Rx diets Flashcards
Why are diet supplememts used and how to introduce them
Some studies have shown that incorporating supplements into diets are preferable and provide better compliance
However, does require a dietary transition (Cost? Preference? Concurrent condition?)
If doing both, need to consider the levels currently in the diet as many supplements have maximum safe dosages
What are omega 3 fatty acids good for
Essential fatty acids–but can be useful in additional levels
Three important omega-3 fatty acids for veterinary medicine are:
α-linolenic acid (ALA)
Eicosapentaenoic acid (EPA)
docosahexaenoic acid (DHA)
What are a-linolinic acid (ALA)
Short chain fatty acid
Found in plants sources such as nuts and seeds (e.g., flax, canola)
ALA is converted in the body to EPA and DHA (poorly in dogs and cats)
What is Eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and is it good to supplement
Long chain fatty acids
Found primarily in marine sources, like cold water fish (e.g., salmon and other fish oils)
Direct sources of EPA and DHA are preferable to ALA-based sources due to poor conversion by dogs and cats
DHA levels are highest retina/brain/sperm cells
How does EPA and DHA work
EPA and DHA incorporate into the cell membrane
Makes the cell membrane more stable to inflammation
Eicosanoids take part in cellular signaling pathways in heart cells, immune cells, and the endocrine system
Action is through inhibition of the prostaglandin pathway, leukotriene pathway and COX-2 pathway
They also inhibit movement of neutrophils and inhibit activity of various cytokines
What is EPA and DHA good for
Anti-inflammatory
Skin disease
Urinary conditions
Gastrointestinal conditions
Osteoarthritis
Reproduction and growth
Important for the development of many body systems
Can improve the learning capacity of puppies
Cardiac and renal
Blood thinning – reduce plasma fibrinogen
Anti hypertentive actions
Aging
Improve athletic performance
Improve brain oxygenation
Neoplasia
Limit the risk of tumors
What can anxiety be related to
Anxiety can be related to a variety of different medical conditions
Often associated with past experiences
Can worsen or present with advancing age due to decline in other senses
In cases of extreme anxiety or behavioural issues, nutraceuticals (including diet) often not enough
Training, socialization, desensitization and medical therapy
What are the goals with anxiety and supplementation
Reduce stress and associated clinical signs
Improve emotional stability
L-tryptophan is and used for
Essential amino acid
Metabolic precursor to serotonin and melatonin
Implicated in many behaviour processes
Mood
Aggression
Susceptibility to stress
What is L-tryptophan used for in cats
Treatment of behaviour disorders in cats
Repetitive behaviour
Vocalization
Agonistic behaviours
α-Casozepine (casein) is and used for
Derived from milk protein
Shown to have a calming effect on babies
Affinity for benzodiazepine site of the GABA-a receptors
Shown to have an anxiolytic effect in dogs and cats
What does a stress formula contain
Contain L-tryptophan and casein
L-theanine is and used for
Amino acid found in tea leaves
Inhibitor of glutamate
Excitatory neurotransmitter
Reduces the excitatory effects
Relaxing affect shown in laboratory animals, humans, dogs, and cats
Medium Chain Triglycerides are and used for
Brain has reduced ability to utilized glucose with aging
MCTG provides alternative energy source for brain
Protective of cognitive decline in epileptic dogs
What are some considerations when feeding diets
Feed in safe place
May need to separate, feed alone or feed by hand depending on preferences
Consider puzzle feeders to help entertain and stimulate
What causes joint disease
Loss of cartilage
Leads to remodeling and thicken of joints
Affects entire joint, not just cartilage
What is the main goal with treatment of joint disease
Reduce discomfort/pain
Improve QoL
Slow down progression
Address contributing or aggravating factors
What can predispose an animal to joint disease
Aging
Obesity
Trauma
Genetics/Breed
Anatomy (Conformation)
What is the goal of nutritional interventions for joint disease
