Go beyond bland & hydrolyzed protein for your acute and chronic GI patients

This episode is sponsored by Royal Canin.

Last month, dvm360 recognized November as Gastrointestinal (GI) Awareness Month. In recognition of that month, our host Adam Christman, DVM, MBA, sat down with Megan Shepherd, DVM, PhD, DACVIM (Nutrition), to talk about acute and chronic GI patients.

Throughout the episode, Shepherd explains the nutritional management side of acute and chronic GI cases in dogs, with a framework of a nutritional assessment to apply to cases like acute pancreatitis; why she cautions against long-term reliance on chicken-and-rice diets; why detailed diet history is important for chronic enteropathies and protein-losing enteropathy; and more!

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Below is a partial transcript, edited lightly for clarity

Adam Christman, DVM, MBA: When I'm...selecting a hydrolyzed protein diet, sometimes it's a little challenging. It's nice to select the diet, but what are some other key nutrients that I should be considering when I'm choosing the right diet for these cases with those chronic enteropathies?

Megan Shepherd, DVM, PhD, DACVIM (Nutrition): On one hand, it's fortunate we have a lot of options. That's good, but then it does make it a little daunting to navigate all the diet options.... One thing that hydrolyzed diets share is that their protein has been broken down to a size that...evades the immune system. Now, the tricky thing with chronic enteropathy patients is [that] anytime we have a patient that responds to [a] hydrolyzed diet...it doesn't confirm food allergy, it just means they've responded to that diet. We really need to do a...rechallenge to confirm whether that patient has a food allergy. There [are] patients that respond to hydrolyzed protein diets, and we don't fully understand why, but...one thing is that [the] protein has been broken down.... There [are] a couple [of] amino acid–based hydrolyzed protein diets. Most of them are peptide-based, so that's a shared theme.

Now, the source of the protein will vary. From a GI perspective, that may not matter as much as it does on the dermatologic side, but that is still a consideration.... I've got hydrolyzed chicken, hydrolyzed soy, hydrolyzed chicken feather meal, [and] hydrolyzed salmon—there [are] lots of different sources.... But other ways that they differ [include] the fat content. So, for patients that are fat sensitive—you may be thinking about that chronic neuropathy patient with protein-losing enteropathy, our lymphangiectasia patients—if that patient [with protein-losing enteropathy] has underlying lymphangiectasia, they are going to be fat sensitive. So we do need to think about [the] fat content [when selecting a] hydrolyzed diet.

But 2 other ways that these hydrolyzed diets differ are ω-3 content and fiber content. Ω-3s [are] very highly bioavailable, and they play a role in modulating inflammation. So inflammation could be playing a role. And a variety of our GI issues that our patients have...the ω-3 acid content can play a role. But fiber, again, is another one, so the fiber content and fiber quantity will differ. So if we have a patient that we want to put on a hydrolyzed protein diet that has a history of some colitis—some large intestinal component—that's a suggestion...that they might benefit from a higher fiber diet, in which case I would want to look for something that is higher in that total dietary fiber...compared [with] others.

Practically...do we need to restrict fat? If so, we're going to look for the [hydrolyzed protein diet with the] lowest fat. Is there evidence that we need to enhance fiber? If so, I want to look for the [hydrolyzed protein diet with the] highest fiber.

Generally, hydrolyzed diets are not high in fiber, so sometimes we need to start thinking about opening it to novel protein diets that might be fiber-enhanced.

Christman: Excellent; [that is] so interesting.