Royal Canin Nutritional Information

Royal Canin Nutritional Information

Exocrine pancreatic insufficiency affects all breeds of dog, but the syndrome is particularly common in German Shepherds and Collies around 2 years of age. (©Lenfant).

Key Points to Remember:

The Role of Nutrition in the Treatment of Pancreatic Disorders

Exocrine pancreatic insufficiency syndrome (EPI) results not only from the reduced digestion of nutrients in the intestinal lumen, but also from insufficient neutralization of chyme, an alteration of enzymes of the brush border and the proliferation of intestinal bacteria. This results in abnormal activity of intestinal mucosal enzymes as well as a reduction in the transportation of sugars, amino acids, fatty acids and vitamins (particularly vitamin B12) from the intestinal lumen to the enterocytes.

The treatment of EPI consists supplementing meals with pancreatic enzymes and feeding these animals a highly digestible diet.

The most effective ways of administering enzyme supplements are:

• Pancreatic powder: 3 g per meal for a 20 - 35-kg dog
• Fresh pig or bovine pancreas: 50 - 100 g per meal for a medium dog

Tablets should be avoided as they are often found intact in fecal matter.

Preincubation of the meal with the enzymes serves no purpose. The initial dose can most often be reduced to 50% as soon as the animal responds to treatment. This procedure is not insignificant given the cost of the enzyme supplements. Supplementation will be life-long for most dogs.

Oral bleeding has been reported in dogs receiving pancreatic enzyme supplements. A 50% reduction in the supplement generally eliminates the clinical signs.

1. Pancreatic Insufficiency Nutritional Therapy

The Traditional Approach

Traditionally, a highly-digestible low-fiber diet with a moderate fat content is generally recommended for the nutritional management of patients with EPI.
- The low fiber content is dictated by the need to safeguard an energy-concentrated diet (for dogs with pancreatic insufficiency that are difficult to keep in good condition). In addition, excess fiber can inhibit the action of the pancreatic enzymes.
- Fat restriction in EPI is recommended to prevent diarrhea which is stimulated by the presence of hydroxylated fatty acids in the intestinal lumen, which stimulates water loss. These hydroxylated fatty acids are produced by the intestinal flora, which proliferate as a result of the influx of non-digested fats in the intestine. The malabsorption of fat, is due to both the pancreatic lipase deficiency and to deconjugation of biliary acids by bacterial.

The Interest of Fat

However, studies have contradicted this practice. A high-fat diet (43% calories) improves fat absorption (and the clinical signs) in dogs with EPI compared with a standard maintenance diet (27% fat calories) or a low-fat diet (16% calories).

Hypothesis: A high-fat diet will result in a better conservation of lipase in the pancreatic supplement. Highly digestible diets that contain approx. 20% fat are very well tolerated by dogs with EPI. High-fat diets also favor energy consumption in underweight animals.

Selecting a Highly Digestible Source of Starch

Its very high starch digestibility makes rice the preferred cereal for dogs with EPI, who may also suffer from allergies and dietary intolerances. Preliminary observations appear to indicate that a protein hydrolysate diet can have a very favorable effect in dogs with EPI. The small peptides in these diets facilitate digestion and absorption.

Preventing Vitamin Deficiencies

Vitamin B12 and vitamin E deficiencies are very common in dogs suffering from EPI. Vitamin A and K deficiencies have also been identified. Parenteral supplementation is necessary to correct these deficiencies.

Prognosis

The quality of life for the majority of dogs suffering from EPI that receive enzyme supplements and are fed twice a day is very similar to that of healthy individuals. The prognosis for dogs with EPI associated with pancreatitis or diabetes is more reserved.

If no improvement (weight gain, reduction in diarrhea or polyphagia) is observed within 4 - 5 days following the start of enzyme or dietetic treatment, an antibiotic treatment should be initiated (metronidazole or tylosin) to combat bacterial proliferation.

