Part one : Is my dog at risk for Nutritionally-Mediated DCM?
As of Feb 2019, the FDA mentions a report of a dog as young as 0.42 years having NM-DCM So it is a reasonable estimate that a few months on a suspect diet may be enough to cause serious concern.In the cooking process of kibbles, meat lose taurine, some companies add taurine to compensate for the loss of itAdding taurine to a suspect diet might NOT solve the problem
PET FOOD MANUFACTURERS ADDING TAURINE TO EXISTING FOODS:
The short story: No, this doesn't solve the problem.
The long story: Dogs don't need extra taurine in their food sources. They make their own taurine in their bodies using cysteine and methionine, two other amino acids. The root cause of the taurine-DCM issue we are dealing with now is NOT that food manufacturers were not putting enough taurine in their foods. It is possibly a deficiency or malabsorption earlier in the amino acid pathway, where the dog should be accessing the cysteine and methionine in the foods, OR it's a leaching/binding of the taurine in the dog's body by the fiber in legumes and pulses, OR both.
So no, adding taurine to the food isn't fixing the issue - it's not even band-aiding it. None of the foods the FDA tested were low in taurine; they didn't need more. The DOGS are low in taurine, not the foods.
The long story: Dogs don't need extra taurine in their food sources. They make their own taurine in their bodies using cysteine and methionine, two other amino acids. The root cause of the taurine-DCM issue we are dealing with now is NOT that food manufacturers were not putting enough taurine in their foods. It is possibly a deficiency or malabsorption earlier in the amino acid pathway, where the dog should be accessing the cysteine and methionine in the foods, OR it's a leaching/binding of the taurine in the dog's body by the fiber in legumes and pulses, OR both.
So no, adding taurine to the food isn't fixing the issue - it's not even band-aiding it. None of the foods the FDA tested were low in taurine; they didn't need more. The DOGS are low in taurine, not the foods.
Personal note: If I see that a dog food company is announcing that they are adding taurine in response to the FDA alert, it is a mark against the company, not for it. It means they didn't listen and don't understand the real problem, but they know that consumers heard the word "taurine" and so they are going to dump some more taurine in the mix.
Added taurine does very little and it’s annoying that companies again change their formula out of fear rather than because they want the best for our pets. Taurine needs to be made in the body of the dog. The sources are good quality red meat proteins.
Echos performed on members' dogs, charting DCM cases
Updated 3/20/19: 365 cases of DCM diagnosed, including 73 deaths
These " Picture below " are echo-cardiogram results reported by owners.Many have submitted their echo-cardiogram reports to veterinarians in the group for review. Many have also submitted to the FDA. All are either "confirmed" or "suspect" nutritionally-mediated DCM at this time.
Key point:
This is not a controlled study, thus we have no way of estimating the actual percentage of dogs affected in the overall population.
Some other points:
The overall tie to certain diet types and increasing DCM is important. It is more difficult to tie DCM to specific diets when they only have 1 or 2 cases correlated with that brand or formula.
This is particularly true with a brand with low case numbers and the caret (^) mark. This caret indicates the only cases reported are when that diet was PART of the diet history.
Part 2 :Why we name brand names and not formulas?
-There are simply too many formulas to fit on the graphs at this point
-As time goes on the correlation continues with companies that do not meet WSAVA guidelines for research, expertise, etc. Although obviously not every formula of these implicated companies is correlated with DCM, their other formulas are usually not well researched either.
-To date, we are not aware of any brand that has taken responsibility to recall a formula correlated with DCM, to compensate owners for medical costs, or to provide scientific evidence why their other formulas are a safer option.
Breeds reported with suspected or confirmed nutritional DCM: over 80 Breeds reported in scientific publications:
Freeman et al. (2018) J Am Vet Med Assoc:
"Dogs for which breed was specified consisted of mixed-breed dogs (n = 134), Golden Retrievers (23), Labrador Retrievers (9), German Shepherd Dogs (8), Cocker Spaniels (7), and between 1 and 5 dogs each of 25 other breeds."
Adin et al. (2019) J Vet Cardiol:
"Breeds of dogs eating GF diets included Doberman Pinscher (6), Golden Retriever (5), Great Dane (4), Labrador Retriever (4), mixed breed (4), Miniature Schnauzer (2), Yorkshire Terrier (1), Miniature Poodle (1), Standard Poodle (1), Malti-poo (1), Shetland Sheepdog (1), Old English Sheepdog (1), Chesapeake Bay Retriever (1), German Shorthaired Pointer (1), German Shepherd (1), Miniature Pinscher (1), and Boxer (1)."
