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It’s Not Just Grain-Free: An Update on Diet-Associated Dilated Cardiomyopathy from Tufts

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It’s Not Just Grain-Free: An Update on Diet-Associated Dilated Cardiomyopathy from Tufts
Posted on December 5, 2018 in News, Caring for your pet

Article by Lisa M. Freeman, DVM, PhD, DACVN.

Heart disease is common in our companion animals, affecting 10-15% of all dogs and cats, with even higher rates in Cavalier King Charles Spaniels, Doberman Pinschers, and Boxer dogs.  Most nutritional recommendations focus on treating dogs and cats with heart disease and there is much less information on the role of diet in causing heart disease. There has been some risk of heart disease associated with boutique or grain-free diets and exotic ingredients.

However, a recent increase in heart disease in dogs eating certain types of diets may shed light on the role of diet in causing heart disease.  It appears that diet may be increasing dogs’ risk for heart disease because owners have fallen victim to the many myths and misperceptions about pet food.  If diet proves to be the cause, this truly is heart-breaking to me. But I’ve also found a tremendous amount of confusion and misinformation in the past 5 months including people who doubt that this is a real issue, some who still haven’t heard about it, and people who mistakenly think it’s just grain-free diets or that it’s only related to taurine.

As a result of the continued confusion, some of my cardiologist colleagues and I wrote an article which was published in the latest issue of the Journal of the American Veterinary Medical Association.  This article provides a summary of our current understanding of diet-associated dilated cardiomyopathy (DCM), how to recognize it, and a recommended protocol for veterinarians to follow when they see dogs with DCM.

To be sure this information reaches as wide an audience as possible and to clear up confusion, I thought I’d provide some updates to address the most common misconceptions I’m hearing:

  1. It’s not just grain-free. This does not appear to be just an issue with grain-free diets.  I am calling the suspected diets, “BEG” diets – boutique companies, exotic ingredients, or grain-free diets.  The apparent link between BEG diets and DCM may be due to ingredients used to replace grains in grain-free diets, such as lentils or chickpeas, but also may be due to other common ingredients commonly found in BEG diets, such as exotic meats, vegetables, and fruits.  In addition, not all pet food manufacturers have the same level of nutritional expertise and quality control, and this variability could introduce potential issues with some products.
  1. Most dogs being diagnosed with DCM do not have low taurine levels. Some owners continue to feed a BEG diet but supplement taurine thinking that this will reduce their risk for heart disease.  In our hospital, we currently measure taurine in all dogs with DCM, but more than 90% of our patients with DCM in which taurine has been measured have normal levels (and the majority are eating BEG diets).  Yet some of these dogs with DCM and normal taurine levels improve when their diets are changed.  This suggests that there’s something else playing a role in most cases – either a deficiency of a different nutrient or even a toxicity that may be associated with BEG diets.  Giving taurine is unlikely to prevent DCM unless your dog has taurine deficiency.  And given the lack of quality control for dietary supplements, you can introduce new risks to your dog if you give a supplement without evidence that she needs it.
  1. Raw diets and homemade diets are not safe alternatives. Out of concern, some owners are switching from BEG diets to a raw or home-cooked diet.  However, we have diagnosed DCM in dogs eating these diets too.  And raw and home-cooked diets increase your dog’s risk for many other health problems.  So, forego the raw or home-cooked diets and stick with a commercial pet food made by a well-established manufacturer that contains common ingredients, including grains.  If your dog requires a home-prepared diet for a medical condition or you feel strongly about feeding one, I strongly recommend you consult with a Board-Certified Veterinary NutritionistTM (acvn.org).  However, because home-cooked diets are not tested for safety and nutritional adequacy like good quality commercial diets, deficiencies could still develop.

