Ken Lambrecht DVM

Medical Director Westside Family Pet ClinicFitness & Rehab Director 4 Paws Swim & Fitness

Presented January 21, 2012

Practical Small Animal Nutrition University of Wisconsin School of Veterinary Medicine

www.slideshare.netklambdvm@gmail.comwww.westsidefamilypet.comFacebook.com/westsidefamilypet .com

Recalls/food safetyRaw vs commercial“Evil” ingredientsBig box corporations vs “Mom & Pop”

1940 Hills made first can of Rx pet food…K/D

2002 “Purina study” (Orthopedic & Longevity)

2004 Nestle bought Purina (Switzerland based)

2006 Mars bought Royal Canin (France based) 2007 Melamine Contamination 2010 AAHA Nutrition Guidelines 2011 WSAVA Nutrition Guidelines

Built 4 Paws Swim & Fitness in 2005 CE emphasis on weight loss,

Neutracueticals, OA , pain management Rehab director for 4 Paws 2006-present Have visited Iams, Hills & Purina’s

facilities Directed Ideal Weight Programs with

over 350 participants in past 5 years Confirmed CE junkie!

Lisa Freeman DVM PhD DAVN Kathryn Michels MS DVM DACVN Tony Buffington MS PhD DVM DACVN Julie Churchill DVM PhD DACVN Dottie LaFlamme DVM PhD DACVN Joseph Wakshlag, DVM, PhD, DACVN, DACVSMR Joe Bartges BS PhD DVM DACVN DACVIM

David Twedt DVM DCVIM Deb Greco DVM PhD DACVIM Deb Zoran DVM PhD DACVIM Michael Lappin DVM PhD DACVIM Phil Roudebush DVM DACVIM

OCD of shoulder Hip dysplasia Irreversible pulpitis 104 Laryngeal Paralysis Osteoarthritis Cognitive Disorder Syndrome

Periodontal Disease Feline Resorptive Lesions(?) Kidney Disease Hyperthyroidism Lung mass Osteoarthritis Cognitive disease IVD Syndrome

Bug Lance

Be evidence based Be well informed & good communicators Be the pet’s advocate always Make a specific recommendation Ask the tough questions!

Be a practicing scientist Share CE “Pearls” Share resources Listen & learn Take a preventive approach

Preserve the bond They want their pet to live a long time Want us to respect their choices/values Preventive approach Control costs

What are you currently feeding? Are you happy with the food? How did you decide on that food? Does he/she seem to enjoy it? Other pets in house? How is stool quality, any vomiting etc?

The new 5th vital sign (WSAVA Nutritional Guidelines 2011)

1.Temperature2.Pulse3.Respiration4.Pain Assessment5.Nutritional Assessment

For every pet Identify risk factors (animal or diet) Body Condition score (9 pt system) Muscle condition score (none to

marked)

1) Animal Specific (changes, lab tests, identify any problems) 2) Diet specific Caloric density Other sources of nutrients Evaluate commercial food 3) Feeding management & practices

Peer reviewed evidence based studies Board Certified Nutrition DVMS

(58+) Internal medicine boarded

“practitioners” Rx Pet Food Company referenced

reviews

Breeders The Internet Pet food retailers (big box & boutique) Random bloggers, magazines etc

Over 70% trust their veterinarian They want us to make a specific

recommendation We are only ones that can make the

nutritional assessment We are the ones that have the scientific

knowledge

1. Nutritional guidelines (WSAVA & AAHA)2. Websites (OSU, Texas A & M, DAVIS, TUFTS)3. Consumerlab.com4. American Academy of Veterinary Nutrition

(AAVN)5. American College of Veterinary Nutrition (ACVN)6. Books “Chow Hounds”, “Feed your pet right” etc7. High Quality CE

AAHA Dental Care Guidelines 2005 AAHA Canine Vaccine Guidelines 2006 AAHA Senior Wellness Guidelines 2009 AAHA Feline Life stage Guidelines 2010 AAHA Nutritional Guidelines 2010 AAHA Anesthesia Guidelines 2011 AAHA/AVMA Dog & Cat Preventive

Guidelines 2011 AAHA Canine Life Stage Guidelines Jan 2012

Dentistry (80% ) Obesity (40 to 50%) Osteoarthritis (20%) Cancer Gastrointestinal Dermatologic Allergies (Food & Atopy) (15%) Renal, Hepatic, Cardiac

0

20

40

60

80

100

Wellness

Dentistry

Weight Management

Osteoarthritis

Allergies, Cardiology etc

Periodontal disease causes kidney, heart, and liver disease (and others) and is 100% preventable.

