Insect Repellent, Antiviral Drug Detected in Jerky Pet Treats for Dogs

Chicken jerky treats consumed by dogs that became sick over the past few month have now been found to be tainted by the insect repellent N,N-diethyl-meta-toluamide, better known as DEET, as well as the antiviral drug amantadine.

This is according to a veterinary pathologist leading an independent probe of the ongoing pet treat mystery.  For more information, click this link to read the article by the Veterinary Information Network News Service.

What's the Expected Time for Signs of Feline Hyperthyroidism to Resolve after Treatment?

My 16-year old cat was recently treated with radioiodine (I-131) for his severe hyperthyroidism. How long after radioiodine treatment will the thyroid values normalize and the symptoms of the hyperactive thyroid begin to resolve so he feels better? 

My cat lost about half of his body weight, much of it in muscle mass. Will his wasted muscles ever return to normal? If so, when can I expect to see improvement?

My Response: 

You have asked two good questions, which, on the surface seem simple enough to answer. The answers to "how long for clinical signs to resolve" however, depend on a number of factors. I'll do my best to explain why it's not possible for me to give you the definitive answers you want.

How long does it take for serum thyroid hormone levels to normalize after I-131?
Depending on the dosing protocol used, about 90% of cats will have serum thyroid hormone concentrations (e.g., T4 and T3) within reference range limits by 30 days after I-131 treatment. Most of the remaining cats will show a nice drop in T4 and T3 levels when rechecked in a month, but it will take longer to for their thyroid hormone concentrations to completely normalize.

In general, the full extent of the radioiodine treatment will be evident by 3 months after treatment, although a few cats continue to show even more (minor) improvement when rechecked at 4 to 6 months.

As the thyroid values normalize, the clinical signs we see also gradually resolve. Some signs, such as nervousness or rapid heart rate, generally resolve fairly quickly, whereas other signs, such as marked weight loss and muscle wasting, obviously take much longer.

How fast do we want the serum thyroid values to fall after radioiodine treatment?
My goal in treating hyperthyroid cats with radioiodine is to gradually normalize the high serum thyroid hormone concentrations— not lower the values too quickly. I'd rather that the thyroid values fall slowly over the first month after treatment, allowing the rest of the body to gradually get used to being euthyroid once again. This is especially true in cats with concurrent kidney disease, when a drastic fall in thyroid values can aggravate the serum kidney values and can even lead to severe renal failure.

To achieve this gradual fall in the high serum thyroid hormone levels, I administer the smallest dose necessary to cure the hyperthyroidism. By giving individualized, lower doses of radioiodine, we can also reduce the incidence of post-treatment hypothyroidism (underactive thyroid condition) in these cats.

How often does the radioiodine fail to cure the hyperthyroidism?
About 5% of cats that I treat will remain slightly hyperthyroid at the 3-month follow-up period. Many treatment facilities will claim a higher rate of cure (98-100%) than I do, which is made possible by administering higher doses of radioiodine to their cats. In addition to decreasing the incidence of persistent hyperthyroidism, the use of higher radioiodine doses will also hasten the rate of decline in the serum thyroid hormone concentrations.

So why not use this high-dose I-131 protocol instead of my lower-dose approach? Simple — the downside of administering higher radioiodine doses is that this method will lead to a higher rate of iatrogenic hypothyroidism as both the thyroid tumor, as well as most normal thyroid tissue, are irradiated and destroyed (1,2). As I've previously discussed (see my post, Estimating the Radioiodine Dose to Administer to Cats with Hyperthyroidism), more that 30% of cats will become hypothyroid using the standard high-dose treatment protocol, but this incidence could in fact be much higher, possibly up to 75%.

Diagnosing iatrogenic hypothyroidism
To monitor for iatrogenic hypothyroidism, we routinely run a serum thyroid panel (i.e., total T4, T3, free T4, and TSH) at 1 and 3 months after treatment (2,3). Most facilities recommend monitoring just the total T4 concentration, but this is not adequate for monitoring since many hypothyroid cats will maintain a low-normal total T4 value, despite being hypothyroid.  Based on our studies, it's becoming increasing clear that feline hypothyroidism can only be diagnosed by finding low to low-normal T4 and T3 values in conjunction with high TSH values.

Restoring lost body weight and muscle mass
Once euthyroidism is reestablished, most cats will gain weight within a few weeks (certainly by 2-3 months). If marked muscle wasting has occurred, it may not be possible to completely regain the lost muscle. Remember that it will help to feed a diet that's higher in protein (40-50% of calories), higher in fat (40-50% of calories), and relatively low in carbs (less than 15% of calories) (4). For more information, check out my post on The Best Diet to Feed Hyperthyroid Cats.

References:

1. Peterson ME, Broome MR. Radioiodine for feline hyperthyroidism In: Bonagura JD, Twedt DC, eds. Kirk's Current Veterinary Therapy, Volume XV. Philadelphia: Saunders Elsevier, 2014.
2. Peterson ME. Feline focus: Diagnostic testing for feline thyroid disease: hypothyroidism. Compend Contin Educ Vet 2013;35:E4. 
3. Peterson ME. Diagnosis and management of iatrogenic hypothyroidism In: Little SE, ed. August's Consultations in Feline Internal Medicine: Elsevier, 2014;in press.
4. Peterson ME. Nutritional management of endocrine disease in cats. Proceedings of the Royal Canin Feline Medicine Symposium 2013;23-28.

Related Blog Posts:

• Peterson ME. How Does Radioiodine Really Work to Treat Hyperthyroidism? Insights into Veterinary Endocrinology blog.  July 12, 2012.
• Peterson MEL Estimating the Radioiodine Dose to Administer to Cats with Hyperthyroidism. Animal Endocrine Clinic blog. April 30, 2013.
• Peterson ME. Success Rates for Radioiodine Treatment in Hyperthyroid Cats. Animal Endocrine Clinic blog. May 24, 2013.
• Peterson ME. The Best Diet to Feed Hyperthyroid Cats. Insights into Veterinary Endocrinology blog. September 13, 2011

Using a Low-Iodine Diet (y/d) in Hyperthyroid Cats Allowed Outdoors

Is feeding the low-iodine diet (Hill's y/d) an appropriate or reasonable choice for a hyperthyroid cat that is allowed outside and hunts? 

Will the diet work to control the hyperthyroid state if the cat eats small prey?

My Response: 

No, Hill's y/d would not work to lower the high serum T4 and T3 in a cat in this situation.

All species (cattle, pigs, chickens, birds, mice and other rodents) all contain iodine in their muscle tissue (1,2). Iodine may be ingested in the diet as a supplement, but it's also present in soil, which ends up in the plants ruminants and other animals may eat (3,4). Remember that iodine is an essential nutrient and is needed by all animals (including humans!).

This cat, by eating birds and rodents (not eating an iodine deficient diet, of course), would ingest too much iodine for the y/d to be effective. To lower T4 secretion, the diet has to be very, very low in iodine.

References:

1. Hemken RW. Factors that influence the iodine content of milk and meat: a review. Journal of Animal Science 1979;48:981-985.  
2. Downer JV, Hemken RW, Fox JD, et al. Effect of dietary iodine on tissue iodine content in the bovine. Journal of Animal Science 1981;52:413-417. 
3. Whitehead DC. Studies on iodine in British soils. Journal of Soil Science 1973;24:260-270.  
4. Fuge R, Johnson CC. The geochemistry of iodine — a review. Environmental Geochemistry and Health 1986;8:31-54.