Current thoughts on DCM

Currently, it appears that there may be three separate groups of dogs with DCM (although this may change as we learn more). I am listing them in the approximate frequency that we are currently seeing them in our hospital:

  1. Diet-associated DCM with normal taurine levels. While this form of the disease was first identified in dogs of breeds not predisposed to DCM that are eating BEG diets, it appears to also occur in dogs of typical DCM breeds that are eating a BEG diet.
  2. Primary DCM in predisposed breeds that is unrelated to diet. This is the traditional, genetically-related DCM in typical breeds, such as the Doberman Pinscher, Boxer, Irish Wolfhound, and Great Dane.
  3. Diet-associated DCM with taurine deficiency: This is the least common form we are seeing in our hospital. This appears to happen both in breeds predisposed to DCM and breeds that are not predisposed to DCM.

Common questions

We still have a great deal to learn about diet-associated DCM.  However, I’m providing answers to some common questions I’ve been getting based on what is currently known:

  1. What’s causing diet-associated DCM in dogs? For the vast majority of dogs, we do not yet know what is causing this disease. There are definitely some dogs with DCM that have low taurine levels, many of which will improve with taurine supplementation and change of diet.  For dogs that have normal taurine levels, however, other nutritional deficiencies may be present. Some nutritional deficiencies can affect the heart’s normal function, so an insufficient amount of these nutrients (or reduced bioavailability) in the diet could cause heart disease.  Diet-associated DCM could also be due to an ingredient in the food that is toxic to the heart.  The FDA and many researchers are actively studying this issue so that it can be solved as quickly as possible.
  1. My dog was diagnosed with DCM. What should I do? Ask your veterinarian to measure taurine levels and give heart medications as directed by your veterinarian. If your dog is eating a BEG diet or other unconventional diet (including vegetarian, vegan, or home-prepared diets), I recommend following the steps outlined in my previous post, including switching to a non-BEG diet.  Three updates to my previous post are:
    • Taurine supplements: Consumer Lab is expected to release a report on independent quality control testing of taurine supplements in late 2018. Given the lack of quality control for dietary supplements (human and pet), having these results will be very useful to find good quality products for dogs that require taurine supplementation. Your veterinarian or veterinary cardiologist can help you determine an optimal dose for your dog.
    • Other dogs in the household: We are now recommending that other dogs in the household of dogs with DCM that are eating the same BEG diet be screened by their veterinarian since their hearts could also be affected (even if they are showing no symptoms).
    • Outcome: Not all dogs with DCM will improve and improvements in the echocardiogram, when they do occur, can take a long time (often more than 6 months).
  1. If my dog is eating a BEG diet but has no symptoms, should I test for DCM or switch to a different diet? It’s unlikely that most dogs eating a BEG diet will develop DCM. However, given the fact that we don’t yet understand why BEG diets are affecting some dogs and because DCM is a life-threatening disease, I recommend you reconsider your dog’s diet until we know more.  Contrary to popular belief, there are no health benefits of grain-free or exotic ingredient diets except in the rare case of food allergy. If your dog is a part of your family and you want to feed him the very best, be sure to base this important decision on more objective factors than marketing and the ingredient list (see our post).Be sure to watch for early signs of heart disease – weakness, slowing down, less able to exercise, shortness of breath, coughing, or fainting. If you notice any of these, get your dog checked out by your veterinarian who will listen for a heart murmur or abnormal heart rhythm (although not all dogs with DCM have any changes that can be heard with a stethoscope). Your veterinarian (or a veterinary cardiologist) may do additional tests, such as x-rays, blood tests, electrocardiogram, and ultrasound of the heart (echocardiogram – the test of choice to diagnose DCM).Tell your veterinarian what you’re feeding your dog. You can help your veterinarian by bringing a list of everything your dog eats to every appointment.If your dog has no symptoms, additional testing is really up to you.  Some owners have measured plasma and whole blood taurine levels or scheduled an echocardiogram to check their dog’s heart size and function.  However, given the cost of an echocardiogram, other owners have elected to have their veterinarian do a blood test called NT-proBNP, which goes up when the heart is enlarged.  While a normal value doesn’t guarantee your dog has no heart disease, a high level suggests your dog’s heart should be evaluated further.
  2. Has diet-associated DCM been seen in cats? The association between BEG diets and heart disease has only been reported in dogs so far. However, that doesn’t mean cats are immune.  If your cat is diagnosed with DCM and is eating a BEG, vegetarian, vegan, or home-prepared diet, I recommend following the same protocol as described for dogs with DCM.

