Investigators scrutinize grain-free kibble with exotic proteins
September 4, 2018 (published)
Edie Lau
For The VIN News Service
Fuji seemed her usual fun-loving doggy self the day Lloyd Taplin took the
Labrador retriever outside their home in Ohio for a game of fetch. But very
quickly, Taplin realized something wasn't right.
"I threw the ball once, she brought it back and just melted in a puddle at my
feet," Taplin recounted.
Up to that point, Fuji had been active and healthy, apart from having skin
allergies. After collapsing in the driveway, Fuji, then age 9, was able to get
up woozily. Taplin rushed the dog to an emergency veterinary hospital,
where she was diagnosed with a serious heart condition called dilated
cardiomyopathy, or DCM.
DCM isn't rare in dogs but typically, it's seen in particular breeds, usually
large ones. Doberman pinschers. Great Danes. Newfoundlands. Boxers.
Irish wolfhounds. Cocker spaniels (an exception to the size rule-of-thumb).
Labrador retrievers aren't on the usual-suspect list.
It turns out that Fuji's case is among a recent spate of canine DCM
diagnoses not explained by heritage. Instead, the common thread is diet:
Affected dogs have been on narrow diets of commercial dry foods that are grain-free and/or contain exotic meat proteins and/or a limited mix of
ingredients, particularly potatoes, or legumes such as lentils or peas.
Fuji ate a kibble consisting primarily of kangaroo and lentils. A second Lab
in the same household, 4-year-old Pippin, also had allergies and ate the same food. In July 2017, seven months after Fuji's
diagnosis, Pippin started coughing. Her veterinarian detected a heart murmur and recommended she see a cardiologist.
Taplin scheduled Pippin at the same time that Fuji was due for a follow-up visit, two months later. In retrospect, Taplin said,
"We were really stupid." While Pippin seemed OK in July, still able to run, by August, she was coughing badly. Taplin and her
husband took the dog to the cardiologist then, but it was too late. Pippin died in September.
Hundreds of reports
As of Aug. 24, the U.S. Food and Drug Administration had received reports
of about 200 cases of dogs with heart disease potentially related to diet. Of
those, 140 have diagnoses of DCM, according to Dr. Martine Hartogensis,
deputy director of the FDA Center for Veterinary Medicine Office of
Surveillance and Compliance.
The agency checked its log of pet food complaints. "Sure enough, we had about 25 to 30 cases in our database," Hartogensis
said in a telephone interview.
In its public notification, the agency elaborated: "Diet 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 their ingredient
list, indicating that they are the 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."
DCM (https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4952598) is a disease resulting in an enlarged, weakened
heart that is unable to pump blood efficiently. Often progressing over time, the condition can cause fluid buildup or sudden
death. Dogs with DCM may tire quickly, cough, and have a labored and increased rate of breathing. More dramatic clinical
signs are episodes of sudden weakness, fainting or collapse.
Although the link between DCM and diet was — and continues to be — undefined, Hartogensis said it was compelling enough
that the FDA believed alerting the veterinary community at large and the general public was warranted.
"Veterinary cardiologists were very concerned," she said. "They said, 'Please do something. We've seen enough of these
cases that we think something is going on, and we want people to be aware of it.' " She added, "Lentils, potatoes, these kinds
of ingredients have exploded in the market."
Grain-free is all the rage
Grain-free and "limited ingredient" pet foods are so popular that in stores such as Petco, one of
the largest pet retailers in the country, such formulations dominate the central aisles. Traditional
recipes containing grains such as corn and wheat are relegated to the outer realm.
"A significant portion of consumer demand is for grain-free, and that's reflected in both our
online and in-store assortments," Dr. Whitney Miller, Petco's director of veterinary medicine, said
by email.
According to a petfoodindustry.com blog post, "Pet food ingredients: What's hot and getting
hotter? (https://www.petfoodindustry.com/blogs/7-adventures-in-pet-food/post/7161-pet-foodingredients-whats-hot-and-getting-hotter)"
grain-free pet foods claimed 43 percent of the pet
specialty market in 2017, with $3.4 billion in sales. (The pet specialty channel comprises mainly
pet stores. It doesn't include mass-market, online or grocery channels.)