Can a Special Diet be Formulated to Treat Hyperthyroidism in Cats?

I have a 13-year old female DSH cat that has recently been diagnosed with hyperthyroidism. Unfortunately found out that she is severely allergic to methimazole (severe vomiting and anorexia), so I cannot treat her with medication (even though I've read this medicine can cause other health issues).

My next option was to feed her the Hill's y/d diet, but she absolutely refuses to eat that food. I then began an online search to see if I could make my own low-sodium cat food that would mimic the Hill's diet. My online research brought me to your blogs about hyperthyroidism and diet.

After reading many of your blogs, I found where you say that a high protein/low carb diet is beneficial to the hyperthyroid cat (http://endocrinevet.blogspot.com/2011/09/best-diet-to-feed-hyperthyroid-cats.html), but it doesn't address sodium content.

Do you believe a diet referenced in your blog would be a life-long treatment for a cat with hyperthyroidism? Or should I pay a veterinary nutritionist to compose a diet for my cat with an iodine level at or below 0.32 ppm (www.2ndchance.info/lowIodine.htm), which Hill's y/d diet allows? I recently called the nutritionists at UC Davis about such a diet, but was told that they have never made a diet for hyperthyroidism in cats.

I've also read that too low of sodium in a cat's diet will cause the thyroid to once again over-produce hormones to compensate. To say the least, I'm confused. I'm at a crossroad wondering if I should try a diet or go ahead and have the I-131 treatment done for my cat. 

Thank you so much for your opinion and response.

My Response:

High protein, low-carbohydrate diet for hyperthyroid cats
First of all, my recommendation to feed hyperthyroid cats a diet higher in protein and lower in carbohydrates is based on what we know about the secondary complications of hyperthyroidism.

Hyperthyroidism is a hypermetabolic, catabolic state. Therefore, in hyperthyroidism, the body may be forced to use it's own muscle tissue to supply increased energy it needs. Because of these increased protein needs of the hyperthyroid cats, loss of lean body mass and muscle wasting is common. By adding more protein to the diet, this will help preserve or restore lost muscle mass, but feeding a high protein diet, by itself, will do nothing to lower thyroid hormone secretion or correct hyperthyroidism.

My recommendation for feeding hyperthyroid cats a low-carb diet is based on the fact that hyperthyroid cats commonly develop a form of prediabetes. Feeding a lower carb diet will help prevent the onset of overt diabetes in these cats. Even if this was not true, cats have absolutely no dietary requirement for carbohydrate and cats in the wild would normally ingest only 1-2% of their daily calories in the form of carbs (1).  But again, limiting the amount of carbohydrates in a hyperthyroid cat's diet would do nothing to treat the hyperthyroid condition.

Overall, a diet higher in protein and lower in carbs, is actually a more "natural" diet for cats (1,2). But this natural diet fed to hyperthyroid cats must be combined with another treatment directed specially at the thyroid gland (e.g., antithyroid drugs, surgical thyroidectomy, or radioiodine).

Salt and the thyroid
In cats, both sodium and chloride (i.e., salt) are required in relatively small amounts in the diet. Nutritional requirements for dietary salt in cats are available from regulation associations or scientific councils, mostly based on studies establishing sodium requirements in cats (3,4). Salt restriction has been historically advocated for cats in some disease states (mainly cardiovascular and kidney diseases) (5,6). No study has confirmed the benefit of such dietary intervention in cats.

However, feeding a cat a low sodium (or salt) diet will not do anything to lower thyroid hormone secretion from the thyroid gland. In other words, we have no evidence at all that a low salt diet can be used as a treatment for hyperthyroidism. Now, because iodine is commonly added to salt as a treatment for iodine deficiency (7,8), using a lower salt diet could lower iodine levels very slightly.

Iodine and the thyroid
The y/d diet made by Hill's (named, Prescription Diet y/d Feline –Thyroid Health) is an iodine deficient diet (9-11). Unlike sodium or chloride, iodine is one of the essential building blocks needed for thyroid hormone synthesis.

The main thyroid hormones secreted by the feline thyroid include thyroxine (T4) and triiodothyronine (T3).  If we look at the thyroxine molecule, it contains four atoms of iodine per molecule, and that's how the common abbreviation "T4" was derived. Triiodothyronine contains one less iodine atom, thus the common abbreviation "T3." Therefore, it's the number of iodine atoms in each of these thyroid hormones that determines the "number" in T4 or T3.

The basis for using a severely restricted iodine diet to treat hyperthyroid cats is that iodine is an essential component of both T4 and T3. With severe dietary iodine deficiency, the thyroid cannot produce adequate amounts of thyroid hormone (8,9).

Hill's y/d is clearly an iodine deficient diet, containing levels of approximately 0.2 mg/kg (0.2 ppm) on a dry matter basis, well below the minimum daily requirement for adult cats (0.46 mg/kg or 0.46 ppm) of food (9-11).  Our current data does indicate that feeding y/d, a diet severely restricted to overtly deficient in iodine, will result in normalization of T4 levels in most hyperthyroid cats. Since iodine is an essential nutrient and has other functions other than making T4 and T3 (12), the long-term effects of such iodine deficiency in cats remains unclear.

Can a low-iodine home-made diet be formulated?

I am well aware of the claim by some, including Dr. Hines, that it is possible to make your own low-iodine diet. However, if this were true, then why would we ever feed the Hill's y/d diet, which is very unnatural? 

You can certainly talk to a veterinary nutritionist about making an iodine-deficient diet for your cat (13). Unfortunately, it is just not that easy to formulate such a diet, and I do not know of anyone who has made one. That's especially true if we want to feed a higher protein, lower-carbohydrate diet (iodine is present is most meat, since iodine is a required nutrient in all animals, including cattle, chickens, and pigs). And remember, cats are meant to eat a low-carb, high-protein diet!

My Bottom Line:

At 13-years of age (a middle-aged senior cat), I would consider a definitive form of treatment of the hyperthyroidism to be ideal. I'd talk to your veterinarian about the possibility of the use of radioiodine or surgical thyroidectomy. Once your cat is cured, then we can concentrate on the use of nutrition to help restore any lost muscle mass and to improve glucose metabolism.