Lastly, if your dog has been eating a BEG diet and has been diagnosed with DCM, please don’t feel guilty. I’ve talked to owners who feel terrible because they wanted to provide the finest care for their dog by feeding them the best diet possible. They often spent a lot of money buying an expensive boutique diet and now that same diet may be associated with their dog’s heart disease. Trying to decide what is really the best food is confusing and difficult because of the many different products available, nutrition fads, and compelling marketing. My hope is that the one bright side of this serious situation is that it will shine a light on the complexities of making safe and nutritious pet food and the importance of nutritional expertise and quality control, rather than just what is new and trendy.

 

Article courtesy of Tufts University

 

 

 

          
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You assessed your cat's body condition score (BCS) to be to be 3 out of 9.

What does this mean? The BCS is an assessment of your cat’s general body composition, including muscle and fat. While a score of 4 to 5 is ideal, a BCS of 3 indicates that your cat is thin.

What to do next: While thin cats are generally at lower risk for serious health issues compared to overweight cats, being underweight can lead to decreased muscle mass, malnutrition, and a weakened immune system. Unless there is an underlying reason for your cat’s thinness, the situation can often be improved with simple lifestyle adjustments, such as:

  • Offering a palatable diet recommended by your veterinarian
  • Feeding small, frequent meals
  • Stimulating the appetite by warming the food or introducing toppers
  • Minimizing stress
  • Weighing your cat monthly
  • Re-checking your cat's BCS at home
  • Staying alert to other health changes (especially continued weight loss and appetite loss)

Your cat's BCS provides valuable insights into their overall health and helps us spot potential issues early. While a BCS of 3 isn’t an immediate cause for concern, it’s a sign that small adjustments to their feeding and care routine could have a positive impact on their health.

Questions? We can help. Let’s work together to score a win for your cat's health.

You assessed your cat's body condition score (BCS) to be to be 6 out of 9.

What does this mean? The BCS is an assessment of your cat’s general body composition, including muscle and fat. While a score of 4 to 5 is ideal, a BCS of 6 indicates that your cat is borderline overweight.

What to do next: Simple daily actions can help prevent your cat from becoming overweight. Even a few extra ounces or pounds can significantly impact their health, increasing the risk of serious conditions like diabetes, arthritis, and kidney disease.

Restore your cat's future health by:

  • Feeding portioned meals (Your veterinarian can assist you with how much to feed)
  • Reducing stress by minimizing household changes and maintaining a routine
  • Decreasing boredom with interactive toys, social interaction, and cat furniture
  • Separating pets during meal time (Consider a microchip-linked feeder for multi-cat households)
  • Weighing them monthly
  • Re-checking your cat's BCS at home

Your cat's BCS is like a warning light for their future health. Taking proactive steps to address your cat’s weight can minimize future complications and help ensure they stay fit, agile, and healthy.

Curious about other ways to improve your cat’s BCS and overall well-being? Get in touch. Let’s work together to score a win for their health.

You assessed your dog's body condition score (BCS) to be to be 4-5 out of 9.

What does this mean? The BCS is an assessment of general body composition, including muscle and fat. On a scale of 1 to 9, with 1 being very thin and 9 being obese, your dog's score means they are at their ideal weight for optimal health and well-being!

