Food Questions

Epi4Dogs Foundation Inc.’s mission is the advancement of science and education relating to EPI (Exocrine Pancreatic Insufficiency), yielding useful insights and positive outcomes in better managing EPI in dogs and cats. Our goals are to support and/or collaborate with veterinary EPI research and researchers, and to promote EPI awareness by educating the general public, pet owners, pet organizations, rescue and shelter organizations, veterinary schools and veterinarians.
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Remy
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Pet name: Remy
My name: Cyndy

Food Questions

Post by Remy » 18 Jun 2020, 11:33

https://www.amazon.com/gp/product/B079F ... UTF8&psc=1

Remy was recently diagnosed with PEI. He was on Gastro Food from the vet, and chicken and rice which seem to be not a good thing by what i am reading. i found the following food in the link above and i just want to confirm it fits the criteria of acceptable foods. Or if somebody has used something better.

We started the enzymes Henry Schein PancreaPower Plus and it has been a bit of a roller coaster on the poop patrol. It is no longer yellow but it is still very loose with sometimes being more formed to pick it up. I think my neighbors hate me because It is tough to clean up and we are required to. He seems to have gained some weight, but is always hungry. We feed him 4 times a day. but only give him 2 teaspoons of the enzymes (per instructions from the vet) at morning and night. I tried to see if adding a 1/2 teaspoon to all meals worked any better it did not. He did lose over 10 pounds since his visit the year before and he is slim by nature. We had him tested for parasites, giardia, and lastly pei. My biggest concern now is getting him on a food that helps and adding more weight. he is still very frisky @ 4 yeas in july. he is a collie, shepherd mix.
My engineer brain only wants me to make one change at a time so what are the best things i can be trying and what seems to have the most impact for people?

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Shirl D.
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Re: Food Questions

Post by Shirl D. » 18 Jun 2020, 16:49

Hello, and welcome to the forum. Your engineer brain is absolutely on the right track with making only one change at a time, and that is what we normally suggest once proper treatment is started. However, you have a few things going on that are not working in Remy's favor, and need to be changed ASAP all at once. You are right that the Gastro Food from the vet usually does not work well for our EPI dogs. The food you have found is not ideal either, however. The biggest considerations with food for our EPI dogs is low fiber (4% or less; the Diamond food has 5% fiber), no rice, and as few peas, lentils and legumes as you can get. The main source of protein should be from meat. Grain free foods typically have the right fiber content and no rice, but sometimes they put in a lot of peas, potatoes and other plant sources of proteins, so you have to really look around. We have a Dog Food Options page on our site under the Managing EPI tab. Take a look at that for some ideas. It's getting harder and harder to find a dog food without peas, but try to make sure it is lower in the ingredient list and that it's not listed several times (peas, pea protein, etc.).

The other glaring issue is only using the enzymes on some meals. Your dog no longer makes his own digestive enzymes to break down and digest his food. We add enzymes so that he can do that. We want him to be able to break down and digest his food every time he eats, not just twice a day, so we need to add enzymes to every meal. He should not have any food at all without enzymes, including treats. Any food without enzymes will go through the system undigested and continue to cause diarrhea and bacterial imbalances. We recommend a ratio of 1 teaspoon powder to 1 cup of dry kibble. This ratio works best, and can be adjusted as needed, but it's a good starting point. I'm certain that this is why he's continuing to have roller coaster poops.

There are actually 4 cornerstones to treating EPI. Food is one, enzymes is another. The last 2 things are B12 and SID (small intestinal dysbiosis). Did your dog have a B12 test (cobalamin) when he had the TLI test for EPI? If so, find out what the actual number was. EPI dogs do best if their B12 is in the upper range of normal (above 600). If his B12 is low, it can also affect his poops and keep him from stabilizing. The last thing, SID, may resolve on its own after proper treatment, so I would suggest getting everything else on track all at once and keep in mind that he may need antibiotics at some point.

So, my suggestions:
1. Start giving enzymes at a ratio of 1 teaspoon per 1 cup of kibble at each meal.
2. Find a food with 4% or less fiber, no rice and limited peas. Check the Dog Food Options page for some possibilities.
3. Check with your vet to see what his B12 level was. If it was not above 600, begin B12 supplementation.