In this group, 94 different breeds/mixes that have been reported (in order of frequency then alphabetically):
Golden Retriever
Labrador Retriever
Goldendoodle
Pit/mix
Weimaraner
Mixed breed
German Shepherd
Great Dane
Standard Poodle
Whippet
Portuguese Water Dog
German Shorthaired Pointer
Miniature Schnauzer
Border collie
English Bulldog
English Mastiff
French Bulldog
Airedale Terrier
Australian Shepherd
Boxer
Brittany
English Setter
Greyhound
Shetland Sheepdog
Australian Labradoodle
Belgian Tervuren
Boxer mix
Catahoula
Chinese Crested
Dalmatian
Doodle
Great Pyrenees
GSD/Collie mix
Miniature Dachshund
Old English Sheepdog
Rottweiler
Saluki
Samoyed
Staffordshire Bull Terrier
Vizsla
Afghan Hound
Akita
American Cocker Spaniel
American Staffordshire Terrier
Australian cattle dog mix
Australian Kelpie
Basset Hound
Beagle
Belgian Malinois
Black Russian Terrier
Boston Terrier
Bouvier des Flandres
Boykin Spaniel
Chihuahua
Chihuahua/Jack Russell Terrier mix
Cockapoo
Collie
Coonhound
Doberman
English Pointer
English Springer Spaniel
Flat-coated retriever
Foxhound
Golden/Pyrenees
Gordon Setter
Great Dane / Presa Canario
Hound mix
Irish Setter
Irish Wolfhound
Jack Russell Terrier
Lab mix
Lab/Golden mix
Labradoodle
Leonberger
Maltese
Maremma
Miniature Bull Terrier
Newfoundland/Lab mix
Papillon
Poodle mix
Rat Terrier
Redbone Coonhound
Rough Collie
Saint Bernard
Shepherd/cattle dog mix
Shiba Inu
Shih Tzu Mix
Spinone Italiano
Tamaskan mix
Toy Poodle
Weimaraner/Labrador mix
Welsh Terrier
Wheaten Terrier
Wheaten Terrier mix
Part 3 : Diagnosing Nutritional DCM: terms and parameters
Added taurine does very little and it’s annoying that companies again change their formula out of fear rather than because they want the best for our pets. Taurine needs to be made in the body of the dog. The sources are good quality red meat proteins.
Echos performed on members' dogs, charting DCM cases
Updated 3/20/19: 365 cases of DCM diagnosed, including 73 deaths
These " Picture below " are echo-cardiogram results reported by owners.Many have submitted their echo-cardiogram reports to veterinarians in the group for review. Many have also submitted to the FDA. All are either "confirmed" or "suspect" nutritionally-mediated DCM at this time.
Key point:
This is not a controlled study, thus we have no way of estimating the actual percentage of dogs affected in the overall population.
Some other points:
The overall tie to certain diet types and increasing DCM is important. It is more difficult to tie DCM to specific diets when they only have 1 or 2 cases correlated with that brand or formula.
This is particularly true with a brand with low case numbers and the caret (^) mark. This caret indicates the only cases reported are when that diet was PART of the diet history.
Part 2 :Why we name brand names and not formulas?
-There are simply too many formulas to fit on the graphs at this point
-As time goes on the correlation continues with companies that do not meet WSAVA guidelines for research, expertise, etc. Although obviously not every formula of these implicated companies is correlated with DCM, their other formulas are usually not well researched either.
-To date, we are not aware of any brand that has taken responsibility to recall a formula correlated with DCM, to compensate owners for medical costs, or to provide scientific evidence why their other formulas are a safer option.
Breeds reported with suspected or confirmed nutritional DCM: over 80 Breeds reported in scientific publications:
Freeman et al. (2018) J Am Vet Med Assoc:
"Dogs for which breed was specified consisted of mixed-breed dogs (n = 134), Golden Retrievers (23), Labrador Retrievers (9), German Shepherd Dogs (8), Cocker Spaniels (7), and between 1 and 5 dogs each of 25 other breeds."
Adin et al. (2019) J Vet Cardiol:
"Breeds of dogs eating GF diets included Doberman Pinscher (6), Golden Retriever (5), Great Dane (4), Labrador Retriever (4), mixed breed (4), Miniature Schnauzer (2), Yorkshire Terrier (1), Miniature Poodle (1), Standard Poodle (1), Malti-poo (1), Shetland Sheepdog (1), Old English Sheepdog (1), Chesapeake Bay Retriever (1), German Shorthaired Pointer (1), German Shepherd (1), Miniature Pinscher (1), and Boxer (1)."
In this group, 94 different breeds/mixes that have been reported (in order of frequency then alphabetically):
Golden Retriever
Labrador Retriever
Goldendoodle
Pit/mix
Weimaraner
Mixed breed
German Shepherd
Great Dane
Standard Poodle
Whippet
Portuguese Water Dog
German Shorthaired Pointer
Miniature Schnauzer
Border collie
English Bulldog
English Mastiff
French Bulldog
Airedale Terrier
Australian Shepherd
Boxer
Brittany
English Setter
Greyhound
Shetland Sheepdog
Australian Labradoodle
Belgian Tervuren
Boxer mix
Catahoula
Chinese Crested
Dalmatian
Doodle
Great Pyrenees
GSD/Collie mix
Miniature Dachshund
Old English Sheepdog
Rottweiler
Saluki
Samoyed
Staffordshire Bull Terrier
Vizsla
Afghan Hound
Akita
American Cocker Spaniel
American Staffordshire Terrier
Australian cattle dog mix
Australian Kelpie
Basset Hound
Beagle
Belgian Malinois
Black Russian Terrier
Boston Terrier
Bouvier des Flandres
Boykin Spaniel
Chihuahua
Chihuahua/Jack Russell Terrier mix
Cockapoo
Collie
Coonhound
Doberman
English Pointer
English Springer Spaniel
Flat-coated retriever
Foxhound
Golden/Pyrenees
Gordon Setter
Great Dane / Presa Canario
Hound mix
Irish Setter
Irish Wolfhound
Jack Russell Terrier
Lab mix
Lab/Golden mix
Labradoodle
Leonberger
Maltese
Maremma
Miniature Bull Terrier
Newfoundland/Lab mix
Papillon
Poodle mix
Rat Terrier
Redbone Coonhound
Rough Collie
Saint Bernard
Shepherd/cattle dog mix
Shiba Inu
Shih Tzu Mix
Spinone Italiano
Tamaskan mix
Toy Poodle
Weimaraner/Labrador mix
Welsh Terrier
Wheaten Terrier
Wheaten Terrier mix
Part 3 : Diagnosing Nutritional DCM: terms and parameters
How is a diagnosis of DCM made?
