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Wednesday, September 28, 2016

Nutritional Research, Corn In Pet Foods, And Resources....The Last Word?

Long-time readers know that pet nutrition is a big interest of mine, and I've written more on this topic than just about any other.  Recently I've had a reader, Peter, debating with me on the pros and cons of corn in pet food on an older post from 2013 ("Corn In Food...No, It's Not Bad").  One of the things that I've been bringing up is the source of my information versus his.  I thought this was worth a post of its own, hence today's blog entry.
Up until about eight years ago I believed many of the myths about pet food ingredients (no corn, meat must be the first ingredient, etc.).  But then I started attending lectures at veterinary conferences and reading articles on the subject, quickly realizing that I had been previously misinformed.  Honestly, I had based my opinions on what I heard others talking about rather than really looking at the science behind what I was saying.  When I did look into the real data I was ashamed that I had been so ignorant and that I had helped perpetuate certain myths.  That's when I really started writing and talking about the truth behind pet nutrition.
I'm not going to go back and repeat points that I've made previously.  You can do a search for pet nutrition on my blog and find quite a lot of articles and information.  My point in today's post is to point out where I have gotten my information, and that there is significant scientific validity to what I write or say.  I'm not looking at "common sense" (something that is often an argument given against me, yet has no real science), I'm looking at hard data by highly educated and respected specialists.  Here are some resources that have helped me form my opinions on pet food.
Small Animal Clinical Nutrition, 5th Edition, Hand et al, 2010--Great text and pretty much the gold-standard on nutrition in dogs and cats.  Lots of good information in this book, but let me give a quote from page 95:
"Multiple protein sources are often combined to improve the overall quality and amino acid profile when foods are formulated. This method of improving protein quality is termed protein complementation (Zapsalis and Beck, 1985).  Protein sources are combined based on their amino acid excesses and deficiencies so that the nutritional weakness of each source will be counterbalanced by the strengths of other sources, resulting in a food with high-quality protein. Corn and soybean meal are typically used in animal food formulations to take advantage of protein complementation."
Studies showing that corn gluten meal has a crude protein digestibility in cats comparable to meat, fish, chicken, and poultry:
Funaba M, Tanaka T, Kaneko M, et al.  Fish meal versus maize gluten meal as a protein source for dry cat food.  Journal of Veterinary Medical Science, 2001; 63:  1355-1357
Funaba M, Matusmoto C, Matsuki K, et al.  Comparison of maize gluten meal and meat meal as a protein source in dry foods formulated for cats.  American Journal of Veterinary Research, 2002; 63: 1247-1251.
Kane E, Morris JG, Rogers QR.  Acceptability and digestibility by adult cats of diets made with various sources and levels of fat.  Journal of Animal Science. 1981; 53: 1516-1523.
Funaba M, Oka Y, Kobayashi S, et al.  Evaluation of meat meal, chicken meal and corn gluten meal as dietary protein sources of protein in dry cat food.  Canadian Journal of Veterinary Research, 2005: 69: 299-304.
In some of the above studies do you know what source consistently had the highest digestibility?  Soy protein!  Even greater than meat sources.
Studies showing that protein quality of corn gluten meal is considered the same as various sources of animal meat and meal:
Brody T.  Protein. In: Nutritional Biochemistry.  San Diego, CA:  Academic Press Inc, 1994; 295-352. 
Jurgens MH, Animal Feeding and Nutrition, 6th ed.  Dubuque, IA:  Kendall/Hunt Co, 1988: 172. 
National Research Council.  Improvement of Protein Nutrition.  Committee on Amino Acids, Food and Nutrition Board. National Academy of Sciences, Washington, DC, 1974.
Robinson DS.  The nutritional value of food proteins.  In: Food Biochemistry and Nutritional Value.  New York, NY:  Wiley & Sons Inc, 1987; 117-151.
Studies analyzing amino acid digestibility of dog foods:
Bednar GE, Patil AR, Murray SM, et al.  Starch and fiber fractions in selected food and feed ingredients affect their small intestinal digestibility and fermentability and their large bowel fermentability in vitro in a canine model.  Journal of Nutrition 2001; 131: 276-286.
Murray SM, Patil AR, Fahey GC Jr, et al.  Raw and rendered animal by-products as ingredients in dog diets.  Journal of Animal Science, 1997; 75: 2497-2505.
Muir HE, Murray SM, Fahey GC Jr, et al.  Nutrient digestion by ileal cannulated dogs as affected by dietary fibers with various fermentation characteristics.  Journal of Animal Science, 1996; 74: 1641-1648.
Yamka RM, Kitts SE, True AD, et al.  Evaluation of maize gluten meal as a protein source in canine foods.  Animal Feed Science and Technology, 2004; 116: 239-248.
Gajda M, Flickinger EA, Grieshop CM, et al.  Corn hybrid affects in vitro and in vivo measures of nutrient digestibility in dogs. Journal of Animal Science, 2005; 83: 160-171.
Yamka RM, Kitts, SE, Harmon DL.  Evaluation of low-oligosaccharide and low oligosaccharide low-phytate whole soya beans in canine foods.  Animal Feed Science and Technology, 2005; 120: 79-91.
Clapper GM, Grieshop CM, Merchen, NR, et al.  Ileal and total tract digestibilities and fecal characteristics of dogs as affected by soybean protein inclusion in dry, extruded diets.  Journal of Animal Science, 2001; 79: 1523-1532.
I have read additional articles and professional opinions by the following specialists, which have helped form my knowledge on various aspects of pet nutrition.  You can look up the various alphabet designations for each, but they mean that these are people highly specialized in animal internal medicine and nutrition.
Denise A. Elliott, DVSc (Hons), PhD, DACVIM
Justin Shmalberg, DVM, DACVN
Preston R. Buff, PhD, PAS, DACAN
Joe Bartges, DVM, PhD, DACVIM, DACVN
Cecillia Vellaverde, BVSc, PhD, DACVN, DECVCN
Jennifer Larsen, DVM, PhD, DACVN
Scott Campbell, BVSc (Hons), MAVSc, DACVN
I have also spoken to and heard lectures within the last year from the following specialists:
Sherry Sanderson, DVM, PhD, DACVIM, DACVN, University of Georgia College of Veterinary Medicine.
Angela Lusby, DVM, PhD, DACVN, University of Tennessee College of Veterinary Medicine.

