The OneVetMed Podcast with Dr Robert Gaston

Show notes coming! Thanks for your patience.

Show notes coming! Thanks for your patience.

Show notes coming! Thanks for your patience.

  Episode 9: Nutritional Deficiencies and Dietary Supplements – Part 2 Answering the questions about use of nutritional supplements: How do we recognize/suspect the need? When should we use nutritional supplements?   In order to better recognize and understand nutritional deficiency, it helps to review some basics of nutritional research Methods: Experimental and observational study used to identify deficiency syndromes Often begun with the observation that certain foods influenced active disease processes Limes used to prevent and treat scurvy Efforts directed toward identifying the beneficial substance(s) in those foods. The primary focus of the early research was on vitamins   Philosophy of Nutritional Scientists: Synthetic Reproduction of ‘Active’ Ingredients Early research failed to recognize the chemical complexity of foods Assumed that foods are simple mixtures of a few easily identified chemical constituents, which, through modern chemistry, can be easily reproduced   Nutritional Research: Defining Nutrient Deficiencies (introduced this idea in episode 2 when describing how “essential” nutrients are identified for pet food.) Defining disease syndromes of nutrient deficiency relies on the total exclusion of a single nutrient, such as a vitamin, over short-term. The manipulated diet produces the classical signs of disease associated with the absence of that nutrient.   Understanding nutritional studies Observational (dietary intake) Diets containing large amounts of foods high in ?-carotene (yielding high blood levels of ?-carotene) have been associated with decreased risk of cardiovascular disease and several types of cancer Intervention trials (supplementation) Different vitamin sources affect outcomes of clinical studies Supplementation trials may yield contradictory results Example: Synthetic ?-carotene supplementation   Nutritional Research-The Key to Understanding ‘Conflicting’ Results The Case Against Vitamins Wall Street Journal March 20, 2006 p. R1, R3 http://www.mythyroid.com/documents/WSJVitamins.pdf http://online.wsj.com/article/SB114235146814497776.html Prevalence – 70% of households buy vitamins $7 Billion spent on vitamins in 2005 Rationale Boost immune system Protect heart Decrease risk of cancer Results “May be doing more harm than good” Detrimental effects Cancer promotion Increased risk of heart failure Last year, Johns Hopkins University researchers in Baltimore published a shocking finding. After reviewing the data from 19 vitamin E clinical trials of more than 135,000 people, the analysis showed high doses of vitamin E (greater than 400 IUs) increased a person’s risk for dying during the study period by 4%. Taking the vitamin E with other vitamins and minerals resulted in a 6% higher risk of dying. Since the analysis was published, another study of about 9,500 patients evaluated long-term use of 400 IUs of vitamin E daily. The study didn’t show any statistically meaningful differences between vitamin users in terms of cancer, heart attacks or stroke, but the vitamin E takers had a 13% higher risk for heart failure. “The psyche of the U.S. population is that a nutraceutical can’t be harmful and might be helpful, so why not take it?” says Dr. Klein. “That thinking is just not correct. What is going on? “Nobody knows why high doses of vitamins taken as pills might cause harm” “What is clear, however, is the important role a healthful diet plays in preventing illness” The critical difference is that vitamin complexes and phytochemicals found in food are fundamentally different than isolated pharmaceutical doses of vitamins.   Observation vs. Intervention: Detrimental Effects of Synthetic Beta Carotene ?-carotene initially appeared to be the associated link between lowered cancer risk and dietary intake of fruits and vegetables (observation) No benefits have been found with ?-carotene supplementation in randomized trials (intervention) CARET (?-carotene and Retinol Efficacy Trial) Vitamin A (retinol) and synthetic ?-carotene supplements 18,314 men and women Study stopped 21 months early No protective benefit Increased risk of lung cancer and higher mortality in the intervention group ATBC (?-tocopherol, ?-carotene cancer prevention study) Synthetic dl-?-tocopherol and synthetic ?-carotene supplements 29,133 male smokers in Finland Increased cancer risk with supplementation   Although studies have suggested an association between diets rich in beta carotene and vitamin A and a lower risk for many types of cancer, the supplements taken in pill form have proved risky. The 1994 Finland study of smokers taking 20 milligrams a day of beta carotene showed an 18% higher incidence of lung cancer among beta carotene users. In 1996, a study called Caret looked at beta carotene and vitamin A use among smokers and workers exposed to asbestos. The trial was stopped when the participants taking the combined therapy showed a 28% higher risk for lung cancer and a 26% higher risk of dying from heart disease. More recently, a 2002 Harvard study of more than 72,000 nurses showed that those who consumed high levels of vitamin A from foods, multivitamins and supplements had a 48% higher risk for hip fracture than nurses who had the lowest intake of vitamin A. Notably, nurses who ate a lot of foods high in vitamin A also had higher risk, possibly indicating that too many foods are: now fortified with the vitamin. Milk, margarine and breakfast cereals are fortified with vitamin A. High intake of vitamin A has also been associated with a higher risk of birth defects. (The Case Against Vitamins Wall Street Journal March 20, 2006 p. R1, R3) Dietary vs. Supplemental Phytochemicals/Antioxidants Why are lower doses of dietary antioxidants beneficial, but higher doses of supplementary antioxidants not offer expected levels of protection against free radicals? Synthetic Reproduction of ‘Active’ Ingredients Synthetic chemical substances often do not convey the identical health benefits as the same compound when consumed with the parent food More complex than can be synthesized and reproduced in the laboratory Complexity of food biochemistry and physiological impacts continue to be poorly understood Balanced intake of synergistic components Balanced absorption (lack of interference from isolated synthetics) Natural nutrient forms (compatible with animal enzyme systems) Lack of induction of detoxification enzyme systems that enhance elimination of supplemental nutrients Gene regulating effects on intracellular detoxification enzyme systems affecting phase I and phase II balance In healthy organisms, there is a balance between oxidants and various antioxidants Reactive oxygen species are not solely harmful but are involved in many defense reactions of the cells “High levels of antioxidants may disturb these reactions with unpredictable and unexpected consequences…” {Rautalahti M, Virtamo J, Haukka J, et al. The effect of alpha-tocopherol and beta-carotene supplementation on COPD symptoms. Am J Respir Crit Care Med 1997 Nov;156(5):1447-1452.