When is a DCM case considered "nutritionally-mediated" vs "genetic" vs "open"? Why is "proof" the wrong word to use when asking if a diet caused an illness. ?We will add posts here that help people understand how to discuss DCM diagnosis and/or how to determine if their dog might have nutritionally-mediated DCM.
-Heart murmurs, echocardiograms, and other diagnostic tools :
I've been reading a couple of different posts and thought it might be helpful to clarify a few things about heart murmurs and the diagnostic tools used to confirm heart disease.
Heart murmurs occur when there is turbulent blood flow through a heart valve (basically a little blood leaks back the wrong way, against the normal flow of blood, and causes a "whooshing" sound that we associate as a murmur). Heart murmurs are a symptom and not the primary disease (much like a cough can be a symptom of a cold or pneumonia - it basically tells us to look at the lungs for more info). Murmurs can be benign in origin, such as innocent or physiologic murmurs of young dogs, or problematic, such as those caused by chronic valvular disease, endocarditis, severe subaortic stenosis, etc. Some murmurs aren't even caused by heart disease but rather by concurrent illness (murmurs due to anemia is one example).
This is why echo-cardiograms (commonly called echos), a procedure during which an ultrasound machine is used to look at the heart, are so critical. We can't possibly determine how severe a murmur is and whether or not there is significant cardiac disease present without looking at the heart in greater detail. Echos can identify which valve is "leaking", the thickness of the heart walls, how effectively the heart is contracting, how fast the blood is flowing through the heart, and so much more. There is no other test that can give us that degree of detailed information about the heart.
X-rays, in contrast, can only tell us if the overall size of the heart is big and if there is any fluid around the heart/in the lungs (it can show a lot about the lungs, so don't discount an x-ray if it's recommended, but it's not going to be useful in diagnosing DCM or any other form of heart disease). EKGs, or electrocardiograms, can tell us whether or not a heart is beating at a normal rate and rhythm. It some cases it can also clue us in to abnormal heart size, but, again, it's not going to give us the same kind detailed information that an echo is. A blood test known as a proBNP can tell us if the heart is undergoing excess stretch or strain, but it cannot tell us what form of heart disease is present and it is often normal in the early phases of heart disease.
If you're concerned, talk to your vet. He or she can help to walk you through this process. And if he or she doesn't mention an echo, don't be afraid to bring it up. You can even ask for one (be prepared to spend anywhere from $250-750, depending on where you live). Also, please don't be upset with your vet if an echo isn't recommended right away. We're still trying to process everything that is coming out in regards to nutritionally-mediated DCM and, despite what studies have come out so far, we still have A LOT to learn. Many vets are naturally cautious and like to wait for consensus statements to be released. That hasn't happened yet. Good veterinary care is about teamwork between the pet owner and the veterinary team so don't be afraid to share what you've learned here with your regular vet (and invite him or her to join this group and our professional group: Taurine Deficiency Veterinary Professionals). We have to work together if we're going to beat this.
How a diagnosis is made of Nutritionally-Mediated DCM ?
NUTRITIONAL DCM vs SUSPECTED NUTRITIONAL DCM vs GENETIC DCM vs DCM of unknown cause
We’ve had questions about how a DCM case is confirmed to be nutritional. This is a good opportunity to discuss diagnostic “differentials” vs confirmed diagnosis vs proof.
Diagnostic terms: when is something suspected, confirmed or “proven”?
Diagnoses in medicine are based on the abundance of the evidence. This evidence includes
-Signalment (breed, age,sex)
-History (diet, environment, exercise, previous health problems, current owner reported-symptoms)
-Physical exam results
-Imaging results
-Laboratory tests.
Diagnosis is not the same as “proof”. To use an extreme example: if I have a dog with a positive parvovirus test, was not vaccinated for parvovirus, and has severe vomiting and diarrhea, is treated and recovers. … it is appropriate for me as a medical professional to diagnose that dog with parvovirus . But this is not “proof”. We did not do an intestinal biopsy to isolate the virus. We did not “prove” that the dog did not eat garbage before his diagnosis. It’s simply not feasible nor appropriate to claim “proof”. Medical professionals have “differentials” in the beginning, “working or suspect” diagnoses during the process, and “confirmed” diagnosis when the evidence is more clear. When we are still very uncertain about the diagnosis it is called “open”.
So back to the DCM. Cardiologists are qualified to diagnose DCM. They do this largely based on echocardiogram imaging. But when the results don’t perfectly fit the diagnosis they might call it something like “equivocal for DCM” or “suspected DCM”.
Now let’s suppose the cardiologist is comfortable with the DCM diagnosis. That is now “confirmd DCM”
Once we know the dog has DCM, how do we know if it is NUTRITIONAL DCM?
First, based on the cardiologists current knowledge, history, and signalment, they can strongly SUSPECT a nutritional cause. The more cases are correlated with diet, the more we understand the role of diet in DCM. We also now have 2 peer-reviewed papers documenting improvement on specific diets.
If your dog is a Doberman with DCM that ate a quality proven diet, the working diagnosis is probably genetic DCM.
