? 5/23 Oren; pancreatitis diet response

[Megan & Oren]

Dr. ISTHISCLEAR finally responded with results of her consultation w/ nutritionist; I post for your information and opinions?

...The components of a ‘good’ pancreatitis diet are theoretically high digestibility, low residue and low fat. Ash (or mineral content) has not been shown to be significant in contributing to or preventing diabetes.

Fancy feast may not be the worst thing to feed for pancreatitis (we know it is not bad for diabetes), but the flavor and type should be kept consistent (consistency is THE most important thing to this specialist notes when treating pancreatitis nutritionally). This diet should be adequate as long as you don’t change it. She also rec’s 2 meals a day of whatever food we choose to feed him if possible.


However, this specialist prefers to try to treat pancreatitis with a ‘novel protein diet’ which would be a diet composed of an uncommon protein such as venison or duck. This is because pancreatitis often goes with IBD (inflammatory bowel dz) in cats, and novel protein diets are definitely easier on cats with this condition, that is in agreement. Also the carb/starch source is potato or rice. There are several prescription diets like this that if you are interested I could get try to figure out if they are good for long term management of diabetes for you. If not, there is one over the counter diet like this I have reviewed the ingredients in ( Natural Balance LID diet in venison or duck). You will have to review that diets, and compare it to the nutritional resource for diabetes that you are familiar with to determine if they are safe to feed him.


Remember when looking at % protein/carbs, etc. you need to look at the dry matter analysis, not the maximums and minimums that are listed on the back of most types of pet food (guaranteed analysis ). Dry matter often is not published on bag, and the company needs to be contacted to get the actual number.

As I said, all doctors will have a different opinion about dietary management of pancreatitis, but I think it would be wise for us to follow one of these rec’s from the nutritionist (again either consistent fancy feast, or a ‘novel protein diet’, keeping with a regular schedule and a consistent flavor and a wet formulation).


Here are the things that she also shared with me that may be helpful moving forward:

We are correct that Oren needs a relatively low carb/high protein diet to help with diabetes. If you are not able to afford the prescription diets for diabetes, the lists and guidelines you have will help you choose a diet. Remember that wet food is better than dry. Less meals is better for most cats, but some tolerate frequent feeds. This specialist reminded me that there are no PROVEN numbers to stay within (regarding % carbs or protein) so we are just looking for a relatively low carb, and relatively high protein diet.
--------------------------------------------------------------
I guess I'm glad she responded, but now I'm trying to figure out which FF would be best. There are no 'novel protein' formulations, so I'm trying to determine which variety if I have to limit it to one. I suppose I could also go w/ the Wellness Core turkey and duck, though that honestly doesn't seem any less expensive than the purina DM, but at least it's not prescription. Cost unfortunately does have to affect my decision.

Any opinions on the novel protein idea? Is it truly worth it for me to switch to that?
For FF, I think I was leaning towards the turkey/giblets, chicken feast or beef/chicken feast, as they seem to be the lowest in phosphorus, though she makes no mention of that as an issue.

Do others think the consistency thing is truly important? I guess i see the concept, no big 'shocks' to the pancreas by switching up food. But could I get away with feeding FF and the wellness, so that it would go further?

Oren goes for his follow up on next Wed, I'll be doing a curve on Mon, and then I guess she'll make an adjustment. He's been fairly flat most days, reds during day, pinks at night, with an occasional dip into yellow. Just by digging more, I believe I understand her treatment strategy now; she is following the AAHA diabetic management guidelines, pretty much to a T. So that's her great expertise being applied. Guidelines written in 2010, with a very conservative approach. She's really pushing the urine glucose testing too. I can't find urine glucose test strips around here,(just the ketones) though I could get dia-stix online; one pharmacist even told me "that's not considered accurate anymore" since we have glucometers..

hope all are well

 

[Andrea&Tennessee (GA)]

Dr. ISTHISCLEAR

Megan, You are so funny!
I'm not sure what to tell you about the novel protein and pancreatitis- I think you are just lucky that Oren is eating well. Tennie would not eat when he had pancreatitis- I had to feed him by syringe for 3 days before his meds kicked in and he began to eat on his own.
I thought it was interesting what the vet said about less meals for cats. I moved Tennie to more frequent, smaller meals because I had read somewhere around here that smaller meals are better for his pancreas.

Maybe someone more experienced can clarify that?

