Raw Feeding Veterinary Society

There is a dedicated team of veterinarians that advocate for the safe, responsible feeding of fresh, raw food for dogs and cats. These vets and other professionals are members of the Raw Feeding Veterinary Society (RFVS). Nicci is also a member of this organization as well and you can learn more about the RFVS here: https://rfvs.info/about-us/

FDA Finds No Evidence that Grain-Free Diets Are Causing Canine Dilated Cardiomyopathy (DCM)

Evidence shows that risk factors for DCM is multi-faceted and is not related to a grain-free diet.

 

INTRODUCTION:

Since 2018, Canine dilated cardiomyopathy (DCM) has been a hot topic in the pet food industry, the veterinary community, the press and among pet owners. Although some veterinarians hypothesized there may be a potential association, there has never been a proven direct link (i.e., cause and effect) to grain-free foods (both over the counter or therapeutic) causing DCM in dogs including the FDA investigation. Unfortunately, the FDA’s original request was for cases involving grain-free pet food only, and that is what people keep sending in (which has resulted in a biased and polluted data pool). Perhaps if the FDA asked veterinarians and the public to send in all cases, regardless of diet, we may have seen something else, like the whole picture or a specific nutrient or lack thereof could be the issue.

 

FDA 2020 DCM UPDATE:

In late September 2020, the Food and Drug Administration (FDA) quietly issued an update on the grain-free pet food and canine dilated cardiomyopathy (DCM) investigation that was a far cry from – and far less publicized than – the initial FDA reports and updates back in 2018 and 2019. In other words, the FDA walked back their initial reports implying a causation between grain-free foods and DCM. Unfortunately, this did not make the headlines.

Since the initial reports, Vet-LIRN (the veterinary laboratory network that FDA partnered with for the investigation) closely examined a subset of approximately 150 dogs diagnosed with DCM to identify potential causative and recovery factors. The results show that DCM is indeed a multifactorial issue with potential variables including, but not limited to, breed, age, weight, gastrointestinal disease, atopy, infection (Lyme and Chagas disease) and more. These results are not surprising. Recently, McCauley et al (2020) reviewed over 150 studies which found no cause-and-effect link of grain-free food to DCM (see figure below). In fact, their review found similar variables related to DCM like infections and concurrent diseases.

Dr. Steven Solomon, director of the FDA’s Center for Veterinary Medicine, acknowledged that the “complex scientific messaging” on DCM and diet has contributed to misinterpretation about the safety of a grain-free diet. Dr. Solomon encouraged dog owners to select the diet that works best for their pet’s nutritional needs and previewed more multidisciplinary, scientific collaboration between the industry, veterinarians, scientists, and other researchers that will further the understanding of DCM.

Solomon also acknowledged:

“This is one of our ongoing struggles: choosing terminology that is scientifically accurate, understandable to pet owners and that does not cast a shadow over products that are otherwise known to be healthful and safe. I appreciate the fact that FDA’s voice is the voice veterinarians and pet owners listen to, yet too often our messages have been repeated inaccurately by third parties. The result is that in the internet age of phenomenally fast sound bites, complex scientific messaging is often lost in translation. We have tried to be careful in our messaging, and we recognize going forward not to speak on this topic publicly unless we are clarifying information or have something substantive to share.”

In addition to acknowledging the lack of connection of grain-free foods with DCM and the miscommunication because of oversimplified sound bites, the FDA provided and a new Question and Answer page on November 3rd which reinforced that grain-free diets were not inherently dangerous and that there has been no link between DCM and grain-free diets established. The FDA still recognizes the incidence of DCM and will continue their investigation into non-hereditary factors to better understand the disease. The FDA also acknowledges that they have received reports of non-hereditary DCM associated with BOTH grain-free and grain-containing diets (Q&A #8).

 

SO, WHAT DO I DO?

If your veterinarian wants to convert you from your current food to their recommended food, it is important to discuss the science behind the “why?”. In fact, the field of nutrition is evolving and advancing, and consumers and veterinarians can benefit from these conversations and by asking questions that help evaluate true quality of pet foods. The truth is that much of the information available for ALL pet foods revolves around marketing rather than nutrient inclusion and availability, but the good news is that you can help change that. Asking the following questions about the food(s) veterinarians recommend and all pet foods in the marketplace can help raise standards and encourage knowledge sharing based on science rather than marketing:

  1. Who formulated the food you are recommending in the marketplace?
  2. Do they perform 3rd party nutrient analysis, and do you have a copy of the data?
  3. Do they perform 3rd party digestibility studies, and do you have a copy of the results?
  4. Does their manufacturing facility (owned or not) have a third certification for quality control and food safety?
  5. Where do the calories in their food come from?

Asking the veterinarian these key questions, will challenge them to think differently about the food they are recommending and come to the realization that the foods they are recommending may be missing this key critical information. Knowing the answers to these questions will enable you to have an open dialogue and make a more informed decision for your pet. This is no different than human medicine. Keep in mind the DCM debacle was started by lack of information tied to nutrient content and availability of the nutrients. Therefore, asking questions #2 and #3 are critical when choosing the right food for your pet. Additionally, when veterinarians started recommending and moving people to Hill’s, likely they were embarrassed, angry and lost credibility with their clients following one of largest recalls in history tied to Vitamin D toxicity which killed and sickened hundreds of pets (question #4).

 

KEY TAKE AWAY:

DCM is not caused by grain-free foods, regardless what a news headline says – as the data does not support this statement. Rather than blaming an ingredient or set of ingredients for any health concern we should instead be focusing on the nutrient analysis and digestibility of all foods in the marketplace to prevent future problems (including grains and ancient grains). For many of us that have studied nutrition, we know that the nutrient content and availability of those nutrients can be significantly impacted by processing conditions.

Using these questions when choosing a food for your pet you should be able to get answers from the manufacturer or from the veterinarian recommending that food. This will enable both of you to have an open discussion about the nutrition of your pet and more importantly help you become an advocate for what you feed your pet. As always if your pet has any health-related issues you should seek veterinary medical advice immediately.