If your dog is a Labrador that ate a grain-free diet such as Acana, Zignature, Diamond, Fromm, or Earthborne the presumptive diagnosis might be “suspect nutritional”. Some might also call this a “working diagnosis”.
If you have a breed susceptible to genetic DCM but no history of it in the family AND your dog ate a suspect diet, the cardiologist might not choose either nutritional nor genetic in the beginning. When does a case become “CONFIRMED NUTRITIONAL DCM?” The cardiologist may not be able to “confirm” unless there is also a taurine deficiency OR the dog later improves after diet change. Sadly, some cases are too far along when diagnosed thus the dog’s heart does not recover. In those cases we may eventually have to look at overall data (ie the occurrence of genetic DCM in the breed vs the occurrence of nutritional DCM on the diet). And the experts will offer their opinion of whether it is likely a nutritional vs genetic case. In other words, the more evidence we collect of certain diets correlating with DCM, the more likely it is that a dog eating those diets and having DCM is experiencing “nutritionally mediated DCM”.
Let’s also point out that some pet food companies are claiming there is no “proof” that their diet is a cause of DCM. Of course not. Because we cannot read the mind of the myocardial cell and get its recorded history that it was damaged by the diet. We can however, use medical and scientific evidence to identify some diets as a causative factor in DCM. So if they tell you there is no “proof”, you might want to turn the conversation to “evidence” and even a “growing body of evidence”.
for example" There is a growing body of evidence connecting nutritionally-mediated DCM with your Formula ADZ"
That is a longer explanation than I intended but I hope it helps answer how a DCM case is classified as "Nutritional" and how that might be changing as the body of evidence grows.
Part 4 : DCM scientific papers and fact-based articles
More in-depth discussion of nutritional DCM: peer-reviewed research, scientifically-sourced review papers, FDA reports where available. (Note: this facebook group's collected case reports are in the "suspect diets" unit)
1- Feb 19, 2019 FDA update with breed and case numbers
This FDA report lists case numbers collected through Nov 30. There are more not yet tended to. There is more data on diet type, ingredients, breeds but FDA is still choosing not to reveal formulas/brands.
https://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm630991?fbclid=IwAR2C-ryyDNlpWMLQ9yT98sWmvuIFPblNfYgBXd4eppvcP3UilzVuqexayzU
2- Feb meeting, FDA official gives some November 30 statistics
https://www.petfoodindustry.com/articles/7887-fda-asks-pet-food-industry-for-dcm-related-information?fbclid=IwAR02peIYiz3lV-el6i5_1rc6CUbz90yaBIk4G92xsv4HDiJycp3oUd5f0nE
3- Review from nutritionists: Pulse ingredients vs formulation in dcm:
A new review commentary came out this week in the Journal of Animal Science with input from multiple nutritionists in the US and Canada.
"The association between pulse ingredients and canine dilated cardiomyopathy: addressing the knowledge gaps before establishing causation"
https://academic.oup.com/jas/advance-article/doi/10.1093/jas/sky488/5279069?fbclid=IwAR2SWR08QMjJ1J_y2JaZUTrVyamukL4R5O9ZMNIWeUceJYo3H24uFeUUpHU
4- Summary from Ann Hubbs and link to research paper (Adin):
Today I am celebrating the researchers and the outstanding research that helps us understand the role of diet in heart disease in dogs. 🎉
There are currently two major peer-reviewed publications that identify features of our dogs’ diets that are associated with these cases. The studies come from two different outstanding veterinary research groups: One group is at the North Carolina State University College of Veterinary Medicine and the other group is headed-up by investigators from the University of California at Davis College of Veterinary Medicine with collaboration from veterinarians in multiple locations in the US and Canada. The papers are peer-reviewed and published in well-respected journals. In addition, the FDA is investigating the connection between canine heart disease and the diets that our dogs eat. The Journal of the American Veterinary Medical Association posted an online news article on the association between diet and heart disease in dogs in July and earlier this month published a commentary from a veterinary nutritionist regarding that association.
The recent scientific publications provide a particularly powerful kind of evidence of an association between a disease and an implicated cause – converging lines of evidence. The unified response from the veterinary research community is something I have never seen in the more than 35 years since I graduated from veterinary school. This is EXTRAORDINARY.
The common theme is that the implicated diets are from boutique companies that do not have much research, contain exotic ingredients, and/or contain legumes and/or potatoes.
None of us know yet the details of where the data will take the research teams in the future but my take away is this: This is veterinary knowledge that is rapidly changing right in front of our eyes. I am not going to get lost in every tiny feature of the studies. There is a really important bottom line:
The veterinary research community appears deeply concerned and to be remembering why each member of that community decided to be veterinarians in the first place - IT'S ALL ABOUT HELPING OUR DOGS .
Dec 30, 2018
Ann Hubbs
Adin D et al. 2019. Echocardiographic phenotype of canine dilated cardiomyopathy differs based on diet type
https://www.sciencedirect.com/science/article/pii/S1760273418300882?fbclid=IwAR3pLN1JOnY4sieQNuQE28tBbj7GpJ_nFQ0xTUIXR9ZtT10gVnJB_gCGxy8
5- Stern et al Taurine deficiency and DCM in Goldens fed commercial diets:
https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0209112&fbclid=IwAR219eNVxAS9wnbpgPB20LgjtvBCJDdZWXYdZMRl2NZ29Zb5ZRJANQaeTxQ
6- Webinar Sept 2018 including FDA vet and 2 nutritionists:
I saw this announcement for a webinar from Pet Food Industry.
https://www.petfoodindustry.com/events/612-webinar-fda-possible-dog-food-link-to-canine-dilated-cardiomyopathy?utm_source=KnowledgeMarketing&utm_medium=email&utm_content=Pet+eNews&utm_campaign=18_08_31_PetENews&eid=431672659&bid=2224952&fbclid=IwAR1BBkR0dvOka6po-3tMJ6pq6iKq4_KCMQdeyiS2g-zNy5OvV37xBaBQgZk
7- JAVMA review July 2018 to notify veterinarians of DA-DCM:
This article was just released. This serves as a guide for family veterinarians in the most widely read veterinary journal in North America.
