Saturday 14 March 2020

Let Food Be Thy Medicine

One of my favorite quotes about food comes from Hippocrates, the father of modern medicine: “Let food be thy medicine, and medicine be thy food”. His knowledge and foresight that this demonstrates, shows that despite living from 460-370BC, he had a better understanding of health than many doctors and vets do today. It seems extraordinary that, even now, if you go to the doctors with high cholesterol, early heart disease, liver disease, or any number of other health issues, the best advice you might get is a single sentence, or “try to eat more healthily”. I find this both sad and frustrating. Hippocrates also believed all disease starts in the gut - there is certainly a lot of truth in this as we now know that around 70% of the immune system is found in the gut, and that the microbiome plays a key role in health.

Diet is so critical to health that I believe we should be teaching it in schools - what could be more important, given that we eat 3 times a day? Teach children to grow vegetables and make healthy complete meals for themselves & their families, rather than teaching them to make cakes and regurgitate information. Also teach them about animals - how to feed, interact with & care for them. Anyway, I digress.

     An unexpected breed to find in India, this young one looked quite healthy.

I fully believe that the most important thing I have learnt since leaving university is about Species Appropriate Feeding, in dogs and cats often referred to as Biologically Appropriate Raw Feeding (BARF). I was lucky enough, as a student, to see practice with my good friend, and a great inspiration, Dr. Nick Thompson of Holistic Vet Ltd. The knowledge he shared with me cultivated a great fascination and thirst to learn more about how we can best feed our domesticated animals of all kinds. I’d had previous experience of working on a game reserve in South Africa, that also housed some big cats for the Born Free Foundation. These were cats, born or raised and kept in captivity that would be unable to feed themselves or survive in the wild, so could not be released. Feeding time involved sawing up huge wildebeest or antelope carcasses and feeding whole limbs or similar, so to mimic how these cats would eat in the wild. In zoos too, the keepers do their best to feed their charges a diet as close as possible to their natural one, to promote optimum health and welfare. Why then do we feed our dogs and cats dry biscuits (kibble) every day?

Almost more importantly, why did we only have 2 lectures on small animal nutrition in our clinical years at university? One from Hills, the pet food giants, and the other from a clinician detailing how different commercial diets were altered for different health conditions, e.g. Hills k/d for kidney disease. We were taught farm animal nutrition relatively well comparatively as, for these ‘working’ animals, optimum performance, growth and health are crucial to herd management and farm profits. But again, why only one lecture on equine nutrition from Dodson & Horrell? How are young vets supposed to advice on species appropriate feeding with little to no knowledge? 

    Nani, an ‘old’ (12yrs is considered old in India cat at one of our guest houses.  

Luckily for me, with my interest sparked, I started researching and learning about animal nutrition for myself. I read many books, researched online, chatted with holistic vets feeding natural diets, and then I looked to my amazing collie companion Fudge to be my next teacher. At university I didn’t have the time or money to feed a natural diet, but I did start to introduce a regular raw meaty bone. After these I noticed his poo would be firmer, easier to pick up and invariably lighter in colour (a common occurrence due to the calcium in bones, excess of which is passed out in the stools). I also noticed that his teeth became shiny and white again, remaining that way throughout the rest of his life. I actually like to play a little guessing game when I see dogs teeth - I can nearly always guess if they are bone eaters or not, the changes can be so obvious. Once I’d left university I started feeding a completely raw diet, and that is when I knew I was on the right track. 

The changes I saw in my own dog I found fascinating. After a month or 2, people would approach me on dog walks to compliment me on how shiny Fudge’s coat was, or how healthy he looked, and ask what I fed him. More importantly his stools normalized from variable colitis (starting firm and ending soft), to consistently firm, easy to pick up, mucus free, almost odourless nuggets (oh the joys!). He was also less itchy and only had one more hot spot the whole of the rest of his life (after an insect bite), having had 5 or 6 in his previous year or 2 with me. As a 1.5 year old he’d developed a sudden onset lameness, later diagnosed as a mild OCD (cartilaginous) lesion of the shoulder joint, with various other inflammatory changes. I only rehomed him as a 1 year old, and was told he had previously eaten “whichever food was on offer”, so suspect his nutrition was sub-par during those crucial growing years when good nutrition is so essential to normal development of bones and joints. After a shoulder arthroscopy, Fudge still suffered on/off bouts of lameness, which I’d been advised to treat with exercise restriction and anti-inflammatories. If they continued, my teachers agreed that intra-articles steroid injections would be next on the cards, but that these would need repeating throughout the rest of his life. Even with my limited knowledge at the time, this seemed a bleak outlook to me. You’ll be thrilled to know that his raw diet, with added omega 3s and joint supplements, kept him free of lameness, bar the very occasional requirement for a resting day or 2, until he was about 9. At that point herbal medicine kept him happy and comfortable, with no further anti-inflammatories ever being needed. I have clients who can report similar successes. What better way to treat disease could there be than feeding the right food?