Pet-food makers say the rise of grain-free varieties during the past 10 years is fueled by pet owners' desire to style their pets'
eating habits after their own. "Many people today have become increasingly interested in their own diet, following trends such
as lower-carb diets, and their food and nutrition philosophies carry over when selecting food for their four-legged family
members," Dana Brooks, president and CEO of the trade group Pet Food Institute, said by email.
Asked whether any pet food makers who invest heavily in grain-free
formulations are considering shifting to more conventional blends, in light
of the health concerns, Brooks replied: "It is important to note that the FDA
has not recommended any recalls or advised any dietary change for
healthy pets — their investigation is in its early stages .... PFI members
also are investigating any possible links [between diet and DCM in dogs
not predisposed to the condition] and are carefully reviewing their
formulations to assess and ensure nutritional adequacy."
To date, news about the potential problem with grain-free diets hasn't
altered consumer buying patterns, according to Miller at Petco. "We've
seen no measurable change in demand since the FDA alert in July," she
said.
Confounding factors
Because multiple brands are involved in suspect cases, researchers and
the FDA are reluctant to publicly name names. Furthermore, evidence
doesn't suggest that any particular ingredient needs to be completely
avoided. The issue is proportion, not presence. "Those ingredients [such
as potatoes and peas] have been in pet foods for years, 30, 40 years,"
Hartogensis said. "It's the amount that has changed."
At first, the culprit generally appeared to be grain-free formulations, but
understanding of the problem is evolving rapidly. Researchers say now that
identifying the problem as grain-free diets is at once too narrow and too
broad.
Trying to more accurately characterize the issue, Dr. Lisa Freeman, a
veterinary nutritionist at Tufts University, coined the term "BEG" diet, for
boutique, exotic and/or grain-free. "I think all of those are suspect at this
point," Freeman said.
Exotic diets have unusual meats such as kangaroo, alligator, bison,
venison and the like.
"We don't know much about the nutritional value of those protein sources
like we do chicken and beef," observed Dr. Darcy Adin, a veterinary
cardiologist who is part of a team at North Carolina State University
working on the puzzle. "So that's one potential cause."
At the same time, grain-free formulations aren't all implicated. "It doesn't
seem to be that all grain-free diets are represented in these [affected]
dogs," Adin said. Another confounding factor, she said, is the fact that "the
majority of foods on the shelves are grain-free."
It could be, Adin said, that affected dogs have a predisposition to
developing heart disease on particular diets.
A further possibility is that a high content of legumes such as lentils and
peas somehow reduces bioavailability of other nutrients, or causes an
interaction among nutrients that leads to disease, she said.
The complicated role of taurine
One nutrient deficiency most associated with DCM is that of taurine, a
sulfur-containing amino acid found abundantly in meat. Veterinarians
discovered 30 years ago that the majority of cats with DCM were taurinedeficient
as a result of eating any of several brands and formulations of
commercial cat foods. Giving the cats taurine supplements cured the
disease. Changing the formulation of cat foods to include more taurine
largely eliminated the disease. Today, DCM in domestic cats is rare.
(Among reports the FDA has received of potentially diet-related DCM in
pets are three reports involving seven cats. The agency said the causes in
those cases, logged in 2015 and 2016, were undetermined.)
In dogs, the role of taurine in DCM is unclear. Unlike cats, dogs can
synthesize taurine from methionine and cysteine, common sulfurcontaining
amino acids found in lots of foods. Consequently, no industry
standards exist for taurine supplementation in dog foods.
Researchers attempting to discern the role of taurine in the development of
typical cases of DCM found that "the vast majority of dogs with DCM had
normal taurine levels," according to a Morris Animal Foundation article.
However, a few breeds have been found to be susceptible to developing DCM related to taurine deficiency: cocker spaniels,
Newfoundlands and golden retrievers.