 

RESOURCES:

Dr. Solomon’s Full Statement

https://www.fda.gov/animal-veterinary/cvm-updates/interdisciplinary-scientific-cooperation-will-lead-way-understanding-non-hereditary-dcm

Questions and Answers: FDA’s Work on Potential Causes of Non-Hereditary DCM in Dogs

https://www.fda.gov/animal-veterinary/animal-health-literacy/questions-answers-fdas-work-potential-causes-non-hereditary-dcm-dogs

DCM and grain-free pet food: September 2020 FDA update

https://www.petfoodindustry.com/blogs/10-debunking-pet-food-myths-and-misconceptions/post/9729-dcm-and-grain-free-pet-food-september-2020-fda-update

‘BEG’ pet food and DCM, part 2: Is veterinary bias at play?

https://www.petfoodindustry.com/blogs/10-debunking-pet-food-myths-and-misconceptions/post/8475-beg-pet-food-and-dcm-part-2-is-veterinary-bias-at-play

‘BEG’ pet food does not equal DCM

https://www.petfoodindustry.com/blogs/10-debunking-pet-food-myths-and-misconceptions/post/8369-beg-pet-food-does-not-equal-dcm

McCauley et al. 2020: Review of canine dilated cardiomyopathy in the wake of diet-associated concerns

https://academic.oup.com/jas/article/98/6/skaa155/5857674

Weird science: Published pet food studies not always sound

https://www.petfoodindustry.com/blogs/10-debunking-pet-food-myths-and-misconceptions/post/9339-weird-science-published-pet-food-studies-not-always-sound

WSAVA pet food recommendations: Useful or useless?

https://www.petfoodindustry.com/blogs/10-debunking-pet-food-myths-and-misconceptions/post/9654-wsava-pet-food-recommendations-useful-or-useless

Pet Nutrition Alliance provides false sense of security

https://www.petfoodindustry.com/blogs/10-debunking-pet-food-myths-and-misconceptions/post/8190-pet-nutrition-alliance-provides-false-sense-of-security

 

Evidence shows that risk factors for DCM is multi-faceted and is not related to a grain-free diet.

McCauley et al., 2020. Review of canine dilated cardiomyopathy in the wake of diet-associated concerns. Journal of Animal Science. 98, No. 6: 1-20

Link: https://academic.oup.com/jas/article/98/6/skaa155/5857674

 

ABOUT THE AUTHOR:

Ryan Yamka, PhD, MS, MBA, FACN, PAS, Dipl. ACAS is founder and an independent consultant with Luna Science and Nutrition, and co-Founder of Guardian Pet Food Company. He is board certified in companion animal nutrition by the American College of Animal Sciences and a fellow with the American College of Nutrition. Yamka calls on his extensive background in pet nutrition, and 20+ years developing, formulating and launching dog and cat foods as a senior executive with leading pet food companies. Yamka has received the 2020 Rogue Pet Science Pet Industry Disruptor Award, the 2019 Pet Age ICON Award and the 2011 ASAS Corbin Companion Animal Biology Award. Dr. Yamka writes a series of blogs Debunking Pet Food Myths and Misconceptions for Pet Food Industry and has been featured in numerous podcasts and seminars.

To learn more about Ryan, check his background credentials on LinkedIn (www.linkedin.com/in/ryanyamka)

Little Known fact, does your dog kiss your face?

Little Known Fact:

Do you let your pet kiss your face? We’re guilty! But we’ve heard some say this could be dangerous.

We were curious about where science stood on this behavior, so we consulted experts in both human and animal health to find out how bad it really is to let your pet kiss you on the mouth.

https://www.petnews.com.au/research/how-unsanitary-is-it-to-kiss-your-pet-on-the-mouth/

Cats Domesticated Themselves: Of course they did!

Though everyone might not agree on cats’ perfection, felines are among the most popular pets in the world today, with approximately 74 million cats living in U.S. homes.

The cat has long been important to human societies as a pest-control agent, object of symbolic value and companions. However, recent evidence from feline DNA shows they took their time domesticating themselves.

 

Article     |     Scientific Publication (Open Access)

Science of ‘Sense’ – how does your pet see the world?

There has always been debate about how and what dogs and cats can see. The reality? Dogs & cats don’t see as clearly as humans, and they’re lacking in the color department. However, they can see movement better than we can.

Learn Something New

One Health Initiative

One Health is an approach that recognizes that the health of people is closely connected to the health of animals and our shared environment. 

 

The World is changing, COVID has accelerated that change in countless ways. I believe that the unprecedented collaboration between disciplines and scientists from all over the world will be looked at as one of the most incredible feats in our modern world.  My hope is that this collaboration (and open access to scientific literature) continues and inspires other professionals to integrate their practices and their knowledge to work together to improve the lives of humans, animals and the environment. In fact, there is something called the One Health Initiative which aims to do just that.

So, what does this mean for us and our pets? What does it mean for nutrition? The reality is that there are numerous research gaps when it comes to nutrition, and even more when it comes to companion animal nutrition. The environment and how we interact with it also has a significant impact on the health of all living things. Much of the research we rely on for canine and feline supplementation, or management of disease is rooted in human research.

Many medical and nutrition professionals have recognized these significant gaps in human and animal medicine and nutrition. Livestock nutrition is arguably the most advanced of all nutrition sciences, followed by human nutrition, and it is frustrating to see the lack of knowledge sharing & collaboration between those and companion animal fields. This is a significant issue because it leaves treatment gaps for canines and felines such as cognitive dysfunction, allergies, gastrointestinal issues, diabetes, heart disease and more.

The One Health Initiative has provided individuals in many disciplines to collaborate and advance multiple fields of science to study and advance knowledge of zoonotic diseases, antimicrobial resistance, food safety and security and environmental factors. We look forward to providing updates and perspective on this initiative in the future.

The One Health Initiative provides opportunity for collaboration between veterinary and human physicians and researchers to advance both fields.

Source: https://onehealthinitiative.com/about/[vc_single_image image=”3888″ img_size=”600×427″ onclick=”custom_link” link=”https://onehealthinitiative.com/about/”]

The Big Miss: Is No-Hide® Actually Rawhide?

A ‘consumer advocate’ recently stirred up drama from July 2017 re-circulating an article (figure 1) claiming that Earth Animal No-Hide® treats were rawhide, again. This was on the heels of the announcement of a class-action lawsuit (figure 2) against Earth Animal Ventures (EAV) questioning the ingredients and sourcing of No-Hide® products. I didn’t think I would have to address this issue, but apparently, I do since misinformation and cherry-picked information from the original chain of events keeps circulating (if it’s on the internet it must be true, right?). Consumers and retailers alike need to see the situation for what it is, so I’ll also write this from both a retailer and consumer standpoint to provide the level of transparency I hold others to. As you read this, you’ll understand that both sides have significant issues. In fact, No-Hide® being (or not being) rawhide is hardly the issue. Instead there is a pervasive lack of transparency and misinformation from both the consumer advocate side and EAV.

