Diet and Gastrointestinal Diseas

Diet and Gastrointestinal Disease

Feeding A Pet With Gastrointestinal Disease

How a pet is fed is the most important determinant to insure lasting recovery from most cases of chronic gastrointestinal disease. That is only possible with feeding a very controlled diet, a diet in which the quality and number of ingredients are optimum for recovery. Pet food manufacturers prepare many special diets to treat these problems. For some patients these diets are effective. Home-prepared diets are the most effective in treating pets with gastrointestinal disease.

The Ideal Diet for Managing Gastrointestinal Disease

The ideal controlled diet should contain highly digestible nutrients, be low in fat and lactose, be hypoallergenic, contain appropriate amounts of fiber for the condition being treated, contain a minimum number of ingredients, be palatable and balanced, and be one that owners can prepare. Controlled diets are usually less palatable than diets most pets eat. The greatest single reason for failure during dietary management of chronic gastrointestinal diseases is cheating on the diet; owners continue to feed some foods that their pet enjoys but shouldn't have. This happens because many owners believe that minor dietary alterations are of little consequence on recovery.

Digestibility
Controlled diets should be highly digestible. High digestibility helps the gastrointestinal system to rest and reduces the potential of foods stimulating or aggravating an allergy. Rest allows recovery which reduces absorption of intact proteins. Rest also reduces intestinal bacterial numbers and products of bacterial activity. Highly digestible proteins reduce ammonia production in the large intestine, by that helping in its protection. Diets needing minimum digestion stimulate secretion of less digestive enzymes than other foods and that helps protect the intestinal mucosa. Consumption of poorly digested protein causes diarrhea that can be bloody. Associated with this is population of the small intestine with pathogenic bacteria.

Fats
For centuries recommendations for treating diarrhea include feeding low fat diets. Dietary fat aggravates most diarrheas. Reasons include conversion of fats to chemicals that cause diarrhea (such as ricinoleic acid, the active agent in castor oil) and to products promoting inflammation (leukotrienes). There are some instances, however, where the fat content of a controlled diet should not be kept at a minimum.

Lactose and Glutens
Controlled diets should contain little or no lactose and low amounts of other sugars, because enteritis reduces mucosal disaccharidase activities. The diets should be free of glutens found in wheat, barley, oats, and rye products. Glutens can be responsible for the diarrhea in sensitized animals. Animals can also develop an allergy to glutens during a bout of diarrhea.

Fiber
In most cases little or no fiber is fed when feeding begins. Fiber irritates mucosal surfaces and causes normal cells to slough more rapidly than diets containing no fiber. On recovery, fiber can be fed and some animals may need fiber to stay in remission. Colonic bacteria ferment many fibers which can cause diarrhea when excess fiber is fed. Dietary fiber also sustains large numbers of colonic bacteria which can cause diarrhea to persist.

Formulation of a Controlled Diet

Selection of Ingredients―Carbohydrate Source
Boiled white rice is the ideal carbohydrate for preparing a controlled diet. More is known about the benefits of this food than for any other carbohydrate source. Most important, rice is digested more thoroughly than any other carbohydrate. Occasionally an animal may appear sensitive or allergic to rice and another source is selected. A second choice can be potatoes or tapioca. Potatoes are not as completely digested as rice and if cooking is not complete that causes more problems. The use of potatoes has been more popular recently. At the Veterinary Medical Teaching Hospital at Davis, tapioca is used when it appears that rice fails to cause recovery. Chronic diarrheas respond well to diets containing tapioca.

Gluten-containing cereals such as wheat, barley, oats, and rye are common causes of persistent diarrhea. The basis of the diarrhea is an allergy to glutens. This is a common reason that many dogs cannot eat commercial pet foods without developing vomiting or diarrhea. Gluten-containing cereals are found in most pet foods; they are found in all commercially prepared treats or biscuits. The following diets are gluten-free.

Carbohydrates can provide 80 percent of the total diet. This is an unusually large intake of carbohydrates, however. Initially animals may not completely digest and absorb large amounts, until mucosal enzyme activities increase to meet the changed digestive requirements. Thus, a change to a high-carbohydrate diet results in slower recovery if digestive enzyme activities are low. Partially digested carbohydrates are not absorbed and that worsens diarrhea. Feeding small meals frequently minimizes the problem; overfeeding invariably delays recovery.

