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Dietary Management of Gastrointestinal Disease
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Clinical Nutrition Assessment
Animal Diet Feeding Method
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GI Functions Diet types Acute GI disease Chronic GI disease
Dietary Management - GI Disease GI Functions Diet types Acute GI disease Chronic GI disease
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Digestion and absorption Water regulation Immune monitoring
Dietary Management - GI Disease Digestion and absorption Water regulation Immune monitoring Hormone production Enteric nervous system Waste elimination
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Highly digestible Fiber enhanced Hypoallergenic Fat restricted
Diet Types Highly digestible Fiber enhanced Hypoallergenic Fat restricted Gluten-free Lactose-free
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Diet digestibility is a function of:
Highly Digestible Diet digestibility is a function of: Ingredients Processing Meal size Animal’s GI function
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Starch Digestibility in Dogs
Highly Digestible Starch Digestibility in Dogs Corn Rice Barley Oats Walker, et.al., J. Animal Sci. 100 75 50 25 99.4 99.5 98.8 98.5
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Nutrient profile (dog)
Highly Digestible Nutrient profile (dog) Increased digestibility > 90% Moderate protein < 30% Moderate fat < 15% Low fiber < 1%
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Nutrient profile (cat)
Highly Digestible Nutrient profile (cat) Increased digestibility > 90% Moderate protein < 35% Moderate fat < 25% Low fiber < 1%
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Highly digestible Fiber enhanced Hypoallergenic Fat restricted
Diet Types Highly digestible Fiber enhanced - High → Low - Soluble vs insoluble - Fermentable vs poorly fermentable Hypoallergenic Fat restricted Gluten-free Lactose-free
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Fiber Complex carbohydrate Resistant to mammalian digestive enzymes
Fiber-enhanced Fiber Complex carbohydrate Resistant to mammalian digestive enzymes Found in plants
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Fiber-enhanced Carbohydrates Simple sugars (Monosaccharides,
dissacharides) Complex carbohydrates (Polysaccharides, oligosaccharides) Starch (a bonds) Fiber (b bonds)
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Fiber Levels in Pet Foods
Fiber Enhanced Fiber Levels in Pet Foods 27% % Fiber (DM) 15% Typical foods. 4% 1% 1% Low Fiber Moderate Fiber High Fiber
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Fiber-enhanced Soluble vs. insoluble Refers to the ability of a fiber to disperse in water Most rapidly fermentable fibers are soluble (e.g., gums, pectins) Most slowly fermentable fibers are insoluble (e.g., cellulose, soy mill run)
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Fermentable vs. poorly fermentable
Fiber-enhanced Fermentable vs. poorly fermentable Digestion of fiber by intestinal microbes Produces SCFA (VFA) and gases SCFA provide nutrition for enterocytes and may modulate GI motility and fecal water content
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Fiber Fermentability in the Colon
Fiber-enhanced Fiber Fermentability in the Colon pectin guar gum soy fiber bran beet pulp soybean hulls peanut hulls cellulose slowly fermentable rapidly fermentable
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Moderately Fermentable
Fiber-enhanced pectin Rapidly Fermentable guar gum soy fiber bran beet pulp soybean hulls Moderately Fermentable peanut hulls cellulose Slowly Fermentable
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Prebiotic fibers FOS MOS GOS Lactosucrose Lactulose Inulin
Fiber-enhanced Prebiotic fibers FOS MOS GOS Lactosucrose Lactulose Inulin
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Fiber VFA → nutritive to mucosa Normalizes motility (insoluble)
Fiber Enhanced Fiber VFA → nutritive to mucosa Normalizes motility (insoluble) Acidifies contents → change flora
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Novel protein/limited antigen Hydrolyzed protein Fat restricted
Diet Types Highly digestible Fiber enhanced “Hypoallergenic” Novel protein/limited antigen Hydrolyzed protein Fat restricted Gluten-free Lactose-free
