The OneVetMed Podcast with Dr Robert Gaston

Show notes coming! Thanks for your patience.

Show notes coming! Thanks for your patience.

Show notes coming! Thanks for your patience.

  Episode 9: Nutritional Deficiencies and Dietary Supplements - Part 2 Answering the questions about use of nutritional supplements: How do we recognize/suspect the need? When should we use nutritional supplements?   In order to better recognize and understand nutritional deficiency, it helps to review some basics of nutritional research Methods: Experimental and observational study used to identify deficiency syndromes Often begun with the observation that certain foods influenced active disease processes Limes used to prevent and treat scurvy Efforts directed toward identifying the beneficial substance(s) in those foods. The primary focus of the early research was on vitamins   Philosophy of Nutritional Scientists: Synthetic Reproduction of ‘Active' Ingredients Early research failed to recognize the chemical complexity of foods Assumed that foods are simple mixtures of a few easily identified chemical constituents, which, through modern chemistry, can be easily reproduced   Nutritional Research: Defining Nutrient Deficiencies (introduced this idea in episode 2 when describing how “essential” nutrients are identified for pet food.) Defining disease syndromes of nutrient deficiency relies on the total exclusion of a single nutrient, such as a vitamin, over short-term. The manipulated diet produces the classical signs of disease associated with the absence of that nutrient.   Understanding nutritional studies Observational (dietary intake) Diets containing large amounts of foods high in β-carotene (yielding high blood levels of β-carotene) have been associated with decreased risk of cardiovascular disease and several types of cancer Intervention trials (supplementation) Different vitamin sources affect outcomes of clinical studies Supplementation trials may yield contradictory results Example: Synthetic β-carotene supplementation   Nutritional Research-The Key to Understanding ‘Conflicting' Results The Case Against Vitamins Wall Street Journal March 20, 2006 p. R1, R3 http://www.mythyroid.com/documents/WSJVitamins.pdf http://online.wsj.com/article/SB114235146814497776.html Prevalence - 70% of households buy vitamins $7 Billion spent on vitamins in 2005 Rationale Boost immune system Protect heart Decrease risk of cancer Results “May be doing more harm than good” Detrimental effects Cancer promotion Increased risk of heart failure Last year, Johns Hopkins University researchers in Baltimore published a shocking finding. After reviewing the data from 19 vitamin E clinical trials of more than 135,000 people, the analysis showed high doses of vitamin E (greater than 400 IUs) increased a person's risk for dying during the study period by 4%. Taking the vitamin E with other vitamins and minerals resulted in a 6% higher risk of dying. Since the analysis was published, another study of about 9,500 patients evaluated long-term use of 400 IUs of vitamin E daily. The study didn't show any statistically meaningful differences between vitamin users in terms of cancer, heart attacks or stroke, but the vitamin E takers had a 13% higher risk for heart failure. "The psyche of the U.S. population is that a nutraceutical can't be harmful and might be helpful, so why not take it?" says Dr. Klein. "That thinking is just not correct. What is going on? “Nobody knows why high doses of vitamins taken as pills might cause harm” “What is clear, however, is the important role a healthful diet plays in preventing illness” The critical difference is that vitamin complexes and phytochemicals found in food are fundamentally different than isolated pharmaceutical doses of vitamins.   Observation vs. Intervention: Detrimental Effects of Synthetic Beta Carotene β-carotene initially appeared to be the associated link between lowered cancer...

Episode 8 is all about KEEPING YOUR PETS TEETH CLEAN A continuation of Dr. Gaston's look at nutritional deficiencies and dietary supplementation. In this episode Dr. Gaston explains the apparent contradictions between many nutritional studies which lead to so much confusion over whether supplements are good or bad. He also presents some examples of examples of nutritional deficiency to help change our perspective on what a real-world nutrient deficiency looks like.     A healthy mouth is important for overall health … and more pleasant when your pet doesn't have bad breath Chronic inflammation from gingivitis and periodontal disease is detrimental to health of people and animals Chronic inflammation can affect many areas of the body Bacteria entering the circulation through inflamed gum tissue can adversely affect heart valves, kidneys, liver, etc. Plaque: Many bacteria in the mouth Bacteria and saliva form a slick coating (‘biofilm') on the surface of the enamel On a clean tooth surface, plaque begins accumulating in less than 30 minutes   Tartar: Mineral from saliva incorporated into biofilm of plaque Tightly bound to enamel surface Process begins within 48 hours   Gingivitis   Periodontitis Heavy accumulation of tartar, red inflamed gums Loss of periodontal ligament, alveolar bone, and receding gumline Controlling plaque and tartar Self-cleaning architecture of dog and cat teeth diminish plaque and tartar accumulation Processed pet foods contribute to plaque and tartar accumulation Canned – soft consistency Dry kibble-type foods – brittle Fibrous/abrasive food stuffs assist in self-cleaning action Scrub surface of tooth to gum line Bones, turkey necks, chicken necks Vegetables – carrots, celery, broccoli stems Other factors influencing gum health Oral Flora pH Raw diet Unknowns and inconsistent results Size of dogs Brushing Brush Manual Motorized spin brush Dentifrice No Xylitol No Flouride Hand scaling General anesthesia with ultrasonic scaling and polishing Thorough scaling and examination Extractions and radiographs as needed Examination and evaluation of health or specific concerns that may affect safety of anesthesia Pre-anesthetic blood work Age limitations?  