Grain-Free Pet Food Diets | What to Know Before Switching

The benefit and necessity of grain-free pet food have come under scrutiny in recent years due to an FDA investigation due to a potential association with a canine heart disease known as dilated cardiomyopathy (DCM). As a result of this potential association, many have been told there is no scientific evidence to support the use of grain-free foods in canines and felines, or that these foods do not provide any benefit over grain-inclusive foods. For the most part, grain-free refers to kibble, although some have also categorized various canned, freeze-dried, and raw diets under the ‘grain-free’ umbrella. But are these claims accurate? Let’s find out:

 

Grain-free foods don’t provide benefits?grain free dog food kible

The pet food industry’s switch to grain-free was not fueled by a problem with the grains themselves or grain allergies like most believe. The largest pet food recalls in history was due to melamine and cyanuric acid contamination of ingredients coming from China. The short version of the 2007 recall is that wheat gluten and rice protein were intentionally combined with melamine for its high nitrogen content. Higher amounts of nitrogen can cause the protein content of an ingredient to test higher than it actually is. Since cyanuric acid was present, and the combination of melamine and cyanuric acid is likely the reason the recall was so deadly – not the melamine on its own. This series of events fueled the consumer trend of wanting grain-free pet food.

Other Concerns

Another major factor absent from the discussion on grain-free vs. grain inclusive diets for people – and pets – is the contamination of grains with herbicides, pesticides, mycotoxins, and fertilizers. This has become an increasingly large concern since the mid-’90s in both the human and animal food supply. Numerous peer-reviewed articles are detailing the disruption many of these agricultural contaminants have on normal gut bacteria function.1,2 In fact, available literature suggests that humans are becoming increasingly intolerant to grain and grain products for exactly these reasons (e.g. wheat & gluten sensitivity & celiac disease in humans).

We are learning that disruption of vital gut bacteria balance can have devastating effects on the health of the host, including diabetes, obesity, autoimmune disease, cancers, GI issues, and even DCM.3–5 Could the contamination of grains in pet food be one reason why many pets experience improvement of various issues with the change from grain-inclusive to grain-free? Could be.

Ultimately the phrase ‘there is no evidence to support the use of grain-free foods’ doesn’t mean there is not a benefit. It simply means that we have a major gap in research into companion animal nutrition and that we easily forget our recent history. On the contrary, we don’t have evidence to support that feeding grains to canines or felines are any more healthful than feeding grain-free diets. Evidence only shows that it meets minimal (known) nutritional standards, not that pets thrive on these processed diets. In short, canine and feline nutrition fields are far behind the knowledge we have in livestock and human nutrition.

 

Are ALL grain-free foods the same?

Many veterinarians and pet owners automatically lump grain-free cans, fresh food, raw food, and freeze-dried products as ‘grain-free’. While this is technically correct – there are stark differences that make these foods different from their kibble counterparts.

Regardless of whether we are feeding grain-free or not, we need to consider the high temps kibble and canned foods are heated to during the manufacturing process. This high heat creates Maillard Reaction Products (MRP) which is the name for a series of reactions that is the product of sugar (carbohydrate) and protein when heated. These are also known as AGE’s or Advanced Glycation End Products.

MRP’s are responsible for the nutrient loss and associated with diseases like diabetes, cardiovascular disease, kidney disease, loss of cognitive function, allergies, periodontal disease, and chronic inflammation.6–12 This can mean things like arthritis, skin, and ear issues, an old injury that keeps resurfacing, bloating, IBS, etc. Also, there is a large amount of research to suggest that they are carcinogenic and accelerate aging.13,14

  • Heterocyclic amines are MRPs from cooking protein that increases with elevated cooking temperature. This phenomenon is more pronounced in meat than fish – and these increase with temperature and dryness of meat or meat products15.
  • Acrylamides are a chemical that forms naturally from starchy foods during high-temperature cooking. According to the European Food Safety Authority evidence from animal studies shows that acrylamides are genotoxic and carcinogenic: they damage DNA and cause cancer. And since we know so little about animal nutrition is it possible that much of the disease we’re seeing – including DCM – has at least something to do with the MRP’s that are in dry and/or canned pet food? Is it a coincidence that freeze-dried, fresh, and raw options do not have as many associated issues as their processed counterparts? Maybe.

 

Allergic to Grains? Probably Not (sorry, not sorry)

Pet food can be made of everything from rendered unfit foods for human consumption to ingredients that are 100% organic and probably better than the food we feed ourselves. I’m not necessarily here to split hairs on ingredients and in the types of ingredients that are in our pet’s food. Because is it these ingredients that are causing the problem? Or is it something else? – These are the questions that the experts seem to avoid entirely. When a dog experiences issues related to food, we are quick as a society to turn over the bag and blame an ingredient or set of ingredients. However, those ingredients as listed are likely not the problem – rather the quality, processing agents, AGE’s and contamination of these ingredients (e.g. herbicides, pesticides, etc.); something you will never find listed on a label.

 

More Important: Nutrient Availability & Digestibility

The digestibility of food is altered as it is processed, mixed with other ingredients, and heated. That said, canned and kibble foods by definition will have varying levels of nutrient availability and digestibility than their lesser processed counterparts. The ingredients (or set of ingredients) that make up a food could be the most nutrient-dense food available – but if they are not digestible by the cat or dog then those ingredients are irrelevant. In short, this means that it is important to ask your pet food company for their digestibility and nutrient analysis to determine if their food is adequate for your pet. Learn more about what questions to ask and why here.

 

About the author: Nicole Cammack

Nicci is the owner of award-winning NorthPoint Pets & Company, in Connecticut. She is also the Founder & CEO of Undogmatic Inc. Her undergraduate and graduate education includes biology, chemistry, business, and nutrition. She has worked in the pharmaceutical industry on multiple R&D projects and has had the privilege to learn from leading international figures in the human and pet health industry. She regularly lectures at national conferences, including federal, state, and municipal K9 events. Her current research involves identifying pathogenic risk factors and transmission among raw fed pets through a comprehensive worldwide survey.

www.northpointpets.com

www.undogmaticinc.com

 

References:

  1. Van Bruggen AHC, He MM, Shin K, et al. Environmental and health effects of the herbicide glyphosate. Sci Total Environ. 2018;616-617:255-268. doi:10.1016/j.scitotenv.2017.10.309
  2. Aitbali Y, Ba-M’hamed S, Elhidar N, Nafis A, Soraa N, Bennis M. Glyphosate based- herbicide exposure affects gut microbiota, anxiety and depression-like behaviors in mice. Neurotoxicol Teratol. 2018;67:44-49. doi:10.1016/j.ntt.2018.04.002
  3. DeGruttola AK, Low D, Mizoguchi A, Mizoguchi E. Current Understanding of Dysbiosis in Disease in Human and Animal Models. Inflamm Bowel Dis. 2016;22(5):1137-1150. doi:10.1097/MIB.0000000000000750
  4. Galland L. The Gut Microbiome and the Brain. J Med Food. 2014;17(12):1261-1272. doi:10.1089/jmf.2014.7000
  5. Yoshida N, Yamashita T, Hirata K. Gut Microbiome and Cardiovascular Diseases. Diseases. 2018;6(3). doi:10.3390/diseases6030056
  6. Jandeleit-Dahm K, Cooper ME. The Role of AGEs in Cardiovascular Disease. doi:info:doi/10.2174/138161208784139684
  7. Pion PD, Kittleson MD, Thomas WP, Skiles ML, Rogers QR. Clinical findings in cats with dilated cardiomyopathy and relationship of findings to taurine deficiency. J Am Vet Med Assoc. 1992;201(2):267-274.
  8. DCM: add taurine to grain-free dog foods, say scientists. Accessed May 15, 2019. https://www.petfoodindustry.com/articles/8162-dcm-add-taurine-to-grain-free-dog-foods-say-scientists?v=preview
  9. DACVIM CDSBM. Breed-specific variations of cardiomyopathy in dogs. dvm360.com. Accessed May 15, 2019. https://veterinarynews.dvm360.com/breed-specific-variations-cardiomyopathy-dogs
  10. Dilated Cardiomyopathy in Dogs. vca_corporate. Accessed May 15, 2019. vcahospitals.com/know-your-pet/dilated-cardiomyopathy-dcm-in-dogs–indepth
  11. Medicine C for V. FDA Investigation into Potential Link between Certain Diets and Canine Dilated Cardiomyopathy. FDA. Published online June 27, 2019. Accessed June 29, 2019. https://www.fda.gov/animal-veterinary/news-events/fda-investigation-potential-link-between-certain-diets-and-canine-dilated-cardiomyopathy
  12. Freeman LM, Stern JA, Fries R, Adin DB, Rush JE. Diet-associated dilated cardiomyopathy in dogs: what do we know? J Am Vet Med Assoc. 2018;253(11):1390-1394. doi:10.2460/javma.253.11.1390
  13. Prasad C, Imrhan V, Marotta F, Juma S, Vijayagopal P. Lifestyle and Advanced Glycation End Products (AGEs) Burden: Its Relevance to Healthy Aging. Aging Dis. 2014;5(3):212-217. doi:10.14336/AD.2014.0500212
  14. Turner DP. Advanced glycation end-products: a biological consequence of lifestyle contributing to cancer disparity. Cancer Res. 2015;75(10):1925-1929. doi:10.1158/0008-5472.CAN-15-0169
  15. Jägerstad M, Skog K, Arvidsson P, Solyakov A. Chemistry, formation and occurrence of genotoxic heterocyclic amines identified in model systems and cooked foods. Z Für Leb -Forsch A. 1998;207(6):419-427. doi:10.1007/s002170050355

Concerned about grain-free diets? The FDA report tells a different story.

Summary:

Recent reports discussing the potential relationship between grain-free pet foods and Dilated Cardiomyopathy (DCM) have given pet owners and veterinarians alike a cause for concern. Pet owners and the veterinary community have been led to believe that some pet foods – particularly grain-free pet foods – are causing heart disease in dogs. However, the data buried within the FDA report tells a different story, one that is complex, without evidence showing a causative relationship between grain-free diets and heart disease. Multiple factors surround this issue – and none of them are simple. The fact is, little research and data are available surrounding this potential relationship, and some within the industry have failed to recognize a greater problem. DCM is just one of many concerns pet owners have to face, along with cancer, diabetes, kidney disease, and allergies to name a few. For owners and veterinarians concerned about grain-inclusive or grain free, they are likely concerned about the wrong risk; instead, the concern should be centered around the significant gaps in the field of animal nutrition. These gaps include but are not limited to formulation guidelines that are narrowly researched, outdated research, and foods full of toxic chemicals and byproducts of food processing. The DCM events have highlighted these gaps and the complexity of the field of nutrition, for those simplifying it to a set of ingredients are doing pets & the scientific community a disservice. In this review, we examine the scientific evidence that highlights the complexity of nutrition & DCM.

Timeline of FDA Investigation & Reports

  • In June of 2018, Lisa Freeman, a board-certified veterinary nutritionist from Tufts University published a blog titled “A broken heart: Risk of heart disease in boutique or grain-free diets and exotic ingredients.” This blog warned pet owners and veterinarians that ‘BEG’ (boutique, exotic, grain free) diets were causing heart disease in dogs.
  • July 2018, FDA announces an investigation into the potential association of canine DCM and grain-free foods. On the heels of this press release, the New York Times published an article creating a media storm.
  • In November of 2018, Dr. Freeman published another blog on the Tuft’s Petfoodology website titled, “It’s Not Just Grain Free: An Update on Diet-Associated Dilated Cardiomyopathy.” This reiterated their warning about BEG diets and their association with DCM. This article also was circulated as if it was peer-reviewed when it indeed was another opinion piece.
  • In December of 2018 Freeman et. al. authored a commentary article in JAVMA titled, “Diet-associated dilated cardiomyopathy in dogs: what do we know?” It’s important to note that this paper also was not peer-reviewed, and the AVMA (American Veterinary Medical Association) disseminated it as gospel. This is unfortunate considering 80% of veterinarians believe or look at AVMA as a source of truth even if a commentary article does not contain true or accurate scientific content.
  • Also, in December 2018 there was a paper published in PLOS ONE by Kaplan et al. titled, “Taurine deficiency and dilated cardiomyopathy in golden retrievers fed commercial diets.” The major complicating variable (and there were many) was that golden retrievers are well known to have a genetic predisposition to DCM, as well as have a higher requirement for taurine. Simply, this means that this study cannot be easily applied to the entire canine population.
  • February of 2019 –  The FDA published an update showing a few hundred reported cases in the prior 7 months. It also revealed that the majority of pets were eating dry food, were golden retrievers, and that ingredients like peas, sweet potatoes, lentils, chickpeas, and potatoes were potentially associated with DCM. They also revealed that all diets implicated did appear to be nutritionally adequate based on testing.
  • June 2019  – the FDA released another update naming the most common 16 brands of dog food reported alongside DCM cases. This report along with the accompanying graphs was taken out of context leading the general public and veterinary community to believe that they had made a connection to specific brands and disease when in fact the FDA report states that they believe it to be a complex scientific issue.
  • In May of 2020 a paper titled, “Development of plasma and whole blood taurine reference ranges and identification of dietary features associated with taurine deficiency and dilated cardiomyopathy in golden retrievers: A prospective, observational study” was published in PLOS ONE. The article contained multiple inaccuracies, failure to disclose conflicts of interest, and issues that are currently being reviewed. In the meantime, the journal has issued an expression of concern. Regardless, this paper also taken out of context has led the public and veterinary community to believe that the issue is a simple relation to ingredients instead of the complex issue that it is.
  • In June of 2020, an article published in Journal of Animal Science highlighted just how complex DCM and various nutritional and non-nutritional etiologies are. The authors state, “based on this review of the current literature, there is no definitive relationship between these implicated diet characteristics and DCM.” While the public and veterinary associated communities made several further conclusions upon the release of the article, it is important to realize that this paper largely identifies the numerous knowledge gaps within the field of canine nutrition rather than drawing concrete conclusions. While no link between ‘BEG’ (boutique, exotic, grain free) pet foods were found, this does not mean that nutrition and other considerations are not at play.1 You can read our full summary of that article here.