References:

1. Eisert R. Hypercarnivory and the brain: protein requirements of cats reconsidered. J Comp Physiol B 2011;181:1-17.
2. Zoran DL. The carnivore connection to nutrition in cats. Journal of the American Veterinary Medical Association 2002;221:1559-1567.
3. AAFCO (Association of American Feed Control Officials). Official Publication, 2007. 
4. NRC (National Research Council). Minerals. In: Nutrient Requirements of Dogs and Cats. Washington DC, The National Academy Press, 2006:145-192. 
5. Xu H, Laflamme DP, Long GL. Effects of dietary sodium chloride on health parameters in mature cats. J Feline Med Surg 2009;11:435-441. 
6. Reynolds B. Dietary salt and cats: evidence-based approach. Proceedings of the 21st ECVIM-CA Congress, 2011.
7. Zimmermann MB. Iodine deficiency. Endocr Rev 2009;30:376-408. 
8. Zimmermann MB, Andersson M. Assessment of iodine nutrition in populations: past, present, and future. Nutr Rev 2012;70:553-570.  
9. Melendez LM, Yamka RM, Forrester SD, et al. Titration of dietary iodine for reducing serum thyroxine concentrations in newly diagnosed hyperthyroid cats [abstract]. J Vet Intern Med 2011 2011;25:683. 
10. Melendez LM, Yamka RM, Forrester SD, et al. Titration of dietary iodine for maintaining serum thyroxine concentrations in hyperthyroid cats [abstract]. J Vet Intern Med 2011;25:683. 
11. Yu S, Wedekind KJ, Burris PA, et al. Controlled level of dietary iodine normalizes serum total thyroxine in cats with naturally occurring hyperthyroidism [abstract]. J Vet Intern Med 2011;25:683-684. 
12. Patrick L. Iodine: deficiency and therapeutic considerations. Altern Med Rev 2008;13:116-127. 
13. Fascetti AJ, Delaney SJ. Nutritional management of endocrine disease In: Fascetti AJ, Delaney SJ, eds. Applied Veterinary Clinical Nutrition. Chickester, West Sussex: Wiley-Blackwell, 2012;289-300.

What's the Best Diet to Fed Dogs with Diabetes?

I'm writing about my dog Minnie, a 7-year old female spayed miniature pinscher (Min Pin). In November of 2012, she was diagnosed with diabetes and started on insulin (Humulin N; NPH insulin). She was very overweight when I adopted her (body weight of 26 pounds) and looked more like a football with legs. After being diagnosed as diabetic, my vet changed her diet to Hills Science Diet w/d. It really helped her lose weight, and now she looks like a Min Pin should look (current weight, 14 pounds).

Despite her body condition normalizing, I am now very concerned about her current health. Her blood sugar levels generally range from 100-120 mg/dl on 7 units of NPH twice daily, but her thirst and urinations remain high. In addition to the polyuria, she now is showing signs of hair loss, muscle weakness, and thinning of the skin. Also, when I feed her, you would think it was her last meal. My thought was that it was from her diet but my vet insists that w/d has everything Minnie needs. 

The vet was concerned that she may have Cushing’s syndrome. We did a screening test for Cushing's syndrome (i.e. a low-dose dexamethasone suppression test), which came back today negative for Cushing’s disease. A test for thyroid function was also normal. I once again asked about the food, which my vet still believes isn’t the cause of her hunger and hair loss.

My question is – Could there be something in W/D that Minnie is allergic to that could be causing some of the same symptoms? Or could it be that she isn’t getting the appropriate nutrition? I’m also wondering what would be another good dog food for diabetic dogs that she might respond to better?

Anyway – thank you for taking the time to read this and I hope you could offer some good advice. 

My Response: 

It's very difficult to attribute all of your dog's clinical signs to the feeding of the Hill's w/d diet. That said, I would change Minnie's diet as the first step in her management.

What's the best diet for canine diabetes?
There is not one type of diet that is recommended for all dogs with diabetes. Diabetic dogs can do well when fed a number of diets as long as they are nutritionally complete and balanced, do not contain simple sugars, are fed at consistent times in consistent amounts, and are palatable to ensure a predictable and consistent appetite. As we all know, it's difficult enough to regulate a diabetic when they are eating consistently well— if they refuse to eat their diet, adequate glucose regulation can become next to impossible.

With any diabetic dog, the most important dietary factor in the diabetic is consistency, so that you can match your insulin dose to the degree of postprandial (after feeding) hyperglycemia. The key to feeding diabetic dogs is to feed the same amount of the same diet at the same time every day!

Feeding diabetic dogs to optimize body weight
In diabetic dogs that are overweight or obese, I always recommend feeding a reduced calorie diet designed to help the dog lose weight. The high fiber diets (such as Hills w/d) are good for this purpose (1-4). So feeding Minnie the w/d when she was grossly obese was a very good idea.

In underweight dogs with diabetes, however, the goal of dietary therapy is the complete opposite. In these thin dogs, our priority is to normalize body weight and restore and preserve muscle mass. These dogs may never regain the weight needed if a food with moderate to high amounts of fiber is fed — they may even continue to progressively lose even more weight. Therefore, these thin to emaciated dogs should be fed a high-quality, higher energy diet that can contain a slightly increased fat content to ensure that they regain their lost body weight (3-5).

Recent studies fail to show a clear-cut clinical benefit of feeding a high-fiber diet over a typical adult maintenance diet with moderate-fiber content to diabetic dogs. In one study, no significant differences in insulin requirements or glycemic control were found in dogs fed a high-fiber, moderate-carbohydrate, moderate-fat diet versus an adult maintenance diet with moderate fiber, lower carbohydrate, and higher fat (5). As expected, weight loss occurred when the dogs were fed the high-fiber diet, whereas body weights were maintained with the moderate-fiber diet. 

Not all diabetic dogs should be automatically fed a high-fiber diet, such as Hills w/d. In your dog, a change in diet to one higher in calories would now be indicated, at least in my opinion.

Cushing's syndrome and diabetes in dogs
I do agree with your veterinarian that the signs of increased hunger, continued polyuria and polyuria (despite good control of the blood glucose values), hair loss, and thin skin all point to hyperadrenocorticism (Cushing's syndrome) (8).  This is a common problem is middle-aged to older dogs, resulting from an excess production of cortisol from the adrenal glands. Secondary diabetes will develop in about 10% of dogs with Cushing's syndrome, and the diabetes is frequently difficult to control (8-10).

The fact that a single test for Cushing's has been negative cannot completely rule out Cushing's syndrome (8,11).  However, the fact that Minnie is showing signs of weight loss cannot be explained by Cushing's, a condition in which weight gain is more common (8-10).

In any case, additional testing of adrenal function should be considered, especially if a diet change hasn't caused a marked improvement within a month or two.

The Bottom Line 

Dogs should never be fed a high-fiber diet just because they have diabetes. Such high-fiber diets are contraindicated in thin or emaciated dogs with diabetes, as well as normal weight dogs that are undergoing unwanted weight loss (5).

Many diabetic dogs do better on maintenance diets containing lower amounts of fiber and carbohydrate and higher amounts of protein. A consistent diet —that is, the type, amount, and time of feeding —is generally much more important in diabetic regulation than any particular fiber content or specific type of diet. Other than that, we want to feed any diabetic dog a diet that will maintain normal body weight.