Selection of Ingredients―Protein Source
Protein selected for controlled diets can be from animals or vegetables. Used most often is a single animal protein with a high biological value, such as cottage cheese or the vegetable protein tofu. Cottage cheese is the protein of choice because there is more experience using it for animals with gastrointestinal disease. Dogs and cats are rarely allergic to milk proteins. Diarrhea developing from feeding milk is caused by lactose that is not digested adequately.

Formulation of a Controlled Diet for Diarrhea in Dogs

The following recipes are used for dogs with recently acquired or chronic gastrointestinal problems causing signs of vomiting and diarrhea. The diets provide the calories needed for maintenance by small to medium‑size dogs (amounts of ingredients are increased for larger dogs). The recipes list the calories in each diet and the table on caloric needs can be used to determine how much to feed. Animals weighing twice as much do not require twice the amount of a recipe. Doubling the amount in the first recipe provides enough to feed a dog weighing about 35 pounds, not 30 to 32 pounds. If a dog is not 15 to 16 pounds, begin by determining how many calories the dog requires each day and then adjust the amount to feed accordingly. These diets provide up to twice the amount of protein a dog requires. The diets listed first in treating a gastrointestinal problem are not balanced with respect to vitamins and minerals. Balanced recipes follow and show how to prepare a complete and balanced diet. During initial treatment for chronic gastrointestinal diseases, small meals should be fed often, up to 4 times a day. With recovery, frequency can decrease to once a day. Some problems require frequent feeding to continue. Dogs with signs of reflux esophagitis often can be managed with frequent feeding and no medications are needed. This problem requires feeding one meal in the late evening. Vomiting during the early morning hours usually stops.

Cottage Cheese and Boiled Rice Diet

2/3 cup cottage cheese, low fat 1% fat (152 grams)
2 cups rice, white polished, long-grain (320 grams)
2 calcium carbonate tablets (calcium 800 mg)
1/4 teaspoon salt substitute-potassium chloride

provides 519 kcalories, 27.1 g protein, 2.4 g fat
supports caloric needs of 14 to 15 pound dog

Rice can be cooked at mealtime or can be prepared ahead and refrigerated. One cup of dry rice is cooked in two or more cups of water. Before cooking add salts and a small amount of vegetable oil to reduce stickiness. The cooked recipe produces more than two cups of cooked rice. Measure two cups of cooked rice and add cottage cheese and calcium. If the rice has been prepared and refrigerated before feeding, the recipe can be warmed before feeding. This diet is less palatable than a dog's usual diet. Offer no other food for three days before anything else is done. Dogs appearing healthy other than showing gastrointestinal signs will begin eating this diet within one to two days. In a few cases flavoring agents can be added to make the diet acceptable. For example, the diet can be flavored with garlic powder or small amounts of bouillon, preferably chicken bouillon. These additions are not done unless the diet isn't eaten after three days. Potassium chloride is added because animals losing body fluids from vomiting or diarrhea need potassium supplements. This is especially important if they have not been eating. This diet provides most of the nutritional needs for a 16‑pound adult dog. Although the diet is deficient in vitamins and some minerals it can be fed without complete balancing for three to four weeks. This diet contains 20 percent crude protein, which is nearly twice this dog's requirement. Calcium is added to levels that almost meet its requirements, which isn't necessary until remission is evident. A reason for adding calcium as a carbonate is that it helps manage the diarrhea. Antacids containing aluminum and calcium, such as calcium carbonate, have a constipating effect. Eggs shells can be fed to provide calcium carbonate. Empty shells are cooked in the microwave. The dried shells are crushed and mixed in the diet instead of giving calcium carbonate tablets. One egg shell weighs about five grams and is almost entirely calcium carbonate. That provides two grams of calcium. The cooked shells will not spoil and can be refrigerated and stored. Cooking also kills bacteria such as Salmonella that commonly contaminate eggs.

With remission of gastrointestinal signs, the diet is balanced completely as follows:

Cottage Cheese and Boiled Rice Diet (balanced)

2 cups cooked rice, white polished, long-grain (320 grams)
2/3 cup cottage cheese, 1% fat (152 grams)
1 teaspoon vegetable (canola) oil (5 grams)
1/4 teaspoon salt substitute-potassium chloride
1/3 teaspoon bone meal powder (2 grams)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 564 kcalories, 27.1 g protein, 7.4 g fat
supports caloric needs of 16 to 17 pound dog

When cottage cheese diets do not achieve remission, tofu (soybean protein) is used:

Tofu and Boiled Rice Diet

5 1/4 ounces tofu, raw (150 grams)
2 cups cooked rice, white polished, long-grain (320 grams)
1/4 teaspoon salt substitute-potassium chloride
1/10 teaspoon table salt
2 calcium carbonate tablet (calcium 800 mg)

provides 546 kcalories, 25 g protein, 6.9 g fat
supports caloric needs of 16 pound dog

This diet contains more than the minimum protein required and it is higher in fat than the low fat cottage cheese diet. Table salt is added because, in contrast to the cottage cheese diet, this diet is low in sodium. The amount added is small. On recovery, the diet is balanced so the following recipe is fed:

Tofu and Boiled Rice Diet (balanced)

5 1/4 ounces tofu, raw, firm (150 grams)
2 cups rice, white polished, long-grain (320 grams)
1/4 teaspoon salt substitute-potassium chloride
1/10 teaspoon table salt
1/3 teaspoon bone meal powder (2 grams)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 629 kcalories, 32.2 g protein, 14 g fat
supports caloric needs of a 19 pound do

When it appears that the cottage cheese or tofu diet fails, the following diet is fed. This tofu and tapioca diet is the most likely one to be successful.

Tofu and Tapioca Diet

5 1/4 ounces tofu, raw (150 grams)
2 cups tapioca (125 g dry), cooked
1/4 teaspoon salt substitute-potassium chloride
1/10 teaspoon table salt
2 calcium carbonate tablets (calcium 800 mg)

561 calories, 16.8 g protein, 6.0 g fat
supports caloric needs of 16 to 17 pound dog

Tofu and Tapioca Diet (balanced)

5 1/4 ounces tofu, raw, firm (150 grams)
2 cups tapioca (125 g dry), cooked
1/4 teaspoon salt substitute-potassium chloride
1/10 teaspoon table salt
1/2 teaspoon bone meal powder (3 grams)
1/5 multiple vitamin-mineral tablet (made for adult humans)

644 calories, 23.9 g protein, 13.1 g fat
supports caloric needs of 19 to 20 pound dog

Supplements
Without supplementation these diets are not completely balanced for adult dogs. The cottage cheese diets are very low in fat, including the essential fatty acids. The reasons for the low fat content are given earlier. Manifestations of a fatty acid deficiency take a long time to develop. Any deficiency is not serious. Dogs and cats do well on a low fat diet for four to six weeks if necessary. A low fat diet is low in the fat-soluble vitamins, A, D, E, and K. The body stores these vitamins and it takes months to deplete them. Thus, it is not urgent to begin supplementing with these vitamins.

When the diet cannot be balanced with natural foods to provide vitamin and mineral requirements, it is necessary to supplement with a vitamin-mineral preparation. Supplements prepared for humans with allergies are used (an example is multiple vitamin-mineral preparations made by Nature's Way Products, Springville, Utah). The common supplements prepared for pets contain flavoring agents, binders, fillers, etc. Many of these may cause diarrhea to return. Meat powder is a common additive and it usually causes diarrhea in a dog with a meat allergy. Such additives are less likely to be used in supplements for humans. Preventatives such as for heart worm disease may contain additives with a similar effect. The preventative causes diarrhea that is not due to the chemical for preventing heartworms.

The amount of vitamin and mineral supplement to give is based on an animal's caloric intake or body weight. Supplements formulated for an adult human supply the average needs for a person weighing much more than most dogs. Thus, a vitamin-mineral tablet for a human contains too high concentrations of ingredients for most dogs. Excessive amounts of most vitamins and minerals are not harmful. Vitamin B₁₂ should be given by tablet several times a month or by feeding a food such as sardines that contains abundant amounts.

Animals with chronic inflammatory bowel disease will benefit from extra supplements of vitamin E which is proven effective in reducing inflammation and damage to cell membranes. A capsule containing 400 IU can be given daily. Excess vitamin E is not toxic.

A salt substitute provides potassium that is lost rapidly with vomiting and diarrhea. Many bodily functions are totally dependent on normal potassium stores. For example, normal gastrointestinal smooth muscle function is lost with potassium deficiency that can paralyze motility, something that by itself causes diarrhea. Potassium's addition corrects the predictable deficiency.

Many of these diets need a calcium supplement which can be given with 1000 mg calcium carbonate tablets containing 400 mg of calcium. These diets also need additional phosphorus that can be added later in the form of vegetables. In some diets the calcium and phosphate are provided by bone meal powder or tablets. The powder used in these recipes are distributed in many different products. The amount to give is based on the amount already in the diet. The dosage recommended on the container is excessive for som. If you follow the dosage on the container check the mineral requirement tables to determine if the proper amount is given. If another form of bone meal is used, calculations can be made to determine how much is needed to meet a recipe's requirement. Examples of bone meal preparation recommended are KAL and Solid Gold steamed bone meal.