What to do next: First, give your dog a scratch behind the ears to celebrate your success! Your commitment to their preventive health—regular vet visits, balanced nutrition, and consistent exercise—is truly paying off. But don’t relax just yet—maintaining a healthy BCS takes ongoing effort throughout your dog's life, including:

  • Feeding portioned meals
  • Avoiding high-calorie treats, diets, and people food
  • Staying active with regular exercise
  • Re-checking your pet’s BCS monthly at home
  • Staying on top of routine care (exams, screening tests) to ensure early detection of health changes

Just like your dog's vital signs, their BCS gives valuable insight into their overall health. Right now, we like what we see—and feel! But remember, supporting your dog's lifelong health is a team effort. By continuing the great work you’re doing and partnering with us, we can help ensure they stay healthy for years to come.

You assessed your cat's body condition score (BCS) to be to be 7-8 out of 9.

What does this mean? The BCS is an assessment of your cat’s general body composition, including muscle and fat. While a score of 4 to 5 is ideal, a BCS of 7-8 indicates that your cat is overweight.

What to do next: Weight issues are a common cause of many feline health problems, some of which can shorten a cat's life. Fortunately, with your dedication and our support, your cat can achieve better health, mobility, and an ideal body weight.

Rather than asking your cat to participate in daily exercise, feline weight loss emphasizes targeted nutrition and stress reduction to help them shed those unwanted pounds. This entails:

  • Offering a palatable weight-management diet recommended by your veterinarian
  • Feeding portioned meals (Your veterinarian can assist you with how much to feed)
  • Using a microchip-linked feeder for multi-cat households to ensure each cat consumes their veterinarian-recommended portion
  • Minimizing stress by maintaining a stable routine
  • Decreasing boredom through positive interactions such as interactive toys, food puzzles, cat-friendly furniture, and social bonding
  • Promoting movement with motion-activated food toys and puzzles
  • Weighing them monthly
  • Re-checking their BCS at home

Overweight cats not only face long-term health risks but can also suffer from discomfort and emotional stress. Intentional, veterinary-supervised changes can help ensure your cat’s fitness, comfort, and overall well-being for years to come. Let’s work together to score a win for your cat's health.

You assessed your dog's body condition score (BCS) to be to be 3 out of 9.

What does this mean? The BCS is an assessment of general body composition, including muscle and fat. While a score of 4 to 5 is ideal, a BCS of 3 indicates that your dog is thin.

What to do next: Although a lean body condition is healthier than being overweight, thinness can indicate muscle loss, health changes, or a lack of appropriate nutrition. Here are a few ways to help your dog reach their optimal weight and health:

  • Follow any recommendations given by your vet (these are personalized for your dog's unique needs)
  • Gradually transition your dog to a calorie-dense diet
  • Weigh them monthly
  • Re-check their BCS at home
  • Provide regular moderate exercise to build healthy muscle
  • Monitor them for other health changes (appetite loss, vomiting, unusual stools, fatigue, etc.)

Just like your dog's vital signs, their BCS gives valuable insight into their overall health and can help identify potential issues early. While a BCS of 3 isn't a serious concern, it suggests that your dog may benefit from adjustments to their diet and exercise routine. Please continue to monitor your dog for any other health changes—including difficulty gaining weight—as these could indicate the need for further evaluation. Let’s work together to help your dog achieve better health, so you can make the most of every moment together.

Now that’s a perfect score.

You assessed your dog's body condition score (BCS) to be to be 9 out of 9.

What does this mean? The BCS is an assessment of general body composition, including muscle and fat. While a score of 4 to 5 is ideal, a BCS of 9 indicates that your dog is obese (weighing 20% or more above their ideal weight).

What to do next: Dogs with obesity are in significant danger of many life-altering health conditions, including arthritis, cardiovascular problems, kidney disease, and cancer. Reducing your dog's weight and improving their body condition is critical to restoring their comfort, mobility, health, and longevity.

Take action today to protect your dog's  health by:

  • Following any veterinarian’s recommendations (these are personalized to your dog's unique needs)
  • Using a measuring cup to portion meals
  • Removing uneaten food after 20 minutes
  • Limiting treats to low-calorie fruits or vegetables
  • Exercising daily for at least 30 minutes (leash walks are a great way to start)
  • Weigh them  monthly
  • Re-check their BCS at home

Just like your dog's vital signs, their BCS gives valuable insight into their overall health. In your dog's case, it’s a signal for immediate action.

