Yet Another Cat Food Guide » feline renal failure

Renafood Redux, or: The Reply Comment that Ate the Blog

Candy — Wed, 03 Mar 2010 00:47:24 +0000

Given the relative obscurity of this cat blog and the fact that I update it once every never, I was really surprised to see a notification pop in my e-mail that somebody had left a comment on my Renafood post. A very long comment. From a vet working for Standard Process, the manufacturer of Renafood. I started replying to the comment, and suddenly realized that I’d written more than 1,300 words of reply. So: time for a new blog post! One about substantive issues, even, instead of pictures of fluffy kittens. I’m going to quote him verbatim in this post, so don’t feel like you need to run over to my Renafood post to read everything he wrote.

Dr. Cameron wrote:

I have been a practicing veterinarian since 1982, and I have used Standard Process supplements in animals (and my own family) for the past 20 years. I am now employed by Standard Process as a technical support veterinarian. I help veterinarians integrate nutrition into their clinical practices. I would like to respond to this post.

The author of the above post expresses skepticism on the value of using herbs, botanicals (plants) and glandular materials to support compromised organs (in this case, his/her cat’s kidneys). He/she lists multiple points of concern.

1. The author does questions the quality control of the ingredients in Renafood (or supplements in general). I would invite him to view a video of how supplements are made at Standard Process on our website (www.standardprocess.com). Standard Process Inc. produces all supplements under the same stringent regulations used in the manufacture of pharmaceuticals. We are inspected by the FDA, USDA and other regulatory organizations multiple times per year. Each supplement we produce is tested by our in-house laboratory up to six times before it is released to the public. Quality control is taken very seriously at Standard Process Inc.

My response:
Thank you for taking the time to respond to my post. Regarding the quality of your supplements: since I’m unable to inspect your factory, and given that you’re an interested party, I’ll take your word that your products do, in fact, contain what they do, unlike the majority of companies (who also make substantially similar claims regarding quality control).

Dr. Cameron wrote:

2. You don’t believe that herbal detoxification is possible. I would be happy to provide you with references of how herbs and foods can affect detoxification mechanisms in the body. After 28 years of practice and years of clinical experience with these products, I can attest to their value. The FDA does not allow supplement companies to make any claims on their products in relation to specific diseases, so will not be doing so. The fact is that most chronic disease have been linked to nutritional deficiencies, so providing quality nutrition to compromised cells can improve their ability to function.

My response:
If you are willing to point me to some peer-reviewed literature regarding a) the biochemistry behind herbal detoxification and b) the actual efficacy of herbal detoxification, I’d love to read it. I’ve tried for years, and the lack of good evidence eventually led me to my skeptical stance today. I would also like to point out that this statement:

The fact is that most chronic disease have been linked to nutritional deficiencies, so providing quality nutrition to compromised cells can improve their ability to function.

Has nothing to do with detoxification; malnutrition is separate and different from detox. Somebody suffering from scurvy needs vitamin C, not an herbal cleanse devoid of vitamin C. Furthermore, while accepting the relatively uncontroversial assertion that some chronic diseases are linked to nutritional deficiencies or other bad dietary practices, it doesn’t necessarily follow that taking commercial vitamin or glandular supplements will cure or correct the conditions. (Diabetes mellitus comes to mind; so do certain types of liver cirrhosis and gout.)

Dr. Cameron wrote:

3. Cell determinants. As I mentioned, we are severely restricted by the FDA as to what we can say about our ingredients, so the information is vague and difficult to get a clear picture.