Episode 7: Nutritional Deficiencies and Dietary Supplements Public Interest in Nutritional Supplementation 50% of the U.S. adult population uses dietary supplements 1990-1997 400% growth in dietary supplement sales for humans Currently growing at 15% per year $37 billion annually 85% of regular supplement users believe that dietary supplements are good for health 82% of Americans would try herbs for terminal illness { http://www.cfsan.fda.gov/~dms/fdsupp.html; Boothe DM. 2004 Vet Clin Small Anim 34:7-38 ; Blendon RJ. 2001 Arch Intern Med 161:805-810 }   Similar interest in supplement use for pets 30% of pet owners have used or have considered using dietary supplements 90% of veterinarians sell some type of herbs or nutraceuticals $20-50 million in annual sales {Boothe DM. 2004 Vet Clin Small Anim 34:7-38}   Important Questions Concerning Nutritional Supplements What are nutritional supplements? Terminology, Definitions, Contents Why do we need nutritional supplements? Evidence for nutritional deficiencies - When should we use nutritional supplements? How do we recognize/suspect the need? What nutritional supplements should we use? - What kind of nutritional supplement is best? How do we use nutritional supplements?   Conventional Thinking About Nutritional Supplementation “The proper role of a supplement is to correct a diagnosed nutrient deficiency” {Small Animal Clinical Nutrition 4th Ed p. 116} However, diagnosis is difficult with current tools and difficult to recognize based on conventional definitions of deficiency “ The most common form of veterinary supplements is a wide variety of vitamin and vitamin-mineral combinations that are used by 10% of animal owners” {Small Animal Clinical Nutrition 4th Ed p. 116} Predominantly consist of isolated, or synthetic, vitamins “Routine use of vitamin mineral supplements is not needed when a dog or cat eats typical commercial pet food” “…dogs and cats consuming commercial dry rations were ingesting from two to five times the daily allowance of vitamins” {Small Animal Clinical Nutrition 4th Ed p. 116} They are already receiving potentially excessive amounts of isolated, or synthetic vitamins The conventional approach to nutritional supplementation is to provide more of the same isolated and synthetic nutrients that are already present in high amounts in the pet foods, expecting a better outcome It has been claimed that insanity is continuing to do the same thing, expecting a different result   Confusion in Terminology: What Are Nutritional Supplements? Food: (according to section 201(f) of the Food, Drug, and Cosmetic Act) “a raw, cooked, or processed edible substance, ice, beverage, or ingredient used or intended for use or for sale in whole or in part for human consumption” “articles used for food or drink for man or other animals, chewing gum, and articles used for components of any such articles.” This includes “dietary supplements and dietary ingredients” { http://www.cfsan.fda.gov/~dms/fsbtac13.html http://www.cfsan.fda.gov/~dms/fc01-1.html1  http://www.cfsan.fda.gov/~ear/ims-a-30.html} Drugs:  “articles [food or non-food] intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals” “ articles (other than food) intended to affect the structure or any function of the body of man or other animals” { http://www.cfsan.fda.gov/~dms/fsbtac13.html   http://www.cfsan.fda.gov/~dms/fc01-1.html1 http://www.cfsan.fda.gov/~ear/ims-a-30.html}   “Medical Food” originally applied to humans For dietary management of a disease or health condition Under the direction of a physician Label must state that the product is to be used to manage a specific medical disorder or condition

