Dilated Cardiomyopathy
(DCM)
FDA Finds No Evidence that Grain-Free Diets Are Causing Canine Dilated Cardiomyopthy (DCM)
The U.S. Food and Drug Administration has issued an alert about reports of canine dilated cardiomyopathy (DCM) in dogs eating pet foods containing peas, lentils, other legume seeds, or potatoes as main ingredients. “These reports are unusual because DCM is occurring in breeds not typically genetically prone to the disease.” DCM is a disease of the heart muscle and results in an enlarged heart that often results in congestive heart failure.
March 2020 Update from Linda Case It’s Not Rocket Science….But, it IS Science
Review of canine dilated cardiomyopathy in the wake of diet-associated concerns
Recommendations
“But given what we do know, we recommend feeding a diet that contains sufficient levels of high-quality, animal-source protein, does not include plant-source proteins as primary protein sources, and does not contain high levels of dietary fiber.” Linda Case - Whole Dog Journal
“A diet with more than 75 grams of protein per 1000 calories is a good place to start” (Pet Food Math Cheat Sheet)
How To Determine Grams of Protein per 1000 calories
“Avoid diets at the current time which appear to rely heavily on legumes to meet the protein content of the diet. This is difficult to evaluate on the label. If a fresh meat is first on the ingredient list, followed by a legume or legume protein, it’s likely the legume that provides more contribution to the diet since it’s dry whereas the meat is mostly water. Similarly, if there’s a number of legumes listed and only one meat, that could also be a sign. Or if a legume is the first or second ingredient. Legumes can afford some nutritional benefits, but their history as a significant protein source is less well known.” https://justinshmalberg.com/blog/2019/7/3/dilated-cardiomyopathy-and-grain-free-diets-thoughts-on-the-fda-update
March 2020 Update from Linda Case It’s Not Rocket Science….But, it IS Science
‘BEG’ pet food and DCM, part 2: Is veterinary bias at play?
The Worst Pet Foods for Carcinogenic Glyphosate Exposure
“Breeds that are typically more frequently affected by DCM include large and giant breed dogs, such as Great Danes, Boxers, Newfoundlands, Irish Wolfhounds, Saint Bernards and Doberman Pinschers. It is less common in small and medium breed dogs, except American and English Cocker Spaniels. However, the cases that have been reported to the FDA have included Golden and Labrador Retrievers, Whippets, a Shih Tzu, a Bulldog and Miniature Schnauzers, as well as mixed breeds.”
“Diets in cases reported to the FDA frequently listed potatoes or multiple legumes such as peas, lentils, other pulses (seeds of legumes), and their protein, starch and fiber derivatives early in the ingredient list, indicating that they are main ingredients. Early reports from the veterinary cardiology community indicate that the dogs consistently ate these foods as their primary source of nutrition for months to years.” https://www.petfoodindustry.com/articles/7984-infographic-official-data-on-grain-free-dog-food-and-dcm
“Most dogs in the U.S. have been eating pet food without apparently developing DCM. It’s not known how commonly dogs develop DCM, but the increase in reports to FDA signal a potential increase in cases of DCM in dogs not genetically predisposed.” [2]
“We suspect that cases are underreported because animals are typically treated symptomatically, and diagnostic testing and treatment can be complex and costly to owners. FDA has observed a reporting bias for breeds like Golden Retrievers due to breed-specific social media groups and activities that have raised awareness of the issue in these communities and urged owners and vets to submit reports to FDA. Because the occurrence of different diseases in dogs and cats is not routinely tracked and there is no widespread surveillance system like the Centers for Disease Control and Prevention have for human health, we do not have a measure of the typical rate of occurrence of disease apart from what is reported to the FDA.” [2]
Dr. Justin Shmalberg Board-Certified Veterinary Nutrition (ACVN)
Consider feeding a higher protein diet. Dogs have requirements for essential amino acids (protein) and fatty acids (fat) but not for carbohydrates (although carb-containing ingredients, including peas and potatoes, provide energy along with a host of phytonutrients and other benefits in moderation). A diet with more than 75 grams of protein per 1000 calories is a good place to start, especially if your pet is overweight, doesn’t eat a lot of food, has a known heart condition, or is active to give pertinent examples. This is determined by calling the company or estimating from a guaranteed analysis. Feeding more protein generally provides more SCAAs, those taurine precursors I mentioned earlier.