“If we eat wrongly, no doctor can cure us; If we eat rightly, no doctor is needed.” - Victor G. Rocine

This is another favorite quote of mine, and I have seen it over and over again in practice. There are always those memorable cases, for me usually of chronic inflammatory gut problems that don’t resolve, and then you discover that, alongside their strict diet plan that you’ve drawn up, they have tea and custard creams every afternoon (how very English!). On the other side, skin disease, gut problems, lameness and even behavior problems have all improved or even resolved by changing animals onto a species appropriate diet. Not every case, of course, and not always straight away - some tweaking and perfecting is often needed, or some herbal or homeopathic support. However, enough cases happen this way, that diet is one of the first things I want to know about in any new patient, especially those suffering from chronic disease. 

So what do I consider as a species appropriate diet for dogs and cats? 
Cats are obligate carnivores, meaning they are designed to eat a diet of prey only - meat, bones, organs, viscera, etc. So this is what I recommend is fed, alongside a little fish, and occasionally some supplements, such as herbs, if needed. (When I talk about herbs as part of diet, I always refer to them as supplements, differing from using them as medicines by dosage and frequency of administration, as well as safety of the herb in question). Cats have no dietary requirement for anything else, most especially not carbohydrates. Originally descended from desert cats, they are designed to get most of their daily fluid intake from their prey. This is one reason that kibble can be such an issue for them - cats eating kibble, even if they drink to thirst, have been found to take in about 50% less water than cats eating wet foods. This can lead to a state of harmonic low level dehydration which, along with synthetic phosphorous in processed foods, increases the risk of kidney disease. Carbs in cat food are not only unnecessary, but they play a huge role in the pet obesity crisis that we see the world over. The satiety center in a cats brain (the bit that tells them when they’re full) responds to protein and fat. This means that if you feed a food containing 50% carbs, they must eat twice as much to feel full! The other indisputable cause of the obesity crisis in dogs and cats (and realistically humans) is overconsumption. I’ve found raw feeding to be a great way of helping dogs and cats to lose weight. Any low carb food will be helpful, but owners can struggle with the decreased portion size. Carbs often act as a filler in many processed foods, so a lot goes in one end, but a lot comes out the other too! With low carb diets, more of the food is utilized, with less wastage, so less food needs feeding overall. If your pet struggles with hunger whilst trying to lose weight, then feeding dogs just once a day, or cats just twice, I’ve found can be helpful, as can the addition of insoluble fiber, such as psyllium husk.

Dogs are a little different. They are facultative carnivores, meaning they are designed to eat prey too, but they are scavengers so can get by eating other things. A highly acidic stomach acid, short gut length, vertical jaw motion, carnivorous teeth, and low amylase levels are similar between dogs, cats, wolves and wild cats, as well as many other carnivores. So my ideal diet for dogs is the same as for cats, although for dogs I do like to add some fruits, veggies and herbs. There is much debate about the addition of these in raw diets amongst the raw feeding community. I include them not because they are essential, but for the additional phytonutrients and health benefits they provide. My favorites are leafy greens, antioxidant-rich berries, and small amounts of yellow-orange veggies - all have been shown to improve canine health in various ways, such as minimizing cancer risk.

                   An overweight Labrador family we met at a German Bakery!