JAVMA_DA-DCM.pdf
Some questions and answers :
Question : I am feeding both lamb and salmon from Purina. Never thought of them as exotic ingredients. Please clarify.??
Answer :
it's not from a boutique company. Purina spends years of research so they know how to use those ingredients.
So "exotic" ingredients really come into play when companies who are not doing research are using them. Both lamb and salmon (and rabbit, venison, duck, kangaroo, white fish, etc) have undergone extensive testing by Purina, Hill's Science Diet and Royal Canin. They have an excellent understanding of what nutrients these ingredients provide and where they deficient so that other ingredients can be added to properly balance the nutrients in their formulas.
Diets in cases reported to the FDA frequently list potatoes or multiple legumes such as peas, lentils, other “pulses” (seeds of legumes), and their protein, starch and fiber derivatives early in the ingredient list, indicating that they are main ingredients. Early reports from the veterinary cardiology community indicate that the dogs consistently ate these foods as their primary source of nutrition for time periods ranging from months to years. High levels of legumes or potatoes appear to be more common in diets labeled as “grain-free,” but it is not yet known how these ingredients are linked to cases of DCM. Changes in diet, especially for dogs with DCM, should be made in consultation with a licensed veterinarian.
The FDA chose to approach this as an ingredient problem/investigation. But the more data we see it's clear this is a formulation problem. Some diets apparently have LARGE amounts of legumes, and they account for the majority of DCM cases.
Question 2 :
I see salmon and lamb both listed as exotic ingredients. Is it okay to feed Purina Pro Plan lamb and rice or the pro plan salmon? I thought that all PPP met the guidelines??
Answer : Yes those ingredients are fine when used by companies like Royal Canin that formulate their foods using veterinary nutritionists and PhDs. Those companies have the expertise and understanding of the strengths and weaknesses of various ingredients and will adjust the rest of the formula accordingly. It's when lamb and salmon (as well as things like wild boar, trout, kangaroo, rabbit, etc.) are used in diets by companies who do not have a deep understanding of nutrition that you can run into problems.
Question 3 : Which company to trust ?
Yes those ingredients are fine when used by companies like Royal Canin that formulate their foods using veterinary nutritionists and PhDs. Those companies have the expertise and understanding of the strengths and weaknesses of various ingredients and will adjust the rest of the formula accordingly. It's when lamb and salmon (as well as things like wild boar, trout, kangaroo, rabbit, etc.) are used in diets by companies who do not have a deep understanding of nutrition that you can run into problems.
Marketing has worked all too well the past 20 years. Some even "market" their limited expertise and research.
I will say that if they are producing basic formulas, like chicken/rice/corn then it's not as complicated. But the public wants grainfree, exotic ingredients etc and sadly those are being made by the companies least qualfied. So here we are..
You can use two of the WSAVA guidelines as my litmus test. First I look to see if feeding trials are happening on any of their formulas (doesn't have to be all) based on what is on the bag or their website. If they tell that they're done, doesn't count. Then I call and ask for a COMPLETE guaranteed analysis (NOT a typical or average). If both boxes are checked, then I look for research. These are things that are really hard to lie about as there is often proof.
Question 4 : Do the WSAVA compliant companies do feeding trials on all of their formulations? And when they change the formulation on their products, do they do new feeding trials? If they don't how do we know which ones have been tested?
Answer : Each company varies slightly. For example, Royal Canin does few trials that are now labeled "AAFCO" but they have over 800 dogs in research at any given moment and the largest science team of anyone I spoke with. Small formula changes still get digestibiility. urinalysis, bloodwork, palatability and whatever the nutritionists deem appropriate.
But to give you a couple of examples, breed-specific research is by definition not a colony match for aafco. RC also selects dogs with minor medical problems which is also not an aafco.
One thing university nutritionists have emphasized to me as I moderate this group is that we not let members think that just getting a nutritionist and doing an aafco trial is comparable to having the full research team when it comes to developing new diets and improving health through diet. You need acvn, PhDs, chemists, food scientists, toxicologists, veterinarians with different backgrounds, etc
Question 5 :Is there somewhere it can be verified that Royal Canin has a full research team and that they’ve done trials on kibble that weren’t AAFCO?
Not that I don’t believe you, but in truth, we’re all just random people on the internet to one another. I’m thinking published interviews with verified news sources, academic articles, white papers, etc.
You could actually contact Royal Canin and ask. From what I have heard, they are very responsive.
Ask your veterinarian .
You can make some researches and analysis by yourself.
Question 6 : About the WSAVA guidelines. Purina is an "approved" brand. But does this apply ONLY to Pro Plan? Aren't all the Purina formulations overseen by a nutritionist? Does this mean ALL Purina products should be considered safe to feed? Purina also makes grain-free formulations. Are these, too, in compliance with WSAVA? Many manufacturers make a variety of foods. Does this mean that all products ares suspect if one formulation has caused DCM?
all meet guidelines but we don't recommend the ones labeled "grainfree" even from Purina. No reported DCM yet but there is just no known benefit to grain free anyway.