}   “Food is an extremely complex matrix consisting of thousands of natural components, many of which have not been characterized.” {Rasooly L, Rose NR. Food toxicology and immunity. Nutrition and Immunology: Principles and Practice Gershwin, German, Keen Eds. 2000}   Complexity of Food Biochemistry: Biologically Active Compounds “Food is more than a source of calories and nutrients to prevent deficiency diseases. It represents a matrix of interacting substances that influence biological response modifiers, the functional aspects of physiology. By manipulating the diet appropriately and using nutritional pharmacology where necessary, dysfunctional patterns of intercellular communication can be modified to establish the physiologic patterns of health.” {Bland, J. 2000 Seminar Series Syllabus: Nutritional management of the underlying causes of chronic disease. P. 161-2   Complexity of Food Biochemistry: “Herbal Remedies” and “Medicinal Botanicals” Currently recognized that there are a host of “nonnutritive” components of plants that can have active roles in disease prevention “Biological response modifiers” Some animal products, not traditionally thought of as foods, also can have active roles in disease prevention Bear gallbladder, ginko lizard, deer antler, shark fins {Gundling K, Borchers A, Gersshwin ME. Nutrition, immunity, and alternative medicine.} {Nutrition and Immunology: Principles and Practice 2000 Gershwin, German, Keen} There is a fundamental difference between the biological action of a pure chemical and the same chemical in a plant matrix Synergy The biological action of the chemical mixture is greater than the sum of the actions of the mixture’s components (“The whole is greater than the sum of the individual parts”) Certain plant compounds with minimal or no biological activity can improve stability, solubility, or bioavailability of active components {Principles and Practice of Phytotherapy: Modern Herbal Medicine. Mills S, Bone K. 2000} More than ‘antioxidants’ Interaction with specific receptors Modulate expression of genes regulating specific enzyme systems A common effect of numerous identified phytochemicals is regulation of gene expression for detoxification enzyme activity Up-regulation of phase II Down-regulation of phase I Alteration of antioxidant status within cells Enhance immune responses Modulate circulating hormone concentrations Modify inflammation via receptor-mediated effects on expression of specific genes Cyclooxygenase-2 PGE-2 Switching off/on specific genes involved in cell growth, proliferation, and death Inhibition of cell proliferation/induction of apoptosis Tumor suppressor genes Oncogenes   Partial deficiency over long term is very different than complete deficiency over short period Typically is not single vitamin or nutrient, but combination of several nutrients operating in conjunction What clinical signs might be expected with long-term partial deficiencies? Example:  The vague signs of decreased immune function can be a result of partial deficiency of: Selenium, zinc, vitamin A, copper, omega 3 fatty acids, taurine, and glutamine Other chronic diseases such as cancer, arthritis, allergies, cardiovascular disease, reproductive problems, and neurodegenerative disorders/ cognitive dysfunction may have nutritional origins Acknowledgement of Partial Nutrient Deficiency in Disease JAMA June 2002 “Classic” deficiency syndromes not seen in Western societies Scurvy, beriberi, rickets ‘Sub-Clinical’ deficiencies common “Sub-Optimal” vitamin status associated with many chronic diseases Cardiovascular disease, cancer, osteoporosis Physicians must learn to recognize those with poor nutrition or reasons for increased vitamin needs Blood, serum, and red blood cell measurements are not reliable indicators of this type of deficiency They recommend a daily multivitamin Unfortunately, “the science of vitamin supplementation for chronic disease is not well developed” Dietary recommendations (RDA) Population-based data Minimums Designed to avoid well-characterized deficiency syndromes When available scientific information is incomplete, RDA estimates can be wrong As knowledge changes, recommended intakes change Folate Metabolic, environmental, and genetic factors along with pathologic conditions may alter individual nutrient requirements   “Sub-Clinical” Deficiency Syndromes: Vitamin A History 1800’s effects of a deficient diet 1900’s identified the foods that treated the deficiency syndrome (What foods, not Why this food?) Identified substances in the foods:  carotenoids and vitamin A 1947 successful, cost-effective synthesis of ‘vitamin A’ But…vitamin A refers to a group of fat-soluble substances called retinoids Vitamin A Status: The “sub-clinical” deficiency No ocular lesions Not ‘classic’ signs Increased mortality Decreased cellular integrity Decreased immune function Difficult to diagnose  “Between the extremes [toxicity, total depletion] is a relatively large zone where status cannot be easily quantified by currently available techniques.” {Prevention of Micronutrient Deficiencies:  Tools for Policymakers and Public Health Workers (1998). http://www.nap.edu/openbook/030906029X/html/106.html, The National Academy of Science} “Sub-Clinical” Deficiency Syndromes: Folate/B12 Dementia & Alzheimer’s-like syndrome in people B12 important for nerve myelination and fat/protein metabolism Atrophic gastritis = ? gastric acid ?protein digestion and ?bacterial growth ?free B12 from protein and ?metabolism of existing  free B12 “Sub-clinical” B12 deficiency Clinical syndrome of confusion and disorientation No evidence of megaloblastic anemia (classical B12 deficiency) {Cyberounds: The Subtle Presentation of Vitamin B12 Deficiency Russell, RM, Mason JB  8/96 http://www.cyberounds.com/conferences/nutrtion/conferences/0896/conference.html “…it is now apparent that degrees of folate depletion that are not severe enough to cause megaloblastic anemia can have deleterious effects on the health of affected people. For example, mild decrease in folate status can lead to elevated levels of homocysteine in the blood which is thought to be an independent risk factor for arteriosclerotic vascular disease.” {Cyberounds: Nutritional Issues In and a Promising New Treatment of Inflammatory  Bowel Disease  Russell, RM, Mason JB  10/96}   Neurodegenerative Disorders & Cognitive Dysfunction Canine C.D. estimated to affect 47% of dogs age 11-12 years, 86% of 15-16 year old dogs Alzheimer’s disease and CD in dogs share many similarities Same regions of the brain affected Beta-amyloid plaque formation Similar neurotransmitter dysfunction/imbalance {Ruehl WW, Hart BL et. al. L-Deprenyl therapy for canine cognitive dysfunction Kirk’s Current Veterinary Therapy XIII 2000 pp.53-57   “The risk of PD [Parkinson’s disease], however, was significantly reduced among men and women with high intake of dietary vitamin E (from foods only). The reduction in risk of PD associated with high dietary vitamin E intake suggests that other constituents of food rich in vitamin E may be protective.” {Zhang SM, Hernan MA, et. al. Intakes of vitamins E and C, carotenoids, vitamin supplements, and PD risk. Neurology 2002 Oct 22;59(8):1161-9.}   “Diets rich in fruits and vegetables have been shown to improve human well-being and to significantly delay the development of pathologic processes, including neurodegenerative disorders.” {Martin A, Cherubini A, Andres-Lacueva C, Paniagua M, Joseph J Effects of fruits and vegetables on levels of vitamins E and C in the brain and their association with cognitive performance. J Nutr Health Aging 2002;6(6):392-404.}   “Nutrition may be useful for preventing dementia…” {Otsuka M, Yamaguchi K, Ueki A Similarities and differences between Alzheimer’s Disease and vascular dementia from the viewpoint of nutrition. Ann N Y Acad  Sci 2002 Nov;977:155-61.