Keep us posted and keep asking questions!

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Madelon
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Re: Food Questions

Post by Madelon » 22 Jun 2020, 13:40

Hi and welcome to our EPI family. There are four cornerstones to properly managing EPI:

ENZYMES: Most of us use EnzymeDiane as her enzymes are much less expensive and you do not need a prescription (www.enzymediane.com). The recommended starting dose is 1 level teaspoon per cup of kibble, mix in a little luke warm water then mix in kibble and sit 20-30 minutes before serving.

B12: Supplementing B12 is critical to managing EPI and low B12 can affect mood, appetite, energy, weight gain. EPI dogs need their B12 on the high side of normal 600+ and supplementing is for life with these dogs. Most of us use WonderLabs Pet Factor B12 pills (www.wonderlabs.com). Use code EPI4DOGS15 when checking out to get a 15% discount.

ANTIBIOTICS: When first diagnosed we recommend using the proper dose of enzymes, B12 and food for a week or two to see if the gut will correct itself. If it does not and you're still dealing with SID (small intestinal dysbiosis) you can try either using Slippery Elm Bark Powder or a 45 day course of Tylan antibiotics.

FOOD: This can be the hardest part of EPI. We recommend grain free with 4% fiber or less, feed 150% of the food for the weight your dog SHOULD be but in smaller more frequent meals until you reach goal weight.

Keep a detailed journal of everything you give and the resulting poops and don't worry, we're here to help guide you along the way.
MADELON and Doc. DX EPI and SIBO: 5/22/2015
Test Results: (1st) 7/2014 = TLI 16.5, B12 894, Folate > 24; (2nd) 5/2015 = TLI < .4, B12 406; Folate >24; (3rd) 10/2015 TLI < .4; B12 >1000; Folate 14.4. Prior to DX: May 2014 (2mos) - DX coccidia/bladder infection; July 2014 (3mos) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Dx SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May 2015 vomitted several times, diarrhea and eating poop. Regimen: 4 cups Sport Dog Food Elite Herding - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 1/2tsp Slippery Elm 2xday; Multivitamin; 1 Zyrtec 10mg 2x day; Salmon Oil

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Remy
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Pet name: Remy
My name: Cyndy

Re: Food Questions

Post by Remy » 22 Jun 2020, 16:08

Thanks for the feed back.
Just adjusting the enzymes has made a Hugh difference. I was not giving him enough.
I am also in the process of changing to a low fiber food ~ 3% fiber it does have peas but seems so far to be ok for him. .
I will have to call the vet on the b12. they did over 400$ worth of blood tests not just the epi so I hoping that was included.
If he is digesting the food properly with the enzymes do i need to add the B12?
Originally they did give him antibiotics but that was just for 10 days. They never mentioned sibo.

What is the difference between the enzymes the vet prescribes and the ones on the web site suggested?

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Shirl D.
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Re: Food Questions

Post by Shirl D. » 22 Jun 2020, 16:32

I'm glad you saw a difference when you increased the enzymes! Hopefully the food you've found will work for him. Keep a close eye on his poop...that will tell the story! They usually do the B12 (cobalamin) test at the same time, but not always. The thing with B12 is that many EPI dogs aren't able to absorb B12 from their food, even with the enzymes because they don't have something called the intrinsic factor which is essential to being able to absorb B12. The vast majority of EPI dogs will need B12 supplementation at some point in their lives, and many of them need it immediately upon diagnosis. If his B12 is not 600 or above, he should get either injections of B12 or B12 pills with intrinsic factor. There are only a couple products that have this. Their information is on our B12 page, and I think there is a discount code for us to use. As for SIBO/SID, virtually all dogs with EPI have this at diagnosis just by the nature of the undigested food in their system. They most likely gave you antibiotics for it without telling you it was specifically for SID. There's no other reason an EPI dogs would need antibiotics for EPI. SID is usually treated based on symptoms, so if, after a week or two, you still see symptoms of SID, you should probably start treating it directly. As Madelon said, you can try slippery elm bark powder or a course of tylan antibiotics. We'll cross that bridge when we come to it. In the meantime, keep doing what you're doing! Sounds like you are making gains already!