Do any signs of deficiency ever develop in dogs fed this diet for an extended time? None have been recognized at the VMTH ad Davis. Sometimes a client does not return for a check up and does not phone because the dog appears normal. Often this client continues to feed the diet for weeks or months without supplementing the diet with vitamins and minerals. Problems are seldom recognized in such cases.

Evaluation of the Controlled Diet
Careful observations are need to determine if a controlled diet is effective. Remission of vomiting and diarrhea does not always indicate recovery. Other signs must be monitored to verify complete recovery. They include borborygmus, flatulence, halitosis, anal pruritus, etc. When none of these signs is observed recovery is complete and plans can be made to introduce different foods.

Gradually introduce one new food over five to seven days. Continue observations to evaluate new foods on maintaining recovery. With time, it is possible to identify many foods the pet can or cannot tolerate. Eventually, enough tolerated foods can be identified to formulate a balanced diet. The long-range goal is to formulate a diet suitable for the animal and also for the meal-preparer.

Feeding Other Foods
Many pet owners will try to first balance the diet by adding fats or oils to satisfy essential fatty acid requirements. For some dogs this causes diarrhea which can be explained several ways. Vegetable oils, which are rich in unsaturated fatty acids, provide the material for producing leukotrienes and prostaglandins; leukotrienes are the most important mediators of inflammation in the gastrointestinal tract. So the addition of oil to the diet results in more agents of inflammation that can cause the diarrhea to return. Also fats stimulate secretion of bile acids which, with some forms of fat, can damage gastrointestinal mucosa. Caution is advised when adding fat to the diet of an animal recovering from diarrhea.

Meat is often added to the diet before trying to feed any other new foods. Most believe that dogs are designed to eat meat, and it is natural to want to satisfy their hunger for meat. Unfortunately, many dogs are sensitive to meat and its addition to the controlled diet results in diarrhea. One reason is that a dog may have lost its oral tolerance or became allergic to meat. This commonly happens during an injury to gastrointestinal mucosa. Also if meat is not completely digested and absorbed in the small intestine, dietary protein enters the colon where bacteria convert it to ammonia which is toxic. Ammonia can also act with other factors to cause or aggravate mucosal damage. If meat is tolerated feed one of the following diets. If little meat is tolerated feed chicken rather than other types.

Chicken and Rice Diet

2 cups cooked rice, white polished, long-grain (320 grams)
1/3 cup chicken breast, cooked (95 grams)
1/4 teaspoon salt substitute-potassium chloride
1/10 teaspoon table salt
2 calcium carbonate tablet (calcium 800 mg)

provides 482 kcalories, 22.1 g protein, 2.3 g fat
supports caloric needs of 13 to 14 pound dog

provides 561 kcalories, 18.4 g protein, 12.9 g fat
supports caloric needs of 16 to 17 pound dog

Many dogs with gastrointestinal problems can eat cooked eggs. This can be tested by feeding egg whites mixed with boiled rice and calcium carbonate. If clinical signs disappearance, whole eggs and additional vegetable oil can be added.

Cooked Egg Whites and Boiled Rice Diet

2 cups cooked rice, white polished, long-grain (320 grams)
egg whites from 3 large eggs, cooked
1/4 teaspoon salt substitute-potassium chloride
1 calcium carbonate tablet (calcium 400 mg)

provides 460 kcalories, 18.7 g protein, 0.9 g fat
supports caloric needs of 12 to 13 pound dog

With recovery whole eggs and vegetable oil can be added as follows:

Cooked Whole Eggs and Boiled Rice Diet (balanced)

2 cups cooked rice, white polished, long-grain (320 grams)
3 whole eggs, cooked
1/4 teaspoon salt substitute-potassium chloride
1/2 teaspoon bone meal powder (3 grams)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 644 kcalories, 27.4 g protein, 16.8 g fat
supports caloric needs of a 19 to 20 pound dog

Or with recovery the diet using only egg whites can be balanced as follows:

Cooked Egg Whites and Boiled Rice Diet (balanced)

2 cups cooked rice, white polished, long-grain (320 grams)
egg whites from 3 large eggs, cooked
2 teaspoons vegetable (canola) oil (10 grams)
1/4 teaspoon salt substitute-potassium chloride
1/2 teaspoon bone meal powder (3 grams)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 548 kcalories, 18.7 g protein, 10.9 g fat
supports caloric needs of 15 to 16 pound dog

Eggs can be inexpensive which makes them a bargain for an excellent source of protein. They are a harmful source of cholesterol for human beings but there is no risk for feeding eggs to dogs. Egg protein can be the cheapest source of protein for dogs.