}   “Sub-Clinical” Deficiency Syndromes: Glutamine Considered to be ‘conditionally’ essential Demand may exceed synthetic capacity any inflammation or disease condition Essential for the entire body Immune function – enteric and systemic Tissue repair Enterocytes Essential for preservation and normalization of: small bowel villus morphology intestinal permeability enterocyte function intestinal healing Prevention of bacterial translocation {Small Animal Clinical Nutrition 4th Ed p. 81} {Allen TA, Hand MS. Conditionally essential nutrients: antioxidant nutrients and glutamine. Kirk’s Current Veterinary Therapy XI Small Animal Practice 1992 pp. 40-43} High heat processing of commercial pet foods destroy large amount of glutamine leaving them depleted Known to be deficient in cancer patients fed commercial dry/canned diets Supplementation shown to be beneficial for quality of life and healing with chemotherapy and radiation therapy Commercial diets…How much is really in there? Deficiencies despite an “adequate” amount in a “balanced” diet? Role in IBD? {Small Animal Clinical Nutrition 4th Ed p. 81} {Ogilvie, G. Complimentary/integrative cancer care: fact or fiction? North American Veterinary Conference lecture notes Jan. 22, 2003}   Examples of Immune Dysfunction From “Subclinical” Deficiencies: Zinc {Verdon DR Study: Zinc common element deficient in forages. DVM Newsmagazine, June 1996, p. 1F} The graph highlights the area of “subclinical” disease In this range, the serum zinc is within the reference ranges and the deficiency is undetectable by conventional measures Compromised immune function and impaired fertility become apparent The appearance of classical signs of dietary zinc deficiency (such as zinc dermatosis) do not appear until later in the course of developing deficiency Bioavailability – interfering substances affect nutrient absorption and utilization   This highlights several important concepts which have been mentioned and deserve repeating: Real-world nutritional deficiencies rarely appear as classical nutrient deficiency syndromes Real-world nutritional deficiencies frequently consist of subtle signs of diminished immune competence and susceptibility to infections, cancer, immune mediated disease, etc. Real-world nutritional deficiencies are usually not easily detected by a blood test   Malnutrition and Susceptibility to Disease Commonly thought that malnutrition diminishes host immune responses and is responsible for increased susceptibility to disease Famines followed by epidemics of infectious disease Nutritional status of the host can affect the genetic expression of a pathogen, changing a normally avirulent organism into a virulent one Examples: Measles generally mild with few complications in unvaccinated individuals when normal vitamin A status Deficiency of vitamin A associated with severe disease and high mortality Increased severity of respiratory syncytial virus infections when vitamin A deficient Malnourished mosquitoes may be more susceptible to certain viruses and may transmit more virus when feeding Experimentally shown with LaCrosse Virus Enhanced pathogenesis associated with increased oxidative stress Oxidative damage to viral genome Diminished clearance of virus by host immune system Increased incidence of mutations in virus     The bottom line – Food is much more complex than synthetic vitamins Many supplements do not feed the body effectively ( and many are dangerous) Nutritional deficiencies occur (!)…. and our index of suspicion should be higher In other words, going back to episode 1, we should be asking whether every illness has a nutritional component   Episode 10 will discuss more about what type of supplementation should be used to feed the body according to its natural design  

Episode 8 is all about KEEPING YOUR PETS TEETH CLEAN A continuation of Dr. Gaston’s look at nutritional deficiencies and dietary supplementation. In this episode Dr. Gaston explains the apparent contradictions between many nutritional studies which lead to so much confusion over whether supplements are good or bad. He also presents some examples of examples of nutritional deficiency to help change our perspective on what a real-world nutrient deficiency looks like. Healthy mouth Tooth/gum cross section     A healthy mouth is important for overall health … and more pleasant when your pet doesn’t have bad breath Chronic inflammation from gingivitis and periodontal disease is detrimental to health of people and animals Chronic inflammation can affect many areas of the body Bacteria entering the circulation through inflamed gum tissue can adversely affect heart valves, kidneys, liver, etc. Plaque: Many bacteria in the mouth Bacteria and saliva form a slick coating (‘biofilm’) on the surface of the enamel On a clean tooth surface, plaque begins accumulating in less than 30 minutes   Tartar: Mineral from saliva incorporated into biofilm of plaque Tightly bound to enamel surface Process begins within 48 hours Tartar/Calculus accumulation   Gingivitis Heavy tartar and red inflamed gums   Periodontitis Heavy accumulation of tartar, red inflamed gums Loss of periodontal ligament, alveolar bone, and receding gumline Controlling plaque and tartar Self-cleaning architecture of dog and cat teeth diminish plaque and tartar accumulation Processed pet foods contribute to plaque and tartar accumulation Canned – soft consistency Dry kibble-type foods – brittle Fibrous/abrasive food stuffs assist in self-cleaning action Scrub surface of tooth to gum line Bones, turkey necks, chicken necks Vegetables – carrots, celery, broccoli stems Other factors influencing gum health Oral Flora pH Raw diet Unknowns and inconsistent results Size of dogs Brushing Brush Manual Motorized spin brush Dentifrice No Xylitol No Flouride Examples of tooth brushing technique Hand scaling General anesthesia with ultrasonic scaling and polishing Thorough scaling and examination Extractions and radiographs as needed Examination and evaluation of health or specific concerns that may affect safety of anesthesia Pre-anesthetic blood work Age limitations?  

Episode 7: Nutritional Deficiencies and Dietary Supplements Public Interest in Nutritional Supplementation 50% of the U.S. adult population uses dietary supplements 1990-1997 400% growth in dietary supplement sales for humans Currently growing at 15% per year $37 billion annually 85% of regular supplement users believe that dietary supplements are good for health 82% of Americans would try herbs for terminal illness { http://www.cfsan.fda.gov/~dms/fdsupp.html; Boothe DM. 2004 Vet Clin Small Anim 34:7-38 ; Blendon RJ. 2001 Arch Intern Med 161:805-810 }   Similar interest in supplement use for pets 30% of pet owners have used or have considered using dietary supplements 90% of veterinarians sell some type of herbs or nutraceuticals $20-50 million in annual sales {Boothe DM. 2004 Vet Clin Small Anim 34:7-38}   Important Questions Concerning Nutritional Supplements What are nutritional supplements? Terminology, Definitions, Contents Why do we need nutritional supplements? Evidence for nutritional deficiencies – When should we use nutritional supplements? How do we recognize/suspect the need? What nutritional supplements should we use? – What kind of nutritional supplement is best? How do we use nutritional supplements?   