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Shirl D.
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Re: Food Questions

Post by Shirl D. » 22 Jun 2020, 16:39

I forgot to mention....the big difference between the vet's enzymes and the ones we suggest is price. Enzyme Diane's enzymes are basically generic so you're not paying for the name and overhead of the big companies that sell to the vets. I have used Pancreatin from Enzyme Diane with my Pixie for 9 years. We first got a bottle of Viokase V from the vet for $150 (choke!). I ordered Diane's when I needed more for $50 for the same amount and it worked exactly the same. She has a comparison chart on her website so you can see breakdown of the amounts of enzymes (lipase, amylase and protease) in them. https://enzymediane.com/info/enzyme-comparison-chart/ There are slight variations, but they all seem to work roughly the same.

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Madelon
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Re: Food Questions

Post by Madelon » 26 Jun 2020, 23:34

Most EPI dogs will have low B12 - if not at the time of diagnosis they will develop it later. The B12 is typically tested with the TLI so hopefully it was done. If it were me I wouldn't pay to have the B12 run at this point - if your dog is definitely EPI then I would supplement the B12 and then test the B12 in 2 months so you can see where it is with supplementation. Just remember they need their B12 on the high side of normal 600+
MADELON and Doc. DX EPI and SIBO: 5/22/2015
Test Results: (1st) 7/2014 = TLI 16.5, B12 894, Folate > 24; (2nd) 5/2015 = TLI < .4, B12 406; Folate >24; (3rd) 10/2015 TLI < .4; B12 >1000; Folate 14.4. Prior to DX: May 2014 (2mos) - DX coccidia/bladder infection; July 2014 (3mos) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Dx SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May 2015 vomitted several times, diarrhea and eating poop. Regimen: 4 cups Sport Dog Food Elite Herding - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 1/2tsp Slippery Elm 2xday; Multivitamin; 1 Zyrtec 10mg 2x day; Salmon Oil

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Remy
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Country: United States
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Pet name: Remy
My name: Cyndy

Re: Food Questions

Post by Remy » 29 Jun 2020, 17:16

What a difference a week makes.! He is doing well on the food. I have almost finished up the enzymes the vet gave me. I did order some from Dianes. (It was 160$ for 12 ozs from the vet).
He is almost back to his original weight. I think we caught it pretty early. You can still see the ribs but not nearly so bad. I think it is tougher to retraining people not to feed him treats. He has serious puppy dog eyes.

We have been giving him extra food to put some weight back on and i am starting to feed him less as he gets back to his normal weight. What do people do for treats? any options?

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Shirl D.
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Re: Food Questions

Post by Shirl D. » 29 Jun 2020, 18:17

I'm glad to hear that he is doing better! We recommend no treats until he is stable (consistent good poops) for at least 3 months. Then there are options. As with everything else EPI, every dog is different, so it may take some trial and error to find out what he can and cannot tolerate when it comes to treats. That's why it's so important to wait until he has been stable for 3 months. We want to make sure, if you see a bad poop, that it's from the treats and not something that needs to be changed in his regular routine. Take a look at the Treats page here for some ideas when he is ready for them! https://epi4dogs.com/treats/

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Madelon
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Location: Nashville, TN
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Re: Food Questions

Post by Madelon » 29 Jun 2020, 19:11

Hi there. Glad things are going well. Have you talked to the vet about the B12? If not please be sure to as you will not see optimal results and might have a set back if you're not supplementing the B12.
MADELON and Doc. DX EPI and SIBO: 5/22/2015
Test Results: (1st) 7/2014 = TLI 16.5, B12 894, Folate > 24; (2nd) 5/2015 = TLI < .4, B12 406; Folate >24; (3rd) 10/2015 TLI < .4; B12 >1000; Folate 14.4. Prior to DX: May 2014 (2mos) - DX coccidia/bladder infection; July 2014 (3mos) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Dx SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May 2015 vomitted several times, diarrhea and eating poop. Regimen: 4 cups Sport Dog Food Elite Herding - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 1/2tsp Slippery Elm 2xday; Multivitamin; 1 Zyrtec 10mg 2x day; Salmon Oil

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