My response:
I would first like to begin by disagreeing that the FDA restricts what you can say about how your ingredients work. The FDA regulates the health and structure/function claims a supplement company can make about its products, i.e., what the products’ health benefits are. As far as I know, there is no law or regulation that restricts the dissemination of truthful scientific information explaining the biological or chemical pathways in which particular compounds work. Most of the most stringent regulations directly relate to labels in particular; as far as I know, detailed information sheets aren’t “labels”. In fact, please refer to Section 403B of the Federal Food, Drug and Cosmetic Act:

(a) IN GENERAL.—A publication, including an article, a chapter in a book, or an official abstract of a peer-reviewed scientific publication that appears in an article and was prepared by the author or the editors of the publication, which is reprinted in its entirety, shall not be defined as labeling when used in connection with the sale of a dietary supplement to consumers when it—
(1) is not false or misleading;
(2) does not promote a particular manufacturer or brand of a dietary supplement;
(3) is displayed or presented, or is displayed or presented with other such items on the same subject matter, so as to present a balanced view of the available scientific information on a dietary supplement;
(4) if displayed in an establishment, is physically separate from the dietary supplements; and
(5) does not have appended to it any information by sticker or any other method.

(b) APPLICATION.—Subsection (a) shall not apply to or restrict a retailer or wholesaler of dietary supplements in any way whatsoever in the sale of books or other publications as a part of the business of such retailer or wholesaler.

Dr. Cameron wrote:

For more information on how protomorphogens, cell determinants, or glandular tissues can be of therapeutic value, look at the more recent subject of Oral Tolerance Therapy. OTT is touted as a ‘new and promising’ therapy for a number of diseases, using cell extracts from various glands to treat specific glandular diseases. This can help explain how eating some kidney can help a compromised kidney. This is what the catalog is talking about when supplying cell determinants.

My response:
From a quick check, Oral Tolerance Therapy seems to be a therapy related to autoimmune diseases, especially T-cell mediated disorders. To grossly oversimplify: the idea is to feed somebody with an autoimmune disorder (say, irritable bowel disease or rheumatoid arthritis) extracts from the relevant tissues to help reduce the immune system’s hyperresponsiveness and therefore reduce the attendant inflammation. However, even if it were proven to work consistently (and I think the science is still kind of uncertain on that), and assuming for the moment that protomorphogens work in the same way OTT does, most incidences of chronic feline kidney disease, as far as I know, are not due to autoimmune disorders. For example: my cat Eric’s polycystic kidney disease in particular had nothing to do with his immune system and everything to do with the fact that he’d inherited an autosomal dominant gene from one of his parents for PKD. The majority of feline kidney disease is, as far as I know, idiopathic. Additionally, the mechanism by which Oral Tolerance Therapy works also seems completely different from what is suggested in the Standard Process literature about protomorphogens. OTT works by desensitizing the immune system so it doesn’t attack the body’s own tissues. I can’t speak on how protomorphogens work, since the information sheet was confusing and opaque, but the sheet seems to claim that protomorphogens affect cell division directly, and to target specific cells or tissues in specific organs. If I’m wrong about this, I’m certainly open to being shown where and how.

Dr. Cameron wrote:

Your not understanding what cell determinants are does not qualify you to say they do not exist or cannot be of clinical value. But I will agree that the writing could be more precise.

My response:
If I’m wrong about this, then I’d love to be educated on the fact—in fact, I would love to have a primer on just exactly what protomorphogens are and how they work. I’ve sent a copy of the Standard Process fact sheet to biochemist friends of mine, and they’ve come right out and said that the “mineral template” idea is nonsensical and not how cell determinants work; they also pointed out that substances that could have the sort of dramatic effect on cells claimed by Standard Process would be along the lines of hormones, mutagens and teratogens, and almost definitely not qualify as a mere supplement—it would be regulated as a drug by the FDA. It doesn’t help that “protomorphogen” seems to be a trademarked term of art, so searching science journal databases doesn’t turn up anything, and Googling merely turns up information sheets and promotional materials written by Standard Process or by sites selling Standard Process supplements.

Dr. Cameron wrote:

4. Dr. Royal Lee spent his life fighting the FDA, and yes, he was brought up before them several times. He was an outspoken critic of the adulteration of foods that came into common practice starting in the 1920’s (bleaching of flour, high-heat processing of foods, processing of foods to increase shelf life, the addition of sugar to so many foods, etc.) He constantly wrote letters to the FDA and other industry leaders pointing out the negative health effects these foods were having. As a dentist, he saw oral pathology due to nutritional deficiencies. This is how he came to start Standard Process Inc. – using quality food sources to replace the trace nutrients that were being lost in the food supply. The FDA and others took offense at his criticism and did go after him. Some of his claims (back in the 1930’s and 1940’s) were that these processed foods would lead to increased obesity, heart disease, cancer and diabetes. Are we seeing any of these conditions today? Are they increasing in frequency? Do we eat a lot of processed foods? Do our animals? As veterinarians, we are seeing the same increase in the same diseases in our pets as in humans. Be sure you check other sources besides QuackBusters.