  Episode 6: Diet Recommendations   Many choices in pet foods Dizzying array in the pet store from the least expensive to the more expensive and ‘holistic' foods What is a ‘holistic' food?   Which one to choose? Why? Two primary concerns: Nutritional quality Safety   Recent safety concerns with commercial foods – What's in the bag?: Melamine Aflatoxin or other fungal toxins Pentobarbital or other drug residues 2002 FDA veterinarian Newsletter Vol XVI, No III http://www.fda.gov/AnimalVeterinary/NewsEvents/FDAVeterinarianNewsletter/ucm110419.htm “After finding that the low levels of pentobarbital that dogs might receive through food are unlikely to cause them any adverse health effects, FDA officials did not think that further research into the issue was necessary.” Bacterial contaminants Human Salmonella Infections Linked to Contaminated Dry Dog and Cat Food, 2006-2008 Seventy-nine case-patients in 21 states were identified; 48% were children aged 2 years or younger. A low attack rate supports the hypothesis that infection might have resulted from practices in a limited number of households. One possibility is that the number of organisms was magnified in some households because of, eg, cross contamination in the kitchens or irregular cleaning of pet food bowls, which might promote bacteria growth. In addition, illness may have occurred primarily in persons who were more susceptible to infection with a small number of organisms. Illness was not reported in dogs or cats from case patient households, although the outbreak strain was cultured from several stool specimens from dogs who ate contaminated dry dog food. Some children may have become ill from contact with a pet carrying the outbreak strain. Prevalence of isolation of Salmonella from feces of healthy dogs is reported to be between 1% and 36%, and from healthy cats between 1% and 18%. Dogs and cats may shed Salmonella in the feces for as long as 12 weeks, and shedding may be intermittent, 11 so the risk of infection could continue for extended periods. In addition, it is thought that Salmonella can survive for extended periods in dry dog and cat food, as it can in similar dried foods such as cereals. Forty-three million US households (37%) own dogs and 37.5 million (32%) own cats, and many pet owners feed the animals dry pet food. …dry pet food, the most common pet food fed to dogs and cats, is not manufactured to be a sterile product. Typically, a more drastic heat treatment is required to destroy Salmonella in dried food products. Since 2006, according to the FDA, at least 13 recall announcements involving 135 pet products (eg, dry dog food and cat food, pet treats, raw diets, and pet supplements) have been issued because of Salmonella contamination.  No human illness was associated with these other pet food recalls. The recommendation to wash hands is the most important prevention step for reducing the risk for disease transmission. {http://pediatrics.aappublications.org/content/early/2010/08/09/peds.2009-3273.full.pdf } http://www.dogfoodadvisor.com/dog-food-recalls/ A total of 49 individuals (47 individuals in 20 states and two individuals in Canada) infected with the outbreak strain of Salmonella Infantis were reported. Among the 24 patients with available information, 10 (42%) were hospitalized. No deaths have been reported. Epidemiologic and laboratory investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies linked this outbreak to dry dog food produced by Diamond Pet Foods at a single production facility in Gaston, South Carolina. Multistate Outbreak of Human Salmonella Infantis Infections Linked to Dry Dog Food (Final Update) http://www.cdc.gov/salmonella/dog-food-05-12/pet-owners-info.html Salmonella Infection (salmonellosis) and Animals