Support joint function
Reduce inflammation
Promote healthy body weight
Glycosaminoglycans is and helpful for
Important part of joint cartilage and synovial fluid
Stimulate the production of proteoglycans and hyalurionic acid
Important for shock absorption
Role is mostly chondroprotective
How does glucosamine help the joints
Promotes the synthesis of cartilage
What does chondroitin do for cartilage
Inhibits the destruction of cartilage
Helps with water retention, important for pressure resistance
Hydrolyzed Collagen is and does what
Obtained by enzymatic hydrolysis of collagenous tissues
Promotes the regeneration of cartilage by providing three key amino acids
- Glycine
- Proline
- Hydroxyproline
Stimulates hyaluronic acid synthesis by synovial cells
Results in the increased synthesis of type II collagen
Role is primarily to increase cartilage development/regeneration
What are some common antioxidants
Vitamins
Vitamin E, Vitamin C
Minerals
Selenium, Manganese
Amino acids
Taurine, glutathione
Other
Green tea polyphenols (also inhibit inflammation, inhibit the destruction of cartilage and promote collagen synthesis)
Combats oxidative stress
Green Lipped Mussel is and contains
Perna canaliculus
Species of mussels found along the coast of New Zealand
Mussels act as a sea water filter and tend to retain essential nutrients
Contain large number of active substances:
Omega 3 fatty acids
Chondroitin and Glucosamine
Vitamins E and C
Zinc, Copper, Manganese
What are some considerations for joint formulas
Weight loss if necessary
6% reduction in weight has been shown to improve mobility and quality of life in dogs
Many multi-function options available
Multimodal therapy! Analgesics, physiotherapy, alternative therapies
What can cause obesity
Obesity can contribute to various health conditions, decreased quality of life and life span
Preventable and treatable
What are the goals with obesity diets
Promote healthy weight loss
Restrict energy without restricting nutrients
What are the nutritional priorities when it comes to obesity diets
Reduced fat (calories)
Reduced carbohydrates (lower glycemic index)
Increased fibre (satiating effect; lowers caloric density)
Increased proteins (maintain lean body mass)
L-carnitine (promotes the use of fat as an energy source)
Balanced levels of nutrients, minerals and vitamins to ensure needs are being met despite marked caloric restriction
What are some other considerations with obesity diets
Promote healthy exercise
Carefully measure portions
Smaller, more frequent feedings
Consider treats
Canned food or adding water to diet
Prevention is key
What are allergies
Proteins that we eat have epitopes on the surface
The cells in our bodies have matching IgE receptors
When we eat proteins to which a sensitivity has developed, these epitopes cross-link to two or more IgE receptors to “unlock” a histamine release
See inflammation and the clinical signs of an allergic reaction
What is the goal with allergy diets
Reduce the clinical signs associated with food allergies
Cutaneous Adverse Food Reactions (cAFR): pruritus, skin infections, hair loss
Non-cutaneous Adverse Food Reactions (typically GI): vomiting, diarrhea
Diets need to be formulated with extensive quality control methods to avoid the risk of protein contamination (ie, off-label protein sources)
What are the nutritional priorities with allergy diets
Appropriate protein source that does not elicit an allergic reaction
Novel protein
Hydrolyzed protein
What is a novel protein
Dependent on the individual patient and individual allergies
Need to consider what has this pet NOT been exposed to previously?
Cross-reactivity can occur between closely related species (ie, chicken and duck) but possible non-related species (ie, fish and mammals)
What are hydrolyzed proteins
Proteins are broken down into smaller fragments to evade the immune response
Depending on the size of the protein pieces and the sensitivity of the pet, may or may not elicit and allergic reaction
40% of dogs with a chicken allergy responded to a partially hydrolyzed poultry diet; 60% did not!