Is periodontal disease Associated with systemic & distant-organ* abnormalities?Yes: There are proven associations between periodontal disease and systemic and distant-organ abnormalities.7 Two studies conducted in dogs demonstrated that microscopic inflammatory or degenerative changes in distant organs (kidney, liver, heart) increase with rising severity of periodontal disease,8,9 and 2 studies have demonstrated an association between periodontal disease and cardiac10 or renal11 disease, though the extent of periodontal disease in these studies10,11 was recorded inconsistently.

Periodontal Health: Causes & Consequences Clinicians Brief Jan 2012 By Colin E. Harvey, BVSc, FRCVS, DACVS & DAVDC University of Pennsylvania

vohc.org

Foods = 20% better than averageTreats & Water products = 10% better

Plaque and/or Tartar claim (Gingivitis claim coming)

Obesity is a serious, almost epidemic disease that is as important as any other disease we treat and is 100% preventable.

Canidae All life stage 8 oz cup 468 Purina High Pro 8 oz cup 441 Royal Canine Mature 8 oz cup 373 Iams Wt Control 8 oz cup 328 Purina Rx DH 8 oz cup 276 Hills Rx Diet Canine 8 oz cup 242

Lindner DE & Freeman L “Evaluation of Caloric Density and feeding directions for commercially available diets designed for weight loss in dogs & cats” JAVMA Vol 236 No 1 January 2010

“Light formulas” range from 224 to 480 cal/cup!!!

Kealy, Gail et al 48 Labrador Retrievers 14 year study (longest ever performed)

Longevity, reducing developmental orthopedic disease, and delaying chronic disease components.

Showed that ideal weight dogs lived an average of 15% longer and had better health and quality of life

Labrador expected life 12 yrs should add 2.2 yrs)

If pet is 2 BCS scores over ideal on BCS or more than 20% over ideal weight a prescription food high in protein should be used

Dogs 1 gm protein per lb of Ideal weight Cats 2 gm protein per lb of ideal weight

85 lb lab whose ideal weight is 60# has a BCS of 8 needs 60 mg protein daily to get to 60#.

A 13lb cat whose ideal weight is 10 lbs and a BCS of 7 needs 20 mg protein daily to get to 10# safely.

Dear Colleagues,

I wonder if the group can help us with some challenges related to the best evidence related to what really works with our current Rx diets and exactly why they are better than OTC foods for pets that are 20% more than their ideal weight.

What we are hearing from 2 major pet food companies is that it is simply the protein that works because it is muscle sparing, satiates & burns more calories while another company claims that the lysine &/or Carnitine levels are more important.

We have primarily been using the 1 gram of protein per lb of ideal weight for dogs (and 2 gm per lb for cats) as presented by Dr Julie Churchill at U of M and using the evidence based summary from JAVMA by Dr Phil Roudebush from 2008.

Thanks much!

Ken Lambrecht DVM

From a nutritional perspective, the concern with feeding any over the counter food for active weight loss is that when you restrict the amount of food fed to decrease energy intake, you are also restricting other essential nutrients such as protein, amino acids, fatty acids, vitamins and minerals. 

Over the counter foods are generally designed to provided appropriate amounts of essential nutrient for pets maintaining their body weight, and when restricted levels are fed, essential nutrients may fall below adequate daily intakes. 

Prescription weight loss foods and over the counter foods designed for active weight loss take this into consideration and boost dietary protein as well as other important essential nutrients to help ensure that protein and other essential nutrient needs are met during caloric restriction.

Preserves lean muscle mass in dogs Hannah SS LaFlamme DP J

Vet Int Med 1998;12:224 in cats LaFlamme DP, Hannah SS

Intern Applied Res Vet Med 2005 Contributes to satiety in dogs Weber M, Bissot et al J Vet

Intern Med 2007 21:1203-1208 in cats Vasconcellos et al J Nutr 2009

139:855-860

To feed to get 10 # ideal wt

Purina OM

Hills R/D

Purina DM

RoyalCaninMobilitySupport

Science Diet Hairball Control Light

Nutrisource Weight Management

% protein

50% 37% 53% 26.5% ? ?