What is DCM? pouring dry dog food into bowl

Dilated Cardiomyopathy (DCM) is defined as a condition where the heart becomes enlarged and is unable to adequately pump blood. DCM can include mechanical dysfunction and/or electrical dysfunction which leads to sudden collapse and death.2 As DCM progresses signs include lethargy, loss of appetite, shallow breathing, intolerance to exercise, and shortness of breath. This disease is known to occur in dogs and cats, at varying levels of severity and has multiple causes.1,3

Further complicating matters DCM has causation that is likely multivariable such as genetics, environmental, nutritional, infections, heavy metal exposure, dysbiosis, and even other unknown causes1,3.

A large issue is that the true prevalence of DCM in canines is unknown. One of the reasons is that there is no central reporting agency that tracks diseases for companion animals. Literature estimates the prevalence of DCM in dogs, prior to grain-free foods being widely available, to be 0.5 to 1.1% of the overall dog population.4 Based on the current data it would appear that the prevalence of DCM is still within the same parameters even with increased reports made to the FDA. That said, it is unclear if cases have been underreported, and continue to be underreported or if there is a significant spike in cases as a result of these diets, or multiple other variables.

DCM is not a ‘new’ concern for dogs or cats. In fact, it has been around for a long time. In the 1970’s -1980’s, DCM was prevalent in cats and it was eventually determined that this was due to low concentrations of taurine and animal protein within the commercialized foods.5 Pet food companies responded by adding taurine through supplementation and additional meat protein which has since seemed to remedy this issue for cats.Since dogs and cats are nutritionally different it is unlikely that adding taurine to any canine diet will be sufficient to solve the current issue in dogs, especially since diet-related canine DCM is likely far more complex. Further complicating matters, the only definitive diagnosis for DCM is an echocardiogram, which the majority of “cases” highlighted within the FDA report lack. Other methods of screening for potential cardiac disease are whole blood taurine, plasma taurine, auscultation, and chest x-ray, although these methods are not reliable in diagnosing DCM.

Genetics at Play

We know that certain breeds are genetically predisposed to DCM and those include (but are not limited to) Doberman Pinschers, Boxers, Great Danes, Labrador Retrievers, St. Bernards, Irish Wolfhounds, Golden Retrievers, Newfoundlands, English, and American Cocker Spaniels5,7. There is no cure for genetic DCM, and conventional treatment provides limited relief for a generally short period of time.8

Not Just Grain Free

Not all dogs diagnosed with DCM were consuming a grain free diet.9. Most dogs were also eating dry food, which raises the question grain free not being a problem per se – instead showing evidence of a knowledge gap in the formulation.9 As the report notes, some improved after a diet change from one grain-free diet to another, and this along with differences identified between dogs fed various grain-free diets, suggests that DCM is not necessarily tied to the grain-free status of the diet.2,10 In addition, many dogs diagnosed with DCM were initially thought to be taurine-deficient, and we’ve since learned that this problem is far more complex than the presence or digestibility of taurine within dry pet food. We’re now realizing the presence of significant knowledge gaps regarding small animal nutrition.

Context: Few Pets are Healthy

In examining the whole picture, we know that dogs and cats are not “healthy” – a reality that most of us either ignore or don’t believe to be true. Common problems like skin conditions, “dog smell”, and GI issues are not – and should not be considered healthy; even though we’ve come to accept them as normal. Some of the causality behind “common” problems is that our pets have been, and still are, subject to many detrimental variables over generations and the consequences of such have impacted the overall wellbeing and susceptibility of varying types of disease. These variables include but are not limited to: toxins and pollution in the air, water, soil, and food supply, overuse of antibiotics and other medication, over vaccination, static diets, poor breeding practices, poor nutrition, lack of exercise, and radiation. Some, or more likely, each of these factors may have contributed to our pet’s susceptibility to a variety of diseases, including DCM. In fact, obesity, diabetes, and other issues have known relationships to DCM.11 All factors that complicate the scientific investigation.

Understanding Risk Factors

For the sake of context, the good news is that just because an individual is “predisposed” to a particular disease does not mean that they are going to “develop” that disease as the expression of a “bad gene” can be altered by a healthful diet and limiting exposure to toxins and stress.12 Let’s imagine for a second that an individual was predisposed to any type of heart disease, but they took care of themselves by consuming a diet consisting of fresh foods, including antioxidants along with moderate fat, and sodium, avoided excess use of vaccinations, limited unnecessary medications, consumed clean water and exercised to maintain strong cardiac function. These individuals most likely have a lesser chance of developing heart disease. The point is that multiple variables influence the expression of disease in any human or animal.

Nutritional Knowledge Gap

Pet food formulation comes from generalized minimal recommendations by the Association of American Feed Control Officials (AAFCO) and the National Research Council (NRC). It’s clear that these minimal benchmarks are not complete with adequate scientific evidence. For example, we do not have optimal levels for many nutrients and do not account for breed-specific requirements in most cases. These minimum nutrient recommendations have been established with research on Beagles as a proxy for all canines regardless of size or breed.2 These same recommendations also place pregnant bitches in the same category as growing animals – even though we know that nutritional requirements are different. Additionally, recommendations made by AAFCO correspond to a total nutrient content within the formulation and do not consider the true digestibility of ingredients leading to the potential of a variety of nutrient deficiencies across multiple breeds.13

Not All Diets Metabolized the Same

Some within the veterinary community have illogically lumped home-cooked, canned and raw diets into the “grain free” category, however, per the FDA report, the vast majority of DCM cases that were reported were for dogs consuming dry foods – not “grain-free” raw or “grain-free” cans, causing unnecessary panic at the expense of pet owners canned and raw foods. These diets are entirely different in formulation, composition, and differ in the way they are metabolized in comparison to dry diets. Fresh and unprocessed diets, like raw, will have abundant taurine and natural nutrients which may limit risks of malabsorption and nutrient deficiencies that are common in kibble and other processed diets. Oversimplifying this issue to “grain-free” raw, canned, and home-cooked diets is irresponsible and likely causing more harm than good.