Conclusion

Contrary to conventional wisdom, some dogs with EPI can tolerate large quantity of fat in their diet. The dietary fat permits better conservation of the enzyme supplementation while it passes through the acid environment of the stomach. Protein hydrolysate-based diets will benefit not only the digestive function but also dietary intolerance.

In German Shepherds the transmission of endocrine pancreatic insufficiency suggests a recessive autosomal gene trait. (©Lenfant).

2. Exocrine Pancreatic Insufficiency and Adverse Reaction to Food in Dogs

Interest of a High-fat Diet Based on Rice and Soy Protein Isolate Hydrolysate

Dermatological signs of adverse reaction to food are common in dogs suffering from EPI, especially in German Shepherd Dogs. Dogs with these two diseases respond poorly to enzyme supplementation and a diet specifically designed for EPI.

The report below describes the positive responses of 4 German Shepherd Dogs suffering from both EPI and skin disease to a rice and soy isolate hydrolysate-based extruded diet with 19% fat.

Four male German Shepherd dogs, age range 2.5 - 9.0 yrs, body weight 31 - 40 kg, and suffering from EPI (TLI 0.88 to 5.08 µg/L) were included in this study.

All dogs were suffering from recurrent diarrhea that was more or less controlled with highly digestible and/or hypoallergenic prescription diets as well as pancreatic enzyme supplementation.

All dogs were lean at presentation and showed various signs of skin diseases compatible with adverse reaction to food. The dogs presenting signs of deep pyoderma were treated with cefalexin. The dogs did not receive any other medication except for pancreatic enzyme supplementation.

After 7 days' exclusive consumption of the food described above, feces were normal in all 4 dogs and no dog showed any signs of diarrhea over a 3-month follow-up. Within 3 months, all 4 dogs were in optimal body condition after gaining 2 to 10 kg of body weight. Over the same period, the skin disease of 3 of the 4 dogs were completely controlled. Only the fourth dog still had average pruritus and some erythamtous lesions and local scabbing associated with hyperpigmentation.

A high level of fat (40.8 % of the calories) was very well tolerated by the dogs of this study and confirms earlier findings. This suggests that high fat and highly digestible diets not only are not contra-indicated in the management of EPI but could be beneficial to restore body condition.

Focus On: Soy Protein Isolate Hydrolysate

Soy proteins are known as excellent quality proteins but in pet food their utilization is limited because soy-beans contain:
- Anti-nutritional factors (e.g., anti-trypsin) that inhibit protein digestion and proper absorption of nutrients
- Non-digestible carbohydrates that are likely to ferment in the colon and to induce flatulence and other digestive disturbances.

Soy hydrolysate is obtained by enzymatic hydrolysis of soy isolate. Compared with intact proteins forming soy isolate, the hydrolysate contains smaller polypeptides.

During the process of obtaining soy protein isolate hydrolysate, the undesirable substances are destroyed or removed. Its main advantages are:
- Very high digestibility and excellent digestive tolerance
- Reduced ability to induce allergic reactions.

Figure 18. The process of obtaining soy protein isolate hydrolysate. The process of obtaining soy protein isolate hydrolysate. Soy isolate is a highly concentrated source of protein (85% protein). Soy hydrolysate has a very good amino acid profile: its biological value is close to that of egg powder and casein when it is enriched with methionine, an essential amino acid that is naturally limiting in soybeans.

Digestibility of soy hydrolysate is more than 96%, which is similar to casein and egg, other reference proteins, and better than high-quality animal proteins.

In human and animal nutrition, soy hydrolysate has become one of the reference proteins. The quality of this protein source is such that it is used as milk protein substitute for allergic infants and in protein supplements for athletes or recovering patients. In human medicine, soy hydrolysate-based diets are used to prevent the development of enteritis in patients undergoing radiotherapy and chemotherapy.

Figure 19. Compared composition of different soy-based products.