Winnie’s customized “senior diet”

Labrador Retrievers seem to stay puppies longer than other large-breed dogs; there seems to be a component of refusal to grow up. While the (long) puppy stage is fun, it’s also exhausting; and adulthood is nice (if you’ve done things remotely right, you have an amazing companion by now); but for me, there’s no better friend than a senior Labrador Retriever. I’m just a sucker for the gray muzzle.

Many owners of senior pets feed commercial pet food marketed as “senior diets.” However, most probably don’t know that there isn’t an official nutritional definition for senior diets like there is for puppy/kitten and adult diets. Commercially-available senior diets are variations on adult maintenance diets; but the variations vary by manufacturer. There is no other unifying feature. While this isn’t necessarily problematic for most healthy senior pets, I believe that more so than almost any other group of pets, seniors need a tailored approach. There is so much potential for them to benefit from a diet that considers and addresses their unique combination of needs.

Now I’ll introduce Winnie; a 13 year-old Labrador Retriever. Her owner, also a veterinarian, had contacted me about making sure she was giving Winnie all the support that she could, and I was happy to help.

In many ways, Winnie is typical of older dogs of her breed. She had trouble getting up and around and tended to be a bit itchy; she always had. Many pet owners would say that “she’s just getting old” and shrug their shoulders. Winnie’s owner took a different approach and I’m glad.

While age is not a disease in and of itself, age is a predisposition to a number of diseases; arthritis is a good example. With that in mind, Winnie’s owner set out to make sure that she knew exactly what was (and was not) going on with Winnie.

It was already known that Winnie had significant arthritis affecting her knees and elbows, as well as her other joints to a lesser extent. She’d been receiving acupuncture treatments and hydrotherapy (exercise done in water to reduce impact on sore joints) to keep her joints comfortable and her muscles strong. She received several types of pain medication, including a non-steroidal anti-inflammatory drug, for her arthritis as needed.

Through a somewhat tedious process of trials with flea preventative medication and an elimination diet, Winnie’s owner had already determined that Winnie’s itchiness was due to environmental allergies. This is similar to a person who has watery eyes and sneezing in response to certain types of pollen or other allergens, but dogs tend to manifest this as itching and licking at their feet.

While Winnie appeared to be completely healthy otherwise, to find out if there was anything else that she needed to know about, Winnie’s owner/veterinarian submitted Winnie’s blood and urine samples for analysis. This screening labwork showed that Winnie’s kidney function was beginning to decline. This was good to know, since non-steroidal anti-inflammatory drugs used to treat arthritis pain can be harmful to a pet with inadequate kidney function. The labwork indicated that Winnie had no other problems.

Winnie seemed to be doing “okay” on her current commercial maintenance diet, but it didn’t specifically address any of her medical concerns. In addition, since it was formulated for healthy adult dogs, it would not be appropriate for Winnie’s chronic kidney disease.

Winnie’s owner knew that many diets for chronic kidney disease in dogs are low in protein (which is helpful in later stages), and that Winnie was already experiencing some loss of muscle mass due to her arthritis, so this didn’t seem like the right choice for Winnie. In addition, she wanted to provide Winnie with a home-prepared diet where she could control the ingredients and make adjustments as Winnie’s needs changed.

In order to create a special diet that provided Winnie with everything she needed, Winnie’s owner/veterinarian contacted Veterinary Nutrition Care. Dr. Farcas reviewed Winnie’s medical and diet history, and spoke at length with Winnie’s owner to make sure she understood what was important for Winnie and her owner. She explained what features of a diet could be used to help Winnie’s arthritis, environmental allergies, and manage her chronic kidney disease.

While nothing can be done to reverse the bony changes that occur within an arthritic joint, treatments (including diet) can be aimed at reducing the inflammation associated with those changes. To achieve this, Winnie’s diet would provide a fairly high dose of anti-inflammatory long-chain omega-3 polyunsaturated fatty acids (from fish oil). Winnie was already at a healthy weight, but had this not been the case, a weight loss plan would have also been needed, since carrying even a few extra pounds can make arthritis pain significantly worse.

A similar approach is taken to address environmental allergies with diet; as this is also an inflammatory process, anti-inflammatory long-chain omega-3 polyunsaturated fatty acids (from fish oil) can help. In addition, making sure that Winnie’s diet provided enough linoleic acid, an essential omega-6 fatty acid was important, since this contributes to the skin’s ability to act as a good barrier to water loss and environmental allergens. Other minerals such as zinc and copper are needed to maintain skin health, so making sure that Winnie’s diet was balanced would also benefit her skin condition.