Consider a diet with additive taurine. We again don’t yet know that taurine is a preventative or treatment factor in atypical DCM cases, but it has a high margin of safety. Diets with supplemental methionine can also be helpful and represent an alternate option (since that’s a taurine precursor in dogs). You can always ask a company how they determined if additional taurine or methionine was or wasn’t required - but you may not get an answer to such a technical question.
Avoid diets at the current time which appear to rely heavily on legumes to meet the protein content of the diet. This is difficult to evaluate on the label. If a fresh meat is first on the ingredient list, followed by a legume or legume protein, it’s likely the legume that provides more contribution to the diet since it’s dry whereas the meat is mostly water. Similarly, if there’s a number of legumes listed and only one meat, that could also be a sign. Or if a legume is the first or second ingredient. Legumes can afford some nutritional benefits, but their history as a significant protein source is less well known. It may end up being perfectly safe, but the reason for higher inclusions (vs. meat) is generally for sustainability, processing, or cost. There’s no reason to avoid legumes or potatoes entirely, and I’ve formulated diets of all types with both ingredients but at low inclusion rates, in the interest of full disclosure.
Consider varying the diet. I’m not a proponent of feeding the same diet for the life of any dog or cat. Nutritional variety helps to overcome any particular issues with a certain formulation. Also consider different types of diets - if you’re feeding kibble, other options can be explored in addition or alone (canned foods, pasteurized foods, fresh foods, balanced home-prepared diets, etc.).
Talk to pet food companies about their testing and formulation process. Do they work with nutritionists to formulate? Do they test the final product to ensure it meets the requirements? Both are preferable.
If you have a Golden Retriever on any diet, screening is an option both in terms of an echocardiogram and taurine level until we know more. There certainly are some Golden retrievers that may have DCM from taurine deficiency, and this may be due to genes and not diet alone.
Remember that vets and other industry experts (including those at companies) aren’t trying to be evasive when not giving answers about the potential DCM association to diet. Simply put, no one has conclusive answers and there are a number of people working to sort this out but it will unfortunately take time.
Pet Food Math Cheat Sheet
Looking for a higher protein, lower carb diet requires doing a some math and very few companies report the number of grams of protein per 1,000 calories (kcal). So I created a Pet Food Math Cheat Sheet to calculate this information for you and so much more. Enter the information from the "Guaranteed Analysis" (or typical analysis / nutrient analysis) and the "Calorie Content" on the food label and the cheat sheet will do the math so you can compare any type of food. The cheat sheet can also uncover errors and potentially misleading information. (e.g. high “ash” content, high fat content, etc.) The Pet Food Math Cheat Sheet is more than a carbohydrate calculator.
More information on the Pet Food Math Cheat Sheet can be found here:
DCM in Dogs: Taurine’s Role in the Canine Diet (Linda Case)
Podcast – DCM, the FDA, and Dog Food-the Science and the Hype with Canine Nutritionist Linda Case
Canine heart disease has spiked - Here's why
Diseases of the heart and lungs — One of the symptoms of a heart condition such as dilated cardiomyopathy in dogs is excessive panting.
Mixed Results from Reaching Out to Pet Food Companies About DCM
Food choice Considerations
My goal would be to select foods that do not appear to rely heavily on peas, lentils, chickpeas, garbanzo beans, and other legumes or potatoes to make up a substantial amount of the protein content in the food.
What do we know?
Webinar: Diet and Dilated Cardiomyopathy - Linda Case
Dilated Cardiomyopathy in Dogs: Study on Protein Source
Diet, Dogs, and DCM (Recap of DCM)
‘BEG’ pet food and DCM, part 2: Is veterinary bias at play?