I did change my civie to Evo dry food, just incase Tennie got in to it (which he still does from time to time- because I forget to pick it up after his brother eats) But, like you said, it is still pretty expensive. Around here we have settled on feeding from the big cans of Friskies. I pretty much stick to 2 flavors- Poultry platter and Turkey and giblets.
You could always try the FF to save $$, then there is alway the option of switching to the EVO duck if it seems necessary.

I have no experience with the urine glucose testing. I just test BG from Tennie's ear and check for ketones now and again.

I hope Oren's pancreatitis clears up soon and you can get his numbers to come down!

 

[Amy&TrixieCat]

There definitely are a LOT of different opinions about p-titis and my only experience is with Trix, who had it pretty badly last year, and has some flare ups here and there.

IMO, the most important thing is that they eat - period. Trix recovered from her p-titis with FF Classic Chicken Pate and Purina One Classic Chicken - and those are the two foods she eats now, too. If Oren is eating what you're feeding, my thought is now is that during a bout with pancreatitis the time to mess around with diet - the last thing you want is to turn him OFF food by offering things he won't/doesn't like.

There were times I had to assist feed Trix to make sure she got enough calories to stave of hepatic lipidosis, so sometimes that is necessary.

I also believe that small frequent meals is better for p-titis than large infrequent meals, since a large meal can "overwhelm" the pancreas.

There are others who can give you a much more detailed response - unfortunately we have a lot of p-titis experience here in L&LL!

 

[Sienne and Gabby (GA)]

I think your vet's response regarding diet is well thought out and reasonable. Novel protein sounds fine but you're not going to find it with FF. Dr. Lisa's food charts are all based on "as fed" values so they are reliable. She contacted all of the manufacturers.

Your vet really needs to re-think the urine glucose issue. The World Health Organization and the International Diabetes Federation (see p. 10) only support urine glucose testing in 3rd world countries or where there are economic limitations. The problem is that UG testing is not sensitive - once you are below renal threshold and the strip tells you there's no glucose in your cat's urine, that's all you know. In practical terms, this translates to your cat could be at a BG test value of 180 or 20. It's all the same on a UG test strip. Is your vet suggesting that numbers in the 20s are safe?

If you've not seen the AAHA guidelines, they're online. My view of the problem is that the guidelines do NOT provide references to the original research supporting their recommendations. (The link to the WHO/IDF document above does provide citations to the original research.) Thus, what you have are a few vets' making recommendations that are based on their experience. You have no clue on what they are basing those recommendations. This is fly-by-the-seat-of-your-pants practice. It is not evidence based veterinary science. Further, they are making generic statements regarding two vastly different kinds of insulin. The pharmacology of Lantus and Prozinc are very different. I also think basing a dose reduction on 150 is not adequate for achieving regulation to numbers that are consistently below renal threshold let alone remission. Just out of curiosity, how many cats has your vet gotten into remission following AAHA guidelines? I bet our record is better!

Sorry for some of the snarky comments. I just get annoyed by professionals spouting off when they have little regard for science or even the practical implications of their recommendations.

 

[tiffmaxee]

Well, one thing is sure. Vets do disagree on what works best and I think that is because every cat is different. If IBD is the cause then a novel protein diet may be the answer. Some cats simply can't handle grains. As for fats I've read by the experts that it unlike with dogs and humans cat do not need to strictly restrict it but it is wise not to feed a diet high in fats. Most do say to feed small amounts more often, at least 5 times a day. My vet told me that is because as they start to feel better and want to eat if they eat too much at a time they don't feel well again. I've been dealing with chronic pancreatitis for over 5 1/2 years and been a member of the FPS yahoo board for longer as my GA Tiffany had bouts of pancreatitis after being diagnosed with lymphoma and what I have seen is that these cats respond differently and ECID holds true with this more than ever. So I believe strongly that we have to find what works for our cat and treat accordingly.

I forgot to add Max got this while his sister was so sick. He is a very sensitive and timid cat. Vet trips can bring on an episode so stress is clearly a major factor for him.

 

[elizabeth and gus]

Dr. ISTHISCLEAR finally responded with results of her consultation w/ nutritionist; I post for your information and opinions?

...The components of a ‘good’ pancreatitis diet are theoretically high digestibility, low residue and low fat. Ash (or mineral content) has not been shown to be significant in contributing to or preventing diabetes.

Fancy feast may not be the worst thing to feed for pancreatitis (we know it is not bad for diabetes), but the flavor and type should be kept consistent (consistency is THE most important thing to this specialist notes when treating pancreatitis nutritionally). This diet should be adequate as long as you don’t change it. She also rec’s 2 meals a day of whatever food we choose to feed him if possible.