Protein gms/100 kcal

15.7 11.4 12.9 7.2 10.2 9

Calories/cup

321 263 592 392 283 280

Cups to feed 180kcal

1/2 2/3 3/10 4/10 2/3 2/3

Gm protein provided (20 gm ideal)

28 21 23 12.9 18.3 16.2

85 lb Lab Ideal weight 60# 2 Previous TPLO’s Owner free feeds

To feed a dog with goal of 60#

Royal CaninCC HP

Purina OM

Hills RD

Purina JM

HillsJD

NutrisourceWeight management

Protein g/100 Kcal

12.2 10.4 8.6 7.4 5.1 6.3

Kcal per cup

234 266 242 295 356 340

Cups to feed per day 700kcal

3.0 2.6 2.9 2.4 2.0 2.1

Gms protein provided (60 gmdesired)

85 73 60 55 36.2 44

Ohio State website Dr Tony Buffington www.vetosu.edu/nssvet

Texas A & M website Dr Deb Zoran www.vetmed.tamu.edu

UC Davis Dr Sally Perea www.vetmed.davis.edu

Consumer Labs www.consumerlab.com

Association of Pet Obesity Prevention Dr Ernie Ward www.petobesityprevention.com

57 participants 20 cats (all cats were WFPC clients) Pets lost from 0 to 3.8% per week Most on Rx food (two on raw)

Clover

Continuously assess BCS (every visit) Keep them on lean side = fist/knuckles

test Teach clients how to count calories Help them choose a safe diet food

I am more concerned about Ideal weight than any one or group of ingredients!

Ideal weight = best health insurance!

(Kealy, Gail Smith et al) using Purina’s research dogs & facility

48 Labradors Followed for 15 years

Years

Num

ber

of d

ogs

0

5

10

15

20

25

Num

ber

of d

ogs

0

5

10

15

20

25

Normal Mild OA Moderate OA Severe OA

0.5 1.0 2.0 3.0 5.0

Osteoarthritis in Control

dogs

Osteoarthritis in Lean-fed

dogs

Effect of Calorie Restriction on OA

We can reduce degenerative orthopedic diseases (DOD) = hip dysplasia, elbow dysplasia and OCD of shoulder

By keeping pets at their ideal weight for their entire life.

Impellizeri JA, Tetrick MA, Muir P J Am Vet Med Assoc. 2000 Apr 1;216(7):1089-91.

“Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis.”

Results—Dogs (9) lost between 11 and 18% of initial body weight. Body weight, body condition score, and severity of hind limb lameness were all significantly decreased at the end of the weight-loss period.

Conclusions and Clinical Relevance—Results suggest that in overweight dogs with hind limb lameness secondary to hip osteoarthritis, weight reduction alone may result in a substantial improvement in clinical lameness. (J Am Vet Med Assoc 2000;216:1089–1091)

Rousch J K et al “Evaluation of the effects of dietary supplementation with fish oil omega 3 fatty acids on weight bearing in dogs with osteoarthritis” JAVMA Vol 236 No 1 Jan 1, 2010

Results—Dogs (129) fed the test food had a significantly higher serum concentration of total omega-3 fatty acids and a significantly lower serum concentration of arachidonic acid at 6, 12, and 24 weeks. According to owners, dogs fed the test food had a significantly improved ability to rise from a resting position and play at 6 weeks and improved ability to walk at 12 and 24 weeks, compared with control dogs.

Conclusions and Clinical Relevance—Ingestion of the test food raised blood concentrations of omega-3 fatty acids and appeared to improve the arthritic condition in pet dogs with osteoarthritis.