‘BEG’ pet food does not equal DCM
Canine heart disease has spiked - Here's why
Analysis by Dr. Karen Shaw Becker
‘BEG’ pet food does not equal DCM
Dilated Cardiomyopathy and Grain-Free Diets: Thoughts on the FDA Update
Dr. Justin Shmalberg - A board-certified specialist in both the American College of Veterinary Nutrition (ACVN) and in the American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR), Shmalberg is also a Clinical Associate Professor and Chief of Integrative Medicine Service at the University of Florida College of Veterinary Medicine.
Update on Diet-Associated Dilated Cardiomyopathy
Veterinarian, board-certified Veterinary Nutritionist
FDA asks pet food industry for DCM-related information
FDA needs pet food producers to report on any changes in ingredients, processing or formulation.
HOW TO CHOOSE DOG FOOD
“Taurine deficiency is well-documented as potentially leading to DCM.” This was a problem with cats in the 1980s. Cats require taurine in their food and it is considered essential in their diet. Taurine has not been considered essential for dogs since they can synthesize taurine from the amino acids cysteine and methionine. The FDA issued their alert after a significant number of dogs developed DCM that were on foods containing high levels of peas, lentils, legumes, or potatoes. These dogs were found to have low levels of taurine in their blood. The exact cause is not known and is currently being studied. It may be that certain dogs have a higher requirement for taurine in their diets. The cause may be low or poor quality proteins in the diet, or be caused by ingredient interactions. DCM in dogs has been studied for years although the cause is not certain there have been low taurine levels in dogs that are associated with lamb meal and rice foods, rice bran, cellulose, beet pulp, and high fiber diets.
“Taurine is found naturally in animal-based proteins; so, providing diets that include a sufficient level of high-quality animal proteins ensures adequate taurine intake.” [1]
“Taurine is present primarily in animal tissues, with greatest concentrations found in muscle tissue. Seafoods provide the most concentrated source (³1000 mg/kg of dry weight), and poultry also contains high levels. 80 Although a carnivorous diet ensures the cat an adequate taurine intake, the consumption of a diet containing high amounts of plant products and cereal grains may not provide sufficient taurine.” [1]
Diet-associated dilated cardiomyopathy in dogs: what do we know? (most recent)
https://www.facebook.com/download/257398794926197/JAVMA_DA-DCM.pdf?hash=AcpTliiI4GuneeGS
Mind Your Peas and Potatoes
https://thesciencedog.com/2018/12/06/mind-your-peas-and-potatoes/
The Heart of the Matter
[1] Canine and Feline Nutrition: A Resource for Companion Animal Professionals Case, Linda P
Research
FDA Investigation into Potential Link between Certain Diets and Canine Dilated Cardiomyopathy June 2019 Update
The association between pulse ingredients and canine dilated cardiomyopathy: addressing the knowledge gaps before establishing causation
Taurine deficiency and dilated cardiomyopathy in golden retrievers fed commercial diets
UC Davis Investigates Link Between Dog Diets and Deadly Heart Disease
Dr. Josh Stern, a veterinary cardiologist and geneticist at UC Davis School of Veterinary Medicine, began seeing an alarming trend in cases at the veterinary hospital two years ago.
High Taurine foods (page 2)
FDA Investigating Potential Connection Between Diet and Cases of Canine Heart Disease
Studies on canine dilated cardiomyopathy
Idiopathic dilated cardiomyopathy in Dalmatians: nine cases (1990-1995) - Journal of the American Veterinary Medical Association, 1996
Effect of Processing on Fate of Dietary [14C]Taurine in Cats1
Myocardial failure in cats associated with low plasma taurine: a reversible cardiomyopathy
Intestinal taurine and the enterohepatic circulation of taurocholic acid in the cat.
Dietary rice bran decreases plasma and whole-blood taurine in cats - The Journal of Nutrition, 2002
Taurine deficiency in dogs with dilated cardiomyopathy: 12 cases (1997-2001) - Journal of the American Veterinary Medical Association, 2003
Taurine status in normal dogs fed a commercial diet associated with taurine deficiency and dilated cardiomyopathy - Journal of Animal Physiology and Animal Nutrition, 2003
Plasma and whole blood taurine in normal dogs of varying size fed commercially prepared food Journal of Animal Physiology and Animal Nutrition 2003
Taurine-deficient dilated cardiomyopathy in a family of golden retrievers - Journal of the American Animal Hospital Association, 2005
Dietary beet pulp decreases taurine status in dogs fed low protein diet – Journal of Animal Science and Technology, 2016
Adin D, DeFrancesco TC, Keene G, et al. Echocardiographic phenotype of canine dilated cardiomyopathy differs based on diet type. Journal of Veterinary Cardiology 2019; 21:1-9.