By following the steps above and your veterinarian’s recommendations, getting your dog back to a healthy weight is possible, but it will take time and effort. That’s why we’re here to help you every step of the way.

Let’s work together to score a WIN for Sydney’s health.

You assessed your cat's body condition score (BCS) to be 1–2 out of 9.

What does this mean? The BCS is an assessment of your cat’s general body composition, including muscle and fat. While a score of 4 to 5 is ideal, a BCS of 1 to 2 indicates that your cat is very thin, at least 20% below their ideal weight. This may be caused by poor nutrition or an underlying illness.

What to do next: Since a BCS of 1 to 2 can indicate potential health concerns, your cat's veterinarian may suggest blood work or other tests.

In addition to following any plan outlined by your cat's veterinarian, the following steps may help them achieve their ideal weight and BCS:

  • Offering a palatable diet recommended by your veterinarian
  • Feeding small, frequent meals
  • Warming the food or introducing toppers
  • Feeding pets separately
  • Minimizing stress
  • Weighing them  monthly
  • Re-checking their BCS at home
  • Watching for other concerning signs, such as loss of appetite, vomiting, or changes in litter box habits, as these may require prompt veterinary care.

Just like your cat's vital signs, their BCS offers important insight into their overall health. While a BCS of 1 to 2 can be concerning, we’ll work together to help your cat safely achieve their optimal weight and vitality.

You assessed your dog's body condition score (BCS) to be to be 6 out of 9.

What does this mean? The BCS is an assessment of general body composition, including muscle and fat. While a score of 4 to 5 is ideal, a BCS of 6 indicates that your dog is borderline overweight.

What to do next: With just a few pounds separating your dog from being overweight, a BCS of 6 is a clear call to action! Excess weight can increase their risk for serious health problems, such as arthritis, heart disease, and even cancer, and studies have shown that it can shorten their lifespan.

Here are a few ways to help Gigi reach their ideal weight:

  • Follow any recommendations given by your veterinarian (these are personalized for your dog's unique needs!)
  • Use a measuring cup to portion meals
  • Don’t leave food out all day
  • Weigh them monthly
  • Re-check their BCS at home
  • Provide regular moderate exercise to build healthy muscle

Just like your dog's vital signs, their BCS gives valuable insight into their overall health and and can help identify potential issues early. While a BCS of 6 isn't dangerous, it does raise their risk for many life-altering conditions and signals a need for change.

Let’s work together to help your dog achieve a better BCS and overall wellness, so you can make the most of every moment together.

Now that’s a perfect score!

You assessed your dog's body condition score (BCS) to be to be 7-8 out of 9.

What does this mean? The BCS is an assessment of general body composition, including muscle and fat. While a score of 4 to 5 is ideal, a BCS of 7 to 8 indicates that your dog is overweight.

What to do next: Your dog's weight is putting them at an increased risk for many serious conditions, including arthritis, diabetes, cancer, and heart disease. Overweight dogs are also clinically shown to have a shorter lifespan and a reduced quality of life.

Thankfully, it’s not too late to get back on track! Here are some simple steps to help your dog achieve a better BCS and a healthier life:

Here are a few ways to help them reach their ideal weight:

  • Reduce meal portions by 10% to 20%
  • Use a measuring cup for accuracy
  • Switch to a weight management diet
  • Swap treats for low-calorie fruits and veggies
  • Increase daily walks and playtime
  • Use a food-dispensing toy instead of a bowl to encourage movement
  • Weigh them monthly
  • Re-check their BCS at home

Just like your dog's vital signs, their BCS gives valuable insight into their overall health and quality of life. The actions you take in the days, weeks, and months ahead can help them slim down, restore their well-being, and allow you both to make the most of every moment together.

Let’s work together to score a WIN for your dog's health and happiness.