References: 

1. Nelson R, Duesberg C, Ford S, et al. Effect of dietary insoluble fiber on control of glycemia in dogs with naturally acquired diabetes mellitus. J Am Vet Med Assoc 1998;212:380–386.  
2. Graham PA, Maskell E, Rawlings L. Influence of a high fibre diet on glycaemic control and quality of life in dogs with diabetes mellitus. J Small Anim Pract 2002;43:67–73. 
3. Rucinsky R, Cook A, Haley S, et al. American Animal Hospital Association. AAHA diabetes management guidelines. J Am Anim Hosp Assoc 2010; 46:215-224. 
4. Zicker SC, Nelson RW, Kirk CA, et al. Endocrine Disorders. In: Hand MS, Thatcher CD, Remillard RL, Roudebush R, Novotny, BJ (eds), Small Animal Clinical Nutrition. Mark Morris Institute. 2010; 559-584. 
5. Fleeman LM, Rand JS, Markwell PJ. Lack of advantage of high-fibre, moderate-carbohydrate diets in dogs with stabilised diabetes. J Small Anim Pract 2009;50:604-614. 
6. Rand JS, Farrow HA, Fleeman LM, et al. Diet in the prevention of diabetes and obesity in companion animals. Asia Pac J Clin Nutr 2003;12 Suppl:S6.1 
7. Elliott KF, Rand JS, Fleeman LM, et al. A diet lower in digestible carbohydrate results in lower postprandial glucose concentrations compared with a traditional canine diabetes diet and an adult maintenance diet in healthy dogs. Res Vet Sci 2011;96; 288-95.
8. Melián CM, Pérez-Alenza D, Peterson ME. Hyperadrenocorticism in dogs In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine: Diseases of the Dog and Cat. Seventh ed. Philadelphia: Saunders Elsevier, 2010;1816-1840.
9. Peterson ME, Nesbitt GH, Schaer M. Diagnosis and management of concurrent diabetes mellitus and hyperadrenocorticism in thirty dogs. J Am Vet Med Assoc 1981;178:66-69. 
10. Eigenmann JE, Peterson ME. Diabetes mellitus associated with other endocrine disorders. Vet Clin North Am Small Anim Pract 1984;14:837-858. 
11. Peterson ME. Diagnosis of hyperadrenocorticism in dogs. Clin Tech Small Anim Pract 2007;22:2-11. 

Podcast: Increasing Rates of Obesity in Our Cats and Dogs

We love our pets. But sometimes, when it comes to rewarding them with treats and food, we might love them a little too much. As a result, our pets are increasingly overweight and obese.

To help quantify just how serious this issue has become, the Association for Pet Obesity Prevention (for which Dr. Peterson serves as a board member) conducts annual surveys on obesity in U.S. pets. Just last week, the group released its 6th annual survey.

In the latest AVMA Animal Tracks podcast, Dr. Ernie Ward, founder of APOP, discusses this year's results. To here the podcast, click this link.

For more information about the 2012 National Pet Obesity survey results or the Association for Pet Obesity Prevention in general, please visit their website at www.petobesityprevention.com.

Muscle Wasting in a Hyperthyroid Cat Fed Hill's y/d

I have read your blog posts concening the Hill's y/d diet with much interest (1-5). We have been feeding our 13-year-old female cat the Hill's y/d diet for 6 months now. The high serum thyroid values have come down into the high-normal range and her weight loss has stopped. However, she doesn't look like the same cat as she used to be, and we have noticed her getting smaller and more bony. She eats the y/d, but not with the same gusto as she used to eat when we fed her regular OTC canned foods.

Is this the muscle wasting you talk about in your blogs? Should we change her treatment and put her on medication in order for her to have a more balanced diet?

Although she is not very old, the procedures listed to "cure" hyperthyroidism look like they may be risky. We don't want our cat to undergo anesthesia or have surgery. Is the radioactive treatment dangerous to our cat's health? What does the radioiodine procedure involve? Is it expensive? Does this procedure make it dangerous to handle the cat litter for awhile?

We want my cat to live a long and happy life, but it looks like she won't be able to keep going very long if we keep her on this diet! Thanks for your advice.

My Response:

Muscle wasting and protein needs in older cats
I agree that it is likely that your cat looks "smaller" because of the loss of muscle mass that can occur in  hyperthyroid cats if not fed enough protein (6-9). Like I discuss in my blog posts, Hill's y/d is not a high protein diet, containing less than 28% of calories as protein (1). In contrast, cats in the wild generally eat between 50-60% of their daily calories as protein.

A recent paper proves that cats, as obligate carnivores, require over 5 grams of protein each day to maintain muscle mass (10). Hyperthyroid cats would be expected to need even more protein, since hyperthyroidism is a catabolic state and it's well known that we see muscle breakdown and muscle loss with this disease (2,6,7). Putting that amount of protein into perspective, that means that we should be feed our cats a diet that contains at least 40% of their calories as protein to restore or regain lost muscle mass, an amount much greater than that contained in the y/d diet.

Best treatment for a young hyperthyroid cat without concurrent disease
In my opinion, we should try to remove or destroy the thyroid tumor in any cat that is relatively young and in good health otherwise. At 13-years of age, your cat certainly is not very old (only about 55-60 in human years). By choosing either surgery or radioiodine, we will be able to cure the thyroid disease and do not have to feed an iodine deficient diet (y/d) or use life-long, twice daily medication (9,11).

In most cats, leaving the thyroid tumor allows it to continue to grow larger and larger, and in some cats, the benign tumor can transpose into a malignant carcinoma (12). Radiodine is generally considered to be the treatment of choice. Compared to surgery, no anesthesia is needed, and we don't have to worry about parathyroid damage (the 4 little glands around the thyroid that control calcium) or possible hypocalcemia. For more information about the pros and cons of radioiodine, see my hospital website (www.animalendocrine.com). I also have a FAQ section on the website that should answer all of your questions about this treatment.

If done properly, radioiodine is not at all risky (12). At our facility, most cats only stay with us for 3-5 days. The doses of radioiodine we use are actually quite small in most cats, so their whole body radiation levels are not very high and no side effects are expected.  To make it easier for you to be separated from your cat, we have even installed webcams within each of their condos so you can check-in whenever you wish.

Like you, I too want all cats to live a long and heathy life. In cats with hyperthyroidism, I believe this includes curing the disease so we can focus on proper nutrition (6,7) and environmental enrichment. By not giving life-long medication, this also reduces the cat's level of stress, which we do see in some cats that have to be chronically medicated. And what cat really wants to eat a single type of food every day for the rest of their lives?

References:

1. Peterson ME. Is Hill's y/d a nutritious diet for hyperthyroid cats? Insights into Veterinary Endocrinology. September 28, 2011. 
2. Peterson ME. Optimal protein requirements for older cats and cats with hyperthyroidism. Insights into Veterinary Endocrinology. November 7, 2011. 
3. Peterson ME. Is the protein content of Hill's y/d too low to restore and maintain muscle mass in cats with hyperthyroidism? Insights into Veterinary Endocrinology. November 10, 2011. 
4. Peterson ME. Can increasing the amount of fat or carbohydrate in a cat's diet compensate for low protein intake? Insights into Veterinary Endocrinology. December 22, 2011. 
5. Peterson ME. Is it feasible for older cats to ingest the optimal amounts of protein they need each day? Insights into Veterinary Endocrinology. December 14, 2011. 
6. Peterson ME. Nutritional management of endocrine disease in cats. Proceedings of the Royal Canin Feline Medicine Symposium 2013; 23-28 2013;23-28.
7. Peterson ME. The best diet to feed hyperthyroid cats. Insights into Veterinary Endocrinology. September 13, 2011. 
8. Sparkes AH. Feeding old cats— An update on new nutritional therapies. Topics in Companion Animal Medicine 2011;26:37-42.
9. Baral R, Peterson ME: Thyroid gland disorders, In: Little, S.E. (ed), The Cat: Clinical Medicine and Management. Philadelphia, Elsevier Saunders. pp. 571-592, 2012.
10. Laflamme DP, Hannah SS. Discrepancy between use of lean body mass or nitrogen balance to determine protein requirements for adult cats. J Fel Med Surg 2013; in press. 
11. Peterson ME, Broome MR. Radioiodine for hyperthyroidism. In: Bonagura JD, Twedt DC (eds): Current Veterinary Therapy V. Philadelphia, Saunders Elsevier, 2013; in press.
12. Peterson ME, Broome MR. Hyperthyroid cats on long-term medical treatment show a progressive increase in the prevalence of large thyroid tumors, intrathoracic thyroid masses, and suspected thyroid carcinoma. J Vet Intern Med 2012;26:1523.