OR OR

Plus DASUquin or Glycoflex

294mg EPA/cup

394 mg EPA/cup

330 mg EPA/cupContains Perna GLM

13 yr old DSH 11.9 lbs BCS 7 2# weight gain in past 4 months Client is free feeding RC LP & RC

Intestinal and giving DASUquin & Denamarin daily

History of undiagnosed hepatic disease at UW

Stage 2 IRIS Renal Disease Mild IBD

Examined 1/19/12 for one episode of falling after missing a jump, not jumping up as much, not quite as active

Weight gain of another 0.5 lb since last visit

All else normal

Repeated labwork (cbc, chem, u/a) Had Creat 3.1 on 10/31/11 (2.6 on 1/19/12)

Phos normal range both visits UspG 1.022 10/31/11 (1.022 on 1/19/12) Radiographs of lat elbows & vd pelvis

normal Articular facets of spine poorly defined

Switch to RC mobility JS 160 kcal/day Weight loss to get to Ideal weight

of 10# Consider gabapentin or amantadine Could supplement EPA as well Will discuss therapeutic laser,

acupuncture etc

Lascelles, BD et al “Evaluation of a Therapeutic Diet for Feline Degenerative Joint Disease” J Vet Intern Med 2010 1-9

Conclusion: A diet high in EPA & DHA and supplemented with green lipped mussel extract and glucosamine/chondroitin sulfate improved objective measures of mobility. Dietary modulation might be 1 method to use to improve mobility in cats with DJD associated pain.

372 kcal/cup 438 mg EPA/cup(212 mg EPA/180kcal)Perna GLM

506 kcal/cup605 mg EPA/cup(216 mg EPA/180 kcal)No joint support

OA Treatment Pyramid

And foods!<<<

1) First & ALWAYS = Ideal weight & exercise plan

2) Hills JD, Purina JM, Royal Canin Mobility or supplement with 20mg/lb EPA

3) DASUquin or Glycoflex or RC Mobility4) Next steps based on client preferences

Inflammatory bowel disease Food allergies Diarrhea

Dogs (n=198)

Beef 36%

Dairy 28%

Wheat 15%

Egg 10%

Chicken 9.6%

Lamb 6.6%

Soy 6%

Cats (n= 89)

Beef 20%Dairy 14.6%Fish 13%Lamb 6.7%Poultry 4.5%Barley/wheat 4.5%

Verlind A, Hesta M et al Food allergy in dogs & cats a review Crit Rev Food Sci Nutr 2006 46:259-273

Corn is not listed on dog or cat and chicken low on dog and missing from cat!

If 3-5% of all pets are food allergic…

36% beef 1.8% of all dogs 28% dairy 1.5% of all dogs 16% wheat 1.1 % of all dogs 10% egg 0.5% of all dogs 9.6% chicken 0.5% of all dogs 6% soy 0.3% of all dogs

Inflammatory bowel disease Food allergies-skin manifestations 90% of food allergic dogs can be

detected using hydrolysate diets (soy or chicken)

vs novel protein diets

ECVIM paper demonstrates almost a 100% replacement of lactulose, pumpkin, etc!

=+

Vohc label 294 mg EPA/cup600 mg EPA/cup

Hands down the toughest question a client can ask us!

Marketing challenges Anthromorphizing “Over animalizing” What is the truth?

FDA & AAFCO regulated Is a legal document

Manufacturer’s info Ingredients list in order of weight (Salt is divider between major & minor) Guaranteed analysis Feeding directions Nutritional adequacy statement Meets nutrient profiles or Feeding Trial Statement

Calories per cup EPA per cup Perna, Glucosamine & chondroitin

sulfate per cup Quality of Ingredients Organic

Grains (corn, wheat & soy) By products Rendering, preservatives, digest

opponents proponents

corn filler poor protein source poorly digestible causes allergies

corn meal is good source of protein

soy cheap source of inferior protein

Fine if used w/ complementary grains

wheat allergenic not allergenic

Link to aflatoxins? Allergies? Filler? Link to high fructose corn syrup? Marketing spin?

An ingredient that has no nutritional purpose

better nutrient balance than other grains

highly available CHO source good linoleic source essential amino acids fiber source Not a common cause of allergies

Soybean meal excellent source of lysine & tryptophan

NOT highly allergenic (6% of allergies to 36% for beef)

Doesn’t cause bloat

Incidence in people _?_% Incidence in pets 1.6%? Irish Setters 1990 study

Poultry by product meal 65 to 70% Chicken meal 63 to 67% Fish meal 60 to 65% Corn gluten meal 60 to 64% Meat & bone meal 50 to 55% Soybean meal 46 to 50%

Wild canids are not apex predators (like wolves) they are more like coyotes and ate small prey, insects, mollusks, carrion, and plant materials (berries, fruits, nuts, seeds, roots, grass, seaweed, gut contents of herbivores)