However, this specialist prefers to try to treat pancreatitis with a ‘novel protein diet’ which would be a diet composed of an uncommon protein such as venison or duck. This is because pancreatitis often goes with IBD (inflammatory bowel dz) in cats, and novel protein diets are definitely easier on cats with this condition, that is in agreement. Also the carb/starch source is potato or rice. There are several prescription diets like this that if you are interested I could get try to figure out if they are good for long term management of diabetes for you. If not, there is one over the counter diet like this I have reviewed the ingredients in ( Natural Balance LID diet in venison or duck). You will have to review that diets, and compare it to the nutritional resource for diabetes that you are familiar with to determine if they are safe to feed him.


Remember when looking at % protein/carbs, etc. you need to look at the dry matter analysis, not the maximums and minimums that are listed on the back of most types of pet food (guaranteed analysis ). Dry matter often is not published on bag, and the company needs to be contacted to get the actual number.

As I said, all doctors will have a different opinion about dietary management of pancreatitis, but I think it would be wise for us to follow one of these rec’s from the nutritionist (again either consistent fancy feast, or a ‘novel protein diet’, keeping with a regular schedule and a consistent flavor and a wet formulation).


Here are the things that she also shared with me that may be helpful moving forward:

We are correct that Oren needs a relatively low carb/high protein diet to help with diabetes. If you are not able to afford the prescription diets for diabetes, the lists and guidelines you have will help you choose a diet. Remember that wet food is better than dry. Less meals is better for most cats, but some tolerate frequent feeds. This specialist reminded me that there are no PROVEN numbers to stay within (regarding % carbs or protein) so we are just looking for a relatively low carb, and relatively high protein diet.
--------------------------------------------------------------
I guess I'm glad she responded, but now I'm trying to figure out which FF would be best. There are no 'novel protein' formulations, so I'm trying to determine which variety if I have to limit it to one. I suppose I could also go w/ the Wellness Core turkey and duck, though that honestly doesn't seem any less expensive than the purina DM, but at least it's not prescription. Cost unfortunately does have to affect my decision.

Any opinions on the novel protein idea? Is it truly worth it for me to switch to that?
For FF, I think I was leaning towards the turkey/giblets, chicken feast or beef/chicken feast, as they seem to be the lowest in phosphorus, though she makes no mention of that as an issue.

Do others think the consistency thing is truly important? I guess i see the concept, no big 'shocks' to the pancreas by switching up food. But could I get away with feeding FF and the wellness, so that it would go further?

Oren goes for his follow up on next Wed, I'll be doing a curve on Mon, and then I guess she'll make an adjustment. He's been fairly flat most days, reds during day, pinks at night, with an occasional dip into yellow. Just by digging more, I believe I understand her treatment strategy now; she is following the AAHA diabetic management guidelines, pretty much to a T. So that's her great expertise being applied. Guidelines written in 2010, with a very conservative approach. She's really pushing the urine glucose testing too. I can't find urine glucose test strips around here,(just the ketones) though I could get dia-stix online; one pharmacist even told me "that's not considered accurate anymore" since we have glucometers..

hope all are well

Hi Megan

Thank you so much for sharing this info. I am very confused with food options for my diabetes/pancreatitis kitty. I use Dr. Lisa food list to select foods that are acceptable for diabetic cat. Gus is very finicky eater and since his Dx we switched him form all you can eat premium dry food to mostly FF. At any time he has option of three or more different foods that depending on ?? he will eat or not. Several times we had to syringe feed. Now his diabetes is better regulated (BG<150) with just a drop of insulin and he eats better I am going to implement dietary recommendation that you shared. Pick appropriate food and stick with it.

As far as diabetes my goal is to achieve remission so I am going to follow proven SLGS/TRP. This would't be the first time I didn't follow my vet's recommendation instead used guidance that members of this board provided. It worked well so far and it is very likely that my sweet Gus wouldn't be with us any more without help from FDMB members.

Best of luck with Oren
Elizabeth

 

[Megan & Oren]

Your vet really needs to re-think the urine glucose issue. The World Health Organization and the International Diabetes Federation (see p. 10) only support urine glucose testing in 3rd world countries or where there are economic limitations. The problem is that UG testing is not sensitive - once you are below renal threshold and the strip tells you there's no glucose in your cat's urine, that's all you know. In practical terms, this translates to your cat could be at a BG test value of 180 or 20. It's all the same on a UG test strip. Is your vet suggesting that numbers in the 20s are safe?