Disproportionate Levels of Macronutrients & Micronutrient Deficiency

DCM aside, all grain-in and grain-free dry foods have a carbohydrate content of at least 30%, most being significantly higher. This can be a problem for several reasons that most haven’t recognized:

  • Ingredients such as potatoes, peas, and other legumes and pulses have been used in grain-inclusive and grain-free dog food for nearly 25 years to provide dietary fiber and protein.14 Use of these ingredients at higher than 15% inclusion on a dry matter basis can decrease crude protein digestibility. Since some foods on the market have greater than 40%, and even up to 60%, inclusion could facilitate a higher risk of nutritional deficiencies, especially if the final product is not validated.2 This can also yield an inadequate amount of animal protein which may lead to an imbalance or not enough of various nutrients – one of which can be taurine, and too little taurine (taurine deficiency) can result in DCM.
  • Some plant-based proteins, like pea or potato protein, can cause malabsorption and inflammatory conditions in humans.15 While insufficient research is available to suggest the same in pets, it is certainly a reasonable theory to explore. More institutions are exploring the similarities in humans and canines and while some still refute these similarities, the stark similarities in types and rates of disease are intriguing.16–18 Logically, these similarities are not surprising considering humans eat a highly-processed diet full of chemicals, lack exercise, overuse medication, and live exposed to environmental toxins and pollution, just like pets.
  • The recent article by McCauley et al. highlighted the various nutritional considerations that may influence dietary DCM including choline, methionine, cysteine, taurine, carnitine, thiamine, copper, vitamin E, selenium among others.1

Before assigning blame to a particular ingredient, set of ingredients, or formulation it is prudent to first identify knowledge gaps – especially before establishing any causation to a particular disease. Further investigation into these inclusion percentages and relationship to canine health and risk factors is needed to understand these relationships. We cannot allow the industry to tunnel vision focus in the way that it has, as it will not yield useful results or a better understanding of the problem at hand.

Why Grain Free?

The pet food industry’s switch to grain free was not fueled by a problem with the grains themselves or grain allergies like most believe. In 2007, the largest pet food recalls in history was due to melamine and cyanuric acid contamination of wheat and rice ingredients coming from China. Also absent from the discussion on grain consumption for pets – and people – is the contamination of grains with herbicides, pesticides, mycotoxins, and fertilizers. Numerous peer-reviewed articles are detailing the disruption that many of these contaminants have on normal gut bacteria function. These are the largest reasons more animals and humans are becoming increasingly intolerant to grain and grain products.19,20 We are also learning that disruption of vital gut bacteria balance can have devastating effects on the health of the host including diabetes, obesity, autoimmune disease, cancers, GI issues, and even DCM.21–23 Said simply, the contamination of grains in pet food is likely why many pets experienced improvement of various symptoms with the change from grain-inclusive to grain-free.

Pet Food Processing & Chemical Factors to Consider

All kibble is heated to high temps which creates a chemical change. A Maillard Reaction Product (MRP) is the name for a series of reactions that is the product of sugar (carbohydrate) and protein when heated. These are also known as AGE’s or Advanced Glycated End Products. MRP’s are responsible for nutrient loss and associated with diseases like diabetes, cardiovascular disease, kidney disease, loss of cognitive function, allergies, periodontal disease, and chronic inflammation.24–29 This can mean things like arthritis, skin, and ear issues, an old injury that keeps resurfacing, bloating, IBS, etc. In addition, there is a large amount of research to suggest that they are carcinogenic and accelerate aging.29,30

Since we know so little about animal nutrition is it possible that much of the disease we’re seeing – including DCM has at least something to do with the MRP’s that are in pet food? Possibly.

Closing Discussion

The considerations surrounding DCM challenges are extremely complicated, with many unknowns. It will likely be many years before any formal answers are reached. Currently, there are no formal dietary recommendations for pet owners from the FDA as of the latest report. If your dog is in a risk group (breed, genetic, or other underlying condition) it is best to seek advice from your veterinarian on the health status of your pet.

Our canines are largely suffering from man-made diseases and conditions such as obesity, type II diabetes, and nutritional deficiency – among others. Most of these can be linked back to feeding low-moisture, high soluble carbohydrate, low meat protein, and ultra-processed dry food with high levels of contaminants. While there is a knowledge gap in the nutrition of both ultra-processed and raw, one cannot deny the association between ultra-processed foods and disease prevalence and progression.

It is imperative to understand and practice methods that recognize each animal as different, having unique needs. Not any one diet is complete – and no feeding regimen will be successful for all pets and this very practice is what has been detrimental to our pets and brought us to this point. As always, all diet changes and additions should always be introduced slowly and carefully. It is always helpful to keep a food journal that can help experts determine potential foods or feeding patterns that may be problematic.

 

 

*This article is for informational purposes only. It is not meant to provide medical advice or replace the advice of a qualified veterinarian. If you think your pet has DCM, or any medical condition please seek the advice of a qualified veterinarian.

About the Author: Nicole Cammack

Nicci is the owner of national award-winning NorthPoint Pets & Company and Undogmatic Inc, in Connecticut. Her undergraduate and graduate education includes biology, chemistry, business, and nutrition. She has worked in the pharmaceutical industry on multiple R&D projects and has had the privilege to learn from leading international figures in the human and pet health industry. She regularly lectures at national conferences, including federal, state, and municipal K9 events. Her current research involves identifying pathogenic risk factors and transmission among raw fed pets through a comprehensive worldwide survey.
www.northpointpets.com
www.undogmaticinc.com

References:

  1. McCauley SR, Clark SD, Quest BW, Streeter RM, Oxford EM. Review of canine dilated cardiomyopathy in the wake of diet-associated concerns. J Anim Sci. 2020;98(6):skaa155. doi:10.1093/jas/skaa155
  2. Mansilla WD, Marinangeli CPF, Ekenstedt KJ, et al. Special topic: The association between pulse ingredients and canine dilated cardiomyopathy: addressing the knowledge gaps before establishing causation. J Anim Sci. 2019;97(3):983-997. doi:10.1093/jas/sky488
  3. Canine Dilated Cardiomyopathy (DCM). Cornell University College of Veterinary Medicine. Published December 13, 2017. Accessed May 15, 2019. https://www.vet.cornell.edu/hospitals/companion-animal-hospital/cardiology/canine-dilated-cardiomyopathy-dcm
  4. Sanderson SL. Taurine and carnitine in canine cardiomyopathy. Vet Clin North Am Small Anim Pract. 2006;36(6):1325-1343, vii-viii. doi:10.1016/j.cvsm.2006.08.010
  5. Pion PD, Kittleson MD, Thomas WP, Skiles ML, Rogers QR. Clinical findings in cats with dilated cardiomyopathy and relationship of findings to taurine deficiency. J Am Vet Med Assoc. 1992;201(2):267-274.
  6. DCM: add taurine to grain-free dog foods, say scientists | PetfoodIndustry.com. Accessed May 15, 2019. https://www.petfoodindustry.com/articles/8162-dcm-add-taurine-to-grain-free-dog-foods-say-scientists?v=preview
  7. DACVIM CDSBM. Breed-specific variations of cardiomyopathy in dogs. dvm360.com. Accessed May 15, 2019. https://veterinarynews.dvm360.com/breed-specific-variations-cardiomyopathy-dogs
  8. Dilated Cardiomyopathy in Dogs. vca_corporate. Accessed May 15, 2019. vcahospitals.com/know-your-pet/dilated-cardiomyopathy-dcm-in-dogs–indepth
  9. Medicine C for V. FDA Investigation into Potential Link between Certain Diets and Canine Dilated Cardiomyopathy. FDA. Published online June 27, 2019. Accessed June 29, 2019. https://www.fda.gov/animal-veterinary/news-events/fda-investigation-potential-link-between-certain-diets-and-canine-dilated-cardiomyopathy
  10. Freeman LM, Stern JA, Fries R, Adin DB, Rush JE. Diet-associated dilated cardiomyopathy in dogs: what do we know? J Am Vet Med Assoc. 2018;253(11):1390-1394. doi:10.2460/javma.253.11.1390
  11. Alpert MA. Obesity Cardiomyopathy: Pathophysiology and Evolution of the Clinical Syndrome. Am J Med Sci. 2001;321(4):225-236. doi:10.1097/00000441-200104000-00003
  12. Hunter P. We are what we eat. The link between diet, evolution and non-genetic inheritance. EMBO Rep. 2008;9(5):413-415. doi:10.1038/embor.2008.61
  13. Columbus D, de Lange CFM. Evidence for validity of ileal digestibility coefficients in monogastrics. Br J Nutr. 2012;108 Suppl 2:S264-272. doi:10.1017/S0007114512002334
  14. Butterwick R, J Markwell P, J Thorne C. Effect of Level and Source of Dietary Fiber on Food Intake in the Dog. J Nutr. 1995;124:2695S-2700S. doi:10.1093/jn/124.suppl_12.2695S
  15. Freed DLJ. Do dietary lectins cause disease? BMJ. 1999;318(7190):1023-1024.
  16. Research by DogRisk. University of Helsinki. Published June 26, 2018. Accessed May 15, 2019. https://www.helsinki.fi/en/researchgroups/dogrisk-health-via-nutrition-epidemiology-and-cancer-detection-dogs/research-by-dogrisk
  17. Dog Disease Mapping Project (DogDNA). Broad Institute. Published June 9, 2011. Accessed May 15, 2019. https://www.broadinstitute.org/project-spotlight/dog-disease-mapping-project-dogdna
  18. Treviño J. A Surprising Way Dogs Are Similar to Humans. Smithsonian. Accessed May 15, 2019. https://www.smithsonianmag.com/smart-news/new-study-suggests-dogs-may-be-better-subjects-research-human-nutrition-180968842/
  19. Van Bruggen AHC, He MM, Shin K, et al. Environmental and health effects of the herbicide glyphosate. Sci Total Environ. 2018;616-617:255-268. doi:10.1016/j.scitotenv.2017.10.309
  20. Aitbali Y, Ba-M’hamed S, Elhidar N, Nafis A, Soraa N, Bennis M. Glyphosate based- herbicide exposure affects gut microbiota, anxiety and depression-like behaviors in mice. Neurotoxicol Teratol. 2018;67:44-49. doi:10.1016/j.ntt.2018.04.002
  21. DeGruttola AK, Low D, Mizoguchi A, Mizoguchi E. Current Understanding of Dysbiosis in Disease in Human and Animal Models. Inflamm Bowel Dis. 2016;22(5):1137-1150. doi:10.1097/MIB.0000000000000750
  22. Galland L. The Gut Microbiome and the Brain. J Med Food. 2014;17(12):1261-1272. doi:10.1089/jmf.2014.7000
  23. Yoshida N, Yamashita T, Hirata K. Gut Microbiome and Cardiovascular Diseases. Diseases. 2018;6(3). doi:10.3390/diseases6030056
  24. Jandeleit-Dahm K, Cooper ME. The Role of AGEs in Cardiovascular Disease. doi:info:doi/10.2174/138161208784139684
  25. OLENIUC M, SECARA I, ONOFRIESCU M, et al. Consequences of Advanced Glycation End Products Accumulation in Chronic Kidney Disease and Clinical Usefulness of Their Assessment Using a Non-invasive Technique – Skin Autofluorescence. Mædica. 2011;6(4):298-307.
  26. West R, Moshier E, Lubitz I, et al. Dietary advanced glycation end products are associated with decline in memory in young elderly. Mech Ageing Dev. 2014;140:10-12. doi:10.1016/j.mad.2014.07.001
  27. Smith PK, Masilamani M, Li X-M, Sampson HA. The false alarm hypothesis: Food allergy is associated with high dietary advanced glycation end-products and proglycating dietary sugars that mimic alarmins. J Allergy Clin Immunol. 2017;139(2):429-437. doi:10.1016/j.jaci.2016.05.040
  28. Advanced glycation endproducts (AGEs) induce oxidant stress in the gingiva: a potential mechanism underlying accelerated periodontal disease associated with diabetes – Schmidt – 1996 – Journal of Periodontal Research – Wiley Online Library. Accessed May 15, 2019. https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1600-0765.1996.tb01417.x
  29. Prasad C, Imrhan V, Marotta F, Juma S, Vijayagopal P. Lifestyle and Advanced Glycation End Products (AGEs) Burden: Its Relevance to Healthy Aging. Aging Dis. 2014;5(3):212-217. doi:10.14336/AD.2014.0500212
  30. Turner DP. Advanced glycation end-products: a biological consequence of lifestyle contributing to cancer disparity. Cancer Res. 2015;75(10):1925-1929. doi:10.1158/0008-5472.CAN-15-0169
  31. Jägerstad M, Skog K, Arvidsson P, Solyakov A. Chemistry, formation and occurrence of genotoxic heterocyclic amines identified in model systems and cooked foods. Z Für Leb -Forsch A. 1998;207(6):419-427. doi:10.1007/s002170050355

Hemp & CBD: Not All CBD is “Natural”

In part II we discussed phytoremediation, and why this is one of the largest hidden risks for those who give CBD to their pets or consume it themselves. To review, cannabis absorbs heavy metals, and many of the agricultural chemicals in the soil such as pesticides, herbicides, and fertilizers. If a company does not have processes and procedures in place that ensure their product is free from contaminants and is actually the concentration that is listed on the label. Don’t believe this is a real issue? Due to a lack of regulation, hemp products have the potential for significant risks.

Consequences Due to Lack of Regulationrisks of hemp products

Unfortunately, due to the phytoremediation properties of hemp, contaminants and formulation errors are common and often go unnoticed. For example, a recent study by Cornell University showed 10 out of 29 CBD products tested were within 10% of the concentration on the label.  That same study also showed that heavy metal contaminants were found in 4 out of 29 products.19 Stop and read that again – because it means that only 34% of the most popular CBD’s were even the correct concentration. Never mind those with contamination issues…Yikes!

