Dr. Amy Farcas with Cheeka

Cheeka’s story: a special diet to manage diarrhea, heart disease, and early-stage chronic kidney disease

This is the story of one of Veterinary Nutrition Care’s patients. It is presented to illustrate the benefits of including nutrition in a pet’s care plan. Many complex aspects of medicine and nutrition have been over-simplified; it is not intended to be taken as advice on nutritional management of any other pet. If you have questions about applying these strategies to your own pet, please contact your veterinarian.

Imagine the nicest little old lady Chihuahua-terrier mix dog you could ever want to meet, and keep in mind that with the Chihuahua (and the terrier) comes a bit of spunk.

You just met Cheeka.

Like many older small-breed dogs, Cheeka has degenerative valvular disease. This means that her heart valves no longer create an effective seal; they allow blood to leak backwards when the heart’s beat should be pushing blood forward. This leak is no small matter. Because of it, she has an impressive heart murmur and fluid that accumulates in her abdominal cavity; this has to be removed periodically to keep her comfortable.

Cheeka’s dedicated owner and stellar veterinary team have done an amazing job in managing her care. She’s happy and comfortable, eats well, takes her medication without too much fuss, and loves her owner. Cheeka’s labwork is repeated routinely to make sure everything stays on track.

When Cheeka started having diarrhea, which was quite distressing to both her and her owner, the team went into action. She’d been started on a probiotic supplement and medication for the diarrhea. There was intermittent improvement, but nothing seemed to make a true difference. At this point, Cheeka’s veterinarian recommended a visit with Veterinary Nutrition Care.

Cheeka’s owner made arrangements for the visit and provided Cheeka’s diet and medical history details beforehand. When Cheeka and her owner met with Veterinary Nutrition Care, Dr. Farcas reviewed Cheeka’s history to make sure that nothing was missing and asked a few more specific questions. She asked Cheeka’s owner if there were any other concerns that they’d need to discuss, then explained the likely cause of Cheeka’s diarrhea: without the heart working as well as it should, circulation to Cheeka’s intestines is not as effective as it should be. This means that the intestines aren’t able to do their job of absorbing nutrients from Cheeka’s food, and if the intestines aren’t absorbing them, those nutrients get utilized by the bacteria in the intestinal tract. While those bacteria are normal, when they get “fed” different amounts or types of nutrients than usual, a change in the numbers and types of bacteria present can occur. The numbers and types of bacteria present in the intestinal tract are important because they affect stool quality, as well as other aspects of health. This is an interesting area of research, and we are always learning more about these effects. In Cheeka’s case, these bacterial changes were causing diarrhea, so this became a focus of her nutritional therapy.

There are several potential nutritional approaches to managing diarrhea in dogs. Feeding specific ingredients, or changing the amount and/or type of dietary fiber intake, and probiotic therapy are common and potentially-sensible approaches. In Cheeka’s case, her usual diet was a home-prepared diet made using a barley-based premix for dogs. Given that her current barley-based diet was likely moderate in dietary fiber, Dr. Farcas elected to start with a low-fiber approach for Cheeka. Unfortunately, because total dietary fiber isn’t required in pet food labeling, it wasn’t possible to know the dietary fiber content of her current diet, so the plan would be to start with a very low-fiber diet and add known amounts of specific fiber sources while assessing her response to this new, well-defined diet.

Another focus for Cheeka’s nutritional therapy is supporting her heart function. Cheeka’s cardiologist and Dr. Farcas agreed that Cheeka should be on a low-sodium diet to reduce the heart’s workload. Because Cheeka’s barley-based diet was intended for healthy dogs, it likely included more salt than was recommended for her. Cheeka also has an arrhythmia, so the inclusion of a concentrated source of long-chain omega-3 polyunsaturated fatty acids was important in her diet plan. One of Cheeka’s heart medications has the side effect of causing loss of potassium in the urine, and her labwork reflected low potassium levels, so her diet would also have to provide extra potassium. Finally, since some pets with heart disease (including Cheeka) experience a loss of muscle mass over time, and because some of her body’s protein is lost each time fluid is removed from her abdomen, making sure that Cheeka’s diet provided enough protein was essential.