Grains have a higher consistency of amino acid quality than meat protein (e.g. lamb has poor methionine & taurine)

Make sure a meat protein is in the top three ingredients

As long as amino acid needs are met grains are fine

Ingredients not used for human food

Includes liver, spleen, tripe etc Does NOT include hair, hooves etc

The animal feed industry has always used the by products of the human food industry

High variability in quality esp meat by products

Source of considerable marketing “spin”

Non-rendered, clean parts other than meat derived from slaughtered animals. It includes but is not limited to lungs, spleen, kidneys, brain, livers, blood, bone, partially defatted low temperature fatty tissue, and stomachs and intestines freed of their contents. It does not include hair, horns, teeth & hooves.

(This does not include backs, necks, and chicken “racks”)

Rendering = cooked & processed into meals Digest = similar to bouillon, sprayed on for

palatability

Rendering is presently a “necessary evil” ofconverting waste from human food processing(meat & plant) into usable items to feed toother animals. According to “Feed Your PetRight” authors it needs much more regulation.

“Besides, the pet food industry serves an important ecological function by using up food that would otherwise be thrown out,”

“If everyone cooked human food for the 472 million cats and dogs in America, it would be like feeding an additional 42 million people.”

Dr. Nestle author of “Feed Your Pet Right”

quoted in NY Times article.

Probiotics are killed by heat Fish oils decrease the shelf life of food Value of Prebiotics?

Urolithiasis Cats & Dogs Protein quality/inflammatory bowel disease

Cats May help satisfy pets to lose/maintain weight Cost, environmental issues, etc Dental benefits of dry?

Do you have a veterinary nutritionist on staff?

Are they available to answer questions? Which of your diets are tested using

AAFCO feeding studies? What specific quality control measures

do you use to assure consistency & quality?

What kinds of research on your products has been conducted and are results published in peer review journals?

Low protein Moderate Protein

High Protein

Humans 14%

Dog <18% 18-25% >25%

Cat 20-30% 30-50% >50%

Hills J/D Canine

20.1%

Purina JM Canine

34.2%

Dogs with chronic renal disease (less than 1% of all adult dogs) may benefit from restricted levels of protein & PO4

Zoran D, Buffington T “Effects of nutrition choices and lifestyle changes on the well being of cats, a carnivore who has moved indoors” JAVMA Vol 239 No 5 Sept 1st 2011

Protecting them from their natural predators (larger carnivores and primates) and providing preventative medical care to decrease their risk of illness from infectious diseases has increased the average lifespan of cats from 4.5 years (which is typical of an outdoor cat) to nearly 15 years.7 However, despite these benefits, this crepuscular carnivore has been removed from a free-roaming, active existence to a captive, indoor, sedentary one.

Cats have gone from frequent consumption of small meals that consisted of animals they could catch and kill to consumption of prepared diets of human choosing, which are often available in excessive amounts and consist of less protein and a wider variety of protein, fat, and carbohydrates than is found in wild birds, insects, and small rodents.

Cats are one of the few true carnivores humans have attempted to domesticate. People also have attempted to get cats to adapt to human lifestyles and preferences, which sometimes leads to a failure to recognize or understand the perils of domestication and its effects on feline behavior, well-being, and health. As a result, there is increasing evidence that many of the chronic health problems of domestic cats are directly or indirectly related to nutrition or lifestyle changes that have been imposed on them by their owners

Prebiotics/probiotics Role of protein in inflammatory bowel

disease Obesity Osteoarthritis Renal disease FLUTD

Small, firm and dark Trial & error What works in one pet will not always

work in others Give several options Can always re-evaluate & change

Cost of pet foods Missing ingredients (antioxidants,

enzymes, vitamins like Vit E, probiotics) Recalls, Treat contamination

Earlier publication of studies from pet food companies in peer reviewed journals

Better FDA regulations (calories and EPA levels per cup on label, get rid of food families, etc)

EPA at 40mg/kg in every pet food Less “negative” marketing More good studies supported by

independent groups like ACVIM, ACVN, AAFP, AAHA, AVCSM

Protein levels approaching wild diet Anti-inflammatory levels of EPA Probiotics & prebiotics at optimal levels Evidence based joint protectants added Organic and no preservatives or by

products Inexpensive & convenient to feed!

Thank you for your attention! Questions?

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