My response:
I think it’s misleading to imply that Dr. Lee was prosecuted because he spoke out against processed foods and refined sugars. He made specific health and medical claims about his supplements and the FDA cracked down on him, and their statements about Dr. Lee being the “largest publisher of unreliable and false nutritional information in the world” concern the false medical claims on his products. Whether or not he’d drawn attention by speaking out against refined foods and existing food processing methods is beside the point; he was guilty of medical fraud because of the various claims he made regarding the efficacy of his supplements for treating various acute and chronic diseases and disorders. If you’re looking for a source beyond Quackwatch, perhaps this particular Notice of Judgment from the FDA regarding Dr. Lee’s products will be more satisfactory. (This is merely the first I found of many; if you go to the Notices of Judgment archive and search for “Royal Lee,” many more hits come up.) Here are the diseases that Dr. Lee claimed various supplements cured, which I’ve excerpted from the bottom of page 2 and on through page 3 of the Notice:

(1) pneumonia, tuberculosis, influenza, colds, whooping cough, measles, and mumps

(2) puerperal sepsis, infection of ear, infections of genito-urinary tract, infections of mucous tract, infections of gastro-intestinal tract, infection of respiratory tract, infections of sinuses, focal infections, and infectious diseases

(3) high blood pressure, low blood pressure, overweight, and underweight

(4) arteriosclerosis, high blood pressure, aortic aneurism, aortic insufficiency, valve leakage, coronary occlusion, coronary thrombosis, or dementia

(5) arthritis, hemorrhagic conditions of the urine, albuminuria, heart disorders, menstrual and ovarian disorders, Bright’s disease, leg ulcers, anemia, wasting of muscles, paralysis, muscular weakness, chronic diseases, amenorrhea, colitis, cystitis, children’s diseases, women’s diseases, liver disorders, dysmenorrhea, eczema, gall-bladder disease, gastritis, eye disorders, and cardiovascular disturbances

(6) acne, acute or chronic alcoholism, angina pectoris, Addison’s disease, adrenal hypertrophy, agranulocytosis, apoplectic sequellae, atrophy of glands or muscles, achlorhydric anemias, backward children, burns, cataracts, chlorosis, chorea, diabetes mellitus, epilepsy, toxic goiter, hyperthyroidism, hyperglycemia, hypertension, hypotension, asthma, hay fever, hyperemesis of pregnancy, sexual impotency, insanity due to endocrine failure, menopause disorders, migraine, menstrual dysfunction, paralysis agitans, phlebitis, poliomyelitis, paralytic sequellae, pancreatic dysfunction, pernicious anemia, nephritis, ideopathic [sic] ovarian disorders, prostate enlargement, peptic ulcers, sclerosis, rheumatic fever and varicose veins

(7) atrophy of organs and glands (testes, liver, spleen, thyroid, pituitary and salivary), infections and degenerations of eyes, physical weakness, nervousness, insomnia, gland swelling in general, renal calculi, bronchitis, endocrinopathies of childhood, nervous indigestion, neurasthenia, disorders of pregnancy, sterility, hypogalactia, retarded growth, loss of hair, fatty infiltration and degeneration of the liver, symptoms of nerve degeneration, Paget’s dermatosis, gastro-enteritis, infantile gastro-intestinal disorders, glycosuria, malnutrition, sprue, low resistance, kidney and bladder disorders, renal dysfunction, formation of stones (calculi), excessive growth of lymphoid tissue, lympathic gland enlargement, loss of weight and vigor, low vitality, stunted growth, emaciation, enlargement of liver, kidney and spleen, acidosis, and [prevention of] carcinoma

The substances to which these claims were attached? Various vitamin and mineral supplements (including A, C, B-complexes) that included various plant and animal extracts, and Catalyn (mostly milk sugar and various wheat extracts, with other plant materials and some “glandular extracts”). I think the list speaks for itself. If still not convinced, I’m certainly happy to dig through more old FDA paperwork and show what exactly the FDA’s beefs were with Dr. Lee’s products and the sorts of medical claims he made about his vitamin and food supplements.

