IBD Diagnosis: Food recs, etc

[Nicole and Teddy]

Hi there! Just left a long string in the Medical issues group as Teddy has received an IBD diagnosis. The GI panel results indicated cobalamin and folate are slightly low. Pancreatic lipase and TLI elevated. Findings are consistent with small intestinal disease like IBD, dietary hypersensitivity, small bacterial overgrowth, and others. They are recommending we begin a novel protein or hydrolyzed protein diet trial that has a lower fat content, starting vitamin B12 (either by injections or oral supplement), a good probiotic (he's on VSL), and folic acid supplement. I currently feed Teddy a home cooked diet but am now leaning towards a "regular" dog food to control the IBD. In addition to peace of mind with knowing where ingredients come from, I am worried whether Teddy will "like it as much" and gobble it up like he does the home cooked brew. Any recommendations/thoughts are much appreciated. Thank you!

[Karen, Jasper and Jackdoodle]

Okay, so as you probably know, a "novel" protein diet requires a food that contains only a single animal protein that the dog has never eaten before. In order to recommend one, we need to know what proteins Teddy has never had. Think over every food and treat he has had in the past, check the ingredients on line if necessary, and make a list. 

Hydrolyzed protein diets are only Rx, unfortunately, and they are all garbage. Sometimes we have no choice in the matter, and then they are life savers. But I don;t think that's where you want to start. 

[Nicole and Teddy]

 Thanks, Karen. Hmm, That’s a tough one – I know I deliberately tried to stay away from novel proteins when Teddy was a puppy on bagged dog food – just in case anything like this happened. From what I can recall proteins he has been exposed to include the following: 

Beef

Chicken

Duck

Salmon 

Pork

Turkey 

Tuna

Other white fish

Shrimp 

Pretty sure lamb, but not positive 

Also, can you explain more about why sticking to just the new diet is so important? I get that there might be a sensitivity to proteins but not quite understanding why it would be necessary to eliminate all treats – especially since we just give him carrots and apples usually. 

[Karen, Jasper and Jackdoodle]

It's not necessary to eliminate all treats; just ones that contain ingredients that might be causing an allergic response, which are usually animal protein, grains, and certain other types of plant foods. In the eosinophilic form of IBD (which you would only know he had by endoscopy and biopsy), anything the dog has eaten before can be causing an immune response.

That "other white fish" is unfortunate, because you can do a homecooked diet with a novel fish; i knew one woman whose dog was on tilapia. But if we aren't sure of the exact fish, that won't work. 

It looks like Teddy is going to have to go with something like venison or bison. There are also always rabbit, kangaroo, alligator...the really exotic ones. 

[Karen, Jasper and Jackdoodle]

Your best bet in a commercial food is going to be Zignature. They have single protein formulas in Goat, Kangaroo, Venison, and Guinea Fowl. And they also have canned versions of all of these, so you can add some wet food, which may help in getting him to eat kibble after having been on a homemade diet. You could even go to all canned, IF you can afford it. That gets pretty expensive. 

https://www.zignature.com/?page_id=333&lang=en

[Nicole and Teddy]

Oh ok- that makes sense with the treats! I think we're leaning towards getting him on the Zignature. It's worth a try and I can always go back to the home cooked if he doesn't do well on it (by the way, I don't think he's ever had tilapia so thank you for the suggestion!). Since he has a few days left of home cooked brew, any suggestions on transitioning him to the Zignature? Also, should I just buy a small bag so I can see how he does? How long does he have to be on it until I know it's a good protein source for him?

[Karen, Jasper and Jackdoodle]

With suspected IBD or food allergies, you typically switch foods cold turkey. Blending the old with the new can actually cause them to develop an immune response to the new protein, which is exactly what you don;t want.
Food trials typically take 8-12 weeks. :(

A tilapia and let's say, red potatoes, home made diet could work. But be aware that you are going to be doing a LOT of cooking, because white fleshed fish is extremely low in calories. 
On the plus side, tilapia is cheap and can usually be bought frozen. 

[Nicole and Teddy]

Oh wow, cold turkey, huh? I am so nervous about what to do with him. He seems to be doing really well on the chicken diet right now. My mom keeps asking me why we need to switch him if he's doing fine. I mean, it IS the right thing to do, right - based on the test results...getting him on a novel protein diet?? I think we're both thinking, why mess with a good thing if he seems to be doing well. But logically I know that this could just be a small window until the next bout and we go through the vomiting/diarrhea again...

[Karen, Jasper and Jackdoodle]

In all honesty, I would feel better about all this if you had a true IBD diagnosis. But I can certainly understand not wanting to do an endoscopy unless you must. 

