Diet and Pancreatic Diseases

Dogs and cats develop two kinds of pancreatic disease. One is pancreatitis where inflammation destroys part or all tissue that produces digestive enzymes. The other is pancreatic enzyme insufficiency that appears in certain breeds of dogs and is thought to be a congenital defect. Insufficiency can also develop from inflammation destroying secretory tissue. Important treatment for both is dietary. Pancreatic tumors are relatively uncommon in dogs and cats and have no dietary management.

Pancreatitis

Etiology and Pathogenesis¹
Pancreatic inflammation is relatively common and sometimes life-threatening. Most cases (about two-thirds) of pancreatitis are secondary to a problem in another organ or tissue. Secondary causes include renal, gasrointestinal, hepatic, and cardiovascular disease. Cancer in the pancreas or other organs, generalized infections and drugs can also cause pancreatitis. Primary pancreatitis represents the remaining third of cases. The cause of primary pancreatitis is unknown. Acute primary pancreatitis has been thought to be caused by what an animal eats. Many have a history of eating high-fat meals or table scraps in garbage. High-fat meals are thought to be an important cause of acute pancreatitis. High-fat meals are routinely fed to some working dogs with no ill-effects, however. Sled dogs can live on a diet containing 60 percent fat and have no problems. Despite that, very low-fat diets are fed during and after recovery from acute pancreatitis.

Foods with the greatest potential for stimulating pancreatic enzyme secretion are believed to cause pancreatitis. Protein and fat are the most potent stimulators. During recovery from acute pancreatitis, animals are often fed high carbohydrate, low fat and low protein diets. Animals with abundant pancreatic stores of digestive enzymes are most susceptible to acute pancreatitis. Undernourished animals are less likely to develop pancreatitis when they are fed a diet rich in protein and fat. Feeding a diet deficient in some important nutrients can cause pancreatitis, however. A deficiency of choline and methionine destabilizes pancreatic membranes isolating pancreatic enzymes before they are secreted. Membrane instability causes enzymes to leak into pancreatic tissue and leads to inflammation and necrosis.

Overweight and overnourished animals are more likely to develop acute pancreatitis. Obese middle-age dogs are at highest risk for pancreatitis. They have rich stores of pancreatic enzymes and are the most likely to eat foods rich in protein and fat. Management to reduce the risk of pancreatitis must include maintaining body weight within normal limits.

Dietary constituents other than nutrients contribute to acute pancreatitis. Bacteria and other infectious agents can cause pancreatitis. Bacteria are common in many commercial dry pet foods and their numbers can increase after food is moistened. Bacteria can reflux from the intestine through the pancreatic duct and into the pancreas. They can also cross the intestinal wall and into the pancreas lying adjacent. Animals with acute pancreatitis have bacteremia and bacteria in the pancreas. Regardless of whether this is a primary or secondary phenomenon affected animal must be treated with antibiotics.

Commercial pet foods and foods contaminated by coliform bacteria contain endotoxin. Their consumption can result in endotoxemia. Endotoxemia is a feature of acute pancreatitis and contributes to the damage, partly because endotoxin disrupts pancreatic microcirculation.

Pancreatitis can be produced by allergic or immune-mediated reactions. If such reactions are against dietary antigens, controlled diets would reduce relapses and hasten recovery.

Diagnosis¹
Acute pancreatitis is often difficult to diagnose. In dogs usual clinical signs are vomiting, anorexia and abdominal pain. None of these signs may be seen in some cases which may make it seem that acute pancreatitis is unlikely. Other signs include depression, fever, diarrhea, abdominal distention, dehydration and shock, respiratory distress, and cardiac arrhythmias. Often the only signs are anorexia and depression. Chronic pancreatitis in dogs is difficult to recognize because they usually show no clinical signs. In some dogs chronic pancreatitis causes diabetes mellitus but signs of pancreatitis were never seen when inflammation destroyed the pancreas. Cats with acute pancreatitis show fewer diagnostic signs than dogs. Most cats are never diagnosed with pancreatitis until necropsy because no signs are evident to suspect pancreatitis.

Acute pancreatitis is proven in dogs by increased plasma lipase activity. No other clinical pathology tests, such as plasma amylase activity, are reliable in identifying acute pancreatitis. Not all animals with increased plasma lipase activity have pancreatitis. About 75 percent have pancreatitis with the other 25 percent having a problem such as kidney, liver, or neoplastic disease.

Abdominal ultrasound is used to confirm that increased plasma lipase activity is due to pancreatitis and not due to another problem. The normal pancreas is not seen with ultrasound but inflammation causes it to be visible. Other diagnostic studies, such as abdominal radiography, can be done but they are either unreliable or provide no additional useful information. Plasma lipase activity is usually normal in dogs with chronic pancreatitis. Abdominal ultrasound is the only diagnostic tool useful for its identification. The chronically diseased pancreas is visible on ultrasound.

Plasma lipase activity increases in cats with acute pancreatitis but it returns to normal in four to five days. Ultrasound is useful in identifying cats with acute pancreatitis.