Conventional Thinking About Nutritional Supplementation “The proper role of a supplement is to correct a diagnosed nutrient deficiency” {Small Animal Clinical Nutrition 4th Ed p. 116} However, diagnosis is difficult with current tools and difficult to recognize based on conventional definitions of deficiency “ The most common form of veterinary supplements is a wide variety of vitamin and vitamin-mineral combinations that are used by 10% of animal owners” {Small Animal Clinical Nutrition 4th Ed p. 116} Predominantly consist of isolated, or synthetic, vitamins “Routine use of vitamin mineral supplements is not needed when a dog or cat eats typical commercial pet food” “…dogs and cats consuming commercial dry rations were ingesting from two to five times the daily allowance of vitamins” {Small Animal Clinical Nutrition 4th Ed p. 116} They are already receiving potentially excessive amounts of isolated, or synthetic vitamins The conventional approach to nutritional supplementation is to provide more of the same isolated and synthetic nutrients that are already present in high amounts in the pet foods, expecting a better outcome It has been claimed that insanity is continuing to do the same thing, expecting a different result   Confusion in Terminology: What Are Nutritional Supplements? Food: (according to section 201(f) of the Food, Drug, and Cosmetic Act) “a raw, cooked, or processed edible substance, ice, beverage, or ingredient used or intended for use or for sale in whole or in part for human consumption” “articles used for food or drink for man or other animals, chewing gum, and articles used for components of any such articles.” This includes “dietary supplements and dietary ingredients” { http://www.cfsan.fda.gov/~dms/fsbtac13.html http://www.cfsan.fda.gov/~dms/fc01-1.html1  http://www.cfsan.fda.gov/~ear/ims-a-30.html} Drugs:  “articles [food or non-food] intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals” “ articles (other than food) intended to affect the structure or any function of the body of man or other animals” { http://www.cfsan.fda.gov/~dms/fsbtac13.html   http://www.cfsan.fda.gov/~dms/fc01-1.html1 http://www.cfsan.fda.gov/~ear/ims-a-30.html}   “Medical Food” originally applied to humans For dietary management of a disease or health condition Under the direction of a physician Label must state that the product is to be used to manage a specific medical disorder or condition Term adopted/applied to veterinary medicine Why a “Medical” food? “…the scientific community generally believes that foods and ingredients play a role in prevention and treatment of certain diseases and that claims to that effect on food labels should not render those products as drugs” {http://cfsan.fda.gov/~dms/ds-medfd.html }  “Specific requirements for the safety or appropriate use of medical foods have not yet been established. Medical foods do not have to include nutrition information on their labels, and their claims do not need to meet specific standards.” Veterinary medical foods do not require pre-market submission of safety or efficacy data for their intended use. “Unfortunately, a product could be exempt from fulfilling any requirements for labeling (including submission of data to support a health message) simply by meeting category definition of a medical food.” {Dzanis D, McGovern L.  The CVM’s role in the practice of small animal medicine.  Kirk’s Current Veterinary Therapy XI Small Animal Practice, 1992, pp. 64-66}         Terminology of Nutritional Supplements “A nutrient is any food constituent that helps support life” FDA’s traditional definition of dietary supplement consisted of only ‘essential’ nutrients – vitamins, minerals, and proteins   “Herbs, or similar nutritional substances” were added in the Nutrition Labeling and Education Act of 1990 {Small Animal Clinical Nutrition 4th Ed p. 21 {http://www.cfsan.fda.gov/~dms/dietsupp.html} {Dietary Supplement Health and Education Act of 1994 (DSHEA)} Amended the Federal Food, Drug, and Cosmetic Act to include provisions specific to dietary supplements and dietary ingredients to dietary supplements Recognition that there is: “a relationship between sound dietary practice and good health” “a connection between dietary supplement use, reduced health-care expenses, and disease prevention.” {http://www.cfsan.fda.gov/~dms/dietsupp.html} {http://www.cfsan.fda.gov/~dms/ds-oview.html} “A dietary supplement is a product taken by mouth that contains a ‘dietary ingredient’ intended to supplement the diet.” “A product that is intended to supplement the diet that bears or contains one or more of the following dietary ingredients : a vitamin, a mineral, an herb or other botanical, an amino acid, a dietary substance for use by man to supplement the diet by increasing the total daily intake, or a concentrate, metabolite, extract, or combinations of these ingredients” {http://www.cfsan.fda.gov/~dms/dietsupp.html} {http://www.cfsan.fda.gov/~dms/ds-oview.html} “Is intended for ingestion in pill, capsule, tablet, or liquid form.” “Is not represented for use as a conventional food or as the sole item in a meal or diet.” “Is labeled as a ‘dietary supplement’.” “Includes products such as an approved new drug, certified antibiotic, or licensed biological that was marketed as a dietary supplement or food before approval, certification, or license.” {http://www.cfsan.fda.gov/~dms/dietsupp.htm}   ‘Nutraceuticals’ “a substance that is produced in purified or extracted form and administered orally to patients to provide agents required for normal body structure and function and administered with the intent of improving the health and well-being of animals.” “Any substance that may be considered food or part of a food and provides medical or health benefits, including the prevention and treatment of disease.” {Small Animal Clinical Nutrition 4th Ed pp.114-115}     Nutraceuticals may contain Isolated nutrients EFA’s, vitamins, chondroprotective agents, DMG, CoQ10, individual phytochemicals Functional foods “Any modified food or food ingredient that may provide a health benefit beyond the traditional nutrients it contains” Designer (genetically-engineered) foods , hypernutritious foods, pharmafoods, processed human foods “Foods or nutrients that claims medical or health benefits, including the prevention and treatment of disease” Herbs {Small Animal Clinical Nutrition 4th Ed pp.114-115}   Nutritional/Dietary Supplements:  The Key Distinctions What nutritional supplements should we use? What kind is best? Synthetic? Chemically-synthesized single substance either duplicates or approximates naturally occurring vitamin substance and has vitamin-like activity Natural? Single vitamin compound extracted or isolated from food source Isolated components (alone or in combination)? Macronutrients Vitamins Minerals Amino acids/proteins Fatty acids Carbohydrates “Trace” minerals “Phytochemicals” (“non-nutrients”) Whole-food based supplements  (including botanicals) Whole-food concentrates Contains naturally-occurring substances as found in food Complete vitamin complexes Synergistic combination of phytochemicals Proteins (nucleic acids) Fatty acids Minerals Food concentrate produced from  specific nutrient-dense food Not isolated single constituent “The best way to get vitamins is from whole foods.” {Stevens L. Nutrition: Vitamins A to K. JAMA Patient Page JAMA Vol. 287, No. 23 June 19, 2002}   Why Do We Need Nutritional Supplementation? Provide vital factors lost during processing Increase specific nutrients and “non-nutrient” factors Manage biochemical individuality Manage periods of increased tissue stress or demand Inherent deficiencies of commercially produced vegetables, fruits, and animal products Recognize importance of partial or “subclinical” nutritional deficiency       Nutrients serve as metabolic substrates  – enter cell and enter into cellular metabolic functions to produce outputs of proteins, enzymes, neurotransmitters, fats, hormones, etc. Deficient input = deficient output Garbage In – Garbage Out Affects potentially any cells in the body: examples – Immune Nutrition provides the components needed by the immune system to generate an effective immune response Leukocyte proliferation and phagocytic activity Oxidant balance Protein activity Antibody production Cytokine balance Acute phase proteins Complement pathways Transcription factors Enzymes Nutrition and Immunology: Principles and Practice Gershwin, German, Keen Eds. 2000 Range of immune problems associated with nutritional deficiencies Increased opportunistic infections Increased risk of cancer development Suboptimal response or adverse response to vaccinations Allergies/autoimmune disease Nutrition and Immunology: Principles and Practice Gershwin, German, Keen Eds. 2000 Nervous Endocrine GI

