazole is superior and does a better job in dogs.

Anyway, i couldn't find the original article that i read, however, i found another article that covers all the grasto protectants by class put out by the ACVIM (American College of Veterinary Science)... published in the Wiley Journal - Oct 2018

It is a HUGE statement.... so i cut and pasted below only the Sucralfate info for you ... and the key take away is at the very end................

In short....
  • Don't mix with some drugs (see info below)
    Liquid form Sulcralfate works much better in dogs
    PPI (Omeprazole) works much better on ulcers in dogs than Sucralfate

4.5 Sucralfate
4.5.1 Mechanism of action

Sucralfate (Carafate) is a complex salt of sucrose octasulfate and aluminum hydroxide.115 Its mechanism of action in acid‐peptic disease is multifactorial. Sucralfate forms stable complexes with protein in damaged mucosa where there is a high concentration of protein, either from fibrinogen, albumin, or globulins from the exudate of an ulcer or from damaged cells.115
4.5.2 Metabolism

In an acidic environment, sucralfate becomes viscous and partially dissociates into sucrose sulfate and aluminum hydroxide. The sucrose sulfate moiety is an anion and binds electrostatically with the positively charged proteins in the damaged mucosa.115 Sucralfate interferes with the action of pepsin either by preventing pepsin digestion of protein substrates, by binding to pepsin, or by providing a barrier to prevent diffusion of pepsin.115 In addition, the protection afforded by sucralfate against esophageal acid injury is mediated by intraluminal pH buffering via aluminum hydroxide and protection against H+ entry and injury via sucrose octasulfate.116
4.5.3 Clinical efficacy

In an ex vivo model of acid‐induced mucosal bleeding in dogs, sucralfate was effective in promoting repair of the gastric mucosal tissue when applied at the time of or shortly after acid‐induced injury.117 Sucralfate also may provide a barrier for bile salts. Sucralfate is known to stimulate prostaglandin production in the gastric epithelium. This may be a potential secondary effect of sucralfate in the esophagus, although the importance and effectiveness of sucralfate as an agent for the treatment of erosive esophagitis is not as established as it has been for H2RAs or PPIs.

In rabbits, esophagitis induced by acid and pepsin was prevented by administration of sucralfate.118 In another study, cats pretreated with liquid sucralfate before acid infusion were protected against esophagitis.119 Studies in humans have compared sucralfate to other forms of treatment including alginic acid/antacid, cimetidine, and ranitidine. Sucralfate was as effective as Gaviscon containing sodium alginate with regard to healing of esophagitis and symptomatic improvement.120, 121 The H2RAs, ranitidine and cimetidine, and sucralfate had equal efficacy for treating reflux esophagitis,121-125 although higher grade esophagitis did not heal as well compared to lower grade esophagitis. In foals, sucralfate had a protective effect on oral, esophageal, and gastric ulcers associated with IV administration of high‐dose phenylbutazone.126 When sucralfate is compared to placebo, conflicting data regarding therapeutic benefit have been obtained in human patients with reflux esophagitis.127 Limited esophageal retention time may decrease effectiveness. In a study of technetium‐labeled sucralfate, the drug was retained within the esophagus for 3 hours in <50% of the patients with reflux esophagitis.128 In addition, sucralfate deposited in a nonacidified esophagus was rapidly cleared and poorly timed to provide protection against reflux injury.129 Sucralfate decreased the frequency of stricture formation in human patients with advanced corrosive esophagitis,130 and topical sucralfate was effective for post‐tonsillectomy analgesia in people.131 No controlled studies have been completed to assess the analgesic effects of sucralfate in people or animals with severe esophagitis, but anecdotal evidence indicates the drug's analgesic properties in people with esophagitis. In addition, in controlled studies, no significant benefit of treatment was observed involving a combination of sucralfate and H2RA, compared to either drug alone in treating acute duodenal ulcer, in ulcer maintenance treatment, in stress bleeding, or in reflux esophagitis.
4.5.4 Adverse effects

Sucralfate is a relatively safe compound and has minimal adverse effects. Aluminum absorption during sucralfate treatment is comparable to that during treatment with aluminum hydroxide, and caution should be exercised with long‐term treatment in patients with renal insufficiency to avoid aluminum intoxication.132, 133 Constipation, caused by aluminum hydroxide, is one of the most common adverse effects, and typically occurs in 1%‐3% of human patients taking the drug.134 Other adverse effects in humans include xerostomia, nausea, vomiting, headache, urticaria, and rashes in 0‐5% of patients.134, 135
4.5.5 Drug interactions with sucralfate

Coadministration of the following drugs with sucralfate results in a substantially decreased bioavailability of single doses of the drug: ciprofloxacin,136-138 theophylline,139 tetracycline, doxycycline, minocycline,140, 141 phenytoin,142 and digoxin.143 The bioavailability of digoxin, tetracycline, doxycycline, and phenytoin was not decreased when they were given 2 hours before sucralfate. Sucralfate impairs absorption of ciprofloxacin in humans and dogs when administered concurrently,136, 144 but the bioavailability of ciprofloxacin is markedly increased when administration of sucralfate is delayed by 2 hours. Interestingly, no significant difference in bioavailability was documented for enrofloxacin coadministered with sucralfate in dogs.136, 144

In contrast to sucralfate suspension, administration of sucralfate tablets had no effect on the absorption of doxycycline in dogs.140 This lack of interaction with sucralfate tablets suggests sucralfate tablets do not adequately disintegrate in dogs and should be administered as a suspension rather than an intact tablet.
Consensus opinion on the effectiveness of sucralfate for managing esophagitis or gastroduodenal ulceration

There is weak evidence in experimental animals and humans to support the use of sucralfate for preventing or treating esophageal injury. There is moderate evidence that sucralfate may have analgesic effects in people post‐tonsillectomy, but no studies have evaluated the analgesic properties of sucralfate in people or animals with esophagitis. No evidence supports either a benefit or interaction when sucralfate is administered concurrently with H2RAs or PPIs. When administered to dogs (and perhaps cats), intact tablets may not fully disintegrate and may not be as effective as a liquid suspension. No evidence indicates that combining sucralfate with either a PPI or an H2RA for treatment of GUE is beneficial or indicated. Proton pump inhibitors (Omeprazole) are superior to sucralfate for management of GUE. (GUE is gastroduodenal ulceration = ULCERS)

Re: Broth and Enzymes

Posted: 17 Jul 2019, 18:39
by Tuckaboo.
Hi there, I am brand new, but I may be able to help. My vet called the pharmacy that issued Pancreved, and he was told the reason the directions say to add liquid and wait is as follows---The porcine enzymes are caustic, and can cause irritation. If a bit of powder were to get stuck under your dog's tongue, or up in his gums, then that could cause a sore to develop. It has nothing to do with how well the enzymes work. Hope this helps.

Re: Broth and Enzymes

Posted: 20 Jul 2019, 11:47
by Madelon
Very interesting - thank you Olesia for once again getting into the weeds of things and explaining in a way that we can understand and posting the research so that we can share with our veterinarians.