I've presented multiple articles on the issue of corn in pet foods because it is the main point that Peter and I have been debating.  However, any information that I have shared on any point of pet nutrition can be attributed to one or more of the above sources
There are other specialists that I've heard lecture over the years whose names I can't remember, but you can get the idea. I don't come to my opinions on my own, based on random thoughts.  I don't listen to the food company representatives as my only source of nutritional information.  I'm looking at and listening to the words of people who are far smarter and more knowledgeable than myself, often with multiple degrees and certifications.  Please, don't believe me. Instead, believe someone with two doctorates and two specialty certifications on top of that!  Who is going to be more informed on proper animal nutrition and biochemistry? The specialists above, or the person writing the holistic website, even if that writer has a DVM degree?
Now I know that some people will look at the above very impressive qualifications and studies and say "Well, they're supported by the food companies, so of course they're going to validate the crappy nutrition these companies produce!"  Unfortunately, that's not the way that works.  Do you really think that this many specialists (and more!  these are only the ones from my personal experience!) and this many studies in multiple international journals are all on the payroll of the "Big Bad Pet Food Co."?  Do you really think that the one blogger you read, or the handful of websites that push "all natural" resources, or that small niche brand of pet food honestly know more and are more qualified than the rest of nutritional science?  Believing so is the height of hubris and close-mindedness.  Thinking that no nutritional research is valid because it is all funded by pet food companies (which it isn't) means that nobody can adequately contradict that science.  So all we are left with is various opinions, NONE of which have scientific validity.

In many discussions on nutrition I challenge people who have a view contrary to mine to support their position with valid scientific studies.  I do so because we are dealing with scientific principles, and in science peer-reviewed studies are the gold standard for data.  No, they're not always perfect, and sometimes such studies are proven wrong.  But they are the best that we have and far better than simply saying "X ingredient is bad because I think so."  If we are automatically going to dismiss studies because of a false perception that they are completely determined by pet food manufacturers, then we have to dismiss ALL nutritional studies.  How reasonable is that?