  Episode 6: Diet Recommendations   Many choices in pet foods Dizzying array in the pet store from the least expensive to the more expensive and ‘holistic’ foods What is a ‘holistic’ food?   Which one to choose? Why? Two primary concerns: Nutritional quality Safety   Recent safety concerns with commercial foods – What’s in the bag?: Melamine Aflatoxin or other fungal toxins Pentobarbital or other drug residues 2002 FDA veterinarian Newsletter Vol XVI, No III http://www.fda.gov/AnimalVeterinary/NewsEvents/FDAVeterinarianNewsletter/ucm110419.htm “After finding that the low levels of pentobarbital that dogs might receive through food are unlikely to cause them any adverse health effects, FDA officials did not think that further research into the issue was necessary.” Bacterial contaminants Human Salmonella Infections Linked to Contaminated Dry Dog and Cat Food, 2006-2008 Seventy-nine case-patients in 21 states were identified; 48% were children aged 2 years or younger. A low attack rate supports the hypothesis that infection might have resulted from practices in a limited number of households. One possibility is that the number of organisms was magnified in some households because of, eg, cross contamination in the kitchens or irregular cleaning of pet food bowls, which might promote bacteria growth. In addition, illness may have occurred primarily in persons who were more susceptible to infection with a small number of organisms. Illness was not reported in dogs or cats from case patient households, although the outbreak strain was cultured from several stool specimens from dogs who ate contaminated dry dog food. Some children may have become ill from contact with a pet carrying the outbreak strain. Prevalence of isolation of Salmonella from feces of healthy dogs is reported to be between 1% and 36%, and from healthy cats between 1% and 18%. Dogs and cats may shed Salmonella in the feces for as long as 12 weeks, and shedding may be intermittent, 11 so the risk of infection could continue for extended periods. In addition, it is thought that Salmonella can survive for extended periods in dry dog and cat food, as it can in similar dried foods such as cereals. Forty-three million US households (37%) own dogs and 37.5 million (32%) own cats, and many pet owners feed the animals dry pet food. …dry pet food, the most common pet food fed to dogs and cats, is not manufactured to be a sterile product. Typically, a more drastic heat treatment is required to destroy Salmonella in dried food products. Since 2006, according to the FDA, at least 13 recall announcements involving 135 pet products (eg, dry dog food and cat food, pet treats, raw diets, and pet supplements) have been issued because of Salmonella contamination.  No human illness was associated with these other pet food recalls. The recommendation to wash hands is the most important prevention step for reducing the risk for disease transmission. {http://pediatrics.aappublications.org/content/early/2010/08/09/peds.2009-3273.full.pdf } http://www.dogfoodadvisor.com/dog-food-recalls/ A total of 49 individuals (47 individuals in 20 states and two individuals in Canada) infected with the outbreak strain of Salmonella Infantis were reported. Among the 24 patients with available information, 10 (42%) were hospitalized. No deaths have been reported. Epidemiologic and laboratory investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies linked this outbreak to dry dog food produced by Diamond Pet Foods at a single production facility in Gaston, South Carolina. Multistate Outbreak of Human Salmonella Infantis Infections Linked to Dry Dog Food (Final Update) http://www.cdc.gov/salmonella/dog-food-05-12/pet-owners-info.html Salmonella Infection (salmonellosis) and Animals You should also know that some pet products, like pet foods and treats, can be contaminated with Salmonella and other germs. Pet food and treats might include dry dog or cat food, dog biscuits, pig ears, beef hooves, and rodents used to feed reptiles including frozen feeder rodents. http://www.cdc.gov/healthypets/diseases/salmonellosis.htm   Safety concerns with raw foods: Parasites Bacteria Documentation? We are led to believe that raw frozen diets present an especially great risk of bacterial contamination and illness Canadian Veterinary Journal / VOL 48 / JANUARY 2007 The risk of salmonellae shedding by dogs fed Salmonella-contaminated commercial raw food diets   Aside from safety concerns, there is the question about how best to feed your pet.   Conventional thinking (the old paradigm): “The nutrient profile of a commercial pet food is important to animals and should be the primary focus rather than concern for specific ingredients” {Small Animal Clinical Nutrition 4th Edition 2000 p.119}   New Paradigm: There are many chemical components in plant and animal tissues that have powerful, beneficial physiologic effects.   Each plant or animal product has a unique combination of chemical ingredients that produce the observed physiologic effects     Therefore, each ingredient in the diet may exert specific physiologic effects or benefits beyond the mere content of proteins, fats, carbohydrates, vitamins, and minerals   Many of these bio-active compounds are not currently considered ‘essential’ and are therefore not included, or not quantified, in commercial pet foods   Modern understanding of genetics has shifted focus to the relationship of nutrition and genetic expression     Focus on functional nutrition rather than ‘minimums’, ‘deficiencies’, and ‘essential nutrients’ Aspects of Functional Nutrition: Nutrigenetics  –  Nutrigenomics  – Epigenetics   Nutrigenetics Genetic variability affects the response to diet Nutritionists are beginning to acknowledge the genetic/biochemical uniqueness of each individual “…certain animals may have genetic or metabolic differences that may respond to intakes greater than are considered adequate to avoid recognized dietary deficiencies.” {LaFlamme DP. 2000 Healthy Skin And Haircoat: The Importance of Nutrition. Purina Research  Report pp.1-4.}   Nutrigenomics            “Modern discipline at the interface of genetics, molecular nutrition, molecular biology, pharmacogenomics, and molecular medicine” { Nutrigenomics. Rimbach G, Fuchs J, Packer L. Eds. 2005 p.1} Dietary components can alter genetic expression Modify health by modifying the way we feed the genes Example: modification of matrix metalloproteinase and proinflammatory cytokine production with EPA Modify genetic expression and inheritance = “Epigenetics”   “Epigenetics” NOVA | scienceNOW | Epigenetics: A Tale of Two Mice (Flash) | PBS NOVA | scienceNOW | Epigenetics | PBS    “While identifying bioactive components in food may be helpful in explaining the health effects of food, such information is likely to be incomplete. All foods come from living organisms where the components interact to produce biological systems. These interactions are relevant when the plant or animal is consumed as food.” {Jacobs DR, Tapsell LC. Food, not nutrients, is the fundamental unit in nutrition. Nutrition Reviews Vol. 165, No. 10, p.439}   “…there are thousands of other substances in the food matrix that must be considered as possibly leading to biological activity, possibly synergistically with each other…These include signal transducers, hormones, sterols, enzymes, enzymes inhibitors, polyphenols, and fungicides, among others. In this light, it seems rather simplistic to evaluate a diet solely in terms of a single food component…” {Jacobs DR, Tapsell LC. Food, not nutrients, is the fundamental unit in nutrition. Nutrition Reviews Vol. 165, No. 10, p.439}   A diet that provides a complex mixture of bioactive chemical compounds