Dr. Cameron wrote:

You make many judgements without much background information. This is the negative side of internet freedom, because people reading your biased opinion will take it as fact. This is unfortunate.

I would be happy to discuss this with you if you would like more information.

Tom Cameron, DVM 800-848-5061

My response:
I’m not a biologist nor a chemist, but I’m trained in the scientific method, and I’m a skeptic and a critical thinker. I’m open to being educated regarding protomorphogens; I’ll admit that the paucity of literature on this topic makes it somewhat suspect in my eyes, but again, my research was hampered by the fact that protomorphogen is not a scientific term but a trademarked term of art, and the Standard Process sheet was not at all clear. I am more than happy to receive information regarding protomorphogens and the way Renafood is supposed to work. I would prefer links to publicly-available documents so that any readers can read exactly what I’m reading as well and draw their own conclusions, but if that’s not feasible, then I would appreciate it if you would e-mail me more information at my gmail.com address (my username is misshepeshu—I’m giving my e-mail address this way to confound spambots).

On Squash, Fermentable Fiber and Feline Kidney Disease

Candy — Tue, 13 Oct 2009 23:05:42 +0000

One of the squashes from our garden

One of the things I did to modify Eric’s diet after finding out about his polycystic kidneys was to reintroduce squash into his diet. In the past several years, I had dropped feeding vegetables to my cats entirely, largely because I was feeding them whole ground animals and canned Wellness and Evo on the side. I figured that the canned food was providing plenty of vegetable matter. Now that Eric’s sick, however, I’m much more draconian about feeding mostly raw food—partly because it’s better for him, and partly because Eric prefers it over the canned, which is strange because in the past his sole food preference, near as I could tell, was HOORAY FOOD OM NOM NOM NOM.

I added the squash back into Eric’s diet largely because I remembered reading back in the day that squash helps trap nitrogenous waste that would otherwise make it into the bloodstream. Today I went on an article hunt to see whether this had any sort of scientific basis, or if it was one of those raw feeding myths that get passed around because it sounds so damn good.

Assessing the Evidence

Therapeutic use of fiber in chronic kidney disease (or, if you’re old-school, chronic renal failure) is much more well-studied in humans than it is in cats. There seems to be some evidence that the consumption of soluble/fermentable fiber leads to increased excretion of nitrogen via poopin’ vs. peein’, thus lowering the amount of nitrogenous waste circulating in the blood and therefore eliminated by the kidneys. But what about cats?

I’ve found one decently reliable study that specifically looks at cats. It’s by researchers at Iams, so it’s not exactly woo-woo; research from the Iams lab is about as mainstream as it gets. The researchers found that feeding moderately fermentable fiber (mostly beet pulp and fructo-oligosaccharides) to cats decreased serum nitrogenous waste and increased fecal nitrogen excretion. The study proposed the following hypothesis as to why this would happen:

The beneficial bacteria in the cat’s lower intestine feed on the moderately fermentable fiber, creating short-chain fatty acids (SCFAs) in the process. SCFAs not only do all sorts of nifty things, such as keep the intestine cells happy and healthy, they also increase blood flow. The increased blood flow to the intestine results in more urea being circulated to the intestines, and the bacteria, which also produce urease (an enzyme that denatures urea), convert the nitrogenous wastes to carbon dioxide and ammonia, which are then incorporated into the bacteria themselves and then pooped out by the cat, as opposed to circulating to the kidneys to be peed out.

This sounds really good and really plausible, and the results show pretty unequivocally that fermentable fiber helps reduce the urea load in the serum, which means less work for damaged kidneys, but keep these things in mind:

1. This study is really small, involving only sixteen cats.

2. They were fed the diets containing fermentable fiber for relatively short periods of time—two weeks total for with an active waste collection period of eight days.