Episode 5: Recognizing Nutritional Deficiency: 2 clinical examples Presenting two examples of nutritional deficiency Not classical nutritional/vitamin/mineral deficiency syndrome Lack of classic signs = “subclinical” deficiency Veterinarians need to increase their level of suspicion that illness may be related to nutritional problems Aspen Presented 4/02: 13 year old spayed female Labrador retriever-shepherd mix The owner – my brother - noticed weakness and exercise intolerance Rapid progression over two-three weeks Syncope/collapse episodes with mild exertion Became unable to walk more than a few steps without resting Diet Science Diet® Chemistry Profile, complete blood count and Thyroid hormone level all  normal Chest x-rays were normal 5/9/02 Evaluation of ECG via Telemedicine consultation with cardiologist HR 50 BPM Diagnosed as complete heart block Possible degeneration, fibrosis, or inflammation of AV node Recommendation: Echocardiogram and possible pacemaker implant Telephone consultation (Oregon - Ohio) Recommended treatment Nutritional support for cardiac function, electrical conductance, muscle function, general nutrition Cataplex® B (Standard Process) L-carnitine (Pure Encapsulations) Vasculin® (Standard Process) Cardio-Plus® (Standard Process) Catalyn® (Standard Process) Calcifood® wafers (Standard Process) Improvement noticed within several days after starting supplementation Continued progress over initial 4 weeks of supplement use Returned to normal activity level within 4 weeks 8/6/02 Echocardiogram Anatomically normal heart Normal contractility Severe bradycardia (32 beats per minute)  with continued complete heart block 2/25/03 progress exam Clinically normal 14 yr old dog Repeat ECG:  unchanged from 5/02 Aspen running up and down long hill in yard with children Continued supplements as initially prescribed Continued Science Diet 9/20/05 progress exam Nearly 17 yrs old Stiff and slow moving, nearly blind, hearing loss, developing urinary incontinence Continued bradycardia due to electrical abnormality No syncope Had more stamina than 4/02 prior to supplementation 12/05 euthanized due to deteriorating physical condition, incontinence, arthritis, etc. – no syncope, no heart failure Gypsy Presented 8-8-05  - 4 year old spayed female golden retriever mix Consultation concerning autoimmune disease, open wound on rear end, and generally declining condition Owner concerned that Gypsy was dying and wanted to incorporate complementary approaches History: Developed severe bone or joint pain at 9 months old Lame, crying when touched Developed immune myositis - diagnosed via muscle biopsy November 2002 Presented as acute-onset muscle pain and inability to open mouth Muscle atrophy developed subsequently Prednisone therapy initiated ( and continued daily since) 4-18-03 Giardia with severe diarrhea and vomiting Several teeth extracted due to loosening/periodontitis Seasonal exacerbations of muscle inflammation and dysfunction x 3 yrs. Approximately October/November 2002, 2003, 2004 Allergic component? Faithfully vaccinated (yearly) Last vaccine 3-8-05 Flatulence; owner feels that abdomen is hot and distended; other dog eats Gypsy's stool Medications: Prednisone 10 mg once daily (continuous use since Nov 2002), Thyroxine 0.7 mg twice daily Blood Chemistries and CBC AlkP    AST    ALT   GGT   P    Gluc    Amyl    WBC    Neutr 8/8/05           1430      72     461      80    4.1   144                  16.9     83% 5/17/05        2738      75     596     430   6.2    44      224       20.6     83% 4/23/05        2842      75     612     410   5.5    18      248       20.7     86%

Episode 4: Nutrition – Does heat-processing adversely affect nutrition? Continuing to examine the big concepts in pet nutrition Effects of heat-processing in commercial foods- Manufacturing affects  nutrient quality and bioavailability Extruded 320ºF Canned 500ºF Heating effects: Alterations in protein structure Maillard reactions Bonding of sugar (glucose, fructose, lactose, maltose) with free amino group (such as lysine) Digestive enzymes do not cleave the peptide bond adjacent to the amino acid with attached sugar molecule May increase microbial degradation of taurine in colon Affected proteins are of no nutritional value Allergenic? Other “unusual crosslinking” of amino acids and peptides which result in compounds “not found in nature” “These compounds are not well-used by animals” “Processing EFA in pet foods may affect their biological activity” {Small Animal Clinical Nutrition 4th Ed pp.55, 61} Heating effects: Alteration of fatty acids Trans configuration Metabolized for energy and incorporated into lipid storage Cannot function as EFA's because they are not further metabolized to eicasanoids C18:1 trans isomers inhibit hepatic carnitine and lead to increased liver triacyglycerol by lowering hepatic oxidation of fatty acids {Giudetti AM, Beynen AC, et. al. Hepatic fatty acid metabolism in rats fed diets with different contents of C18:0, C18:1 cis, and C18:1 trans isomers. Br J Nutr. 2003 Nov;90(5):887-93} More pieces to the puzzle of heat processing effects: Carprofen half-life in cats Recent study showed variation 17 hours to 44 hours Difference in liver enzyme activities attributed to diet Fresh, whole foods enhanced liver detoxification Commercial diets detrimental effect Propranolol half-life in cats Study done ~20 years ago showed variation from 1-2 hours to >12 hours Diet effects as seen with carprofen Major pet food manufacturer had no interest in investigating why the variation in metabolism {Dr. William Muir, lecture delivered at Veterinary Chiropractic Convention April 2003, and personal conversation.} Study of food allergy in dogs After successful elimination diet, introduced commercial canned or kibble ‘equivalent' diet 25% recurrence of clinical signs (pruritus) “With every treatment diet tried, some percentage of dogs redeveloped pruritus.” Explanations/Speculations 3-D protein structure altered with heating? Decreased digestibility? Loss of important co-factors? {Rosser, EJ. Diagnosis of food allergy in dogs. JAVMA, Vol. 203, No. 2, July 15,1993 pp.259-262 Pottenger's Cats Nutritional study completed 1932-1942 Multigenerational study Nine hundred cats Four basic feeding groups Optimum diet groups 2/3 raw meat, 1/3 raw milk, Cod Liver Oil 2/3 raw milk, 1/3 raw meat, Cod Liver Oil Deficient diet groups 2/3 cooked meat 2/3 cooked milk (pasteurized, sweetened condensed, evaporated, metabolized vitamin D) Effects observed with deficient diet Dental disease Reproductive abnormalities Allergies Immune disorders Skeletal disease and osteoarthritis Cardiac abnormalities Renal disease Respiratory abnormalities Gastrointestinal abnormalities Hepatic abnormalities Behavioral abnormalities Endocrine abnormalities Ocular abnormalities {http://www.amazon.com/Pottengers-Cats-A-Study-Nutrition/dp/0916764060 } {http://ppnf.org/ } Multigenerational effects – demonstrated “epigenetics” prior to understanding of gene structure or tools to examine Studies in epigenetics reveals that food affects more than just calories and deficiencies…it alters the essence of genetic expression…in the individual…and for subsequent generations Understanding nutrition is critical to longevity and health { NOVA | scienceNOW | Epigenetics | PBS }