in the form of intact foods is more effective for health maintenance than when nutrients are taken by themselves   An optimal diet will contain a wide variety of minimally processed whole foods and whole-food based supplementation     Ingredient Source/Quality Organic when possible, affordable, available Evidence of higher trace mineral content and variations in phytochemical concentrations No pesticide/herbicide residues – may be especially important in ill or dysfunctional animals Grass-fed meat and dairy product sources Significant differences in essential fatty acid content Increased omega 3 fatty acids Effects on inflammation and immune function Conjugated Linoleic Acid (CLA) Effects on immune function – decreased cancer Effects on weight loss Decreased shedding and risk of enterotoxigenic E. coli   Commercial Diets AAFCO feeding trials…not alone sufficient but a necessary step Variety of ingredients? Processing? Raw vs. cooked? Post-heating application of EFA’s? Freeze-dried ‘bio-coating’? Rotation? Company philosophy? Manufacturing facility? (Salmonella from one plant producing several brands)   Approaches to formulation of a balanced diet at home Overall diet General % of various ingredients tailored to the individual animal Complete Guide to Natural Nutrition for Dogs and Cats by Kymythy Schulze Cautions: Over-generalized restrictions, synthetic vitamins   Each meal Recipes Dr. Pitcairn’s Complete Guide to Natural Health for Dogs and Cats by Dr. Richard Pitcairn Cautions: synthetic vitamins, reliance on grains Home-Prepared Dog and Cat Diets: The Healthful Alternative by Donald R. Strombeck, DVM, PhD Excellent resource Caution: reliance on multiple (synthetic) vitamin-mineral tablets for balancing meals   What do I feed my dogs and cat? NV raw boost kibble and Steve’s Real Food + SP Whole Body Support + regular supplements of fresh meats, fruits, vegetables    

Episode 5: Recognizing Nutritional Deficiency: 2 clinical examples Presenting two examples of nutritional deficiency Not classical nutritional/vitamin/mineral deficiency syndrome Lack of classic signs = “subclinical” deficiency Veterinarians need to increase their level of suspicion that illness may be related to nutritional problems Aspen Presented 4/02: 13 year old spayed female Labrador retriever-shepherd mix The owner – my brother – noticed weakness and exercise intolerance Rapid progression over two-three weeks Syncope/collapse episodes with mild exertion Became unable to walk more than a few steps without resting Diet Science Diet® Chemistry Profile, complete blood count and Thyroid hormone level all  normal Chest x-rays were normal 5/9/02 Evaluation of ECG via Telemedicine consultation with cardiologist HR 50 BPM Diagnosed as complete heart block Possible degeneration, fibrosis, or inflammation of AV node Recommendation: Echocardiogram and possible pacemaker implant Telephone consultation (Oregon – Ohio) Recommended treatment Nutritional support for cardiac function, electrical conductance, muscle function, general nutrition Cataplex® B (Standard Process) L-carnitine (Pure Encapsulations) Vasculin® (Standard Process) Cardio-Plus® (Standard Process) Catalyn® (Standard Process) Calcifood® wafers (Standard Process) Improvement noticed within several days after starting supplementation Continued progress over initial 4 weeks of supplement use Returned to normal activity level within 4 weeks 8/6/02 Echocardiogram Anatomically normal heart Normal contractility Severe bradycardia (32 beats per minute)  with continued complete heart block 2/25/03 progress exam Clinically normal 14 yr old dog Repeat ECG:  unchanged from 5/02 Aspen running up and down long hill in yard with children Continued supplements as initially prescribed Continued Science Diet 9/20/05 progress exam Nearly 17 yrs old Stiff and slow moving, nearly blind, hearing loss, developing urinary incontinence Continued bradycardia due to electrical abnormality No syncope Had more stamina than 4/02 prior to supplementation 12/05 euthanized due to deteriorating physical condition, incontinence, arthritis, etc. – no syncope, no heart failure Gypsy Presented 8-8-05  – 4 year old spayed female golden retriever mix Consultation concerning autoimmune disease, open wound on rear end, and generally declining condition Owner concerned that Gypsy was dying and wanted to incorporate complementary approaches History: Developed severe bone or joint pain at 9 months old Lame, crying when touched Developed immune myositis – diagnosed via muscle biopsy November 2002 Presented as acute-onset muscle pain and inability to open mouth Muscle atrophy developed subsequently Prednisone therapy initiated ( and continued daily since) 4-18-03 Giardia with severe diarrhea and vomiting Several teeth extracted due to loosening/periodontitis Seasonal exacerbations of muscle inflammation and dysfunction x 3 yrs. Approximately October/November 2002, 2003, 2004 Allergic component? Faithfully vaccinated (yearly) Last vaccine 3-8-05 Flatulence; owner feels that abdomen is hot and distended; other dog eats Gypsy’s stool Medications: Prednisone 10 mg once daily (continuous use since Nov 2002), Thyroxine 0.7 mg twice daily Blood Chemistries and CBC AlkP    AST    ALT   GGT   P    Gluc    Amyl    WBC    Neutr 8/8/05           1430      72     461      80    4.1   144                  16.9     83% 5/17/05        2738      75     596     430   6.2    44      224       20.6     83% 4/23/05        2842      75     612     410   5.5    18      248       20.7     86% 2-26-05                 4280      92     719     752   5.9    59     213       26.3     99% 1-24-05         2708      78     707     452   6.4    62     229       22.1     89% Diet: Iams large breed (“Complete and balanced”) Frozen Bil-Jac Greenies (daily) Physical Exam: Weak, lethargic Thin, dry (straw) hair coat Severe atrophy of masticatory muscles Rear feet flat – stretching of flexor tendons/connective tissue Mild pendulous abdomen (Cushingoid appearance) Generalized poor muscle mass/tone Supraspinatous/infraspinatous atrophy Ulceration left upper lip over PM2 Heavy tartar with periodontitis right upper first molar Left upper first molar previously extracted 2 broken incisors with retained roots Excessive subcutaneous scar tissue formation over pressure points –  especially severe over tuber ischii Non-healing open wound over left tuber ischium present >2 months Arthritis elbows – Exostoses Irregular surface of left dorsal iliac crest (pelvis)- (no previous sx or trauma in hx) Assessment: Chronic immune mediated muscle disease Bizarre scar tissue formation Gastrointestinal dysfunction Weak, debilitated condition Plan: #1. Nutritional support/supplementation #2. Diet change (eliminate possible dietary antigens) #3. Adjustment #4. Dental – cleaning/extractions (relieve pain and reduce inflammation) Initial supplementation SP Canine Musculoskeletal Support™ Nutritional support for muscle/joint/connective tissue SP Canine Enteric Support™ Nutritional support for gastrointestinal function SP Canine Hepatic Support™ Nutritional support for liver function Chronic inflammatory/immune mediated responses Elevated liver enzymes Recommended initial reduced dosage with gradual increase to label dose over two weeks Telephone follow-up: 8-10-05 (2d.) Owner reported that Gypsy is noticeably improved; more energy Progress exam: 8-17-05 (7d.) Gypsy was “bouncing around the house” Playing with other dogs and with toys Abdomen not hot or as distended Other dog stopped eating Gypsy’s stool Flatulence considerably decreased and less odorous Ulcer in mouth nearly healed Began raw food diet (no diet change at that point) 8-29-05 Chiropractic Adjustment Owner felt that Gypsy had been painful around the ribs/shoulder area – occasionally yelping when