3. The decreased waste could be due in part to the decrease in protein digestibility. The study noted that the protein digestibility decreased to 87-91% with the fermentable fiber blends.

4. As far as I could tell, they didn’t actually actually draw any blood and run blood panels; they looked at urine and feces only.

So the verdict right now is: it probably does help a little bit, but as with anything scientific, the people in the white coats need to study it more. Given that steamed squash doesn’t contain anything harmful to cats, and given the potential benefits vs. potential dangers (yes, there’s a decrease in protein digestibility from the fiber, but Eric’s getting so much high-quality protein in his food that I’m not worried about marginal decreases at this point), I decided to go ahead and give Eric a heaping tablespoonful of pureed squash per day, which comes to about 10-15% of his total food. I created a mix from a gem squash harvested straight from my garden and organic butternut from the store. He loves it. I don’t need to mix it in with the food; it’s a lurid orange dot amidst the raw rabbit and Nature’s Variety, and he often eats it first. I suppose we’ll find out whether it does anything when we test his blood again in January.

Fiber Content for Various Squash Species

If you’re curious about the fiber content of different species of squash, here’s the information I looked up on the USDA National Nutrient Database per 100 grams of raw squash (unless otherwise noted):

Butternut squash: 2.0 g (86.41% water)
Acorn squash: 1.5 g (87.78% water)
Generic winter squash: 1.5 g (89.76% water)
Pumpkin: 0.5 g (91.6% water)
Canned pumpkin: 2.9 g (89.97% water)

Canned pumpkin has almost double the fiber content of raw butternut (on a dry matter basis) and six times more than raw pumpkin, which is interesting. It looks like you can get more bang for the buck by feeding canned pumpkin. Eric likes the fresh stuff much better, however, so I’m sticking with it for now.

Eric’s Kidneys

Candy — Sat, 10 Oct 2009 09:13:23 +0000

(Note: Parts of this were posted previously to my Livejournal as well. I’m playing catch-up over here to get to Story At Hand, as it were.)

About a month ago, Eric, my little chow hound who’d scarf up stray cornflakes I’d drop on the floor, my little orange dude who’d dive into the trashcan to find choice rancid leftovers, suddenly became fussy over his food. It manifested in the weirdest way, too: he seemed reluctant to chew. He’d nibble and lick very daintily at his food, and then spit out large chunks of it, almost as if chewing hurt his mouth.

Concurrently, I noticed that I was refilling the water dishes a lot more frequently than I ever had. I didn’t think too much about it; Portland was going through a heatwave, and not only were both cats drinking a lot more, water was also evaporating somewhat faster than it normally would.

But that chewing thing, man. That worried me. Eric has always had bad teeth; I’ve often described his breath as “doom and destruction,” and that’s been true ever since he was a little kitten. So I was all “Oh shit he needs another dental” and hauled his furry butt into the vet, even though he’d had an annual exam just a couple weeks before.

The orange menace hadn’t lost any weight—on the contrary, he’d put on a whole six ounces since his checkup in early August. His temperature was perfectly normal, and his heart sounded good. His teeth looked a bit gross, but we knew that already, but the vet hadn’t thought it serious enough to warrant an immediate teeth cleaning.

But. But. While wrestling with Eric for the blood draw (and of course the poor monkey doesn’t get the fact that if he just sat still instead of leaping for freedom and glory, it’d be over much sooner; if there were one thing I could communicate to my cats during vet visits, that would be it), the vet noticed that his kidneys felt enlarged. Eric had also peed himself during the course of the Blood Draw Olympics, and she noticed that the pee was unusually dilute as well.

And all of a sudden, the dip in his appetite and rise in water intake clicked together into a picture that made a lot of sense. I mean, not to rule out his teeth, because they do need to get cleaned, too. But yeah. Suddenly, the specter of chronic renal failure raised its ugly head.