Potatoes are probably the most common source of starch in human diets. Dogs can eat potatoes but they do not digest them as completely as cooked rice. If potatoes are not completely cooked, dogs digest them incompletely. That can be a cause for diarrhea in normal dogs. Potatoes are the source of carbohydrates in the following diets. Recently they have been the main source of starch in some commercial diets specially prepared for dogs with diarrhea. That was done with the idea that dogs are unlikely to have ever eaten potatoes so they are not likely to be allergic to them.

Cottage Cheese and Potato Diet

3 cups potatoes boiled in skin (369 grams)
1/2 cup cottage cheese, 1% fat (113 grams)
2 calcium carbonate tablet (calcium 800 mg)

provides 488 kcalories, 22.8 g protein, 1.6 g fat
supports caloric needs of 13 to 14 pound dog

Cottage Cheese and Potato Diet (balanced)

3 cups potatoes boiled in skin (369 grams)
1/2 cup cottage cheese, 1% fat (113 grams)
2 teaspoons vegetable (canola) oil (10 grams)
1/2 teaspoon bone meal powder (3 grams)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 577 kcalories, 22.8 g protein, 11.7 g fat
supports caloric needs of 17 pound dog

These diets supply a dog's protein requirements and they are more expensive than the diets formulated with rice. They contain less cottage cheese and therefore are also less palatable. The potato diets are very deficient in multiple vitamins. It is important to supplement potato diets with vitamins.

Vegetarian Diets

For some people it is important to feed dogs natural and vegetarian diets. Such diets are not at all natural for dogs. A dog is more of a carnivore than a herbivore. To feed a dog a vegetarian diet use the following recipes. Dogs do not digest the primary protein source, blackeye peas, as completely as animal sources of protein. Thus, if the amount of peas is too much for any dog, it is likely that any diarrhea will not improve. If that were not the primary problem, diarrhea may appear. The vegetarian recipes are listed without and with the inclusion of vegetable oil.

Vegetarian Diet

2 cups cooked rice, white polished, long-grain (320 grams)
2/3 cup boiled blackeye peas (115 grams)
1/4 teaspoon salt substitute-potassium chloride
2 calcium carbonate tablet (calcium 800 mg)

provides 544 kcalories, 17.3 g protein, 1.0 g fat
supports caloric needs of a 15 to 16 pound dog

Vegetarian Diet (balanced)

2 cups cooked rice, white polished, long-grain (320 grams)
2/3 cup boiled blackeye peas (115 grams)
2 teaspoons vegetable (canola) oil (10 grams)
1/4 teaspoon salt substitute-potassium chloride
1/2 teaspoon bone meal powder (3 grams)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 631 kcalories, 17.2 g protein, 11.0 g fat
supports caloric needs of a 19 pound dog

Occasionally a dog will have gastrointestinal problems that these diets do not relieve. In such cases a purified diet, consisting of purified nutrients, is fed. For example, instead of feeding a starch source such as rice, the diet is formulated with purified starch. Rice contains protein to which the animal might be allergic. The following recipe contains corn starch. The purified source of protein can be from milk or soybeans.

Special Diets

Purified Diet for Gastrointestinal Disease

1 cup cottage cheese, low fat 1% (226 grams)
7 tablespoons Cornstarch (150 grams)
8 ounces water
1/3 teaspoon salt substitute-potassium chloride
2 calcium carbonate tablet (calcium 800 mg)

provides 735 kcalories, 28.3 g protein, 2.5 g fat
supports caloric needs of a 23 to 24 pound dog

Purified Diet for Gastrointestinal Disease (balanced)

1 cup cottage cheese, low fat 1% (226 grams)
7 tablespoons Cornstarch (150 grams)
8 ounces water
2 teaspoons vegetable (canola) oil (10 grams)
1/3 teaspoon salt substitute-potassium chloride
1/2 teaspoon bone meal powder (3 grams)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 823 kcalories, 28.3 g protein, 12.5 g fat
supports caloric needs of a 27 to 28 pound dog

Healing of gastrointestinal mucosa requires dietary nutrients found in varying concentrations. Purines are one substance needed to form building blocks for cellular regeneration (see Protection of Intestinal Tract Integrity). Purine-rich foods such as sardines and anchovies can be used to support healing. Excess levels of purine can be toxic and they should not be added to the diet for dogs with chronic kidney or chronic liver disease. Animals with those diseases have problems excreting purine.