So I'll make a new challenge. Forget giving me references to studies that show that I'm wrong.  Point me to people who have a DVM and PhD in veterinary nutrition, are a diplomate of an appropriate College of Veterinary Nutrition, or similar qualifications which are equivalent to my sources above.  If anyone can show me someone with comparable training and background to my own resources who disagrees with what I and the above specialists say, I will absolutely be willing to look at their opinions.  But remember that you and your sources are not disagreeing with me, they are disagreeing with the above specialists and researchers.

If you can't provide studies or people with backgrounds and specialties in animal nutrition who support contrary viewpoints, then you really have no leg to stand on and are being intentionally oblivious to the truth of nutritional science.  Pet owners who would ignore the views of the dozens of people that I've referenced above are being willingly ignorant.  I can inform people.  I can't change closed minds.

If someone really wants to get an opinion other than mine, and one far more expert and educated, look a the web page for the American College of Veterinary Nutrition and find the closest diplomate.  Ask them what they think of corn, by-products, grain-free diets, and other nutritional myths.  You'll find that what I've written over the years is what nutritional specialists believe.

I would like to say that this is the last word on this topic, and that I've adequately shown how absolutely overwhelming the information is that form the opinions I share.  Unfortunately I'm sure that won't be the case, and I'm interested to see how Peter and others contradict or challenge me, and how they are able to support their views.

Sunday, September 25, 2016

Pet Food Recalls

Astute readers may have noticed a new gadget on the left-hand side of my blog.  This is an incredibly helpful tool created by Arby Abraamyan of  Even as a veterinarian I've been hard-pressed to keep up with pet food recalls since they don't often make major news or are the source of big articles.  Arby says that such lists are difficult to maintain as the information doesn't always come up on the US FDA (Food and Drug Administration) website, and therefore his company monitors multiple sources.

Keep in mind that almost every food company has had to issue recalls.  This is true of both major and minor brands.  Having a recall doesn't mean that the company is doing a bad job or that the food will kill your pet.  While those dramatic situations are possible, most recalls happen because the quality assurance methods by the company work and they notice a problem before the food causes any serious health consequences.  The best companies will usually catch problems before the product is shipped to the public, but no company or person can ever be 100% accurate.  

I'll keep this widget in a prominent place on my blog to help educate the pet owners that come here.  Feel free to share this information with others.

Thursday, September 22, 2016

Out Of Whack Priorities

Some pet owners have their priorities all mixed up.  It's something that really bothers those of us in this profession because it often means that the pet loses out.
Recent case in point....
We had a dog brought in because the owner was worried about vomiting for a few days.  We didn't have any available appointments but wanted to make sure the pet was okay so the client agreed to drop it off.  When she did she asked how long it would take because she had a grooming appointment for him.
Really?  You brought your dog in for vomiting and you're more worried about his haircut?  He might have pancreatitis, a toxin, an intestinal foreign body, or something else bad and you are more interested in him getting his bath and trim on time?

This happens more frequently than those outside of the profession might realize.  And it often revolves around grooming.  Often we'll see a pet for a rabies vaccine only because the previous one had expired and the grooming facility required it.  Otherwise the client would have never brought their pet in!  I have also seen many cases where we do the rabies vaccine and the owner declines all other vaccines, heartworm testing and prevention, and any other preventative care.  Why do they refuse these necessary preventative services?  Because they can't afford it.  Why can't they afford it?  Because they need the money to get their dog groomed.

So basically they're saying that they can't afford a $40 test and $35 prevention against a common and life-threatening disease, but they can afford $60 or more to get their dog a bath, haircut, and cute little bows. 


This frustrates the heck out of us in this field.  We are worried about preventing serious diseases or diagnosing and treating health issues, and this is our primary focus.  For some clients they could care less about the health risks to their dog and put the priority on them looking pretty and smelling nice.  Frankly, I'd rather see a stinky, dirty dog who is current on vaccines and heartworm prevention than one with the perfect haircut who barely has his rabies vaccine up to date.

I'm really glad that clients like this are the minority of our caseload, and most people do a great job of putting the focus for their pets on the important things.  Most of my clientele are great people who listen to our recommendations (for the most part).  But I don't think I'll ever be comfortable with the ones who put their priorities for their pets in the wrong order.