Should Hill's y/d Diet Ever Be Used to Manage Cats with Hyperthyroidism?

Hyperthyroid cat with an allergic reaction (facial pruitus) secondary to methimazole

We are unlikely enough to have not one... but two cats with hyperthyroidism. One has responded well to treatment with methimazole, with normalization of the serum T4 value, while the other cat had a severe allergic reaction (facial pruitus) so we had to stop the medication. Because of her age and how ravaged she was by the allergic reaction, we didn't want to do radiation or surgery.

My veterinarians suggested that we could try Hills' y/d diet, since no other good options were available. Since we had no other options available, we felt that we had nothing to lose.  Luckily, our cat will eat the diet. Slowly, she has improved and is doing fairly well.

Who knows if this food will be good for her long term (I take your comments seriously about what cats truly need in their diet), but she's almost 16-years old and has enjoyed a good life. Considering our situation, trying the diet was worth a shot, and it has lowered the serum T4 value to normal.

Now I'm feeling guilty — should I continue the y/d or should I rethink my decision not to use the radioiodine?

My Response:

I consider the feeding of Hill's y/d diet to be a fourth-line of treatment for hyperthyroidism; I'd recommend this treatment only if none of the 3 other options (i.e., radioiodine, surgical thyroidectomy, or methimazole) can be used (1-3).

If a hyperthyroid cat will eat this ultra-low iodine food (and not eat anything else), the y/d certainly will lower the serum thyroid hormone concentrations (4). Remember that iodine is an essential nutrient and is needed to make thyroid hormone; with this diet, we are inducing an iodine deficient state so the cat's thyroid tumor will not be able to continue to produce large amounts of thyroid hormone on this diet (5).

However, like methimazole, feeding an ultra-low iodine diet can not cure the primary cause of hyperthyroidism (ie, the thyroid tumor). The thyroid tumor, which is almost always benign at time of diagnosis) will continue to grow with time (5,6). In some cats, this benign tumor can also transform to a more malignant carcinoma after a few months to years. So whenever possible,  I believe it's always better to remove the thyroid tumor with surgery or ablate it with radioiodine —in that way, we are curing rather than prolonging the disease and not allowing the thyroid tumor to continue to grow.

Now, if you consider 16 year's of age too old for definite treatment, then y/d can certainly be fed. For a geriatric cat, I don't consider 15 or 16 years of age too old for definitive treatment unless other concurrent problems are present that are known to shorten their lives. Remember that old age itself isn't a disease, and I see many senior cats that are still doing well at 18 to 20 years of age.

The main advantage of the methimazole over the y/d is that we can control what the cat is fed (remember that cats managed with y/d can ONLY eat that diet).  The best diet for a hyperthyroid cat or any senior cat for that matter is one that is lower in carbohydrates (<15% of calories) and higher in protein (>35-40% of calories) (7).  Senior cats don't absorb protein as well as younger cats and will develop weight loss and muscle wasting as they age (8-11). Other than exercise (and good luck with getting most cats to enter a weight lifting regime), the best way we know to maintain muscle mass is to feed a higher protein diet.

When we look at the dietary composition of Hill's y/d, it's way too high in carbs (>23% of calories), and much too low in protein (<28% of calories). In addition, the protein that's contained in the dry y/d is all plant protein, which isn't as good as animal protein is for cats — when was the last time you heard of a feral cat that was a vegetarian?

Obviously, in your cat, we can never use methimazole again because of the severe allergic reaction that occurred.  So, should you continue the y/d for your cat?  That's a decision that you will have to make— remember that any treatment, including the y/d, is better than no treatment at all.

But I like to treat the whole animal, however, and that involves more than just giving pills, feeding an iodine-deficient diet, or even giving an injection of radioiodine. For me, that involves proper geriatric nutrition, supplements in some cats, and finally, environmental stimulation to help enrich their lives (1-3, 7).

References: 

1. Mooney CT, Peterson ME. Feline hyperthyroidism In: Mooney CT, Peterson ME, eds. BSAVA Manual of Canine and Feline Endocrinology. Fourth ed. Quedgeley, Gloucester: British Small Animal Veterinary Association. 2012;92-110.
2. Baral RM, Peterson ME. Thyroid gland disorders In: Little SE, ed. The Cat: Clinical Medicine and Management. St. Louis: Elsevier Saunders, 2012;571-592.
3. Peterson ME. Hyperthyroidism in cats In: Rand JS, Behrend E, Gunn-Moore D, et al., eds. Clinical Endocrinology of Companion Animals. Ames, Iowa Wiley-Blackwell, 2013;295-310.
4. Yu S, Wedekind KJ, Burris PA, et al. Controlled level of dietary iodine normalizes serum total thyroxine in cats with naturally occurring hyperthyroidism [abstract]. J Vet Intern Med 2011;25:683-684.
5. Peterson M. Hyperthyroidism in cats: What's causing this epidemic of thyroid disease and can we prevent it? J Feline Med Surg 2012;14:804-818.
6. Peterson ME, Broome MR. Hyperthyroid cats on long-term medical treatment show a progressive increase in the prevalence of large thyroid tumors, intrathoracic thyroid masses, and suspected thyroid carcinoma. J Vet Intern Med 2012;26:1523.
7. Peterson ME. Nutritional management of endocrine disease in cats. Proceedings of the Royal Canin Feline Medicine Symposium 2013; 23-28 2013;23-28.
8. Teshima E, Brunetto MA, Vasconcellos RS, et al. Nutrient digestibility, but not mineral absorption, is age-dependent in cats. J Anim Physiol Anim Nutr (Berl) 2010;94:e251-258. 
9. Sparkes AH. Feeding old cats--an update on new nutritional therapies. Top Companion Anim Med 2011;26:37-42. 
10. Perez-Camargo G. Feline decline in key physiological reserves implications for mortality. Proceedings of the Nestlé Purina Companion Animal Nutrition Summit: Focus on Gerontology 2010;6-13. 
11. Freeman LM. Cachexia and sarcopenia: emerging syndromes of importance in dogs and cats. J Vet Intern Med 2012;26:3-17.

My Related Posts on Hill's y/d Diet (Insights into Veterinary Endocrinology Blog)

How to Feed Cats: Examining the Nutrition of Feral Cats

Paper Review: The Nutrition of Feral Cats 

Estimation of the dietary nutrient profile of free-roaming feral cats: possible implications for nutrition of domestic cats. 

British Journal of Nutrition 2011;106 Suppl 1:S35-48. 

by E.A. Plantinga, G. Bosch, and W.H. Hendriks 

Abstract
Cats are strict carnivores and in the wild rely on a diet solely based on animal tissues to meet their specific and unique nutritional requirements. Although the feeding ecology of cats in the wild has been well documented in the literature, there is no information on the precise nutrient profile to which the cat's metabolism has adapted.

The present study aimed to derive the dietary nutrient profile of free-living cats. Studies reporting the feeding habits of cats in the wild were reviewed and data on the nutrient composition of the consumed prey items was obtained from the literature.