Cottage Cheese and Boiled Rice Diet (purine-enriched)

1/2 cup cottage cheese, low fat 1% fat (113 grams)
2 cups rice, long-grain, cooked (360 grams)
1 tablespoonful sardines, canned (20 grams)
1/4 teaspoon salt substitute-potassium chloride
2 calcium carbonate tablets (calcium 800 mg)

provides 528 kcalories, 25.8 g protein, 4.4 g fat
supports caloric needs of a 15 to 16 pound dog

Cottage Cheese and Boiled Rice Diet (purine-enriched, complete)

1/2 cup cottage cheese, low fat 1% fat (113 grams)
2 cups rice, long-grain, cooked (360 grams)
1 tablespoonful sardines, canned (20 grams)
1 teaspoon vegetable (canola) oil (5 grams)
1/4 teaspoon salt substitute-potassium chloride
1/3 teaspoon bone meal powder (2 grams)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 573 kcalories, 25.8 g protein, 9.4 g fat
supports caloric needs of a 17 pound dog

Polyamines are another group of dietary nutrients needed for gastrointestinal healing (see digestive tract environment). The gastrointestinal system also produces polyamines both by intestinal bacteria and by mucosal enzymes. The content of polyamines is unknown for most foods but protein products of soybeans are high in polyamines; milk products contain low levels. This may be one reason that feeding a diet containing tofu works so well in the recovery of dogs with gastrointestinal problems. Polyamines are produced from arginine. Thus, the diet needs ample amounts of this amino acid. Bacteria in the intestinal tract and mucosal cell enzymes use arginine to make polyamines. (It is apparent that antibiotics reducing intestinal bacterial numbers reduces polyamine production.)

Polyamines stimulate mucosal regeneration. Without this nutrient the injured lining is unable to recover quickly. Recipes described in this section contain arginine in concentrations that are mostly 8 to 12 times greater than the minimum NRC requirements. Thus, the diets would support optimal healing.

Diets for Growing Dogs

Cottage Cheese and Rice

1 cup cottage cheese, low fat 1% fat (226 grams)
1 cup rice, long-grain, cooked (160 grams)
1/4 teaspoon salt substitute-potassium chloride
2 calcium carbonate tablets (calcium 800 mg)

provides 574 kcalories, 36.5 g protein, 3.2 g fat
supports caloric needs of a 16 pound dog
1 tablespoonful (20 grams) sardines, canned can be added and calories increase by 36, proteins by 3.3 g, and fat by 2.4 g

Cottage Cheese and Rice(balanced)

1 cup cottage cheese, low fat 1% fat (226 grams)
1 cup rice, long-grain, cooked (160 grams)
2 teaspoon vegetable (canola) oil (10 grams)
1/4 teaspoon salt substitute-potassium chloride
1 calcium carbonate tablets (calcium 400 mg)
1/4 teaspoon bone meal powder (1 gram)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 654 kcalories, 36.5 g protein, 12.2 g fat
supports caloric needs of a 20 pound dog
1 tablespoonful (20 grams) sardines, canned can be added and calories increase by 36, proteins by 3.3 g, and fat by 2.4 g

Tofu and Tapioca Diet

1 cup tofu, raw, firm (252 grams)
1/2 cups tapioca (125 g dry measure), cooked
1/4 teaspoon salt substitute-potassium chloride
1/10 teaspoon table salt
1 calcium carbonate tablets (calcium 400 mg)

487 calories, 27.8 g protein, 10.1 g fat
supports caloric needs of 13 to 14 pound dog
1 tablespoonful (20 grams) sardines, canned can be added and calories increase by 36, proteins by 3.3 g, and fat by 2.4 g

Lamb and Rice Diet(balanced)

1/2 pound ground lamb (raw weight), cooked (228 grams)
1 cups cooked rice, white polished, long-grain (160 grams)
1/4 teaspoon salt substitute-potassium chloride
3/4+ teaspoon bone meal powder (5 grams)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 847 kcalories, 42.1 g protein, 53.6 g fat
supports caloric needs of 28 pound dog
1 tablespoonful (20 grams) sardines, canned can be added and calories increase by 36, proteins by 3.3 g, and fat by 2.4 g