Lastly, Winnie’s new diet would be designed to accommodate her early stage of chronic kidney disease. At this stage, patients don’t show any symptoms, so treatment is aimed at delaying progression of the disease. One important aspect of this is limiting phosphorus intake. It’s the kidneys’ job to excrete excess phosphorus, but if the kidneys aren’t functioning properly, excess phosphorus is retained and drives a process called renal secondary hyperparathyroidism, which results in worsening of kidney function. So, to keep that from happening, dietary phosphorus must be limited.

Another aspect of protecting Winnie’s remaining kidney function was already to be included in her diet; besides the anti-inflammatory effects of the long-chain polyunsaturated fatty acids from fish oil, these fatty acids can also help to manage blood pressure within the part of the kidney that acts as a filter for the blood, thus protecting it from further damage.

People often discuss protein restriction for pets with chronic kidney disease. This is important at a later stage of the disease when, in addition to worrying about delaying progression, we also want to manage symptoms of chronic kidney disease. The symptoms of poor appetite, vomiting/nausea, oral/stomach/intestinal ulceration, dry mouth, and others that are associated with chronic kidney disease are attributable to a group of compounds, collectively called uremic toxins that accumulate when the kidneys lose the ability to excrete normal by-products of protein breakdown. At this point, less protein = less by-products = less uremic toxins = pet feels better. That said, every pet has an absolute requirement for certain amounts of protein every day, and inadequate protein intake is detrimental as well. Finding a balance can be tricky, but is absolutely worth doing.

There’s no evidence to suggest that a low-sodium diet (to avoid high blood pressure) is needed for pets with chronic kidney disease, since sodium intake doesn’t appear to drive hypertension in healthy pets. However, as long as Winnie’s sodium requirement was met, there would be no harm in also making her diet low in sodium.

While I’m never happy when a patient has multiple diseases to manage, it makes life easier for everybody when the nutritional management strategies for the different diseases don’t conflict with each other. Read about Cheeka for an example of a patient with conditions requiring opposite nutritional strategies.

Winnie’s new home-prepared diet would provide her with a high dose of fish oil, be restricted in phosphorus, moderate in protein, and low in sodium. Rather than using a separate fish oil supplement, Winnie’s owner was happy to use salmon as the protein source to supply long-chain omega-3 polyunsaturated fatty acids. Salmon provides calories as both protein and fat. A small amount of a plant-based oil provided linoleic acid and some calories as fat, and the remainder of Winnie’s calories came from white rice, which is low in phosphorus. Using these 3 ingredients alone, or even with added fruits and vegetables would mean that Winnie’s diet would be deficient in several important vitamins and minerals (including calcium). For this reason, a vitamin and mineral supplement was also included to make sure that the diet was balanced to meet all of Winnie’s needs.

Once the specific amounts of each ingredient needed to provide Winnie with the right amounts of calories and nutrients were determined, a detailed recipe and preparation instructions were delivered to Winnie’s owner/veterinarian. Along with this came recommendations to monitor Winnie’s weight, response to the new diet, and to continue to monitor Winnie’s kidney function parameters.

Winnie’s owner gradually transitioned her to the new home-prepared diet. Being a good Labrador Retriever, Winnie loved the new diet. She initially lost a bit of weight, and a slight increase in the amount fed per day was all that was needed to correct that. This is not uncommon when changing to a new diet if the exact amount of food (and treats) that the pet ate previously isn’t known.

When Dr. Farcas checked in on Winnie a few months later, she was thrilled to hear that Winnie’s owner had been able to transition her completely off of her non-steroidal anti-inflammatory drug, and that Winnie was happy and more active. Her itching, while not completely resolved, was improved, and her coat was full and soft. Repeat labwork showed no progression of Winnie’s kidney disease. Happy to hear that Winnie had done so well with her new diet, but wanting to determine if the response was due solely to the diet, Dr. Farcas asked more questions; Winnie’s owner/veterinarian answered them all and assured her that nothing else had changed. She attributed the changes she was seeing in Winnie to her customized home-prepared diet and was very happy with the results.

For Winnie, her owner’s proactive approach means that she gets all the support she needs so that while she’s not acting like a puppy again, she’s happy and comfortable. Since her medical status is known and appropriately managed, her owner knows that she’s providing the best care possible to Winnie. The fact that Winnie’s owner is a veterinarian doesn’t affect very much about the story; a pet owner with any other background dedicated to proactive care could accomplish the same for their own pet with the help of an involved veterinarian and a resource like Veterinary Nutrition Care.

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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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