My preference is always to feed dogs and cats a fresh raw diet, ensuring it is varied and balanced over time. I believe this is the diet they evolved to eat and so it can provide them with optimum health. I do understand, and have seen, that this diet does not suit every dog or cat that walks into my consulting room. Some seem to do much better on cooked food, either all the time or during periods of disease, or old age. Key points to remember when feeding a raw diet include:
  1. Ensure it is varied, and balanced over time. 
  2. Bones must only ever be fed raw, NEVER cooked (cooking makes them brittle and hard, making them more likely to damage teeth or cause an obstruction as they cannot be digested).
  3. Bones should be carefully selected according to the size of your pet and their mouth shape, as well as being ideally non-weight-bearing (this will minimize the risk of tooth damage).
  4. Hygiene and common sense around storage, serving and handling raw meat is paramount. (The same could be said for kibble, as recalls are not uncommon for bacteria such as Salmonella or Listeria).
  5. It is best not to feed a mixture of raw and cooked foods, as they digest at different speeds and require slightly different acidity and enzyme levels.

Here in India I can tell you that the dogs are definitely not eating this diet! The cats fare better as their diet consists mostly of rats, mice and birds that they catch for themselves. From what I can tell, most dogs are surviving on a mixture of rice, chapati (flat breads), Parle G (very sweet) biscuits and leftovers from human meals. These leftovers will mostly be vegetarian, as most Hindus are vegetarian. Those that do get dog food have the usual culprits of Pedigree Chum and the like. I have seen one dog eating a raw meaty bone, tied up outside his home. Others I have seen feeding on animal carcasses by roadsides or in the countryside. There are hundreds of dogs everywhere we go in India, and many pups in various stages of growth. I expected to see more issues linked to such a poor diet, but the pups externally seem to grow relatively well for the most part. They can clearly survive on this diet, but they most certainly do not thrive! I have seen maybe 5 or 6 dogs over the last 3 months that I would consider as looking in premium health. 3 or 4 of those must have been under 1 or 2 years old, where youth can give the appearance of health. Obviously other factors are involved in their appearance - mange, fleas, and all the secondary skin complaints that follow are seen in most dogs. I have seen more bizarre gaits and postures than I could possibly describe - whether from injuries, developmental joint or bone abnormalities from poor diet of pup or mum, or a combination I couldn’t say. I have not seen many old dogs. When I thought of coming to India I expected the majority of dogs to be underweight, but I’ve seen as many here that are overweight, ranging from a little chunky to full on obesity. The surprising number of labradors and their crosses over here definitely win the obesity stakes, as they often do in the rest of the world! In truth, seeing how carb and sugar-filled their diets are, I am unsurprised. What does surprise me is how they can grow and survive so well on such poor food. They’re not thriving, but it has still got me thinking...

We live in times of environmental crisis and destruction, where the encouragement for humans to eat less meat for environmental reasons abounds. Can we justify feeding this much meat to our pets if they can survive without it? I don’t eat meat myself, yet I feed it to my pets to ensure they have the optimum nutrition, and so health. Should we be making a compromise? Should we maybe sacrifice the very peak of health in our pets, to help save our planet?
Raw feeding is becoming increasingly popular, for all the reasons I have outlined here, so the pet food industry is requiring more and more meat to meet demand. At the same time, there are various vets around the world, including renowned holistic vet Richard Pitcairn, who have started advocating vegetarian diets for dogs and cats, for environmental or health reasons (such as severe food intolerances). However, I have seen for myself disease and ill health caused by imbalanced vegan and vegetarian diets. Recently a few diets have come out using insects as a protein source. Insects reproduce quickly and in huge numbers, making them potentially a more environmentally friendly option. Could they be used to make a diet as healthy as one made from meat or fish? 
I am starting to think that we ought to be researching these options more thoroughly, to see if a truly healthy and balanced diet for dogs at least, can be made with insects or vegetarian food. In the meantime should we consider a compromise? Maybe feed a vegetarian food 1 or 2 days a week, and meat the rest of the time? 
As humans we are constantly compromising our own health, by consuming things unsuited to optimum health, yet most of us are unaffected on a day to day basis by these poor choices. As a vet, I find the idea of feeding a sub-optimum diet extremely difficult, but as a green-minded lover of the environment I find the idea of the amount of meat needed to feed even just the dogs and cats of the UK slightly disturbing. What should we do? Feed for the health of our pets? Or for the good of the planet? Can we find a diet, or way of feeding that does both?

“In all affairs it’s a healthy thing now and then to hang a question mark on the things you have long taken for granted.”- Bertrand Russell

                          

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