5-Month Check-Up

Almost immediately after diagnosis of Limoncello’s DCM, news regarding the grain-free diets being the culprit for many dogs’ cardiac issues exploded.

At this appointment with Cello’s cardiologist, Dr. Bossbaly, an echocardiogram was done. This time the test revealed that despite the fact that Limoncello was taking the suggested supplements and had displayed no symptoms whatsoever, her heart murmur increased in severity from a grade 2 to a grade 3, and her DCM had worsened. Although Cello’s heart rate was normal, her echocardiogram measurements of her heart’s left ventricle both in diastole (relaxation) and in systole (contraction) phases had increased, which confirmed progression of her heart disease. We were devastated.

Due to the new developments on the grain-free diets, it was highly suggested that change not only Limoncello’s diet, but the diet of our whole pack. Blood work was drawn and sent to UC Davis to determine Limoncello’s Taurine level. Results revealed that Cello had a low plasma Taurine level of 50. (Normal plasma range of Taurine in dogs is 60-120, and Normal Whole Blood range is 200-350).

We were told to increase Cello’s Taurine from 1,000mg twice daily to 1,500mg twice daily, and to keep her L-Carnitine and Coenzyme Q10 the same. A 5-month follow-up echocardiogram was also scheduled.

During the appointment I was provided with a handout with information about the study of grain-free diets. The following information is copied directly from Limoncello’s discharge paperwork, and is written by Dr. Lisa M. Freeman, a veterinary nutritionist and professor at Cummings School of Veterinary Medicine at Tufts University:

  1. Popular grain-free dog foods may be linked to heart disease. The common factor was a diet heavy in peas, lentils, chickpeas, and potatoes – the carbohydrates typically intended to replace the grains. Diets with exotic ingredients such as kangaroo, duck, fava beans, buffalo, tapioca, salmon, lamb, barley, bison, and venison and even some vegan diets have been associated. DCM has now even been seen in dogs eating raw or home-prepared diets.
  2. There is ongoing suspicion that the disease is associated with these boutique or grain-free diets, with some of dogs improving when their diets changed. The US Food and Drug Administration (FDA) Center for Veterinary Medicine and veterinary cardiologists are currently investigating this issue.
  3. Exotic ingredients are on the rise. Exotic ingredients are more difficult to use. Not only are the more exotic ingredients unnecessary, they also require the manufacturer to have more nutritional expertise to be nutritious and healthy. Exotic ingredients have different nutritional profiles and different digestibility than typical ingredients, and also have the potential to affect metabolism of other nutrients. For example, the bioavailability and metabolism of Taurine is different in a lamb-based diet compared to a chicken-based diet or can be affected by the amount and types of fiber in the diet.
  4. Dr. Freeman believes pet owners are feeding these exotic ingredients because they’re falling victim to marketing which portrays exotic ingredients as more natural or healthier than typical ingredients. There is no truth to this marketing, and there is no evidence that these ingredients are any more natural or healthier than more typical ingredients. This is just good marketing that preys on the desire of pet owners to do the best for their pets.
  5. There is no proof that grain- free is better. Many pet owners have unfortunately also bought into the grain-free myth. The fact is that food allergies are very uncommon, so there’s no benefit of feeding pet foods containing exotic ingredients. And while grains have been accused on the Internet of causing nearly every disease known to dogs, grains do not contribute to any health problems and are used in pet food as a nutritious sources of protein, vitamins, and minerals.
  6. Consider your dog’s diet. If you’re feeding boutique, grain-free, or an exotic ingredient diet, reassess whether you can change to a diet with more typical ingredients made by a company with a long track record of producing a good quality diet. Stop reading the ingredient list. Although this is the most common way owners select their pet’s food, it is the least reliable way to do so. Be careful about currently available pet food rating websites that rank pet foods either on opinion or based on myths and subjective information. It is important to use more objective criteria such as research, nutritional expertise, and quality control in judging a pet food. The best way to select what is really the best food for your pet is to ensure the manufacturer has excellent nutritional expertise and rigorous quality control standards.
  7. If you are feeding your dog a boutique, grain-free, or exotic ingredient diet, watch for early signs of heart disease… Weakness, slowing down, less able to exercise, short of breath, coughing, or fainting. Your veterinarian will listen for a heart murmur or abnormal heart rhythm, may do additional tests, or send you to see a veterinary cardiologist for your dog to have x-rays, a blood test, electrocardiogram, or ultrasound of the heart (echocardiogram).
  8. If your dog is diagnosed with DCM and eating one of the diets discussed above, the following steps are recommended:
    • Ask your veterinarian to test whole blood and plasma taurine levels. The University of California Davis Amino Acid Laboratory is recommended.
    • Report to the FDA. This can be done either online or by telephone. The FDA may be able to help with testing costs for your dog. Reporting it will also help us identify and solve This current problem.
    • Change your dog’s diet to one made by a well-known reputable company and containing standard ingredients such as: chicken, beef, rice, corn, wheat. Changing to a raw or home-cooked diet will not protect your dog from this issue and may increase the risk for other nutritional deficiencies. If your dog requires a home-cooked diet, or has other medical conditions that require special considerations, be sure to talk to a veterinarian or a veterinary nutritionist before making a dietary change.
    • Start Taurine supplementation. Your veterinarian or veterinary cardiologist can recommend an appropriate dose for your dog. Be sure to use a brand of Taurine with good quality control.
    • Any improvements in your dogs DCM can take 3 to 6 months. Your dog will need regular monitoring and may require heart medications during this time. There is no guarantee that your dog will improve but it is certainly worth a try. Make sure your dog is getting the best combination of medications to treat for heart disease, as this can make a difference in the outcome.You can find a board certified veterinary cardiologist near you on this website: https://find.vetspecialists.com/