0% of dogs with a chicken allergy responded to an extensively hydrolyzed poultry diet
What are some other considerations with an allergy diet
Complete dietary history necessary to determine what proteins pet has been exposed to previously
Trial should be performed for 8 weeks, and diet fed EXCLUSIVELY
Dietary challenge can be performed after positive response seen
Add in single protein source one at a time to see if pet will respond
Positive response to challenge indicates a protein the pet is sensitive to
No response to challenge indicates a “safe” protein
Helps determine potential long-term feeding options
What is atopy and what is it asociated with
Hypersensitivity of the immune system to allergens in the environment
Pollen, fleas, cleaners, plants
Clinical signs often seasonal
Associated with seasonal allergens
However can be year-round if allergen is year-round (ie, dust mites)
Typically clinical signs associated with skin
Can also affect the respiratory or gastrointestinal system
Includes a weakened skin barrier which increases water loss and access of allergens
What are the goals with atopy diets
Improve skin health and reduce clinical signs of skin disease and environmental allergies
What are the nutritional priorities with atopy diets
Highly digestible protein w appropriate amino acid profile
Healthy fats
EPA and DHA
B vitamins and histidine
Glycyrrhizin (licorice root extract)
How do highly digestible proteins help with atopy
30% of dietary protein goes to support skin and coat
Heal skin and regrow hair coat
How do healthy fats help with atopy
Maintains healthy skin barrier
Reduces evaporation of water from the skin (less itching from dry skin)
Reduces ability of environmental allergen to be absorbed through skin
How does EPA and DHA help with atopy
Reduces inflammation
Omega 3’s from fish oil (ie, EPA/DHA) shown to improve pruritus and inflammation better than omega 3’s from mineral oil or flax seed oil
How do B minerals and histidine help with atopy
Shown to help improve ceremide production and decreased transepidermal water loss
Improve the skin barrier
Decreases permeability of skin to allergens
How does glcrrhizin help with atopy
Glycyrrhizin (licorice root extract)
Immunomodulating effect (decrease activation of Th 2 IL4)
What are some other considerations with treating atopy
Multi-modal management
Topical therapies
Shampoos
Immunotherapy
Medications
Allergen avoidance
Possible concurrent cAFR
What causes GI conditions
Wide variety of conditions that result in gastrointestinal disturbances
The nutritional strategy is not always the same
Consider whether the pet needs:
Fat reduction
Fibre modification
Hydrolyzed or novel protein (ie, non-cutaneous adverse food reaction):
What are the goals with GI diets
Support GIT, minimize irritation
Promote emptying
Normalize motility
Address the symptoms–vomiting, diarrhea, constipation, weight loss, etc
What are the nutritional priorities with GI diets
Highly digestible protein
Novel or hydrolyzed protein source if food reaction suspected
Lower fat
Aids in passage of food
Necessary in fat-responsive conditions (ie, canine pancreatitis)
Cats quite fat-tolerant!
Supplemented electrolytes
Fibre to help regular motility
Can address both colitis and constipation
Consider fibre types!
Highly digestible carbohydrate sources
Prebiotics to support healthy GIT microbiota
What are some other dietary considerations with GI disease
Consider food volume needs
Post sx may require smaller food volumes–high calories
Small, frequent feedings to avoid overloading the GIT
Prebiotic fibre to feed the enterocytes
Avoid repeated dietary changes
Allow 3-6 weeks for the microbiome to adjust to the new diet
What causes liver disease
Liver aids in digestion, removal of waste products and production of molecules and substances necessary for both bodily function
Many different conditions that can affect the liver
A diagnosis is not made (ie, elevated liver enzymes)
Need to consider the degree of disease, age of onset and specific condition
Ie , PSS or MVD typically present in very young dogs
Copper storage disease
Genetic mutation related to copper excretion
Can occur in Bedlington terriers, Labrador Retrievers, Dalmatians
Results in excess copper build up in the liver
What are the goals with liver disease and their diet
Provide an appropriate amount of protein
In cases of PSS or MVD, lower protein recommended
However low protein can result in muscle wasting
Hepatic encephalopathy can be worsened when muscle mass is low since ammonia is metabolized by the liver
Vegetable based proteins tend to be lower in purine which lower the metabolic demand on the liver
Moderate sodium levels
Management of portal hypertension
Restricted copper levels
When necessary
What is milk thistle and what does it do
Contains pharmaceutical compound silymarin
Silymarin is a liver protectant
Used in liver disease, cancer patients, patients who are on chronic drug therapies with adverse liver effects
Such as phenobarbital or steroids
There is a wide therapeutic range (mg/kg dose) and has few adverse effects
What causes renal disease
Kidneys function to process and eliminate waste products via the urine, as well as conserve water and balance minerals
Kidney dysfunction results in build up of waste products and loss of concentrating ability of the kidneys
Kidney disease is diagnosed and staged based on evaluation of various laboratory tests (creatinine, SDMA, RenalTech, USG, proteinuria,etc)
Staging is important to understand the medical and nutritional priorities of the patient
Very generally, the nutritional recommendations can be broken down into early renal recommendations (IRIS Stage I-II in dogs, IRIS Stage I in cats) and advanced renal recommendations (IRIS Stage III-IV in dogs, IRIS Stage II-IV in cats)
Some exceptions exist!
What are the goals with renal diets
:
Slow down the progression of renal disease
No diet can “prevent” or “stop” renal disease
Support energy requirements
Maintain lean muscle mass
Support hydration
What are the protein considerations with renal diets
Protein may play a role in progression of renal disease
High levels of dietary protein were historically linked to faster progression of experimentally induced kidney disease in cats
Lower protein diets are recommended to manage chronic renal insufficiency
Would you recommend a lower-protein diet to protect against renal disease?