Got the bloodwork back a few days later, and it was bad. Not as horrible as it could be, but Eric’s levels of blood urea nitrogen (BUN) and creatinine were extremely elevated—classic symptoms of chronic renal failure. His BUN was 88 when the normal range for a healthy cat is 14-36, and his creatinine was 3.8 when the normal range is 0.6-2.4. BUN and creatinine are waste products normally processed and filtered by the kidneys, but if the kidneys are damaged enough, these waste products end up hanging out in the bloodstream instead of being excreted.

His blood phosphorus levels were normal, though, which was a relief, because phosphorus is a mineral damaged kidneys have an especially difficult time excreting, and hyperphosphatemia (excess phosphorus in the blood) leads to all sorts of problems, up to and including calcium absorption abnormalities and hyperparathyroidism (production of excess parathyroid hormone).

The vet recommended going to VDIC, a company specializing in advanced veterinary diagnostics, to get an ultrasound of his kidneys. The vet and I were worried and perplexed at the young age (Eric’s only 7, and shouldn’t be showing bloodwork values like that for at least another 7 or 8 years) and the fact that his kidneys felt swollen. And away I hauled the Great Orange Kitty to have his kitty belly shaved and bombarded with INVISIBLE SOUND WAVES OF THE FUTURE.

And Eric once again proven himself to be an exceptional cat. Turns out he has a fairly advanced case of polycystic kidney disease (warning for the faint of heart: picture of hole-riddled kidney on that page). It’s an autosomal dominant genetic disorder that’s distressingly common among purebred Persians and Exotics, but very rare in muttly types like he. So hey, if he has to have renal failure, at least it’s HIGH-CLASS renal failure. He’s right on schedule, too: the average age for a PKD kitty to show symptoms of renal failure is about 7 years old. The very sweet ultrasonographer told me that Eric has no visible normal renal structures left in his kidneys, and doesn’t know how much longer he has left with us, realistically.

I’m going to go into the details of the diet modifications I have made and plan to make in another post, but I wanted close with the following heart-warming lessons that I gained from this little experience:

1. Even small, seemingly insignificant changes in cat behavior may indicate major illnesses. Anybody looking at Eric now wouldn’t know he’s as sick as he is: he’s energetic, muscular and happy, and his appetite is just about as good as it’s ever been, after that first initial dip that caught my attention. Now that I’m tracking his water consumption more closely, I’m astonished at how much water he’s drinking—he goes through at least six ounces a day, maybe a bit more, which is completely atypical for cats on nothing but wet food.

Here’s the most important moral of the story: Cats are astonishingly stoic, and by the time they’re showing signs of something wrong, it’s usually because something is really, really fucked up. Watch them carefully, and if their food or water intake goes through a noticeable change and it’s not due to something like a diet switch, your radar should go off and you should take your little bastard to the vet as soon as you can.

2. Once your cat is about 7 or 8 years old, have an annual blood and urine panel done. It doesn’t matter if they appear sick or not; the point is to establish healthy baselines for your cat so that if a serious deviation appears one year, your eye will be drawn to it much more quickly. I didn’t have a senior panel done for either of my cats this year because I’m in law school, and money is even tighter than usual, but once I found out that Hitlercat may have PKD as well (what with the disease being autosomal dominant and all), I ran her fuzzy butt back in for a blood analysis. And this isn’t the way it should be; the analyses should be something routine. I’m not saying you should go without food or miss paying bills just to get bloodwork done on your seemingly healthy middle-aged cat, but if you can at all afford it, you should git ‘er done.

3. Life has a way of biting you in the ass. I was fully expecting to have a solid 15-20 years with my little bastards, and I was counting on Eric to drive me crazy well into my 40s. Now, I’m savoring every purr and head-butt I get, and every scritch and cuddle and pet is loaded with affection and meaning. In the past couple of years, I haven’t been especially good about paying attention to my two cats or playing with them, especially once law school started and began to eat me alive, but that’s definitely changed over the last couple of weeks.

All I’m saying is: Savor your time with your cats while you still have them. Life gets crazy and you can start taking them for granted, but your lives will be so much richer if you make the time to spend with them.