Episode 3: A Better Understanding of a “Complete” Diet - Part 2 In Episode #2, we talked about the “complete and balanced diet” myth. Now in Episode 3 we will look more at the issue of whether veterinarians and nutritional scientists really understand nutrition thoroughly enough to make a claim of “complete” Are there examples of our continually improving understanding of nutrition that proves that the claim of “complete” at any point in time is always subject to revision  - to be ‘more' “complete”? Are there complexities in food which make the Nutritional Essentiality paradigm dangerous to our pets? Are there concrete examples of these “complete” diets causing problems in pets that were eating them?  “It is nothing short of a tragedy for a patient to be permitted to suffer from simple starvation while being given the so-called benefit of modern science in a modern hospital, and still gradually fade away by reason of some unrecognized form of malnutrition.” {Lee R. October 23-24,1943. Malnutrition As A Primary Cause Of Disease, Lectures of Dr. Royal Lee p.32.} Look at the relatively recent example of Taurine Currently considered “non-essential” in dogs Able to synthesize taurine from sulfur amino acids cysteine and methionine Recent published reports of dilated cardiomyopathy in dogs eating “complete and balanced” diets associated with low blood taurine levels Improved cardiac function with taurine supplementation Prolonged survival time and withdrawal of medications other than taurine supplementation DCM is typically progressive and fatal {Backus, et. al. JAVMA Vol. 223, No 8, October 15,2003: Fascetti, et. al. JAVMA Vol. 223, No 8, October 15,2003} Reported cases of DCM in dogs Diets “met recommended nutrient profiles or passed minimum feeding protocol tests recommended by the Association of American Feed Control Officials.” Bioavailability of methionine and cysteine appeared to be adequate for the synthesis of taurine Diet change improved taurine status “…Other dietary factors precluded adequate synthesis of taurine” 2 dogs fed home-prepared low protein tofu-based diet that met National Research Council requirements for adult maintenance {Backus, et. al. JAVMA Vol. 223, No 8, October 15,2003: Fascetti, et. al. JAVMA Vol. 223, No 8, October 15,2003} Mechanism of heart failure in taurine deficiency is poorly understood Heritable susceptibility – genetic component Individual biochemical variations in taurine absorption, metabolism, excretion Lacking a necessary contributing factor? “The variation in clinical manifestation of taurine deficiency is suggested to be a result of the variable presence of contributing factors.” {Backus, et. al. JAVMA Vol. 223, No 8, October 15,2003} Taurine in cats Thought to be unimportant other than for bile conjugation until the 1960's Research showed that retinal degeneration in cats improved with addition of meat to casein-based diet No change with added Vitamin A In 1987, a connection between taurine deficiency and feline dilated cardiomyopathy was discovered As in dogs, DCM was considered to be progressive, irreversible, fatal condition After more research, it was found that cats require dietary taurine What other the other signs that might be visible with taurine deficiency? Non-specific as with some nutrients (i.e. Scurvy with C) Poor reproductive performance – abortions, stillbirths, low birth weights Poor growth rates Skeletal deformities Neurological abnormalities – degenerative changes in retina, cerebellum, and visual cortex Compromised immune function Hearing loss (We will mention this same list again when we talk about Pottnger's Cats and the benefits of raw food in Episode 4!) BUT…Not all taurine depleted cats develop DCM “It is, therefore, apparent that taurine deficiency alone is not sufficient to...