Monday, September 19, 2016

Some Amusing Irony

Several years ago I changed the comments on this blog so that all of them had to be approved by me.  This was done because I was having a big problem with people making comments, often unrelated to the original post, that contained a link to some other website or service.  For example, on a post about skin problems in dogs I might get a comment with a link to hair loss treatment for men.  I'm always open to opinions contrary to my own (as long as they are polite), as anyone can see by reading my comments sections.  However, I don't want to clutter the comments with spam messages and I absolutely don't want to support those spammers in any way, shape, or form.  So I screen each and every comment, deleting ones that are obviously spam.
Today I had a comment on a blog I made two years ago.  My post was titled "Vaccines Are A Money-Making Scam!" and talked about some of the financial issues around vaccinating pets.  The comment I received was the following: 

 Get daily ideas and methods for generating THOUSANDS OF DOLLARS per day FROM HOME for FREE.
The last line included a link, which I have removed from this quote.  This is the kind of comments that I get every week on various posts and is the main reason why I screen and authorize every comment.  But what I find particularly interesting and ironic is that whoever wrote it only saw the key words of "money-making" in the title and didn't realize that the title was completely sarcastic.  They obviously never read the post or even considered the topics or theme of the my blog.  The irony comes in that I was talking about scams, and the link is almost assuredly a scam!
Typically I just delete the comment, but I couldn't resist sharing this one.  These spammers and marketers are pretty darn stupid since I have a clear statement that this kind of comment will be deleted immediately and yet they still make them.

Friday, September 16, 2016

Is Charging For Prescriptions Legal Or Ethical?

Connie recently emailed me a great question....
As a veterinarian do you feel justified in charging a fee for writing a prescription?
I was a long-time client of a veterinarian who had one of my cats on a common medication that is very inexpensive at the pharmacy. I had been purchasing the medication from the vet who was charging substantially more for the medication. The condition my cat had was chronic, and I had spent quite a lot of money over time. The cat would continue to need this medication for the rest of his life, and I finally decided that it was nonsensical for me to be paying so much extra by purchasing this medication from the vet, so I asked for a written prescription which I planned to take to my pharmacy and save myself a little money. My vet did provide me with a written prescription, but charged a fee to do so. This actually hurt my feelings. It was as though he was saying, "I don't care about your many years of loyalty to my practice and the many animals I have treated for you, all I care about is your money. If you're not going to pay my high prices for medication, I will punish you by getting my share of the profit this way instead." I never went back to that vet.
I imagine that it's legal for a veterinarian to charge a fee for writing a prescription, but I find it unethical when the obvious reason for the fee is to recover lost revenue. I would really appreciate your thoughts about this type of situation.
Issuing a prescription isn't quite as simple as pulling out the pad and a pen.  Sometimes the size of medications in the human and veterinary fields can vary, so the doctor will have to look up what may be available somewhere else.  Sometimes we have to tweak the dose if we're changing medication.  We also need to take time to record the prescription in the patient's medical notes so that we can track it appropriately and any other doctors that see the records after that can know exactly what medications the pet is taking.  In some locations we have to do extra recording for controlled substances.  All of this takes time, and in any business time is money.  If we're taking even 5-10 minutes to do all of the above it can take away from other patients or services.  When we fill prescriptions in the clinic the costs of the time to do all of this is included in the prices, as well as the costs of labels, prescription bottles, and the medication itself.
In the US if a client asks for a written prescription the doctor legally must given them that prescription.  It is absolutely illegal for a doctor to refuse to authorize a prescription at another facility or pharmacy if they have fulfilled a legal client-patient-doctor relationship and would allow the prescription to be completed in their own clinic.  So if a vet (or any doctor) refuses to authorize a prescription just because you won't buy it from them they are breaking the law.  You are always legally entitled to a written prescription.
It is perfectly legal for a veterinarian to charge to write a prescription, and my first paragraph is generally the justification that is used for making these charges.  The question then changes from "can they charge" to "should they charge?"
I don't think it's unethical for a vet to charge for a written prescription.  However, I think that it's more trouble that it's worth, and pushes away more clients than an average practice would want (as in Connie's case).  Several years ago my practice owners decided to charge for prescriptions.  That lasted for a year or two but frequently caused problems with owners complaining and was a big hassle to explain why we were doing it.  They finally decided to take away that charge and we write prescriptions for free.  Personally I was very pleased with this decision, even though I understand the justification for the charge and won't condemn a vet who does so.
In my opinion you are losing more in goodwill and client loyalty by charging for written prescriptions than you lose in revenue or time.  I believe that if you happily and readily authorize prescriptions for patients those clients will be more likely to trust you in your decisions and agree to treatment plans in the future.  I would rather keep great clients than turn them away over a $5 prescription fee.
The veterinary profession has been facing big challenges in the last couple of decades as more people want prescriptions from online pharmacies.  Historically our clinics have been the only ones able to provide many veterinary-only medications which aren't stocked in human pharmacies.  Online options and even some regular pharmacies can be cheaper than the vet because of lower overhead and bulk ordering, all of which makes it hard for a veterinarian to compete.  But that's a problem with certain models of veterinary business and not with the medications themselves.  For too long veterinarians as a profession have relied far too heavily on income from vaccines and medications.  With vaccine durations lengthening and medications being available from other sources, many vets have seen reductions in revenue.  This topic has been heavily discussed in the profession for as long as I've been practicing, and I doubt we'll stop talking about it any time soon.
I believe that the answer to these challenges is to more closely model certain aspects of human medicine.  Human physicians don't stock medications for dispensing and concentrate pretty much on doing exams, making diagnoses, and authorizing treatment.  The real value in a doctor is in their knowledge and experience, not what they sell.  This is true of veterinarians and something that many of my colleagues need to realize.  We need to get away from retail and medication sales and focus on what we know and can do as doctors.