Backus RC, Cohen G, Pion PD, Good KL, Rogers QR, Fascetti AJ. Taurine deficiency in Newfoundlands fed commercially available complete and balanced diets. J Am Vet Med Assoc. 2003;223:1130–6.
Backus RC, Ko KS, Fascetti AJ, Kittleson MD, MacDonald KA, Maggs DJ, Berg JR and Rogers QR: Low plasma taurine concentration in Newfoundland dogs is associated with low plasma methionine and cyst(e)ine concentration and low taurine synthesis, J Nutr 136:2525-2533, 2006.
Backus RC, Morris JG, Kim SW, O’Donnell JA, Hickman MA, Kirk CA, Cooke JA and Rogers QR: Dietary taurine needs of cats varies with dietary protein quality and concentration, Vet Clin Nutr 5:18-22, 1998.
Barnett KC, Burger IH: Taurine deficiency retinopathy in the cat, J Small Anim Pract 21: 521-526, 1980.
Belanger MC, et al. Taurine-deficient dilated cardiomyopathy in a family of Golden Retrievers. Journal of the American Animal Hospital Association 2005; 41:284-291.
Chiofalo G, De Vita G, Presti VL, et al. Grain free diets for utility dogs during training work: Evaluation of the nutrient digestibility and faecal characteristics. Animal Nutrition 2019; in press.
Delaney SJ, Kass PH, Rogers QR and Fascetti AJ: Plasma and whole blood taurine in normal dogs of varying size fed commercially prepared food, J Anim Physiol Anim Nutr 87:236-244, 2003.
Donadelli RA, Aldrich CG, Jones CK, Beyer RS. The amino acid composition and protein quality of various egg, poultry meal by-products, and vegetable proteins used in the production of dog and cat diets. Poultry Science 2018; October; pp. 1- 8, https://doi.org/10.3382/ps/pey462
Douglass GM, Fern EB and Brown RC: Feline plasma and whole blood taurine levels as influenced by commercial dry and canned diets, J Nutr 121:S179-S180, 1991.
Earl KE, Smith PM. The effect of dietary taurine content on the plasma taurine concentration of the cat. British Journal of Nutrition 1991; 66:227-235.
Fascetti AJ, Reed JR, Roger QR, et al. Taurine deficiency in dogs with dilated cardiomyopathy: 12 cases (1997 – 2001). Journal of the American Animal Veterinary Association 2003; 223:1137-1141.
Freeman LM, et al. Diet-associated cardiomyopathy in dogs: What do we know? Journal of the American Veterinary Medical Association 2018; 253:13901394
Freeman LM, Michel KE and Brown DJ: Idiopathic dilated cardiomyopathy in Dalmatians: nine cases (1990-1995), J Amer Vet Med Assoc 209:1592-1596, 1996.
Freeman LM, Rush JE, Brown DJ, et al. Relationship between circulating and dietary taurine concentrations in dogs with dilated cardiomyopathy. Veterinary Therapeutics 2001; 370-378.
Hickman HA, Morris JG, Rogers QR. Intestinal taurine and the enterohepatic circulation of taurocholic acid in the cat. Advances in Experimental Medicine and Biology 1992; 315:45-54.
Hickman MA, Morris JG, Rogers QR. Effect of processing on the fate of dietary taurine in cats. Journal of Nutrition 1990; 120:995-1000.
Hickman MA, Morris JG, Rogers QR: Intestinal taurine and the enterohepatic circulation of taurocholic acid in the cat, Adv Exp Med Biol 315:45-54, 1992.