petted/held Stamina improved Continued decrease in flatulence Progress exam: 9-21-05 (6 wks) No pain, no yelping Great activity level/NRG Excellent appetite Hole over left tuber ischium was beginning to decrease in size Plan was to begin reduction in prednisone then discontinue –  if no adverse response to lower dose Progress exam: 10/24/05 (10 weeks) Bright, alert, and responsive Increased muscle mass evident in face and head Normal yawn without restriction in opening Active, energetic Visibly improved coat – thickness, decreased dryness No typical autumn conjunctivitis On prednisone 2.5 mg every other day Little flatulence Normal stool Hole in skin at left tuber ischium healed completely Mild pruritus and scattered superficial staph pustules abdomen Marked decrease in gingivitis 11# weight loss Treatment recommendations and diagnostics Chiropractic adjustment Complete blood count and chemistry profile Continue supplements and raw food diet Continue prednisone reduction Clean teeth approximately Jan. 1 if no relapses after discontinuing prednisone Blood Chemistries and CBC AlkP    AST    ALT   GGT   P    Gluc    Amyl    WBC    Neutr 10/24/05     177       38       99       5     6.2   104      —          9.84     82% 8/8/05           1430      72     461      80    4.1   144                  16.9     83% 5/17/05         2738      75     596     430   6.2    44      224       20.6     83% 4/23/05         2842      75     612     410   5.5    18      248       20.7     86% 2-26-05         4280      92     719     752   5.9    59     213       26.3     99% 1-24-05         2708      78     707     452   6.4    62     229       22.1     89% Progress exam 1/25/06 (5 months) Lean body condition, active, energetic, vocal Prednisone  2.5 mg every 3 days for the previous 4 weeks Off Canine Hepatic Support™ x 3 weeks Little flatulence Normal stool No pruritus W = 62.4#  (initially 79.2#) Thick plaques of calcified SQ fibrous tissue persist Atrophy of muscles of mastication unchanged Generalized increased muscle mass Excellent hair coat – thick, dark red, shiny Plan Chiropractic adjustment Repeat blood work Complete blood count and chemistry profile Thyroid profile Continue Canine Enteric Support ™ and Canine Whole Body Support ™ Blood Chemistries and CBC AlkP    AST    ALT   GGT   P    Gluc    Amyl    WBC    Neutr 1/25/06        40      40      54       1     5.4   119      – –        10.4      82%                   10/24/05      177       38                 99       5     6.2   104      —          9.84     82% 8/8/05           1430      72     461      80    4.1   144                  16.9     83% 5/17/05        2738      75     596     430   6.2    44      224       20.6     83% 4/23/05        2842      75     612     410   5.5    18      248       20.7     86% 2-26-05         4280      92     719     752   5.9    59     213       26.3     99% 1-24-05         2708      78     707     452   6.4    62     229       22.1     89% Continued regular spinal manipulative therapy for on-going wellness care Gradual reductions in supplementation Continued  Canine Whole Body Support ™ (Standard Process) and fresh food diet Gradually tapered dose and discontinued Canine Enteric Support ™ (Standard Process) 11-06 through1-07 with no adverse effects Euthanized in 2012 due to advancing age-related illnesses Key points to emphasize about Aspen and Gypsy: In both cases, these dogs were eating “complete and balanced” major name-brand foods They did not present with signs typical of classic nutritional deficiency Nutritional supplementation yielded immediate improvement Broad-spectrum support essential Exact factors unknown Likely to have been several factors simultaneously  

Episode 4: Nutrition – Does heat-processing adversely affect nutrition? Continuing to examine the big concepts in pet nutrition Effects of heat-processing in commercial foods- Manufacturing affects  nutrient quality and bioavailability Extruded 320ºF Canned 500ºF Heating effects: Alterations in protein structure Maillard reactions Bonding of sugar (glucose, fructose, lactose, maltose) with free amino group (such as lysine) Digestive enzymes do not cleave the peptide bond adjacent to the amino acid with attached sugar molecule May increase microbial degradation of taurine in colon Affected proteins are of no nutritional value Allergenic? Other “unusual crosslinking” of amino acids and peptides which result in compounds “not found in nature” “These compounds are not well-used by animals” “Processing EFA in pet foods may affect their biological activity” {Small Animal Clinical Nutrition 4th Ed pp.55, 61} Heating effects: Alteration of fatty acids Trans configuration Metabolized for energy and incorporated into lipid storage Cannot function as EFA’s because they are not further metabolized to eicasanoids C18:1 trans isomers inhibit hepatic carnitine and lead to increased liver triacyglycerol by lowering hepatic oxidation of fatty acids {Giudetti AM, Beynen AC, et. al. Hepatic fatty acid metabolism in rats fed diets with different contents of C18:0, C18:1 cis, and C18:1 trans isomers. Br J Nutr. 2003 Nov;90(5):887-93} More pieces to the puzzle of heat processing effects: Carprofen half-life in cats Recent study showed variation 17 hours to 44 hours Difference in liver enzyme activities attributed to diet Fresh, whole foods enhanced liver detoxification Commercial diets detrimental effect Propranolol half-life in cats Study done ~20 years ago showed variation from 1-2 hours to >12 hours Diet effects as seen with carprofen Major pet food manufacturer had no interest in investigating why the variation in metabolism {Dr. William Muir, lecture delivered at Veterinary Chiropractic Convention April 2003, and personal conversation.} Study of food allergy in dogs After successful elimination diet, introduced commercial canned or kibble ‘equivalent’ diet 25% recurrence of clinical signs (pruritus) “With every treatment diet tried, some percentage of dogs redeveloped pruritus.” Explanations/Speculations 3-D protein structure altered with heating? Decreased digestibility? Loss of important co-factors? {Rosser, EJ. Diagnosis of food allergy in dogs. JAVMA, Vol. 203, No. 2, July 15,1993 pp.259-262 Pottenger’s Cats Nutritional study completed 1932-1942 Multigenerational study Nine hundred cats Four basic feeding groups Optimum diet groups 2/3 raw meat, 1/3 raw milk, Cod Liver Oil 2/3 raw milk, 1/3 raw meat, Cod Liver Oil Deficient diet groups 2/3 cooked meat 2/3 cooked milk (pasteurized, sweetened condensed, evaporated, metabolized vitamin D) Effects observed with deficient diet Dental disease Reproductive abnormalities Allergies Immune disorders Skeletal disease and osteoarthritis Cardiac abnormalities Renal disease Respiratory abnormalities Gastrointestinal abnormalities Hepatic abnormalities Behavioral abnormalities Endocrine abnormalities Ocular abnormalities {http://www.amazon.com/Pottengers-Cats-A-Study-Nutrition/dp/0916764060 } {http://ppnf.org/ } Multigenerational effects – demonstrated “epigenetics” prior to understanding of gene structure or tools to examine Studies in epigenetics reveals that food affects more than just calories and deficiencies…it alters the essence of genetic expression…in the individual…and for subsequent generations Understanding nutrition is critical to longevity and health { NOVA | scienceNOW | Epigenetics | PBS } { NOVA | scienceNOW | Epigenetics: A Tale of Two Mice (Flash) | PBS } { http://www.amazon.com/Pottengers-Prophecy-Resets-Wellness-Illness/dp/1935052330 } Developing a better paradigm for nutrition – beyond the “essential” nutrients There are chemical compounds in plants (‘phytochemicals’), and a number of beneficial components in animal products, that have powerful and beneficial physiologic effects, including