Fiber Supplementation²

Controlled diets for diarrhea are low in fiber. Low fiber content results in smaller fecal volume. Fiber can be added to the diet after recovery from diarrhea. Controlled diets can produce fecal volumes small and dry enough to cause signs of constipation or no bowel movements for several days. Fiber is also added for meeting the nutritional needs of colonic mucosa. Only small amounts of soluble fiber is required and excess causes diarrhea. Controlled diets provide that small amount and supplementation is not necessary. Recovery from diarrhea is usually complete on feeding a controlled diet, and most remain normal after years on a diet without fiber supplementation. Fiber such as Siblin (Parke-Davis) or Metamucil (Procter & Gamble) can be added at a level of one to two teaspoons per recipe providing 500 to 600 calories. The amount is adjusted to meet a pet's needs. Amounts too small cause small fecal volume to persist and amounts too large result in large fecal volume. Cereals are the richest source of fiber. Most cereal products come from wheat, oats, or barley. These are gluten-containing foods that should not be fed because of possible sensitivity to gluten. Rice is low in fiber so eventually rice diets are supplemented with fiber. Potatoes with skin are a good source of fiber. Broccoli, cauliflower, green beans and turnip greens are examples of vegetables that provide a good source of fiber. When fed they should be introduced gradually. Some clinicians believe that certain causes of diarrhea require fiber for recovery. Fiber supplementation may not cause recovery but may merely mask the diarrhea by causing feces to be more formed. Fiber absorbs and binds water so it can make feces formed and less watery; the volume of feces does not decrease, however. This results in an apparent but not real recovery. It is like symptomatic treatment for diarrhea using a motility modifying agent like loperamide.

Long-term Dietary Management for Dogs

Dogs can remain healthy for months or years when fed one of the balanced controlled diets. Some clients have prepared and fed their dogs such diets for more than 10 years.

Controlled Diets for Cats

Cats with vomiting and diarrhea, due to gastrointestinal disease, are not fed the diets described for dogs. The most effective diets for dogs contain vegetable (tofu) or milk (cottage cheese) proteins. These proteins contain little or no taurine, an essential amino acid for the cat. It is essential because, in contrast to the dog, cats cannot synthesize taurine fast enough to meet its needs. Feeding taurine deficient diets to cats causes eye problems and heart disease. Taurine-free proteins can be fed but only if they are supplemented with taurine, something that increases the burden of preparing a pet's diet.

Based on clinical experience it is known that the best diet for achieving recovery from diarrhea in a cat is based on feeding poultry meat as the protein source. Cat are seldom allergic to poultry. Meat is rich in taurine so supplementation is unnecessary. At the VMTH at Davis affected cats are managed at the beginning by feeding nothing but poultry meat.

Poultry Diet for Growing or Adult Cat With Diarrhea

6 oz.(raw) ground turkey, cooked (171 grams)
1 calcium carbonate tablet (calcium 400 mg)
1/10 multiple vitamin-mineral tablet (made for adult humans)

provides 284 calories, 30.1 g protein, 17.2 g fat
supports caloric needs of a 9 pound cat

When the cat recovers give bone meal powder (base on body weight) instead of the calcium carbonate tablet. The turkey or chicken diet is complete except for fat soluble vitamins A, D, E, and K. Some water soluble vitamins are lower than required. It is not necessary to supplement these vitamins for the first three to four weeks.

It is possible to formulate a poultry diet with carbohydrate using cooked rice. The following diet is the same as the all poultry diet except rice provides much of the energy. The cat is a true carnivore and so it should eat only meat. Cats digest cereal carbohydrates such as rice, however. This is similar to dogs which now are not true carnivores. Therefore, they should do as well when fed the rice and poultry diet as dogs, but they don't. It may be because cats can only tolerate a reduced level of dietary starch compared with dogs. Dogs can digest and absorb up to 2.5 times as much starch as can cats. Cats do not recover as well from this diet as from the all poultry diet.