Fifty-five studies reported feeding strategy data of cats in the wild. After specific exclusion criteria, twenty-seven studies were used to derive thirty individual dietary nutrient profiles. The results show that feral cats are obligatory carnivores, with their daily energy intake from crude protein being 52%, from crude fat 46% and from N-free extract (i.e., carbohydrates) only 2%. Minerals and trace elements are consumed in relatively high concentrations compared with recommended allowances determined using empirical methods.

The calculated nutrient profile may be considered the nutrient intake to which the cat's metabolic system has adapted. The present study provides insight into the nutritive, as well as possible non-nutritive aspects of a natural diet of whole prey for cats and provides novel ways to further improve feline diets to increase health and longevity.

My Comments 
In this excellent study (1), the researchers reviewed 27 published studies reporting the feeding habits of feral cats and obtained data on the nutrient composition of the cats’ prey. The results showed that feral cats are obligatory carnivores with a diet high in protein (52% of daily energy) and fat (46% of daily energy) content, but low in carbohydrates (2% of daily energy). The results of this study should be expected since it has long been recognized that cats are strict carnivores, with a high dietary need for protein and fat but no dietary need for carbohydrates (2-5).

The typical prey diet of cats is low in carbohydrate (<10% of metabolizable energy (ME) (6-9). However, most commercially available cat foods are moderate to high in carbohydrate content (> 25 – 55 % ME), partly because of the difficulty in formulating extruded, dry diets that are low in carbohydrate. But higher carbohydrates are also used in cat food diets because cereal is a relatively inexpensive ingredient, and there is demand for lower-cost diets in the pet food market.

I believe strongly that many of the present-day diseases of the domestic cat are related to an "unnatural" diet, one too high in carbohydrates and too low in protein and fat. I believe we should be feeding our cats closer to what they would be eating in the wild, at least if they do not have special nutritional needs because of diseases such as kidney disease. Future research should focus on the value of feeding a natural diet of whole prey as a means of enhancing both feline health and longevity.

The authors should be commended for doing this excellent study and publishing the results. Hopefully, the pet food industry will pay attention.

References:

1. Plantinga EA, Bosch G, Hendriks WH. Estimation of the dietary nutrient profile of free-roaming feral cats: possible implications for nutrition of domestic cats. British Journal of Nutrition 2011;106 (Suppl 1):S35-48.
2. MacDonald ML, Rogers QR, Morris JG. Nutrition of the domestic cat, a mammalian carnivore. Annual Review of Nutrition 1984;4:521-562.
3. Zoran DL. The carnivore connection to nutrition in cats. Journal of the American Veterinary Medical Association 2002;221:1559-1567. 
4. Morris JG. Idiosyncratic nutrient requirements of cats appear to be diet-induced evolutionary adaptations. Nutrition Research Reviews 2002;15:153-168. 
5. Bradshaw JWS. The evolutionary basis for the feeding behavior of domestic dogs (Canis familiaris) and cats (Felis catus). Journal of Nutrition 2006;136:1927S–1931S.
6. Myrcha A, Pinowski J. Weights, body composition and caloric value of post-juvenile molting European tree sparrows. Condor 1970;72:175–178.
7. Vondruska JF. The effect of a rat carcass diet on the urinary pH of the cat. Companion Animal Practice 1987;1:5-9.
8. Crissey SD, Slifka KA, Lintzenich BA. Whole body cholesterol, fat, and fatty acid concentrations of mice (Mus domesticus) used as a food source. Journal of Zoo and Wildlife Medicine 1999;30:222-227.
9. Eisert R. Hypercarnivory and the brain: protein requirements of cats reconsidered. Journal of Comparative Physiology B, 2011;181:1-17.

Can a New Thyroid Health Food (Hill's y/d) Live Up to the Hype?

Can a New Thyroid Health Food Live Up to the Hype?

A new prescription cat food promises to treat hyperthyroidism in cats. 
Maybe so, if the studies pan out. Where are those studies, anyway?


Dr. Eric Barchas
www.catster.com
May 3, 2012

In the blog post entitled, Can a New Thyroid Health Food (Hill's y/d) Live Up to the Hype?, Dr. Eric Barchas provides us with a good overview of what's wrong with all the hype associated with Hill's y/d diet.

As Dr. Barchas states in the beginning of his post (1): "For months, every veterinary publication I receive has been plastered with full-page advertisements for a new prescription cat food...... The new cat food is called Hill's y/d —or, more formally, Hill's® Prescription Diet® y/d™ Feline Thyroid Health on the company's website. Call me old-fashioned, but I am naturally suspicious of any food that has two ®s and a ™. Might the diet be more marketing ploy than medical breakthrough?"

For those of you who have followed my rants about what's wrong with Hill's y/d diet (2,3), you would be able to predict that this post made me smile.

So what's this diet all about and what's the problem with it? 

First of all, Hill's y/d diet certainly does offers another treatment option for hyperthyroid cats. The basis for how the diet works to control the hyperthyroid state is by severely limiting the amount of iodine in the y/d (the diet is actually iodine deficient).

Because thyroid hormone contains large quantities of iodine, the diet should reduce secretion of the hormone. Indeed, the clinical experience of practicing veterinarians to date indicate the this diet is effective in lowering serum T4 values in many hyperthyroid cats, although not always to levels that we would consider "low enough."

The biggest concerns are in regard to the long-term side effects of feeding an low iodine or iodine deficient diet to cats. For y/d to work, no other food can be fed for the rest of the cat's life — so the y/d diet, if successful, would potentially be fed for years to a cat suffering from hyperthyroidism.

As Dr. Barchas points out in his post, large, long-term safety studies are needed to determine what happens when cats with or without thyroid disease eat y/d months to years. Now I know it seems difficult to believe, but adequate long-term safety studies of cats fed this diet have yet to be done.

Because Hill's y/d is not a drug (although it's certainly being marketed as a replacement for methimazole), the company is not required to do long-term safety studies. And it's fairly clear that they have no intention of paying to have them done.

The bottom line: 

Again, Dr. Barchas says it better than I could do so let me quote the summary for his post (1): "In short, I believe that Hill's has unleashed y/d with too little research and too much hype. The food may turn out to be a veritable godsend, or it could be a disaster. Only time, and more studies, will tell.... 


For now, no matter how many fancy ads I see, I am hesitant to recommend the food unless a cat absolutely is not a candidate for any of the other three hyperthyroidism treatments."

Related links: 

1. To read the complete post by Dr. Barchas, click this link. 
2. To read my posts on y/d on the Animal Endocrine Clinic blog, click this link.
3. To read my posts on y/d on the Insights into Veterinary Endocrinology blog, click this link.

State of Pet Health Report Shows Chronic Diseases, Overweight, and Obesity Up Dramatically in Past 5 Years

Banfield Pet Hospital Releases State of Pet Health 2012 Report

The Banfield Pet Hospital released its State of Pet Health 2012 Report, revealing that certain chronic diseases in dogs and cats have risen drastically since 2007. The report, compiled by Banfield's internal research team, captured and analyzed medical data from the 2 million dogs and nearly 430,000 cats cared for in Banfield's 800 hospitals in 2011. The largest report of its kind, the State of Pet Health 2012 Report breaks down the data by these chronic diseases: overweight and obesity, diabetes, thyroid disease, arthritis, kidney disease, and heart disease.