Spoiler alert: these are some of the most popular pet CBD supplements on the market today. Most of them are sold locally to Cheshire – so you may want to pay attention.

Lack of regulation for CBD means that companies who are NOT members of the NASC are not required to test raw ingredients or finished products for contaminants or adequacy. Heavy metal contamination, poor sourcing, and/or formulation errors could potentially be a contributing factor to elevated liver function testing and other documented adverse effects relating to hemp & CBD use. This highlights the need to screen companies for adequate product testing and transparency. The reality is that a very small handful of companies can provide verification that their products are contaminant-free, or within concentrations listed on the label.

Ask Questions Verifying Quality

When looking for a CBD product, or any supplement for yourself or your pets you must ask the following questions:

  • Are you a member of the NASC? (pets only)
  • Do you inbound test your raw and concentrated ingredients for contaminants such as heavy metals, fertilizers, and other agricultural chemicals?
  • Do you test your raw ingredients specifically active ingredients to ensure their concentrations are correct?
  • Do you source any ingredients from China?
    • Are you willing to provide certificates of origin?
    • Note that ingredients from China are not necessarily bad if they are responsibly sourced, and they are verifying quality and purity.
  • Do you complete an analysis of your final product to ensure the formulation is correct and ensure there are not any contamination issues? This is important to ensure that active ingredients match the label.

If companies are unwilling to transparently ask these questions or use the excuse of information being proprietary, I would strongly suggest that you find another brand. Not being transparent or testing products when it comes to ensuring safety is unacceptable. Brands that are not meeting these standards could potentially be poisoning the market for other companies who do their due diligence. As consumers, demand better.

Summary

CBD may have its benefits when well-sourced and formulated. While more research is needed, this is a common problem for a lot of supplements and pharmaceuticals on the market. Overall, the risk of adverse effects appears to be low, but consideration should be taken for those pets who may have liver problems.

Some veterinarians are well educated in the CBD landscape and available products, and some simply are not. If your vet is unable to provide information or recommend products it is ok to ask them for someone who can. Many reputable companies do have veterinarians and scientists on-staff that you or your veterinarian may also be able to speak to for more information.

As always, this is a rapidly evolving field. We expect to see changes as the FDA and AVMA begin to release more guidance and information in this area. We also will see more research regarding safety, efficacy, and other applications as time goes on. While it can be frustrating to see both advice and information change, remember this is a good thing and something you should embrace and support!

Did you miss part I, II, III of this series?

About the Author: Nicole Cammack

Nicci is the owner of award-winning NorthPoint Pets & Company, in Connecticut. She is also the Founder & CEO of Undogmatic Inc. Her undergraduate and graduate education includes biology, chemistry, business, and nutrition. She has worked in the pharmaceutical industry on multiple R&D projects and has had the privilege to learn from leading international figures in the human and pet health industry. She regularly lectures at national conferences, including federal, state, and municipal K9 events. Her current research involves identifying pathogenic risk factors and transmission among raw fed pets through a comprehensive worldwide survey.

www.northpointpets.com

www.undogmaticinc.com

References

  1. Sawler J, Stout JM, Gardner KM, et al. The Genetic Structure of Marijuana and Hemp. PLoS ONE. 2015;10(8). doi:10.1371/journal.pone.0133292
  2. Marijuana, the Second Trip. Revised Edition by Bloomquist, Edward R.: Good PAPERBACK | Earthlight Books. Accessed June 3, 2020. https://www.abebooks.com/Marijuana-Second-Trip-Revised-Edition-Bloomquist/22676164305/bd
  3. Kogan L, Schoenfeld-Tacher R, Hellyer P, Rishniw M. US Veterinarians’ Knowledge, Experience, and Perception Regarding the Use of Cannabidiol for Canine Medical Conditions. Front Vet Sci. 2019;5. doi:10.3389/fvets.2018.00338
  4. Fitzgerald KT, Bronstein AC, Newquist KL. Marijuana Poisoning. Top Companion Anim Med. 2013;28(1):8-12. doi:10.1053/j.tcam.2013.03.004
  5. Mackie K. Cannabinoid Receptors: Where They are and What They do. J Neuroendocrinol. 2008;20(s1):10-14. doi:10.1111/j.1365-2826.2008.01671.x
  6. Maroon J, Bost J. Review of the neurological benefits of phytocannabinoids. Surg Neurol Int. 2018;9. doi:10.4103/sni.sni_45_18
  7. Levinsohn EA, Hill KP. Clinical uses of cannabis and cannabinoids in the United States. J Neurol Sci. 2020;411:116717. doi:10.1016/j.jns.2020.116717
  8. Mechanisms of CB1 receptor signaling: endocannabinoid modulation of synaptic strength | International Journal of Obesity. Accessed June 5, 2020. https://www.nature.com/articles/0803273
  9. Commissioner O of the. FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD). FDA. Published online March 10, 2020. Accessed June 4, 2020. https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd
  10. Commissioner O of the. FDA Warns Companies Illegally Selling CBD Products to Treat Medical Conditions, Opioid Addiction. FDA. Published April 26, 2020. Accessed June 6, 2020. https://www.fda.gov/news-events/press-announcements/fda-warns-companies-illegally-selling-cbd-products-treat-medical-conditions-opioid-addiction
  11. How CBD pet product brands avoid federal warnings. Accessed June 12, 2020. https://www.petfoodindustry.com/articles/8793-how-cbd-pet-product-brands-avoid-federal-warnings
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  14. FAQs. NASC LIVE. Accessed June 13, 2020. https://nasc.cc/faqs/
  15. Resnik DB. Beyond post-marketing research and MedWatch: Long-term studies of drug risks. Drug Des Devel Ther. 2007;1:1-5.
  16. Deabold KA, Schwark WS, Wolf L, Wakshlag JJ. Single-Dose Pharmacokinetics and Preliminary Safety Assessment with Use of CBD-Rich Hemp Nutraceutical in Healthy Dogs and Cats. Animals. 2019;9(10):832. doi:10.3390/ani9100832
  17. McGrath S, Bartner LR, Rao S, Kogan LR, Hellyer PW. A Report of Adverse Effects Associated With the Administration of Cannabidiol in Healthy Dogs. :5.
  18. Commissioner O of the. What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD. FDA. Published online March 3, 2020. Accessed June 12, 2020. https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis
  19. Wakshlag JJ, Cital S, Eaton SJ, Prussin R, Hudalla C. Cannabinoid, Terpene, and Heavy Metal Analysis of 29 Over-the-Counter Commercial Veterinary Hemp Supplements. Vet Med Res Rep. 2020;11:45-55. doi:10.2147/VMRR.S248712