During this appointment, I was also given a handout from the FDA on how to report a pet food complaint.

Although I have different views on some of the dog food ingredients that were considered standard in Dr. Freeman’s above statements, our entire pack was immediately taken off their grain-free diet of Orijen brand kibble, and I began to research food companies. I also spoke to our primary veterinarian, Dr. Campbell about our pack’s individual nutritional needs. Lastly, I also spoke in great length to the owner of a local dog food supply store who has had relationships with several prestigious dog food companies and distributers for an extensive amount of time.

Cardiology Service Update: Dog Food & Dilated Cardiomyopathy

The following handout was forwarded to me by Limoncello’s cardiologist, Dr. Beth Bossbaly. The Direct link can be accessed by clicking HERE.

The Cardiology Service has developed this document in response to the alerts from the FDA. These alerts identify an
associated risk for some grain-free diets containing certain ingredients (legumes like peas, pea components, lentils; white
potatoes, sweet potatoes) and a diagnosis of dilated cardiomyopathy (DCM). The links provided throughout this document
can be copied and pasted to obtain additional information.
FDA Alerts found here:

What is Dilated Cardiomyopathy (DCM)?
DCM is a heart muscle disorder that results in a weak pump function and heart chamber enlargement. In the early stages of
this disease pets may appear totally healthy with no apparent clinical signs. Later in the course of this disease, dogs may
have a heart murmur, an arrhythmia (irregular heart beat), collapse episodes, weakness or tiredness with exercise, and even
trouble breathing from congestive heart failure. While there are some breeds of dogs (like Dobermans) that have a genetic
predisposition to development of DCM, there are also nutritional factors that may result in this disease.

What should I do?
If you are feeding a diet of concern based upon the FDA alert we recommend that you consult with your veterinarian or
veterinary cardiologist. We provide 4 general points for guidance below:

  1. An initial step is to consider whether you are willing or interested in performing additional testing to assess whether
    your pet is affected with DCM. If you believe your dog is at risk, showing any of the aforementioned clinical signs or would
    prefer to simply rule out any heart disease, we recommend that you first have your pet’s taurine levels tested (both whole
    blood and plasma levels) as well as seek an echocardiogram by a board-certified veterinary cardiologist. Low taurine levels
    are associated with development of DCM in dogs and are sometimes a component of this current issue.
    Information on taurine testing can be found here: https://www.vetmed.ucdavis.edu/labs/amino-acid-laboratory
  2. At this time, diet change is recommended when possible and should be considered regardless of the results obtained
    from any testing. You can consult with your veterinarian in selecting a new diet that avoids the ingredients of concern listed
    by the FDA. When selecting this diet, we recommend that you choose a diet that is manufactured with rigorous quality
    control measures and research behind the formulation. A way to ensure that your diet meets these recommendations is to
    follow the following guidelines that were generated by a large number of the world’s leading experts in veterinary nutrition.
    Food selection guidelines found here:
  3. If your pet is identified through testing to have a low blood taurine level or evidence of DCM by echocardiogram, we urge
    you to report this information to the FDA.
    FDA reporting guidelines found here: https://www.fda.gov/AnimalVeterinary/SafetyHealth/ReportaProblem/ucm182403.htm
  4. Work with your veterinarian(s) to determine the best course of action and medical treatments if indicated. In the case of
    a DCM diagnosis, diet change alone may not be sufficient and additional medications may be prescribed.

Please continue to monitor the FDA website and the UC Davis School of Veterinary Medicine Newsfeeds for updates and
recommendations regarding this issue.