Doing so will result in somewhat increased costs of office visits and procedures as the lost revenue from pharmacy sales has to be made up in order for a vet to stay in business.  But having this kind of business model more appropriately represents where our true value lies, and clients will be able to find medications elsewhere, often for lower prices than a vet clinic can charge.

First and foremost we are doctors and surgeons, and need to position ourselves as such.

Connie, I hope that answers your question!

Sunday, September 11, 2016

Will Teeth Grow Back?

I know that many times veterinarians (and other professionals) shake their heads and make fun of clients or customers.  On one hand we probably shouldn't be laughing at the people that provide our livelihood.  But on the other hand sometimes people say things that are so crazy that you can't help but wonder what they were thinking.

Today I saw a dog for a routine dental cleaning.  His teeth were pretty bad and several were loose due to periodontal disease.  During the cleaning some incisors came out and we had to pull a bad molar.  These were pretty minor procedures but because of infection I sent him home with antibiotics.  All in all, a common outcome for a day.

When the owner picked up at the end of the day my technician was going over the discharge instructions.  The client then asked "will those teeth grow back?"

She came back and told me this and I just stared with my mouth open.  In 34 years in this profession that's the first time I've ever heard anyone ask that.  And frankly, the question kind of took me by surprise.  Other than sharks, I really can't think of any animals where lost teeth grow back.  Certainly not a dog!  When would an average person expect teeth to regrow?  

I hate to laugh at a client who was doing the right thing for their pet, but at the same time it was a really crazy and unexpected question.

Thursday, September 8, 2016

It's Pumpkin Season!

Here in the US we really celebrate Autumn, Halloween, and everything related to it.  Over the last few years one of the biggest and fastest growing trends has been pumpkin spice flavoring.  It's becoming almost comical how many products come out with a pumpkin variety this time of year. 
And I love it!
Yes, I'm one of those weirdoes who will consume just about anything pumpkin flavored.  These companies are marketing to me when the make these seasonal varieties.  Look at some of my recent purchases.
I know that this has been ingrained into the public consciousness (at least here in the US) enough that memes are all over social media.



Some of my friends have ranted because Fall doesn't officially start until September 22nd, so the fact some of these products came out while it was still technically Summer bothers them.  I can sympathize, as I get frustrated at how early Christmas is advertised by retailers.  But at the same time I am so excited to have all of my pumpkin products!

This time of year reminds me of the scene in Forrest Gump where Bubba is talking about all of the ways to make shrimp....

But in my case, it's pumpkin!  Pumpkin spice latte, pumpkin pie, pumpkin spice cereal, pumpkin donuts, pumpkin snickerdoodles, pumpkin pie Pop Tarts......

Someone actually made a meme about that!

I have only a few months to enjoy this pumkiny goodness, and I'm going to take full advantage of it.