High protein intake has not been shown to contribute to the development of CKD in healthy pets
More recent studies show that the role of dietary protein in the progression of CKD is confounded by caloric intake and differences in protein source
Exact protein requirements of animals with CKD is unclear
Dietary phosphorus restriction is key to help slow down disease progression
Most of phosphorus from the ingredients comes from the protein source
Protein restriction in renal disease = phosphorus restriction
What are the nutritional priorities with early renal disease
High quality protein (mitigate muscle loss)
Moderate phosphorus restriction (below AAFCO minimum not necessary at this time)
Omega 3 FA (anti-inflammatory, improve blood flow to the kidneys)
Antioxidants (Vitamin E & C,ß carotene)
What are the nutritional priorities with advanced renal disease
Low protein (mitigate urea and creatinine build up)
Low phosphorus (highest link to longevity)
Low sodium (mitigate hypertension)
Omega 3 FA (anti-inflammatory, improve blood flow to the kidneys)
What are some other considerations wiht a renal diet
Diet transitions in advanced stages are SLOW (sometimes weeks)
Need to consider nausea and malaise that may be affecting appetite
Ensure adequate hydration
SQ or IV fluids may be necessary
Ensure energy needs being met
In advanced stages feeding tubes may be necessary
What is hyperthyrodism
Characterized by an overproduction if the thyroid hormone, resulting in an increased metabolic rate
Weight loss
Polyphagia
Restlessness, aggression
Night wandering, vocalization
Common in older cats (typically >12 years)
Some environmental risk factors including exposure to some pollutants, have hypothesized to be a predisposition
What diet is used for hyperthyrodism
Hill’s y/d is the only formula to nutritionally manage hyperthyroidism
Limited iodine intake to control T4 production
L-carnitine to maintain muscle mass
Needs to be fed exclusively
Good option in cases where there are no concurrent health conditions needing nutritional management, and when other methods of treatment not possible
What is urinary disease
Urine is not just water
Also contains minerals and mineral precursors
Genetic predispositions and lifestyle factors can increase the risk of certain minerals accumulating to form crystals or uroliths (stones)
Most common stone types are struvite and calcium oxalate
What are the risk factors for UTD
Risk factors include:
Obesity
Stress
Diet
Breed
Water intake
What are the goals with UT diets
Increase urine volume
Typically by increasing water intake
Results in lower USG
Dissolve struvite crystals/uroliths
Calcium oxalate stones cannot be dissolved, must be removed
Create urinary environment less favorable to development of crystals/stones
What are struvites
In dogs, almost always secondary to a UTI
In cats, the cause is multifactorial
What is calcium oxalate
Genetic predisposition
Medical conditions resulting in hypercalcemia
What are the nutritional priorities with urianry diets
Controlled levels of magnesium and phosphate (struvite)
Controlled levels of calcium (calcium oxalate)
Acidifying (struvite)
Alkalinizing (calcium oxalate)
Additionally, can manage concurrent conditions which increase risk
Obesity
Stress
What are some other considerations with treating urinary disease
Encourage water intake
Fresh water
Alternative water types (still, filtered)
Alternative watering methods (fountain, bowl, tap)
Alternative receptacles (bowl size, shape, depth)
Small frequent feedings
Provide opportunities to urinate
What are the risk factors for dental disease
Size–small breeds
Breed–Greyhounds, Basset Hounds, Boxers
Age–increased with age
Anatomy–brachycephalics, retained deciduous teeth
Lifestyle–hard chews
Disease–Felk, FIV, certain medications
How to slow down the progression of dental disease?
COHAT
Brushing
Chews/treats/diets
When to sue kibble vs canned for dental disease
Crunching action of dry should clean teeth
Less residue in the mouth with dry
Less dental disease? Studies suggest no
Many kibbles shatter with chewing, no mechanical cleaning
Size, shape and texture of the kibble can have positive effect
Dietary fibre can affect plaque and tartar formation
This really only benefits chewing teeth
What do dental diets look like
Promote chewing and full contact with teeth
Texture, shape, size
Prevent the mineralization of plaque to tartar
Calcium chelators
Limited calcium levels
Antioxidants to reduce oxidative stress
What are the risks with dental chews
Esophageal foreign body obstruction
Tongue entrapment
High calories (weight gain)
Nutritional imbalances if fed excessive treats
Gastrointestinal upset
Fractures from very hard chews (antlers, hooves, nylon bones)
Should be able to dent chew with a fingernail