Further, Cheeka’s routine labwork has indicated that she may be experiencing a decline in kidney function. Heart disease and later stages of chronic kidney disease are difficult to treat together, since their management strategies when it comes to fluid balance and protein intake are essentially opposite, so protecting her remaining kidney function is critical. There are a few nutritional strategies that can help delay progression of chronic kidney disease. One of these, inclusion of long-chain omega-3 polyunsaturated fatty acids, had already been incorporated into Cheeka’s diet plan. The other, phosphorus restriction, would also be included. While a low-protein diet is often used to manage patients with later stages of chronic kidney disease, this was not indicated at this point for Cheeka.

So, to accommodate Cheeka’s diarrhea, heart disease, and early stage of chronic kidney disease, her diet would have to be low in dietary fiber, low in sodium, potassium-supplemented, high in long-chain omega-3 polyunsaturated fatty acids, moderate in protein, and low in phosphorus. In addition to this, the rest of Cheeka’s body still needs to be supported, so her diet must also be complete and balanced to meet the rest of her nutrient needs and fed in an amount that provides her with enough calories to maintain her weight. Because even the most perfectly-designed diet is a failure if it isn’t eaten, the diet would also have to be palatable to Cheeka. Cheeka’s owner prefers to continue home-cooking for her, which was good, since it was unlikely that a commercial diet could meet all of these needs.

While this may seem a daunting task, it was possible to design just such a diet for Cheeka. Cheeka was transitioned first to the diet’s main ingredients alone, and then a specific concentrated fish oil supplement was introduced, followed by incorporation of a specific vitamin/mineral supplement. The plan would be to monitor Cheeka’s stool quality and weight for a week, and make changes as needed to either the diet or the amount fed based on these findings. Cheeka continued eating well, but still had diarrhea. While just having Cheeka’s diarrhea improve right away would have been ideal, this trial was still helpful. Now that Dr. Farcas knew Cheeka’s response to a very low-fiber diet, she could begin to test her response to the addition of known amounts and types of fiber.

Dietary fiber is interesting, and can even seem a bit magical, as it can be used to treat both diarrhea and constipation. It’s not really magic, but chemistry and physiology. Different types of fiber draw water into the stool in either a structured (insoluble fiber) or an unstructured (soluble fiber) way. Dietary fiber also influences numbers and types of intestinal bacteria, which affects stool quality.

For Cheeka, Dr. Farcas recommended a low dose of a specific mixed (soluble and insoluble) fiber source. When she checked in a few days later, Cheeka was still doing fairly well overall. Her owner reported some improvement, but Cheeka was still having either soft stools or diarrhea. Since this fiber supplement appeared to be having a beneficial effect, Dr. Farcas recommended doubling the dose and monitoring for a few more days. If Cheeka was still having diarrhea, the plan would be to change to a supplement providing a different type of dietary fiber. Happily, the next update was a good one. Cheeka’s owner reported that Cheeka had been having normal stools. Cheeka’s team celebrated.

Until more research is done on the effects of specific types of dietary fiber in dogs and cats, using it to manage either diarrhea or constipation can be a trial-and-error process, but taking a methodical approach reduces the amount of error involved.

While Cheeka’s customized therapeutic diet plan isn’t going to address the root cause of her diarrhea (inadequate circulation to her intestines), it has effectively managed it. In addition, it’s giving Cheeka all of the support that her heart, her kidneys, and the rest of her needs to keep being her sweet, spunky, self.

 

Published by

Amy

Dr. Amy Farcas is the owner of Veterinary Nutrition Care, as well as your veterinary nutritionist. She is a veterinarian, board-certified specialist in small animal nutrition, and holds a master's degree in nutritional biology. Dr. Farcas is passionate about families, teaching, and food.

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