Rice and Poultry Diet for Growing or Adult Cat With Diarrhea

1/2 cup rice, long grain cooked (80 grams)
6 oz.(raw) ground turkey, cooked (171 grams)
1 1/2 calcium carbonate tablet (calcium 600 mg)
1/10 multiple vitamin-mineral tablet (made for adult humans)

provides 387 calories, 32.3 g protein, 17.4 g fat
supports caloric needs of a 12 pound cat

When the cat recovers give bone meal powder instead of the calcium carbonate tablet. A whole turkey or parts of the turkey can be cooked and ground before feeding. This provides the required minerals calcium and phosphorus in their proper amounts. In that case the bone meal tablets should not be given. Sometimes lamb or chicken is recommended instead of turkey. Other recipes include vegetable oil but that is not necessary with the turkey diet. The addition of lamb baby food or small quantities of liver (0.5 oz) to improve palatability is sometimes recommended. Neither is necessary. Many feed human baby foods to sick cats. These foods are not complete for meeting a cat's nutritional needs. In addition, recent studies criticize these foods for human consumption. The studies show the foods to be loaded with fillers, extenders, and water. They also can contain onion which causes heinz body anemia in cats. The most important reason for not feeding baby foods is that they are not balanced diets.

Diarrhea and other gastrointestinal diseases are common in cats, and cats outnumber dogs as family pets. No pet food manufacturer formulates a diet for feline gastrointestinal diseases, however. Sometimes a pet food company recommends one of its specialty products as useful for managing diarrhea. No products are effective for recovery, however. Most of these specialty products are canned foods and since some cats suffer from chronic diarrhea merely because they eat a dry cat food (reason for this is unknown), a change to any canned cat food results in recovery. Cats cannot be fed the specialty products prepared for dogs with chronic gastrointestinal disease; dog foods are deficient in protein and taurine.

Some cats must eat a controlled diet indefinitely to maintain recovery from a gastrointestinal problem. Then it is necessary to insure that the diet contains all the necessary nutrients. Use the poultry diet to build on; cats have no requirement for carbohydrates so do not need rice or any other form of carbohydrate. Low-fat ground turkey or chicken will need additional fat, added easiest as vegetable oil. Approximately 1/2 to 1 teaspoon vegetable oil is added daily. A vitamin-mineral supplement is the only other addition needed to balance the diet. A fraction of human vitamin-mineral preparation is used. A high potency preparation containing no vitamins A and D can be divided so the cat receives the equivalent of one tenth of a tablet daily. To supplement vitamins A and D give one fifth of a complete supplement once every week or two. Deficiencies of these vitamins are rarely seen in an adult cat.

For the cat there is no known requirement for fiber.

Management to Prevent Bloat (Acute Gastric Dilation)³

Bloat is a common and serious problem that most often affects larger-breed dogs. Its frequency is 7 percent to 10 percent for Great Danes and Irish Setters, two high-risk breeds for developing the problem. Other breeds at high risk include St. Bernard, Weimaraner, Gordon Setter, Standard Poodle, Basset Hound, Doberman Pinscher, Old English Sheepdog, and many others. Bloat is a major problem because about 30 percent of affected dogs die, despite anything that can be done. The cause of bloat is unknown. Dogs at highest risk have a body conformation that includes a deep and narrow chest. Many breeders and dog owners believe that feeding dry dog food increases the risk of bloat. Nearly all owners of larger breed dogs feed them commercial dry dog foods. What can be done to prevent bloat in a high-risk dog? Bloat appears to be much more common since 1950, since the feeding of dry dog foods has become popular. No one has proven one way or another that bloat is caused by feeding dry dog food. Until more is known the recommendation should continue to not feed dry food or to feed it often in small amounts. As an alternate the dog's diet can be prepared by the owner. Any one of the diets here for normal dogs can be fed. The higher caloric density diets are better because the volume of food required will be less than by feeding a low caloric density diet. Thus the diet fed should be relatively high in fat and low in carbohydrates (cereals, pasta, potatoes, etc.). Universal recommendations to prevent bloat include feeding more frequent and smaller meals per day. Most also recommend restricting exercise before and after meals. No drug therapy can prevent bloat.

1. Guilford, W. Grant. 1996. Nutritional Management of Gastrointestinal Diseases. In Small Animal Gastroenterology, edited by W. Grant Guilford, Sharon A. Center, Donald R. Strombeck, David A. Williams and Denny J. Meyer, 889-910. Philadelphia: W.B. Saunders.

2. Bauer, John E. and Ian E. Maskell. 1994. Dietary Fibre: Perspectives in Clinical Management. In The Waltham Book of Clinical Nutrition of the Dog and Cat. Edited by J. M. Wills and K. W. Simpson, 87-104. Oxford: Pergamon Press.

3. Glickman, Lawrence T., Nita W. Glickman, Diana Schellenberg, Cynthia Perez, William R. Widmer, Gary C. Lantz, Qi-long Yi and Tim Emerick. 1995. Epidemiologic Studies of Bloat in Dogs. Veterinary Previews 2(2):10-15.