Johnson ML, Parsons CM and Fahey CG Jr: Effects of species raw material source, ash content, and processing temperature on amino acid digestibility of animal by-product meals by cecectomized roosters and ileally cannulated dogs, J Anim Sci 76:1112-1122, 1998.
Kaplan JL, Stern JA, Fascetti AJ, et al. Taurine deficiency and dilated cardiomyopathy in Golden Retrievers fed commercial diets. PLOS One; 13(12):e0209112, 2019.
Kim SW, Morris JG and Rogers QR: Dietary soybean protein decreases plasma taurine in cats, J Nutr 125:2831-2837, 1995.
Kim SW, Rogers QR and Morris JG: Maillard reaction products in purified diets induce taurine depletion in cats which is reversed by antibiotics, J Nutr 126:195-201, 1996.
Kittleson ME, Keene B and Pion PD: Results of the Multicenter Spaniel Trial (MUST): Taurine- and carnitine-responsive dilated cardiomyopathy in American Cocker Spaniels with decreased plasma taurine concentration, J Vet Intern Med 11:204-211, 1997. 84.
Ko KS, Backus RC, Berg JR, et al. Differences in taurine synthesis rate among dogs relate to differences in their maintenance energy requirement. Journal of Nutrition 2007; 137:1171-1175.
Ko KS, Fascetti AJ. Dietary beet pulp decreases taurine status in dogs fed low protein diet. Journal of Animal Science and Technology 2016; 58:29-39.
Kramer GA, et al. Plasma taurine concentrations in normal dogs and in dogs with herat disease. Journal of Veterinary Internal Medicine 1995; 9:253-258.
Mansilla WD, Marinangeli CPF, Ekenstedt KJ, et al. The association between pulse ingredients and canine dilated cardiomyopathy: Addressing the knowledge gaps before establishing causation.
Marshall HF, et al. Sulfur amino acid stability: Effects of processing on legume proteins. Journal of Food Science 1983; 47:1170-1174.
Morris JG, Rogers QR, Seungwook WK, and others: Dietary taurine requirement of cats is determined by microbial degradation of taurine in the gut, Vet Clin Nutr 1:118-127, 1994.
Morris JG, Rogers QR: The metabolic basis for the taurine requirement of cats. In Lombardine JB, Schaffer SW, Azuma J, editors: Taurine: nutritional value and mechanisms of action, Adv Exp Med Bio 315:33-44, 1992.
Oba PM, Utterback PL, Parsons CM, deGodoy MRC, Swanson KS. Chemical composition, true nutrient digestibility, and true metabilizable energy of chicken-based ingredients differing by processing method using the precision-fed cecectomized rooster assay. Journal of Animal Science 2019 ;97:998–1009 .
Pion PD, Kittleson MD, Rogers QR, et al. Myocardial failure in cats associated with low plasma taurine: A reversible cardiomyopathy. Science 1987; 237:764-768.
Rabin AR, Nicolosi RJ, Hayes KC: Dietary influence of bile acid conjugation in the cat, J Nutr 106:1241-1246, 1976.
Sanderson SL, Gross KL and Ogburn PN: Effects of dietary fat and L-carnitine on plasma and whole blood taurine concentrations and cardiac function in health dogs fed protein-restricted diets, Amer J Vet Res 62:1616-1623, 2001.
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Stratton-Phelps MR, Cackus RC, Rogers QR and Fascetti AJ: Dietary rice bran decreases plasma and whole-blood taurine in cats, J Nutr 132:1745S-1747S, 2002.
Tegzes JH, et al. Comparison of mycotoxin concentrations in grain versus grain-free dry and wet commercial dog foods. Toxicology Communications 2019;3:61-66.
Torres CL, Backus RC, Fascetti AJ, et al. Taurine status in normal dogs fed a commercial diet associated with taurine deficiency and dilated cardiomyopathy. Journal of Animal Physiology and Animal Nutrition 2003; 87:359-372.
Torres CL, Backus RC, Rascetti AJ, Rogers QR: Taurine status in normal dogs fed a commercial diet associated with taurine deficiency and dilated cardiomyopathy, J Anim Physio Anim Nutr 87:359-372, 2003.
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