Management: medical¹Intravenous fluids and antibiotics are essential in treating dogs and cats with acute pancreatitis. Without fluid therapy mortality can be high. Many other treatments are described but none are of any proven value. During the initial acute phase no food is given. Many are anorectic and vomiting so offering food is of no value. Food is avoided because feeding stimulates the pancreas to secrete which is thought to worsen its inflammation.

Management: Dietary¹

Feeding can begin for dogs four to five days after the onset of acute pancreatitis. Carbohydrates and electrolytes are given first; they stimulate pancreatic secretion little. Initial feedings can be glucose solutions and gradually an easily digested starch such as boiled rice can be given. Proteins of high biological value, such as egg white, are added next. Whole eggs are not fed because their yolks are high fat. Other low fat proteins with high biological value include low-fat cottage cheese and lean meat such as chicken breast.

Recovering cats are fed following the principles for dogs. Cats have a higher protein requirement and they are not likely to accept the same foods as dogs. Cats should also be fed a relatively low fat diet. No one has shown that cats recover poorly if they are fed a high fat diet, however.

If pancreatitis results from an immune-mediated or allergic response to something in the diet, a controlled diet must be fed.

Diets for Dogs with Pancreatitis

Cottage Cheese and Rice Diet
low fat, low protein

1/2 cup cottage cheese, 1% fat (113 grams)
2 cups rice, long-grain, cooked (320 grams)
1 egg yolk, chicken, large, cooked
1/3 teaspoon bone meal powder (2 grams)
1/4 teaspoon nosalt (salt substitute-potassium chloride)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 551 kcalories, 25.4 g protein, 7.2 g fat
supports caloric needs of 16 pound dog
choline content is higher than with vegetable oil

Cottage Cheese and Rice Diet
low fat, low protein

1/2 cup cottage cheese, 1% fat (113 grams)
2 cups rice, long-grain, cooked (320 grams)
1 teaspoon vegetable (canola) oil (5 grams)
1/3 teaspoon bone meal powder (2 grams)
1/4 teaspoon nosalt (salt substitute-potassium chloride)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 535 kcalories, 22.6 g protein, 6.9 g fat
supports caloric needs of 15 pound dog

Egg Whites and Rice Diet
low fat, low protein

4 egg whites, chicken, large, cooked
2 cups rice, long-grain, cooked (320 grams)
1 egg yolk, chicken, large, cooked
1/3 teaspoon bone meal powder (2 grams)
1/4 teaspoon nosalt (salt substitute-potassium chloride)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 537 kcalories, 25.4 g protein, 6.1 g fat
supports caloric needs of 16 pound dog
choline content is higher than with vegetable oil

Egg Whites and Rice Diet
low fat, low protein

4 egg whites, chicken, large, cooked
2 cups rice, long-grain, cooked (320 grams)
2 egg yolks, chicken, large, cooked
1/3 teaspoon bone meal powder (2 grams)
1/4 teaspoon nosalt (salt substitute-potassium chloride)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 597 kcalories, 28.2 g protein, 11.2 g fat
supports caloric needs of 18 pound dog
choline content is higher than with vegetable oil

Egg Whites and Rice Diet
low fat, low protein

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

provides 520 kcalories, 22.4 g protein, 5.8 g fat
supports caloric needs of 14 to 15 pound dog
choline content is lower with vegetable oil

Egg Whites and Rice Diet
low fat, low protein

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

provides 561 kcalories, 22.4 g protein, 10.4 g fat
supports caloric needs of 16 pound dog
choline content is lower with vegetable oil

Chicken and Rice Diet
low fat, low protein

1/2 cup chicken breast, cooked (143 grams)
2 cups rice, long-grain, cooked (320 grams)
1 teaspoon vegetable (canola) oil (5 grams)
1/2 teaspoon bone meal powder (3 grams)
1/10 teaspoon table salt
1/4 teaspoon nosalt (salt substitute-potassium chloride)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 562 kcalories, 28.9 g protein, 7.8 g fat
supports caloric needs of 16 pound dog
choline content is lower with vegetable oil

Chicken and Rice Diet
low fat, low protein

1/2 cup chicken breast, cooked (143 grams)
2 cups rice, long-grain, cooked (320 grams)
1 egg yolk, chicken, large, cooked
1/3 teaspoon bone meal powder (2 grams)
1/10 teaspoon table salt
1/4 teaspoon nosalt (salt substitute-potassium chloride)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 577 kcalories, 31.8 g protein, 8.2 g fat
supports caloric needs of 17 pound dog
choline content is higher with egg yolks

provides 615 kcalories, 36.8 g protein, 7.6 g fat
supports caloric needs of 18 pound dog

Cottage Cheese and Potato Diet
very low fat, moderate protein

1 cup cottage cheese, 1% fat (226 grams)
3 cups potato, cooked with skin (369 grams)
1/3 teaspoon bone meal powder (2 grams)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 574 kcalories, 36.8 g protein, 2.8 g fat
supports caloric needs of 17 pound dog