Thank you very much if you had any questions about dog feeding please write in a comment
-Heart murmurs, echocardiograms, and other diagnostic tools :
I've been reading a couple of different posts and thought it might be helpful to clarify a few things about heart murmurs and the diagnostic tools used to confirm heart disease.
Heart murmurs occur when there is turbulent blood flow through a heart valve (basically a little blood leaks back the wrong way, against the normal flow of blood, and causes a "whooshing" sound that we associate as a murmur). Heart murmurs are a symptom and not the primary disease (much like a cough can be a symptom of a cold or pneumonia - it basically tells us to look at the lungs for more info). Murmurs can be benign in origin, such as innocent or physiologic murmurs of young dogs, or problematic, such as those caused by chronic valvular disease, endocarditis, severe subaortic stenosis, etc. Some murmurs aren't even caused by heart disease but rather by concurrent illness (murmurs due to anemia is one example).
This is why echo-cardiograms (commonly called echos), a procedure during which an ultrasound machine is used to look at the heart, are so critical. We can't possibly determine how severe a murmur is and whether or not there is significant cardiac disease present without looking at the heart in greater detail. Echos can identify which valve is "leaking", the thickness of the heart walls, how effectively the heart is contracting, how fast the blood is flowing through the heart, and so much more. There is no other test that can give us that degree of detailed information about the heart.
X-rays, in contrast, can only tell us if the overall size of the heart is big and if there is any fluid around the heart/in the lungs (it can show a lot about the lungs, so don't discount an x-ray if it's recommended, but it's not going to be useful in diagnosing DCM or any other form of heart disease). EKGs, or electrocardiograms, can tell us whether or not a heart is beating at a normal rate and rhythm. It some cases it can also clue us in to abnormal heart size, but, again, it's not going to give us the same kind detailed information that an echo is. A blood test known as a proBNP can tell us if the heart is undergoing excess stretch or strain, but it cannot tell us what form of heart disease is present and it is often normal in the early phases of heart disease.
If you're concerned, talk to your vet. He or she can help to walk you through this process. And if he or she doesn't mention an echo, don't be afraid to bring it up. You can even ask for one (be prepared to spend anywhere from $250-750, depending on where you live). Also, please don't be upset with your vet if an echo isn't recommended right away. We're still trying to process everything that is coming out in regards to nutritionally-mediated DCM and, despite what studies have come out so far, we still have A LOT to learn. Many vets are naturally cautious and like to wait for consensus statements to be released. That hasn't happened yet. Good veterinary care is about teamwork between the pet owner and the veterinary team so don't be afraid to share what you've learned here with your regular vet (and invite him or her to join this group and our professional group: Taurine Deficiency Veterinary Professionals). We have to work together if we're going to beat this.
How a diagnosis is made of Nutritionally-Mediated DCM ?
NUTRITIONAL DCM vs SUSPECTED NUTRITIONAL DCM vs GENETIC DCM vs DCM of unknown cause
We’ve had questions about how a DCM case is confirmed to be nutritional. This is a good opportunity to discuss diagnostic “differentials” vs confirmed diagnosis vs proof.
Diagnostic terms: when is something suspected, confirmed or “proven”?
Diagnoses in medicine are based on the abundance of the evidence. This evidence includes
-Signalment (breed, age,sex)
-History (diet, environment, exercise, previous health problems, current owner reported-symptoms)
-Physical exam results
-Imaging results
-Laboratory tests.
Diagnosis is not the same as “proof”. To use an extreme example: if I have a dog with a positive parvovirus test, was not vaccinated for parvovirus, and has severe vomiting and diarrhea, is treated and recovers. … it is appropriate for me as a medical professional to diagnose that dog with parvovirus . But this is not “proof”. We did not do an intestinal biopsy to isolate the virus. We did not “prove” that the dog did not eat garbage before his diagnosis. It’s simply not feasible nor appropriate to claim “proof”. Medical professionals have “differentials” in the beginning, “working or suspect” diagnoses during the process, and “confirmed” diagnosis when the evidence is more clear. When we are still very uncertain about the diagnosis it is called “open”.
So back to the DCM. Cardiologists are qualified to diagnose DCM. They do this largely based on echocardiogram imaging. But when the results don’t perfectly fit the diagnosis they might call it something like “equivocal for DCM” or “suspected DCM”.
Now let’s suppose the cardiologist is comfortable with the DCM diagnosis. That is now “confirmd DCM”
Once we know the dog has DCM, how do we know if it is NUTRITIONAL DCM?
First, based on the cardiologists current knowledge, history, and signalment, they can strongly SUSPECT a nutritional cause. The more cases are correlated with diet, the more we understand the role of diet in DCM. We also now have 2 peer-reviewed papers documenting improvement on specific diets.
If your dog is a Doberman with DCM that ate a quality proven diet, the working diagnosis is probably genetic DCM.
If your dog is a Labrador that ate a grain-free diet such as Acana, Zignature, Diamond, Fromm, or Earthborne the presumptive diagnosis might be “suspect nutritional”. Some might also call this a “working diagnosis”.
