Diet-Associated Heart Disease Advisory – An Update

by Dr. Beedle

This is an issue that has hit close to home at Frontier. As you may remember from our advisory last year, this first came to light when Frontier’s own Dr. Palmer and Dr. Yung diagnosed a case of Diet-Associated Dilated Cardiomyopathy (DCM) in one of our patients who was eating a Grain-Free diet. Since then, our doctors have diagnosed several more cases, sadly including some with fatal consequences. Losing a patient is like losing one of our own family members, and stopping this preventable disease from harming our patients and hurting their families is our priority.

What do we know a year later?
Unfortunately, the information surrounding this issue has only become more complex. The FDA is still conducting a study to determine the cause of Diet-Associated Dilated Cardiomyopathy (DCM). Dilated Cardiomyopathy is the dilation/stretching of the heart muscle that reduces the heart’s ability to pump blood. This can then lead to heart failure.

In 2018, the FDA put out a warning that unusually high cases of DCM were being reported in dogs* eating Grain-Free foods containing peas, lentils, other legume seeds, or potatoes as main ingredients. These ingredients were thought to be causing a taurine deficiency within dogs. This deficiency is a known factor for causing DCM. However, since this issue became more widely known, Grain-Free diets were not the only type of diet causing the heart issue. The latest categories of diets associated with this disease are called “BEG” diets.

BEG stands for Boutique, Exotic-ingredient, and Grain-free. The “Boutique” brands are those from smaller companies that may not be financially able to do rigorous and extensive quality control of their foods. This can be very expensive process. “Exotic ingredients” include kangaroo, alligator, chick peas, buffalo, etc. These different ingredients typically have not had extensive studies on their nutrient profiles, and therefore, a full understanding of how a dog’s body uses the nutrients is unknown. For example, the usable taurine levels found in lamb are less than in chicken. Lastly, “Grain-Free” diets are those that have replaced grain with other ingredients such as legumes, peas, lentils, and potatoes. Taurine deficiency is a known factor in DCM, but the issue with BEG diets is that they may be deficient in other nutrients, not just taurine. Choline, copper, l-carnitine, magnesium, thiamine, vitamin E and selenium have all been associated with cardiomyopathies. To make matters more confusing, Diet-Associated DCM has even been found in dogs eating vegan, vegetarian, and home cooked diets.

Isn’t pet food production regulated?
Pet food production is a surprisingly complex process. There are standards from the Association of American Feed Control Officials (AAFCO) that dictate the minimal or maximum amount of certain types of nutrients required in food, such as crude protein, fiber, fat, etc. However, the effect of processing these nutrients, the way in which these nutrients interact with additional ingredients in the food, and the way that this interaction may affect how a dog is able to break down and utilize these nutrients and ingredients has to be taken into account. Again, to reach a full understanding of these factors is time consuming and costly. This is why smaller food companies may not be able to afford such testing. Extensive testing is also not required by AAFCO, only a food analysis to quantify that the nutrients are present. Therefore, a food company may be able to say it meets the AFFCO requirements, but not have any information on how your dog’s body will actually utilize the food.

What breeds are affected?
Further complexity to Diet Associated DCM are the breeds of dogs involved. There are two main categories of dogs:

• The first are breeds that are known to be sensitive to taurine deficiency: Golden Retrievers, Cocker Spaniels, Newfoundlands, English Setters, Saint Bernards, Irish Wolfhounds, and Portuguese Water Dogs. The majority of cases have been the taurine sensitive breeds, but the FDA study is trying to determine what about these diets are causing the problem because many of these dogs are testing in the normal range for taurine levels. This means the solution isn’t just as simple as “add more taurine”.
• The second group are breeds not typically associated with a taurine sensitivity, but have developed DCM from unknown dietary factors. Determining what about these foods is causing DCM is critical.

There are also breeds of dogs that are genetically predisposed to developing DCM, such as Doberman Pinschers, Boxers, and Great Danes. This type of DCM is not related to diet. However, there are current studies to determine if the progression of genetic DCM is influenced by Diet Associated DCM issues.

My dog has been eating a BEG food, what should I do now?
See your veterinarian to be screened for DCM. This can include an exam to listen for a heart murmur, checking taurine levels, and/or an echocardiogram to see whether there is any heart enlargement. The treatment for Diet Associated DCM involves changing foods, +/- taurine supplementation, and other medications to help the heart function. Some dogs can recover within a few to several months. Unfortunately, there are also dogs with irreversible damage to their heart, and secondary congestive heart failure.

My dog was diagnosed with Diet-Associated DCM and is receiving treatment from a cardiologist. What else can I do?
It is recommended that owners of dogs with possible diet-associated DCM save samples of all dietary components they are currently feeding, including the main food, treats, chews, and supplements. The owner should then report the case to the FDA, which can be done either online or by telephone. This information will help the FDA identify possible underlying causes as quickly as possible.

More Information:
Frontier’s original Grain Free Pet Food Advisory
Does my pet need a grain-free food?
FDA’s Investigation into Diet-Associate DCM

* Diet-Associated Cardiomyopathy has not been reported in cats as of 2019.