Egg Whites and Potato Diet
low fat, low protein

4 egg whites, chicken, large, cooked
2 cups potato, cooked with skin (246 grams)
1 teaspoon vegetable (canola) oil (5 grams)
1/3 teaspoon bone meal powder (2 grams)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 381 kcalories, 19.8 g protein, 5.1 g fat
supports caloric needs of 9 to 10 pound dog

Egg Whites and Potato Diet
low fat, low protein

4 egg whites, chicken, large, cooked
2 cups potato, cooked with skin (246 grams)
1 egg yolk, chicken, large, cooked
1/3 teaspoon bone meal powder (2 grams)
1/5 multiple vitamin-mineral tablet (made for adult humans)

provides 397 kcalories, 22.7 g protein, 5.4 g fat
supports caloric needs of 10 to 11 pound dog
choline content is higher with egg yolks

Pancreatic Exocrine Insufficiency^1,2

Chronic relapsing pancreatitis and juvenile pancreatic atrophy are the most common causes of deficient pancreatic secretion. The latter appears in young dogs with German Shepherds most commonly affected, suggesting the problem is congenital in that breed. Clinical signs frequently do not appear until the animal is six to twelve months old, which suggests that enzyme secretion is adequate in very early life. Other possible causes include viral infection and abnormal immune-mediated damage to pancreatic acinar tissue.

Clinical signs of pancreatic insufficiency in dogs are weight loss, bulky feces that can be formed or loose, and increased appetite. Feces show steatorrhea and other signs of undigested food. Steatorrhea is most easily confirmed by fecal smears stained with Sudan stain to show fat globules. Steatorrhea develops with many causes of maldigestion and malabsorption so pancreatic exocrine insufficiency must be confirmed with another test. Measurement of serum trypsin-like immunoreactivity is used to confirm a diagnosis.

Pancreatic exocrine insufficiency is most importantly treated with pancreatic enzymes in form of a powder mixed with food. Digestion is more complete and less enzyme replacement therapy is needed when an owner-prepared rather than commercial pet food is fed. The diet should be made with foods having the highest digestibility and should be low in fiber to maximize digestibility. Excess carbohydrates should be avoided because they escape optimum digestion even with enzymes added to the diet. Increased calories are needed to restore weight losses. It may be easier to accomplish that with fat rather than carbohydrates. A readily digested protein is fed. Affected dogs should be fed 3 times a day. The following recipes include low-fat and moderate to high-fat diets. Dogs may respond to one type better that the other. Use the diet that gives the best results in restoring weight loss and producing normal feces.

Diets for Pancreatic Enzyme Insufficiency

Cottage Cheese and Boiled Rice Diet (low fat)

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

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

Chicken and Rice Diet (low fat)

1/2 cup chicken breast, cooked (143 grams)
2 cups rice, long-grain, cooked (320 grams)
1 egg yolk, chicken, large, cooked
1/3 teaspoon bone meal powder (2 grams)
1/10 teaspoon table salt
1/4 teaspoon salt substitute-potassium chloride
1 multiple vitamin-mineral tablet

provides 577 kcalories, 31.8 g protein, 8.2 g fat
supports caloric needs of 17 pound dog

Cottage Cheese and Boiled Rice Diet (moderate to high fat)

1 cup cottage cheese, 2% fat (226 grams)
2 1/2 cups rice, long-grain, cooked (400 grams)
2 tablespoon sardines, canned, tomato sauce (38 grams)
1 1/2 tablespoons vegetable (canola) oil (21 grams)
1/4 teaspoon salt substitute-potassium chloride
1/2 teaspoon bone meal powder (3 grams)
1 multiple vitamin-mineral tablet

provides 973 kcalories, 47.8 g protein, 31.2 g fat
supports caloric needs of 34 pound dog
Omission of sardines reduces caloric content by 68 kcalories, protein by 6.2 g and fat by 4.6 g.

Poultry Meat and Potato Diet (moderate to high fat)

1/3 pound (weight before cooking) poultry meat (152 grams)
3 cups potato, cooked with skin (369 grams)
2 tablespoon sardines, canned, tomato sauce (38 grams)
1 tablespoons vegetable (canola) oil (14 grams)
1/4 teaspoon salt substitute-potassium chloride
1/10 teaspoon table salt
1/2 teaspoon bone meal powder (3 grams)
1 multiple vitamin-mineral tablet

provides 851 kcalories, 42.4 g protein, 34.3 g fat
supports caloric needs of 28 to 29 pound dog
Omission of sardines reduces caloric content by 68 kcalories, protein by 6.2 g and fat by 4.6 g.

References

1. Williams, David A. 1996. Malabsorption, Small Intestinal Bacterial Overgrowth, and Protein-Losing Enteropathy. In Small Animal Gastroenterology, edited by W. Grant Guilford, Sharon A. Center, Donald R. Strombeck, David A. Williams and Denny J. Meyer, 381-410. Philadelphia: W.B. Saunders.

2. Williams, David A. 1996. The Pancreas. In Small Animal Gastroenterology, edited by W. Grant Guilford, Sharon A. Center, Donald R. Strombeck, David A. Williams and Denny J. Meyer, 367-380. Philadelphia: W.B. Saunders.