Now that’s a perfect score!

You assessed their body condition score (BCS) to be to be 9 out of 9.

What does this mean? The BCS is an assessment of your cat’s general body composition, including muscle and fat. While a score of 4 to 5 is ideal, a BCS of 9 indicates that your cat is obese (20% or more over their ideal body weight).

What to do next: Cats with obesity are in a health crisis. Excess weight strains their joints, leading to painful and decreased mobility. In addition, abundant fat tissue increases their risk for life-altering diseases like diabetes, arthritis, kidney disease, heart disease, and cancer.

Let their BCS be a turning point in their health.

With simple lifestyle changes and guided support from our team, we can restore your cat's quality of life and help them lose those unnecessary pounds.

We’ll focus on nutrition and stress reduction to create positive results. This includes:

  • Offering a palatable weight-management diet recommended by your veterinarian
  • Feeding portioned meals (Your veterinarian can assist you with how much to feed)
  • Using a microchip-linked feeder for multi-cat households to ensure each cat consumes their veterinarian-recommended portion
  • Minimizing stress in your cat’s environment
  • Decreasing boredom through positive interactions (interactive toys, food puzzles, cat-friendly furniture, and social bonding)
  • Encouraging healthy movement and exploration (motion-activated toys, food puzzles, ramps to perches, scratching posts, cat tunnels)
  • Weighing them monthly
  • Re-checking their BCS at home

Your cat’s body condition is a key factor in their health and longevity. Together, we can score a victory by helping them lose weight and reclaim their health, happiness, and mobility.

You assessed your cat's body condition score (BCS) to be 4-5 out of 9.

What does this mean? The BCS is an assessment of your cat’s general body composition, including muscle and fat. On a scale of 1–9, with 1 being very thin and 9 being obese, this score means they are at their ideal weight for optimal health and well-being!

What to do next: First, give your cat a head bump or a scratch to celebrate your success! Your dedication to their overall health—through regular vet visits, balanced and portion-controlled nutrition, a low-stress environment, and plenty of physical and mental activity—is truly paying off.

But don’t relax just yet—maintaining your cat’s healthy BCS will take ongoing effort throughout their lifetime. Keep up the good work by:

  • Minimizing stress
  • Creating a mentally and physically stimulating environment
  • Satisfying your cat’s social needs with one-on-one time
  • Encouraging movement with interactive toys, perches, and furniture
  • Feeding measured portions of a veterinarian-recommended, high quality, palatable diet
  • Checking your cat’s BCS monthly at home
  • Staying on top of routine veterinary care

Just like your cat's vital signs, their BCS gives us valuable insight into their overall health. Right now, we like what we see—and feel! But remember, supporting your cat's lifelong health is a team effort. By continuing the great work you’re doing and partnering with us, we can help ensure they stay healthy for years to come.

You assessed your dog's body condition score (BCS) to be 1–2 out of 9.

What does this mean? The BCS is an assessment of general body composition, including muscle and fat. While a score of 4 to 5 is ideal, a BCS of 1 to 2 indicates that your dog is very thin, at least 20% below their ideal weight. This may be caused by poor nutrition or an underlying illness.

What to do next: Since a BCS of 1 to 2 can indicate potential health concerns, your dog's veterinarian may suggest  blood work or other tests.

If no issues are found, the following steps may help your dog achieve their ideal weight and BCS:

  • Gradually transitioning them to a calorie-dense diet
  • Feeding more frequent meals
  • Weighing them monthly
  • Re-checking their BCS at home
  • Providing regular moderate exercise to build healthy muscle
  • Monitoring them for other health changes (appetite loss, vomiting, unusual stools, fatigue, etc.)

Just like your dog's vital signs, their BCS offers important insight into their overall health and can serve as an early warning that something may be wrong. While a BCS of 1 to 2 can be concerning, please know that your pet's well-being is our top priority. Let’s work together to help your pet pal achieve better health, so you can make the most of every moment together.