This report shows that the prevalence of many chronic diseases of dogs and cats has increased dramatically, just over the last 5 years.

• Overweight and obesity up 37% in dogs and 90% in cats
• Arthritis by increased 38% in dogs and 67% in cats
• Nearly half of arthritic dogs and more than 1 in 3 arthritic cats are also overweight
• Almost half of diabetic dogs and diabetic cats  are overweight
• About 60% of dogs with hypothyroidism are also overweight
• Feline chronic kidney disease, a common cause of death in cats, increased by 15% 

The rise in pet overweight and obesity mimics the increase in humans. According to the Centers for Disease Control and Prevention (CDC), overweight and obesity in humans is also on the rise. The CDC reports that overweight/obesity in humans has increased to 1 in 3 of U.S. adults.

To view and download the full State of Pet Health 2012 Report, visit www.stateofpethealth.com.

Pet Obesity: No Laughing Matter

As the number of Americans who are overweight has grown, studies show that the same statistics apply to our companion animals. About half of all dogs and cats in American homes are overweight or obese, up slightly from 2010, according to a recent study by the Association for Pet Obesity Prevention.

And although owners may think their pudgy dog or cat is cute, all that extra weight spells trouble the some 85 million U.S. pets who are considered overweight.

And many pet owners are finding that the extra pounds on a pudgy cat or dog can lead to severe secondary health problems. Just as diabetes, joint problems, and heart disease are more common in people who are obese, these diseases also are more common in overweight animals. The average cost of veterinary care for a diabetic dog or cat in 2011 was more than $900, according one pet insurance company. Treatment for arthritis and cruciate ligament tears in dogs, which can be caused by the strain of an overweight frame that weakens joints, cost pet owners an average of $2,000.

Last week, an interesting article the cost of pet obesity was published in the Wellness section of the New York Times. To read the complete article, entitled "Paying the Price of a Fat Pet," click this link.

• O'Connor, AO. Paying the Price of a Fat Pet. Well Pet Blog, The New York Times. April 20, 2012. 

Proper Nutrition and Lifestyle Essential for Cats

Cats have lived on the outer edges of human society for many thousands of years. However, domestication has changed cats relatively little. Diet options for cats in the wild have included consumption of small mammals, birds, and insects. These are meat or protein-based diets that contain little carbohydrate.

Cats, as a species, are strictly carnivorous. In many societies, they have been removed from their former free-roaming, active existence to a captive, indoor, sedentary one. They have also gone from consuming frequent, small meals of animals they could catch and kill to consuming prepared diets of human choosing.

Proper nutrition plays a key role in the prevention and management of many common feline endocrine disorders, including obesity, diabetes mellitus, and hyperthyroidism.

For more information, see this interesting blog post published last week in Cat Health News from the Winn Feline Foundation entitled, Cats: nutrition and lifestyle choices.

Related articles: 

• Zoran DL and Buffington CAT. Effects of nutrition choices and lifestyle changes on the well-being of cats, a carnivore that has moved indoors. Journal of the American Veterinary Medical Association 2011; 239: 596-606. 
• Zoran D. The carnivore connection to nutrition in cats. Journal of the American Veterinary Medical Association 2002; 221: 1559-67.

American Diabetes Alert Day: March 27, 2012

24th ANNUAL AMERICAN DIABETES ALERT DAY   

AMERICAN DIABETES ASSOCIATION

What is American Diabetes Association Alert Day?
Today is the American Diabetes Association Alert Day, which is held every year on the fourth Tuesday in March (1). The purpose of this Diabetes Alert Day is to call special attention to diabetes and to encourage everyone to find out if they are at risk.

While diabetes is often a hereditary condition, it is still possible to develop diabetes even if you have no known history of it in your family. In addition, type 2 diabetes is often preventable through regular medical checkups and a healthy lifestyle.

Why is Alert Day important? 
Diabetes is a serious disease that strikes nearly 26 million children and adults in the United States, and a  quarter of them—7 million—do not even know they have it. An additional 79 million, or one in three American adults, have prediabetes, which puts them at high risk for developing type 2 diabetes.

Unfortunately, diagnosis often comes 7 to 10 years after the onset of the disease, after disabling and even deadly complications have had time to develop. Therefore, early diagnosis is critical to successful treatment and delaying or preventing some of its complications.

The Diabetes Risk Assessment Quiz
To find out if you are at risk for diabetes, you can do so by taking the Diabetes Risk Assessment and then read more below about what you can do to prevent or manage type 2 diabetes. Click here to take the diabetes risk test.

This test asks users to answer simple questions about weight, age, family history, and other potential risk factors for prediabetes or type 2 diabetes. Preventative tips are provided for everyone who takes the test, including encouraging those at high risk to talk with their health care provider.

I took the test and it was quick and painless. The results of my test? I'm at medium risk for type 2 diabetes. Although I'm not overweight, I'm almost 60 years old (remember that type 2 diabetes increases with age), and my mother has had type 2 diabetes (she's lost weight so she's not on insulin now and is doing well).

Why is the Diabetes Alert Day important for diabetic cats and dogs? 
Diabetes is a serious disease that strikes more than 1 in every 200 cats. Like the situation in human diabetic patients, Type 2 diabetes is the most common form of diabetes in cats. Although dogs commonly develop diabetes, the form of diabetes they develop is not type 2 and more closely resembles type 1 diabetes (2).

Many of the risk factors for development of Type 2 diabetes in domestic cats are similar to man and include advancing age, obesity, and physical inactivity (3-7). Cats are obligate carnivores and have no need for dietary carbohydrates (2).  Feeding cats diets high in carbohydrate can increase blood glucose and insulin levels and may predispose cats to obesity and diabetes. Feeding low-carbohydrate, high-protein diets may help prevent diabetes for cats at risk.

The incidence of feline diabetes has progressively increased over the past few decades (6,7). In one study looking at records of cats with diabetes mellitus from 1970 through 1999 (7), prevalence increased significantly from only 8 cases per 10,000 in 1970 to 124 per 10,000 in 1999!

The exact cause of this increase in feline diabetes in not known but may relate to higher obesity rates and more cats being fed high-carbohydrate diets (6,7). Male cats appear to be at greater risk, representing approximately 60-70% of all diabetics (2-7). Increasing age also correlates with increasing risk of diabetes, with two-thirds of cats diagnosed when older than 10 years (3,5-7).

Feline diabetes is definitely treatable and need not shorten the cat's life span or life quality. Management of the diabetic cat should be a multipronged approach incorporating insulin, dietary therapy (to reduce carbohydrate load and induce weight loss if the cat is overweight), and management of any infection or concurrent condition.  With early intervention and good glycemic control, diabetic remission was achieved in over 75% of cats (2).