If you have a breed susceptible to genetic DCM but no history of it in the family AND your dog ate a suspect diet, the cardiologist might not choose either nutritional nor genetic in the beginning. When does a case become “CONFIRMED NUTRITIONAL DCM?” The cardiologist may not be able to “confirm” unless there is also a taurine deficiency OR the dog later improves after diet change. Sadly, some cases are too far along when diagnosed thus the dog’s heart does not recover. In those cases we may eventually have to look at overall data (ie the occurrence of genetic DCM in the breed vs the occurrence of nutritional DCM on the diet). And the experts will offer their opinion of whether it is likely a nutritional vs genetic case. In other words, the more evidence we collect of certain diets correlating with DCM, the more likely it is that a dog eating those diets and having DCM is experiencing “nutritionally mediated DCM”.
Let’s also point out that some pet food companies are claiming there is no “proof” that their diet is a cause of DCM. Of course not. Because we cannot read the mind of the myocardial cell and get its recorded history that it was damaged by the diet. We can however, use medical and scientific evidence to identify some diets as a causative factor in DCM. So if they tell you there is no “proof”, you might want to turn the conversation to “evidence” and even a “growing body of evidence”.
for example" There is a growing body of evidence connecting nutritionally-mediated DCM with your Formula ADZ"
That is a longer explanation than I intended but I hope it helps answer how a DCM case is classified as "Nutritional" and how that might be changing as the body of evidence grows.
Part 4 : DCM scientific papers and fact-based articles
More in-depth discussion of nutritional DCM: peer-reviewed research, scientifically-sourced review papers, FDA reports where available. (Note: this facebook group's collected case reports are in the "suspect diets" unit)
1- Feb 19, 2019 FDA update with breed and case numbers
This FDA report lists case numbers collected through Nov 30. There are more not yet tended to. There is more data on diet type, ingredients, breeds but FDA is still choosing not to reveal formulas/brands.
https://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm630991?fbclid=IwAR2C-ryyDNlpWMLQ9yT98sWmvuIFPblNfYgBXd4eppvcP3UilzVuqexayzU
2- Feb meeting, FDA official gives some November 30 statistics
https://www.petfoodindustry.com/articles/7887-fda-asks-pet-food-industry-for-dcm-related-information?fbclid=IwAR02peIYiz3lV-el6i5_1rc6CUbz90yaBIk4G92xsv4HDiJycp3oUd5f0nE
3- Review from nutritionists: Pulse ingredients vs formulation in dcm:
A new review commentary came out this week in the Journal of Animal Science with input from multiple nutritionists in the US and Canada.
"The association between pulse ingredients and canine dilated cardiomyopathy: addressing the knowledge gaps before establishing causation"
https://academic.oup.com/jas/advance-article/doi/10.1093/jas/sky488/5279069?fbclid=IwAR2SWR08QMjJ1J_y2JaZUTrVyamukL4R5O9ZMNIWeUceJYo3H24uFeUUpHU
4- Summary from Ann Hubbs and link to research paper (Adin):
Today I am celebrating the researchers and the outstanding research that helps us understand the role of diet in heart disease in dogs. 🎉
There are currently two major peer-reviewed publications that identify features of our dogs’ diets that are associated with these cases. The studies come from two different outstanding veterinary research groups: One group is at the North Carolina State University College of Veterinary Medicine and the other group is headed-up by investigators from the University of California at Davis College of Veterinary Medicine with collaboration from veterinarians in multiple locations in the US and Canada. The papers are peer-reviewed and published in well-respected journals. In addition, the FDA is investigating the connection between canine heart disease and the diets that our dogs eat. The Journal of the American Veterinary Medical Association posted an online news article on the association between diet and heart disease in dogs in July and earlier this month published a commentary from a veterinary nutritionist regarding that association.
The recent scientific publications provide a particularly powerful kind of evidence of an association between a disease and an implicated cause – converging lines of evidence. The unified response from the veterinary research community is something I have never seen in the more than 35 years since I graduated from veterinary school. This is EXTRAORDINARY.
The common theme is that the implicated diets are from boutique companies that do not have much research, contain exotic ingredients, and/or contain legumes and/or potatoes.
None of us know yet the details of where the data will take the research teams in the future but my take away is this: This is veterinary knowledge that is rapidly changing right in front of our eyes. I am not going to get lost in every tiny feature of the studies. There is a really important bottom line:
The veterinary research community appears deeply concerned and to be remembering why each member of that community decided to be veterinarians in the first place - IT'S ALL ABOUT HELPING OUR DOGS .
Dec 30, 2018
Ann Hubbs
Adin D et al. 2019. Echocardiographic phenotype of canine dilated cardiomyopathy differs based on diet type
https://www.sciencedirect.com/science/article/pii/S1760273418300882?fbclid=IwAR3pLN1JOnY4sieQNuQE28tBbj7GpJ_nFQ0xTUIXR9ZtT10gVnJB_gCGxy8
5- Stern et al Taurine deficiency and DCM in Goldens fed commercial diets:
https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0209112&fbclid=IwAR219eNVxAS9wnbpgPB20LgjtvBCJDdZWXYdZMRl2NZ29Zb5ZRJANQaeTxQ
6- Webinar Sept 2018 including FDA vet and 2 nutritionists:
I saw this announcement for a webinar from Pet Food Industry.
https://www.petfoodindustry.com/events/612-webinar-fda-possible-dog-food-link-to-canine-dilated-cardiomyopathy?utm_source=KnowledgeMarketing&utm_medium=email&utm_content=Pet+eNews&utm_campaign=18_08_31_PetENews&eid=431672659&bid=2224952&fbclid=IwAR1BBkR0dvOka6po-3tMJ6pq6iKq4_KCMQdeyiS2g-zNy5OvV37xBaBQgZk
7- JAVMA review July 2018 to notify veterinarians of DA-DCM:
This article was just released. This serves as a guide for family veterinarians in the most widely read veterinary journal in North America.