If you've not seen the AAHA guidelines, they're online. My view of the problem is that the guidelines do NOT provide references to the original research supporting their recommendations. (The link to the WHO/IDF document above does provide citations to the original research.) Thus, what you have are a few vets' making recommendations that are based on their experience. You have no clue on what they are basing those recommendations. This is fly-by-the-seat-of-your-pants practice. It is not evidence based veterinary science. Further, they are making generic statements regarding two vastly different kinds of insulin. The pharmacology of Lantus and Prozinc are very different. I also think basing a dose reduction on 150 is not adequate for achieving regulation to numbers that are consistently below renal threshold let alone remission. Just out of curiosity, how many cats has your vet gotten into remission following AAHA guidelines? I bet our record is better!

Sorry for some of the snarky comments. I just get annoyed by professionals spouting off when they have little regard for science or even the practical implications of their recommendations.

Sienna, I mentioned the AAHA guidelines thing because indeed I had read them in my own researching, and it suddenly clicked that was what my vet was doing! The problem comes in that I can't challenge her apparently, because she gets too sensitive, touchy or something , that I'm questioning her skills. Though she claimed to be open to new options, she so far has shown quite the opposite. My catch 22 also is if I try to present info, she's shutting me down with threats of charging me to read it!

I still will be looking for a new vet, I just want to get through his recheck next week.
Believe me, I once again self edited this post to remove some snark. ...plus, her response is after she consulted with a nutritionist, and a lot of what she passed along, I already knew and in fact, I had just asked for why FF was no good in her opinion, because that's what he'd been eating. She had to ask someone else herself to answer me?!

I had been feeding FF already, but definitely a wide variety of favors. He eats them all willingly, so it's not a question of that, just if there is one that is best for the pancreatitis and yes, I know they have no novel protein options. That's why I was asking for opinion on whether I could mix a FF variety with the wellness core or some other novel protein food.

And yes, the urine glucose thing, I felt like rolling my eyes at that. I knew that is not a reliable measure. And she knows I home test already?! She is a bundle of contradictions and obviously not interested for whatever reason, in doing extra. I know of one patient of hers whose cat did go into remission after only a few months under her care. She claimed the switch to DM food did it. I know kitty reached just over 3u BID at highest, so not a high dose kitty like Oren may be. I assume that kitty got this treatment. But if I ask her track record, I'll probably get a huffy response if at all

 

[Tina & Sammy]

When Sammy had a bout of pancreatitis before the doctor recommend a novel protein, which we did try, but some of the proteins seemed to cause Sammy's numbers to go up, which the doctor said could be some sort of allergic reaction or just a reaction due to the fact that he wasn't use to that type of food. She continues to say that if Sammy has pancreatitis again she would want to put him on a hypoallergenic diet, but again those diets don't really work well for diabetic kitties. So when all else fails she recommended sticking to one or two foods and not the huge variety that I was feeding before, which was anywhere from 8-12 different food varieties. They are all Friskies, but the large variety of flavors was probably too much for the pancreas to handle.

I do still throw in other foods occasionally when Sammy won't eat well, because like Amy stated, the most important thing is that the kitty eats.

The bottom line is that you need to find what will work for Oren as well as your budget.

 

[tiffmaxee]

Fish, meat, and chicken often are the problem if the protein source is the issue. Many foods say the are only one protein but if you look carefully they have multiple sources. One that comes to mind is Fancy a Feast chicken which contains fish.

 

[Sienne and Gabby (GA)]

I train physicians. Many of them have an attitude not unlike your vet's. Rather than tell them or give them readings (which, trust me, I would love to do but sometimes, trying to get residents to read is not likely to happen), I ask them for the research that has helped them form their opinion so we can be on the same page or I can learn something new. The next time we meet, I start asking them more questions (did they understand the statistical analysis, did they realize that it was an opinion piece and not research, did they go back and read the original research -- you get the idea). After they've had to go through this a couple of times, the light begins to go on that maybe they don't know what they're talking about.

My point is to ask her questions. It will make her feel like she's sharing her knowledge and educating you vs her getting defensive. And maybe, by virtue of looking for information to pass along, she'll realize there's more current information available. If not, you ask her more questions and force her to do the homework.

 

[Megan & Oren]

Fish, meat, and chicken often are the problem if the protein source is the issue. Many foods say the are only one protein but if you look carefully they have multiple sources. One that comes to mind is Fancy a Feast chicken which contains fish.

well, that might seem to rule out the chicken feast variety then(yes, i caught on that some have mixed protein sources) Note, I have also been giving him plain, boiled skinless chicken breast all along, mixed into his food. he LOVES it, and I told my vet, she seemed ok with it. Perhaps the only way to know is to stop it entirely.

