Advice on Diets

3. Advice on Diets

Nutritional Advice at Every Appointment

At the very least, a diet history should be collected and a brief discussion of the patient's performance on its current diet should be completed at every appointment. A diet history must be detailed enough that the patient could be fed the correct diet and amount with the recorded information.

The veterinarian should strive for a diet history that would enable tracking of every calorie consumed by the patient (i.e., main diet, secondary diets, dog treats, human treats, etc.), but often this level of detail is reserved for patients that have undergone unintentional weight loss or gain. The use of a standardized form (Table 3) may prove useful in collecting detailed and accurate information on a patient's diet. Having a form available for clients to take home enables them to complete the diet history at home where the specific diet name and amount can be more readily determined. The form also can easily be filed into the patient's medical record for later review and comparison. It has been the experience of the authors that such forms elicit more truthful and complete answers than simply questioning the client.

Numerous services can be provided on an outpatient basis to the client and patient. These services vary in their complexity and the amount of effort that is required to provide them.

Commercial Diet Recommendations

Every veterinarian should feel comfortable making recommendations to clients regarding commercial diets for healthy patients. As veterinarians focus more on preventative medicine, dietary recommendations will play a more important role in every patient's overall wellness plan. When recommending a diet, two important aspects to consider are nutritional adequacy and the ability of the diet to maintain the patient in an appropriate body condition.

Nutritional adequacy is constantly evolving as nutrient requirements are defined and refined. In the U.S., the non-profit organization, Association of American Feed Control Officials (AAFCO), has developed testing protocols and nutrient profiles in an effort to ensure nutritional adequacy of animal feeds including commercial pet foods. Diets that have undergone feeding trials are often preferred since they may provide better evidence that a diet's nutrients are available. In comparison, diets that simply meet nutrient profiles have not established that their nutrients are available and, thus, may not perform as anticipated based solely on recommendations.

Ideally, all food producers should have feeding test results for the food they are selling. Product quality also depends on the producer's vigilance with respect to the raw ingredients used and the end products sold.

One approach to help ensure the likelihood that a particular product is nutritionally adequate is to recommend feeding commercial diets that have a long-term history of use. Smaller companies often lack the same level of experience and expertise in diet formulation, employ few, if any, full-time nutritionists, and rarely have active research and development programs. Larger companies have many more "sentinels" for potential diet problems due to the increased number of dogs fed their products. Thus, if problems do arise, they are less likely to be missed or overlooked as an isolated incident.

The veterinarian's product range must be split into three distinct groups: Health Nutrition (for healthy animals), Feed & Secure Nutrition (to address specific risks) and Clinical Nutrition, to support the treatment of some pathologies.

The only intervention proven to delay the onset of disease and extend lifespan is maintenance of an optimal body condition (Kealy & al., 2002). Therefore, it is important that each client be counseled on the importance and health benefits of maintaining a lean body condition in their pet. It is also important to remember that in every feeding equation there are three major factors that affect the final outcome; the animal, the diet and the husbandry/environmental conditions in which the animal is maintained. Therefore, the ability of the client to use a diet to maintain a lean body condition in their pet is an important indicator of how that diet performs in any given situation. In many instances, diets designed for maintenance or all life stages can be used successfully. However, sometimes a diet that is less energy dense may be necessary. At the same time, a less energy dense diet should have increased concentrations of all nutrients per unit of energy, as the delivery of nutrients may be artificially limited when fed to maintain a lean body condition.

Nutritional Supplements

The act of selecting a diet that is nutritionally adequate should negate the need for additional supplementation. Veterinary medicine suffers from anthropomorphism in many areas, and one of the most extensive areas where this occurs is nutritional supplementation. Clients are inundated by the media and the human medical community about the beneficial effects of increasing their own intake of selected nutrients. Many of these beneficial effects would be blunted or lost if the daily diet of the client was as balanced as their pet's commercial food. Unfortunately, this point is often lost on clients and the perception that additional supplementation is in the best interest of their pet continues. This perception is difficult to counter, especially when supplementation is seen as innocuous and only beneficial. This is clearly not the case, and the client may need to be educated on the potential risk of adding nutrients into an already complete and balanced diet.

Beyond education, the veterinarian should provide guidance regarding the proven efficacy of the product. Efficacy studies rarely exist in the veterinary literature. Any research that has been done is often not in vivo studies, but rather in vitro work where the concentrations used exceed the amount physiologically possible. Alternatively, the amount of the nutrient being supplemented is quite possibly a fraction of the amount already in the diet and thus of little additional benefit. Clients' energies and finances may be better spent on the selection and purchase of a complete and balanced maintenance diet that maintains optimal body condition. Additional supplementation of any nutrient should only be advised in conditions where an increased requirement has been shown and where the amount provided in the diet is known in order to avoid dietary excesses. If a diet is found to be low in a particular nutrient, selection of an alternative diet with appropriate levels of the nutrient in question is a more prudent course of action rather than supplementation.

Home Prepared Diets

Some clients choose to prepare food at home out of a concern that commercial pet foods are not as wholesome or nutritious as a diet they make themselves. Others have allowed their dogs to develop a fixed-food preference, usually based around home-cooked ingredients. Some clients are required to prepare their dog's meals out of medical necessity. Some dogs have multiple concurrent disease states, which cannot be managed using a commercially available pet food.

An all-meat diet is imbalanced and especially leads to calcium deficiency.

Whatever the underlying cause, all of these clients are equally at risk of feeding a diet that is inappropriate, incomplete or unbalanced. Although these diets are unlikely to cause a problem in the short term (2 - 3 months), there is a risk of clinical signs developing over the long term in the healthy adult and most likely sooner in the growing or unhealthy dog. Evaluation of the client's home prepared diet should be offered and recommended.

Initiating a successful consultation with a board-certified nutritionist usually requires that a very detailed and accurate diet and medical history be provided, along with the patient's current weight and body condition score, as well as the client's goals and concerns regarding the patient's diet. For puppies, the owner should be encouraged to regularly update the weight gain curve.

If specific, but uncommon ingredients (for which little nutrient data is known) are utilized by the client, determining their willingness to change the ingredient or their reason for using the ingredient can be very useful. It can be quite difficult to determine the overall caloric distribution, let alone specific nutrient concentrations, by simply looking at the ingredients. However, the veterinarian should feel comfortable identifying simple and obvious nutrient deficiencies in home prepared diets.

The following items should be identifiable in every home prepared diet:

• Protein source - Usually from an animal or a concentrated vegetable protein (i.e., tofu);
• Essential fatty acids - Especially linoleic acid - animal-source proteins rarely provide adequate levels of this fatty acid, thus a vegetable oil should be included;
• Calcium and phosphorus - These minerals are required in high concentrations and therefore are often provided in the form of bone meal or a calcium supplement;
• Other minerals and vitamins - Unless liver or whole egg is provided in relatively high amounts, a source of other minerals and vitamins is necessary;

Proteins are composed of twenty or so amino acids, only half of which are indispensable to the dog and must be provided in the food.

Essential fats are polyunsaturated fatty acids. They are more sensitive to oxidation and must therefore be stored with care.

The calcium and phosphorus requirement is particularly important in growth and lactation. These two minerals should be properly balanced.

The presence of each of these components does not guarantee completeness or balance, but their absence can serve as an easy indicator to the practitioner and client that the diet should be evaluated.