Among recent cases of DCM in atypical breeds, changing the diet and adding taurine has improved or reversed the heart
disease in many instances. That's true even for dogs who didn't present with low taurine levels, said Adin, who offered an
example of seven patients she and her colleagues followed. After the dogs were changed to a grain-based diet and given
taurine supplements, they showed significant improvement in three to nine months, she reported. (Whether the improvement
came about because of the added taurine, the different diet, or both is an open question.)
While taurine might be a factor in some cases of DCM, Freeman cautioned against assuming it is true of all cases. "There are
dogs with taurine deficiency, both typical and atypical breeds, but there are also dogs, both typical and atypical breeds, that do
not have taurine deficiency," she said.
"Then, there are the typical breeds of dogs with DCM that has nothing to do with diet but is the result of their genetic
predisposition," she said.
At the same time, DCM in individual members of those typical breeds could, in fact, be diet-related. "We saw a doberman [a
typical breed] last week that had taurine deficiency," Freeman said. "His condition is improving with diet change and taurine
supplementation."
Which food to give?
Tracy McGlinchey, a pet owner in Connecticut, has been reading up on
dietary factors in DCM since her 3-year-old Boston terrier, Millie, was
diagnosed in July. The first sign that something wasn't right surfaced the
weekend after the Independence Day holiday, when Millie developed a
random dry cough. "Think: cat with furball," McGlinchey said. "Nothing
terrible. You half ignore it."
On Monday, McGlinchey's 16-year-old daughter noticed Millie breathing fast
and shallow. They took the dog to the veterinarian. An X-ray revealed an
enlarged heart. An immediate trip to the emergency hospital for an
echocardiogram showed DCM.
Millie is prone to allergies, and McGlinchey believes potatoes are the cause,
so she's always steered clear of foods containing potato. Millie seemed to
do well on a kibble composed of venison, lentils, peas and chickpeas. When the brand was discontinued, McGlinchey switched Millie to a boutique blend
the first four ingredients of which are anchovy meal, peas, fava beans and
sunflower oil.
Now that Millie has heart disease, McGlinchey is diving deep into ingredient
labels, and trying one diet after another. Millie likes them all, but McGlinchey
hasn't found one that she loves.
"Finding grained foods is challenging," she said. "Everything is grain-free.
And if it doesn't have grains, then there's a lot of potatoes. And the peas. It's
crazy."
She's been searching in pet stores rather than grocery stores, which are
more likely to stock traditional brands, because buying pet food at the
supermarket is "almost embarrassing," McGlinchey said, half laughing at
herself. "Like buying your kids a soda."
She understands that the grain-free movement is fed by marketing. She
said, "Who says dogs shouldn't have grains?"
Freeman, the Tufts University veterinary nutritionist, said grains are perfectly
fine ingredients. "Grains do not contribute to any health problems, and are
used in pet food as a nutritious source of protein, vitamins and minerals,"
she said.
While many pet owners may feed grain-free and/or limited-ingredient
formulations in an attempt to control allergies, the pet might not actually be
allergic to a food or foods, according to Freeman. It might be allergic to
pollen, molds and/or dust mites instead, she said.
Even if a dog with skin or gastrointestinal problems gets better on a different
diet, that doesn't mean that the improvement is attributable to a change in
ingredients. Changing the diet brings changes in fat level, fiber level, fiber
type and digestibility, too, Freeman noted. "While owners commonly think it's the ingredients that helped, many other factors
also changed that are more likely to have caused the improvement," she said.
Millie's case has caused her veterinarian, Dr. Neil Marrinan, to change his ways when it comes to talking about diet with dog
owners. Earlier in his career, he would advise them to feed a variety of foods, regularly changing brands and ingredients. After
awhile, although his opinion remained firm, he stopped offering it. "People [have] ... a preconceived idea of what they want to feed their dog, and [they] come to the doctor for validation," he said. "Unless I heard something that seemed out of the
ordinary, I would avoid commentary."
No more. "It got out of hand, these narrow-cast diets," Marrinan said. "It's cause for us to say, 'This is not good.' "
He's back to speaking up now. His advice: "I recommend varying the diet to include grains, with meat as the first ingredient."
Complete article can be seen on
https://www.vin.com/members/news/default.sapx?pld=210&id=8700146
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