And i had also been feeding a wide variety, so I guess I will definitely cut back to 1 or 2. He really hasn't shown any aversion to eating, I'm guessing this can't be an extremely severe case of pancreatitits after hearing about all here who have had to syringe feed and try anything to get their kitties to eat. Oren eats ravenously. even the DM food.

it is also my understanding that the FF classics DO NOT contain grains. I've seen wheat gluten in some of the other varieties, but he hasn't ever had those except w/ one episode where i had to feed HC to bump him up a bit.

thanks everyone for input. Wow, what a whirl all this is...

 

[tiffmaxee]

well, that might seem to rule out the chicken feast variety then(yes, i caught on that some have mixed protein sources) Note, I have also been giving him plain, boiled skinless chicken breast all along, mixed into his food. he LOVES it, and I told my vet, she seemed ok with it. Perhaps the only way to know is to stop it entirely.

And i had also been feeding a wide variety, so I guess I will definitely cut back to 1 or 2. He really hasn't shown any aversion to eating, I'm guessing this can't be an extremely severe case of pancreatitits after hearing about all here who have had to syringe feed and try anything to get their kitties to eat. Oren eats ravenously. even the DM food.

it is also my understanding that the FF classics DO NOT contain grains. I've seen wheat gluten in some of the other varieties, but he hasn't ever had those except w/ one episode where i had to feed HC to bump him up a bit.

thanks everyone for input. Wow, what a whirl all this is...

You are right that fancy feast classics don't contain grains. I brought that up because some of the novel protein diets too. Friskies SD contains fish as does my mc food, Trader Joes turkey and giblets.

 

[julie & punkin (ga)]

You could always try making raw - then you control exactly what goes into the food.

Punkin had one bout of obvious pancreatitis, although the vet said she thought he probably had chronic pancreatitis too. We fed him Fancy Feast classics - didn't change his diet for that. When he developed kidney issues, then we tried several low phosphorus foods (FF is very high in phosphorus) and ended up with Friskies Special Diet Turkey & Giblets.

Marje has research linked in her Primer on Pancreatitis.

How long does she want you to hold this 4.5u? He's got 14 consecutive cycles at it and nothing less than 200.

 

[tiffmaxee]

You could always try making raw - then you control exactly what goes into the food.

Punkin had one bout of obvious pancreatitis, although the vet said she thought he probably had chronic pancreatitis too. We fed him Fancy Feast classics - didn't change his diet for that. When he developed kidney issues, then we tried several low phosphorus foods (FF is very high in phosphorus) and ended up with Friskies Special Diet Turkey & Giblets.

Marje has research linked in her Primer on Pancreatitis.

How long does she want you to hold this 4.5u? He's got 14 consecutive cycles at it and nothing less than 200.

Julie sorry for hijacking the condo but the Friskies SD is for urinary issues. I'm wondering how good that would be for a CKD cat. It also contains fish. Always something. It seems making raw would be hard to make sure they are getting all they need.

 

[Megan & Oren]

@julie & punkin (ga) , which flavor of FF classic did you go with? I have a bunch left of various flavors, as he likes them all, but she really is pushing pick one and sticking with it. I'm just confused as to which one would be best. No matter what, I will continue to add the boiled, cooked chicken to each meal, which according to BJ, dilutes fat/carbs/ etc. and is supposedly easily digestible protein. He LOVES it.

as for the dose, i do a curve on Mon (the 2wks. she wanted) and send her the results, at which time I assume she better make a change. She thinks he's been getting 4, i kept him at 4.5 because was afraid of the even worse results at that lower dose. He at least has been fairly flat, which hopefully means something; not so hard on his body as the big swings?

 

[rhiannon and shadow (GA)]

shadow supposedly is dealing with ibd right now. I was advised to try the novel protein ( which the only one shadow hadn't eaten was kangaroo)
she told me it took 6 months to develop an allergy to a novel protein. (have no idea if that's true or not) but shadow won't eat the kangaroo anymore. And the raw is super challenging... if Oren will eat it, it's truly the way to go.
Shadow has never had pancreatitis. antijinx!! And I think marje's primer on it has the most update information. "they " really don't know that much about it.

 

[julie & punkin (ga)]

He ate a variety of fancy feast - all the classics. I didn't just go with one. I did mostly stick with poultry, but he got some fish too. The Friskies Special Diet Turkey & Giblets was low in phosphorus - that's the reason we switched to it after his kidneys became compromised. I don't know more than that.