reducing cancer risk Ingredients vs. nutrients A diet that provides these nutrients in the form of intact foods is more effective for disease prevention than when nutrients are taken by themselves An optimal diet will contain a wide variety of minimally processed whole foods and whole-food based supplementation “Nearly every expert in the field agrees that a diet high in fresh fruits and vegetables conveys many health benefits, including those pertaining to cancer prevention and cardiovascular disease. As is evident from the carotenoid story, a particular nutrient in that type of diet when taken alone does not necessarily provide that same benefit. The reasons for this are not clear.” { Russell RM, Mason JB. Carotenoids – A Lesson in Physiologic Versus Pharmacologic Doses of Nutrients. Cyberounds  Nov. 1996. http://www.cyberounds.com/conferences/nutrition/conferences/1196/conference.html } “…Among the possible explanations are that other compounds contained in fresh fruits and vegetables, such as the so-called “phytochemicals”, are the beneficial components. Also, taking a large bolus of a particular nutrient may not provide the same benefits that taking smaller doses over an extended period of time might.” { Russell RM, Mason JB. Carotenoids – A Lesson in Physiologic Versus Pharmacologic Doses of Nutrients. Cyberounds  Nov. 1996. http://www.cyberounds.com/conferences/nutrition/conferences/1196/conference.html } Food is a complex mixture of bioactive chemical compounds “Food is an extremely complex matrix consisting of thousands of natural components, many of which have not been characterized.” {Rasooly L, Rose NR. Food toxicology and immunity. Nutrition and Immunology: Principles and Practice Gershwin, German, Keen Eds. 2000}  

Episode 3: A Better Understanding of a “Complete” Diet – Part 2 In Episode #2, we talked about the “complete and balanced diet” myth. Now in Episode 3 we will look more at the issue of whether veterinarians and nutritional scientists really understand nutrition thoroughly enough to make a claim of “complete” Are there examples of our continually improving understanding of nutrition that proves that the claim of “complete” at any point in time is always subject to revision  – to be ‘more’ “complete”? Are there complexities in food which make the Nutritional Essentiality paradigm dangerous to our pets? Are there concrete examples of these “complete” diets causing problems in pets that were eating them?  “It is nothing short of a tragedy for a patient to be permitted to suffer from simple starvation while being given the so-called benefit of modern science in a modern hospital, and still gradually fade away by reason of some unrecognized form of malnutrition.” {Lee R. October 23-24,1943. Malnutrition As A Primary Cause Of Disease, Lectures of Dr. Royal Lee p.32.} Look at the relatively recent example of Taurine Currently considered “non-essential” in dogs Able to synthesize taurine from sulfur amino acids cysteine and methionine Recent published reports of dilated cardiomyopathy in dogs eating “complete and balanced” diets associated with low blood taurine levels Improved cardiac function with taurine supplementation Prolonged survival time and withdrawal of medications other than taurine supplementation DCM is typically progressive and fatal {Backus, et. al. JAVMA Vol. 223, No 8, October 15,2003: Fascetti, et. al. JAVMA Vol. 223, No 8, October 15,2003} Reported cases of DCM in dogs Diets “met recommended nutrient profiles or passed minimum feeding protocol tests recommended by the Association of American Feed Control Officials.” Bioavailability of methionine and cysteine appeared to be adequate for the synthesis of taurine Diet change improved taurine status “…Other dietary factors precluded adequate synthesis of taurine” 2 dogs fed home-prepared low protein tofu-based diet that met National Research Council requirements for adult maintenance {Backus, et. al. JAVMA Vol. 223, No 8, October 15,2003: Fascetti, et. al. JAVMA Vol. 223, No 8, October 15,2003} Mechanism of heart failure in taurine deficiency is poorly understood Heritable susceptibility – genetic component Individual biochemical variations in taurine absorption, metabolism, excretion Lacking a necessary contributing factor? “The variation in clinical manifestation of taurine deficiency is suggested to be a result of the variable presence of contributing factors.” {Backus, et. al. JAVMA Vol. 223, No 8, October 15,2003} Taurine in cats Thought to be unimportant other than for bile conjugation until the 1960’s Research showed that retinal degeneration in cats improved with addition of meat to casein-based diet No change with added Vitamin A In 1987, a connection between taurine deficiency and feline dilated cardiomyopathy was discovered As in dogs, DCM was considered to be progressive, irreversible, fatal condition After more research, it was found that cats require dietary taurine What other the other signs that might be visible with taurine deficiency? Non-specific as with some nutrients (i.e. Scurvy with C) Poor reproductive performance – abortions, stillbirths, low birth weights Poor growth rates Skeletal deformities Neurological abnormalities – degenerative changes in retina, cerebellum, and visual cortex Compromised immune function Hearing loss (We will mention this same list again when we talk about Pottnger’s Cats and the benefits of raw food in Episode 4!) BUT…Not all taurine depleted cats develop DCM “It is, therefore, apparent that taurine deficiency alone is not sufficient to cause myocardial failure or central retinal degeneration in all cats. Still unknown is why taurine-depleted cats may manifest myocardial failure and/or feline central retinal degeneration, or neither.” {Pion PD, Kittleson MD, et. al. July 15, 1992. Response of cats with dilated cardiomyopathy to taurine supplementation. JAVMA vol. 201, No. 2 pp. 275-284} Why is that? “most likely in our opinion, these conditions may be caused by taurine deficiency and other, currently unidentified, cofactor or cofactors.” {Pion PD, Kittleson MD, et. al. July 15, 1992. Response of cats with dilated cardiomyopathy to taurine supplementation JAVMA  vol.201, No. 2 pp.275-284} Acknowledgement of our limitations in understanding the complexities of nutrition Food companies attempted to correct the previously unknown deficiency But, DCM still occurred in cats fed canned food even though taurine content had been increased significantly in both canned and dry foods Proposed mechanism for taurine deficiency Increased soluble fiber Bacterial overgrowth Increased deconjugation of bile acids Loss of greater amounts of taurine in the stool However…“We have found that these same canned diets when fed in an uncooked form, do not cause clinically significant taurine deficiency.” { Pion PD. 1992. JAVMA 201(2):275-284} “When you look at the classic example of taurine, many [diets] were deficient. The cats that didn’t become ill were those that were going outside and catching mice.” {Smith CA. November 15, 1993. Dr. Donna Dimski quoted in Changes and Challenges in Feline Nutrition, J Am Vet Med Assoc.  Vol. 203, No. 10 pp.1395-1400} Taurine Just one example of our continually improving understanding of nutrition that proves that the claim of “complete” at any point in time is always subject to revision Provides insight into the complexities in food which make the Nutritional Essentiality paradigm dangerous to our pets – food is much more than protein, fat, carbohydrates, vitamins, and minerals Is a concrete example of the way that “complete” diets can cause health problems in pets Provides insight into the effect of heating on nutrient bioavailability. In episode 4, we will talk more about heating effects on nutrient availability and raw food feeding