JAVMA_DA-DCM.pdf
Some questions and answers :
Question : I am feeding both lamb and salmon from Purina. Never thought of them as exotic ingredients. Please clarify.??
Answer :
it's not from a boutique company. Purina spends years of research so they know how to use those ingredients.
So "exotic" ingredients really come into play when companies who are not doing research are using them. Both lamb and salmon (and rabbit, venison, duck, kangaroo, white fish, etc) have undergone extensive testing by Purina, Hill's Science Diet and Royal Canin. They have an excellent understanding of what nutrients these ingredients provide and where they deficient so that other ingredients can be added to properly balance the nutrients in their formulas.
Diets in cases reported to the FDA frequently list potatoes or multiple legumes such as peas, lentils, other “pulses” (seeds of legumes), and their protein, starch and fiber derivatives early in the ingredient list, indicating that they are main ingredients. Early reports from the veterinary cardiology community indicate that the dogs consistently ate these foods as their primary source of nutrition for time periods ranging from months to years. High levels of legumes or potatoes appear to be more common in diets labeled as “grain-free,” but it is not yet known how these ingredients are linked to cases of DCM. Changes in diet, especially for dogs with DCM, should be made in consultation with a licensed veterinarian.
The FDA chose to approach this as an ingredient problem/investigation. But the more data we see it's clear this is a formulation problem. Some diets apparently have LARGE amounts of legumes, and they account for the majority of DCM cases.
Question 2 :
I see salmon and lamb both listed as exotic ingredients. Is it okay to feed Purina Pro Plan lamb and rice or the pro plan salmon? I thought that all PPP met the guidelines??
Answer : Yes those ingredients are fine when used by companies like Royal Canin that formulate their foods using veterinary nutritionists and PhDs. Those companies have the expertise and understanding of the strengths and weaknesses of various ingredients and will adjust the rest of the formula accordingly. It's when lamb and salmon (as well as things like wild boar, trout, kangaroo, rabbit, etc.) are used in diets by companies who do not have a deep understanding of nutrition that you can run into problems.
Question 3 : Which company to trust ?
Yes those ingredients are fine when used by companies like Royal Canin that formulate their foods using veterinary nutritionists and PhDs. Those companies have the expertise and understanding of the strengths and weaknesses of various ingredients and will adjust the rest of the formula accordingly. It's when lamb and salmon (as well as things like wild boar, trout, kangaroo, rabbit, etc.) are used in diets by companies who do not have a deep understanding of nutrition that you can run into problems.
Marketing has worked all too well the past 20 years. Some even "market" their limited expertise and research.
I will say that if they are producing basic formulas, like chicken/rice/corn then it's not as complicated. But the public wants grainfree, exotic ingredients etc and sadly those are being made by the companies least qualfied. So here we are..
You can use two of the WSAVA guidelines as my litmus test. First I look to see if feeding trials are happening on any of their formulas (doesn't have to be all) based on what is on the bag or their website. If they tell that they're done, doesn't count. Then I call and ask for a COMPLETE guaranteed analysis (NOT a typical or average). If both boxes are checked, then I look for research. These are things that are really hard to lie about as there is often proof.
Question 4 : Do the WSAVA compliant companies do feeding trials on all of their formulations? And when they change the formulation on their products, do they do new feeding trials? If they don't how do we know which ones have been tested?
Answer : Each company varies slightly. For example, Royal Canin does few trials that are now labeled "AAFCO" but they have over 800 dogs in research at any given moment and the largest science team of anyone I spoke with. Small formula changes still get digestibiility. urinalysis, bloodwork, palatability and whatever the nutritionists deem appropriate.
But to give you a couple of examples, breed-specific research is by definition not a colony match for aafco. RC also selects dogs with minor medical problems which is also not an aafco.
One thing university nutritionists have emphasized to me as I moderate this group is that we not let members think that just getting a nutritionist and doing an aafco trial is comparable to having the full research team when it comes to developing new diets and improving health through diet. You need acvn, PhDs, chemists, food scientists, toxicologists, veterinarians with different backgrounds, etc
Question 5 :Is there somewhere it can be verified that Royal Canin has a full research team and that they’ve done trials on kibble that weren’t AAFCO?
Not that I don’t believe you, but in truth, we’re all just random people on the internet to one another. I’m thinking published interviews with verified news sources, academic articles, white papers, etc.
You could actually contact Royal Canin and ask. From what I have heard, they are very responsive.
Ask your veterinarian .
You can make some researches and analysis by yourself.
Question 6 : About the WSAVA guidelines. Purina is an "approved" brand. But does this apply ONLY to Pro Plan? Aren't all the Purina formulations overseen by a nutritionist? Does this mean ALL Purina products should be considered safe to feed? Purina also makes grain-free formulations. Are these, too, in compliance with WSAVA? Many manufacturers make a variety of foods. Does this mean that all products ares suspect if one formulation has caused DCM?
all meet guidelines but we don't recommend the ones labeled "grainfree" even from Purina. No reported DCM yet but there is just no known benefit to grain free anyway.
Thank you very much if you had any questions about dog feeding please write in a comment