The test results themselves are not conclusive. Since cobalamin is absorbed through the gut, any time a dog has been through a prolonged digestive upset, you could get a low cobalamin reading. The low folate is related to SIBO, which is small intestine bacterial overgrowth, and a bacterial imbalance in the gut doesn't necessarily mean IBD. It's a condition in itself. I'm not sure about the meaning of the TLI and pancreatic enzyme values. 
IBD is a very serious disease and I would never tell an IBD dog owner not to follow a recommneded treatment protocol (unless it sounded absolutely nuts to me, lol.) But since we don;t know for sure that Teddy has it (and I sincerely hope he doesn't), maybe start with the supplements and keep going with the VSL and postpone the diet changes for a bit? The VSL alone will take care of the SIBO, and the cobalamin supplements should also reverse that issue. I would once again urge you though to go with the B12 injections rather than the oral supplements. I just have more faith in them, and if nothing else, they work faster. If the VSL and supplementation aren't enough, then you could switch his diet? Maybe run this idea past your vet? 
Do you ever hear really loud noises from Teddy's stomach, maybe after he drinks water? I mean really, really loud and rumbly , not just the typical tummy gurgles. 

[Nicole and Teddy]

The pancreatic lipase results are "consistent with pancreatitis" though the dr didn't say he HAD pancreatitis, just that we should get him on a low fat diet and retest. The TLI fasting interpretation: "increased cTLI concentrations can be associated with pancreatitis, decreased renal excretion, emaciation, or in some cases chronic intestinal disease." Back with his first bout of throwing up/diarrhea his primary vet did a blood test for pancreatitis though and the results were normal. Both vets are recommending the diet trial with a recheck in one month. It's hard to know what to do when they both say go with the diet trial and yet he's done well for the last 2 weeks or so on the chicken. Does that sometimes happen with doggy IBD - that he can have times when he's doing well (for no apparent reason) and then he'll have a flare up? I am very familiar with human IBD as my mom has UC. I will go with the B12 shots and they are going to teach me how to give them at home - is that what you did? Sorry for so many questions, Karen - I know you are probably trying to enjoy your Saturday. I am definitely one of those people that overthinks everything! I just so want to get it right and do what's best for Teddy. Oh, and also, I do hear frequent tummy gurgles but nothing I would consider REALLY loud. He does belch and pass gas pretty frequently though.

[Karen, Jasper and Jackdoodle]

Don't be sorry. I've been though all this myself and "overthink" doesn't even begin to cover what I did, lol. If I hadn't had a human sounding board, I don;t know what I would have done. 
Flares are part and parcel of IBD; the goal is to get them into remission (there is no "cure"), but you do have calm periods interspersed with flare ups, hopefully mild. 
I took JD to the vet for his B12 shots. I am very very squeamish about needles, and since we were in one or another vet's office at least once a week, it wasn't a big deal to get a B12 shot every month. His holistic vet did it for free when he saw her, other times it was anywhere from $12-20, depending on which vet's office we were at when he needed one, lol. I always brough y own sharps containers to keep the costs down a little bit. if you can give the shots yourself, that's great. That option wasn't even given to me. And since you'll be giving the immunotherapy shots yourself if he goes on immunotherapy, it will be good practice. My DD did Jack's immunotherapy shots until he got on maintenance, and then he got them at the vet's office at no charge . 
I think that you should probably try the new diet, with both vets recommneding it. 

[Nicole and Teddy]

Thanks for the encouragement, Karen - so appreciated. The internist wants me to do the B12 shots but they are further away. Hopefully my regular vet can do them too and will let me know procedure since they are closer. As long as they show me how to do it, I think I could manage it. It's amazing the things I didn't think I could do but now don't bat an eyelash about - ha! So I got him a smaller bag of the goat Zignature and 2 cans of wet to see how he does. They also recommended the raw goat's milk so I got a small container of that. He's got another day or two worth of the chicken brew so will probably finish up with that and start on the new food. So really just switch cold turkey? Can I expect any tummy upset by not doing a slower transition?

[Karen, Jasper and Jackdoodle]

I'm not a big fan of goat's milk, and with the VSL, it's unnecessary and could even cause stomach upset. I'd see if you can return it for a credit. It really annoys me how some of the better pet supply store clerks give nutritional advice that they are not qualified to give. 
It's very possible that he will have some minor stomach upset from the food change, but that would happen even if you transitioned slowly. 
You might start by just giving the canned food, if you can afford it and then adding the kibble.