"To Grain-Free or Not to Grain-Free..."

​by Jen Reeder
Pat Fay was surprised when a veterinarian heard a heart murmur during a routine exam of her 17-month-old standard poodle, Lucy—and shocked when a veterinary cardiologist diagnosed the young dog with dilated cardiomyopathy (DCM).
“We bought her as a puppy from a breeder who shows standard poodles and has absolutely no genetic dilated cardiomyopathy in their gene line,” she said.
Eager to help her beloved dog, Fay followed the cardiologist’s recommendations to start heart medication and stop feeding a grain-free diet. Since Lucy’s health improved within six months—and because Lucy is participating in the US Food and Drug Administration (FDA) investigation into a potential link between canine DCM and certain diets, many labeled “grain-free”—Fay now shares her concerns about diet-related DCM with other pet owners, including users of a private Facebook group with about 20,000 members.

Links to DietFay regrets that when Lucy was a puppy with a sensitive stomach, she asked for advice at a boutique pet store and started Lucy on a grain-free food now being investigated by the FDA.
“You want to do the best for your dog baby and we got caught up in the hype of all of it,” she said. “We did a boutique dog food thinking we were doing the absolute right thing by her.”
Allison Heaney, DVM, MS, DACVIM (Cardiology), cardiologist at several Petcardia Veterinary Cardiology locations, including AAHA-accredited Wheat Ridge Animal Hospital in Wheat Ridge, Colorado, diagnosed Lucy with DCM in June 2018 and recommended switching from the grain-free food.
She’s treated numerous patients whose conditions have improved with medication and a diet change—and some with just a diet change. In one instance, a dog with DCM and heart failure was referred by another veterinary cardiologist who had already advised medication, taurine supplementation, and other protocols. The only thing left was to change food, which she did. On the next visit, the dog’s heart was dramatically smaller.
“We always stress that we only want the best for the pet and the clients. We often praise the clients for wanting what is best and then talk about concerns with their current diet.”
—CASSIE PANNING, BS, CVT, VTS (Nutrition)
“Now we’ve had enough cases in which we switch foods and they improve,” she said. “I definitely know there’s something happening and it’s for real. I don’t know exactly why that food switch would make a difference. What is the deficiency? Is it a toxicity? Is it a malabsorption? I have no idea, but we’ve seen enough that have reversed that it’s not . . . propaganda.”
While some clients are quick to follow Heaney’s recommendations—one woman feeding a vegan diet to her two-year-old dog with DCM immediately asked where to get traditional pet food when she learned the diet might be contributing to her pet’s heart disease—others resist or flatly refuse to alter their pet’s diet.
“It’s really frustrating,” Heaney said. “A client [I had] yesterday wouldn’t change the food. She said, ‘I’m not going to change until I have a specific answer as far as what the problem is.’ And I was like, ‘I don’t know why people are dying of vaping, but you know what habit I’m not going to pick up right now? Vaping.’”
Public PerceptionHeaney is concerned that perceived expertise on nutrition seems to have shifted to pet stores.
“That has not done us any favors,” she said. “I think that as a profession we’re going to have to, in some way, shape, or form, take the reins back and define what is good pet food for dogs.”
Talking to clients about pet nutrition can be a daunting task with the increased interest over the past decade or so—potentially sparked by the FDA’s 2007 recall of melamine-tainted pet food—in feeding pets what were once considered “unconventional” or “nontraditional” diets, such as raw, vegan, homemade, and grain-free. Many boutique pet foods are now marketed with buzzwords like organic, natural, grain-free, nongenetically modified, and human-grade.
So perhaps it’s unsurprising that the FDA’s 2018 announcement of an investigation of a possible link between canine DCM and certain foods, many of which were labeled “grain-free,” has received strong pushback from consumers. (A representative from the FDA declined to comment on the status of the investigation for this article, instead referring to previously published material on the FDA’s website.)
Cassie Panning, BS, CVT, VTS (Nutrition), at the University of Minnesota’s Veterinary Medical Center, has been a veterinary technician for more than 16 years. She’s seen increased interest in grain-free diets for pets as gluten-free diets have grown popular with humans.
“In the last 10 years, there have been many more dogs and cats harmed by issues with conventional diets—melamine/cyanuric acid, vitamin D, aflatoxin—than reported with unconventional diets.”
—JOE BARTGES, DVM, PHD, DACVIM, DACVN
“There are many people who think that the alerts by the FDA are made up and a big conspiracy from the big pet food companies,” she said. “When you are on the front lines and seeing dogs die from something that is preventable, it is really sad. While the research is ongoing and we still don’t know a cause or the exact link, until we know more, it seems silly to not feed something else.”
Panning noted that veterinary technicians can be the front lines of communication with clients. They can go over nutrition recommendations for new puppies and kittens, and they should feel comfortable discussing feeding management and foods. She said they should also be able to teach clients body condition scores so that pet owners feel empowered at home. 
She suggests a nonjudgmental approach when discussing nutrition with clients.
“We always stress that we only want the best for the pet and the clients. We often praise the clients for wanting what is best and then talk about concerns with their current diet,” said Panning. “Really listening to a client’s goals and finding a diet that works best for their pet and their lifestyle will help you get much further; any time a client feels that they are being shamed, they will put up a wall.”
Other Problematic DietsAngela Rollins, DVM, PhD, DACVN, clinical associate professor of small-animal clinical services at the University of Tennessee, is glad researchers are working on finding answers about the potential link between DCM and grain-free diets. With legumes being examined as a possible cause, until a study proves otherwise, she’s hesitant to recommend vegan diets for dogs because legumes are often the primary protein source in such foods.
However, she said there is plenty of evidence about the risks associated with raw diets. When communicating with clients about raw-food issues, she suggests emphasizing that they can introduce pathogenic bacteria like Salmonella, Escherichia coli, Listeria, and Campylobacter.
“All of these potential bacteria can make our pets sick, but they can also make the humans in the household sick as well,” she said. “These will be spread in your pet’s saliva and feces. Think about a cat on a raw-food diet. They’re then going to groom their entire hair coat, so they can be this walking ball of Salmonella all through your house. . . . I think there’s a significant risk of liability as a medical professional if we’re not warning our clients about those risks.”
Joe Bartges, DVM, PhD, DACVIM, DACVN, professor of medicine and nutrition at the University of Georgia’s College of Veterinary Medicine, served on the task force that created the 2010 AAHA Nutritional Assessment Guidelines for Dogs and Cats.
He said the guidelines included “unconventional” diets such as homemade, vegetarian, and raw as a nutritional screening risk factor primarily because veterinarians were less familiar with the diets at the time. He noted that what were once considered unconventional diets have become major parts of the pet-food market and do not pose more potential danger than conventional diets. (He posited that a better term than conventional might be heat-processed grain-containing diets.)
“In the last 10 years, there have been many more dogs and cats harmed by issues with conventional diets—melamine/cyanuric acid, vitamin D, aflatoxin—than reported with unconventional diets,” he said.
Bartges stated that obesity is the “number one” nutritional problem in dogs and cats (and people), so it should be the biggest nutritional concern for everyone.


"To Grain-Free or Not to Grain-Free: The Shifting Dialogue Surrounding Grain-Free, Vegan, Raw, and Boutique Diets" by Jen Reeder 
(https://www.aaha.org/publications/trends-magazine/trends-digital-archive/free-trends-article/?fbclid=IwAR3SgTKNqQ6ZG-sZ1xfKIbH2YLWx8uyCVL73Tc0yjmz9NdGjJuuViXJneE8).