References:

1. American Diabetes Association Website: American Diabetes Alert Day, 2012.    
2. Rand JS, Fleeman LM, Farrow HA, et al. Canine and feline diabetes mellitus: nature or nurture? Journal of Nutrition 2004;134(8 Suppl):2072S-2080S. 
3. Baral RM, Rand JS, Catt MJ, et al. Prevalence of feline diabetes mellitus in a feline private practice. Journal of Veterinary Internal Medicine 2003;17:433.
4. Lederer R, Rand JS, Jonsson NN, et al. Frequency of feline diabetes mellitus and breed predisposition in domestic cats in Australia. Veterinary Journal 2009;179:254-258. 
5.  Panciera D, Thomas C, Eicker S, et al: Epizootiologic patterns of diabetes mellitus in cats: 333 cases (1980-1986). Journal of the American Veterinary Medical Association 1990;197:1504-1508. 
6. McCann TM, Simpson KE, Shaw DJ, et al. Feline diabetes mellitus in the UK: the prevalence within an insured cat population and a questionnaire-based putative risk factor analysis. Journal of Feline Medicine and Surgery 2007;9:289-99. 
7. Prahl A, Guptill L, Glickman NW, et al. Time trends and risk factors for diabetes mellitus in cats presented to veterinary teaching hospitals. Journal of Feline Medicine and Surgery  2007;9:351-358. 

FDA Video: Safe Handling of Pet Food in the Home

This week the U.S. Food and Drug Administration’s Center’s for Veterinary Medicine released a new video that cautions consumers about the health dangers — in the form of food-borne illness and disease—associated with feeding pet foods.

Based upon the unsettling assumption that pet food or treats might be contaminated, the video brings to light how your pet (and you) might avoid becoming ill if you follow some basic, commonsense food safety guidelines. And what steps to take should you suspect a pet food has adversely affected you or your pet.

Taking these precautions are very important in animals with endocrine disease, especially since many hormonal problems (e.g., diabetes, hyperadrenocorticism, hyperthyroidism) lead to a suppressed immune system and a decreased ability to ward off infections or other toxicities.

To see the video, click here to to directly to the FDA website or see the link below.

Link:

• FDA Website: Safe Handling of Pet Food in the Home (Video) http://www.fda.gov/AnimalVeterinary/ResourcesforYou/AnimalHealthLiteracy/ucm296800.htm?source=govdelivery

3 Brands of Chicken Jerky Treats Implicated in Causing Illness in Dogs

According to FDA records obtained by MSNBC.com, 3 brands of chicken jerky treats made in China have been connected to multiple canine illnesses following their consumption.

Brands most often cited in Priority 1 cases — instances in which the animal was younger than 11 years old and medical records were available — included Waggin' Train and Canyon Creek Ranch jerky or tenders, produced by Nestle Purina PetCare, and Milo's Kitchen Home-style Dog Treats, manufactured by Del Monte.

See the MSNBC/Vitals blog for the complete story.

FDA Released Q & A Regarding Jerky Treats from China

Continued complaints of dogs becoming ill after consuming chicken jerky treats from China has prompted the U.S. Food and Drug Administration to release a document entitled, "Questions and Answers Regarding Chicken Jerky Treats from China."

Click the link to go to the FDA website to read the content of this informative Q & A document.

Movement to Ban Chicken Jerky Treats Gains Momentum

The FDA has received some 600 complaints that chicken jerky treats from China are causing kidney disease, and in some cases death, in dogs across the U.S. But since extensive testing hasn't confirmed a contaminant, the FDA is only warning consumers about a possible problem. Newer tests, which are looking for heavy metal contaminants, are still pending.

Owners are pushing for further action, and one owner-geared Facebook group on the issue now has over 2,600 members (1).  The same group has posted a YouTube video that outlines the situation (2). One petition demanding the ban of jerky treats from China has acquired more than 3,300 signatures (3).

For more information, see the article posted today on the Food Safety News.com (4).

Links:

1. Facebook Group. Animal Parents Against Pet Treats Made in China!
2. YouTube Video. Animal Parents Against Pet Treats Made in China! 
3. Care2petitionsite. Ban All Poisonous Chicken Jerky Treats Imported From China
4. Andrews, J. Dogs fall ill as owners, vets, and lawmakers blame treats from China. Food Safety News. March 9, 2012.

Pet Obesity Epidemic Expanding, But Owners in Denial

Big Pets Get Bigger: 

Latest Survey Shows US Dog and Cat Obesity Epidemic Expanding 

The “fat pet gap” continues to widen according to the latest nationwide survey conducted by the Association for Pet Obesity Prevention (APOP). The fifth annual veterinary survey found 53 percent of adult dogs and 55 percent of cats to be classified as overweight or obese by their veterinarian. That equals 88.4 million pets that are too heavy according to veterinarians.

“The most distressing finding in this year’s study was the fact that more pet owners are unaware their pet is overweight.” comments APOP founder Dr. Ernie Ward. “22 percent of dog owners and 15 percent of cat owners characterized their pet as normal weight when it was actually overweight or obese. This is what I refer to as the “fat pet gap” or the normalization of obesity by pet parents. In simplest terms, we’ve made fat pets the new normal.”

 Perhaps even worse was the finding that the number of obese pets, those at least 30 percent above normal weight or a body condition score (BCS) of 5, continues to grow despite 93.4 percent of surveyed pet owners identifying pet obesity as a problem. The study found 24.9 percent of all cats were classified as obese and 21.4 percent of all dogs were obese in 2011. That’s up from 2010 when 21.6 percent of cats and 20.6 percent of dogs were found to be obese. “What this tells us is that more and more of our pets are entering into the highest danger zone for weight-related disorders.” says Ward.

Endocrinologist and fellow APOP Board member Dr. Mark Peterson agrees. “Obesity in dogs and cats is not just the accumulation of large amounts of adipose tissue, but it is associated with important metabolic and hormonal changes in the body. For example, heavy or obese cats are up to four times more likely to develop diabetes as a complication of their obesity. Losing weight can lead to reversal of the diabetic state in some of these obese cats.”

To read or download the complete article and results of the APOP survey, click here.

To learn more about pet obesity or the APOP, go to the Association for Pet Obesity Prevention website.

The Cooking of Commercial Pet Food

As an endocrinologist, I have now been in practice for a very long time (over 3 decades). But the longer I practice and care for dogs and cats with a variety of hormonal problems (from diabetes to thyroid disease to Cushing's syndrome), the more I realize the vital roles proper nutrition and diet make in the overall success of the patient's treatment.

Susan Thixton has an excellent website — TruthaboutPetFood.com —that I recommend to anyone interested in learning more about pet foods. After reviewing the website, you might want to subscribe to the 'Truth' Newsletter to keep up to date with her many reviews and alerts.

In one of this week's posts (The Cooking of Pet Food), Susan provides a link to an article published on the Pet Food Institute website on "How Pet Food Is Made" written by Greg Alldrich, PhD, a consultant to the pet food industry. In this article, Dr. Alldrich explains that the cooking process of pet foods — both kibble and canned —"provides a number of benefits, including convenience, enhanced flavor and texture, improved consistency, pathogen control and decreased spoilage."

He continues "However, extensive processing can increase variability, destroy essential nutrients and create unwholesome by-products. From a formulator’s perspective, this creates a dilemma regarding how to assure the diet is sufficiently fortified while avoiding excess after accounting for processing effects."

In this article, Dr. Alldrich encourages the pet food industry to learn more about how pet food ingredients are affected during the cooking process.

Links:

• TruthAboutPetFood.com website http://www.truthaboutpetfood.com/
• Pet Food Institute website www.petfoodinstitute.org 
• The Cooking of Pet Food www.truthaboutpetfood.com/articles/the-cooking-of-pet-food.html
• How Pet Food Is Made www.petfoodinstitute.org/Index.cfm?Page=HowPetFoodisMade