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Nutrient profile – limited or controlled antigen diet
Novel protein Nutrient profile – limited or controlled antigen diet Avoid protein excess Limited number, novel proteins Highly digestible protein Additive free Free of vasoactive amines
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Hydrolyzed protein (protein hydrolysates)
Native protein Denatured protein Protein hydrolysate
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Hydrolyzed protein (protein hydrolysates)
Inhalation Transdermal Ingestion Injection Allergen Chymase Tryptase Leukotriene Histamine Cytokines TNF-α Mast cell/Basophil
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Hydrolyzed protein (protein hydrolysates)
No cross linkage No degranulation
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Advantages Disadvantages Truly “hypoallergenic”
Protein Hydrolysates Advantages Truly “hypoallergenic” Will not elicit IgE-mediated response Protein source is less important Disadvantages Expensive Difficult to manufacture Bitter taste
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Highly digestible Fiber enhanced Hypoallergenic Fat restricted
Diet Types Highly digestible Fiber enhanced Hypoallergenic Fat restricted - Amount - Fatty acid content (amount/ratio) Gluten-free Lactose-free
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Fat Levels in Dog Foods Fat Restricted Diets % Fat (DM) Moderately
15-50 50 Typical 8-15 3-8 10 % Fat (DM) Growth 8 Adult 5 Moderately Restricted Severely Restricted
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Gluten Cereal grain protein which contains the antigen gliadin
Gluten-Free Diets Gluten Cereal grain protein which contains the antigen gliadin Present in wheat, barley, rye and oats Many diets don’t contain gluten
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Lactose-Free Diets Lactose-free diets Brush-border lactases often deficient in intestinal disease Lactose osmotic diarrhea
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Lactose-Free Diets Salivary Gastric Enterocyte Pancreatic Amylase HCI
Lactase Sucrase Maltase Isomaltase Pancreatic Amylase
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Nutrient content milk Lactose mg/kcal ME Bitch 28 Queen 71 Cow 77
Lactose-Free Diets Nutrient content milk Lactose mg/kcal ME Bitch 28 Queen 71 Cow 77 Goat 62
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Acute gastroenteritis Gastric dilatation-volvulus
Acute GI Disease Acute gastroenteritis Gastric dilatation-volvulus
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Most common GI disease Causes: Parasites Diet indiscretion
Acute Gastroenteritis Most common GI disease Causes: Parasites Diet indiscretion Infectious diseases Toxins
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Dietary management Reduce stimulus for vomiting NPO 12-24 hrs
Acute Gastroenteritis Dietary management Reduce stimulus for vomiting NPO hrs Reduce/resolve diarrhea no food hrs
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Gastric Emptying Nutrients - Fats, Proteins Acute Gastroenteritis
Hormonal Secretin CCK Gastrin Neural Myogenic Autonomic Nutrients - Fats, Proteins
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Acute Gastroenteritis
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Dietary management Small frequent meals (3-6 x’s/day)
Acute Gastroenteritis Dietary management Small frequent meals (3-6 x’s/day) Gradually increase amount (3 days) Highly digestible diet
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Appropriate emergency medical/surgical management
Acute Gastric Dilation-Volvulus Appropriate emergency medical/surgical management Dietary management = acute gastroenteritis
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Dietary risk factors? Large meals
Acute Gastric Dilation-Volvulus Dietary risk factors? Large meals Temporal relationship: exercise & eating Rapid/competitive eating Diet form/size/ingredients Elevated food bowls
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Dietary management - prevention
Acute Gastric Dilation-Volvulus Dietary management - prevention Reduce aerophagia Multiple daily feedings Highly digestible diets
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Maldigestion Malabsorption EPI Bile acid deficiency
Malassimilation Maldigestion EPI Bile acid deficiency Loss of brush border enzymes Malabsorption Lymphangiectasia Bacterial overgrowth Inflammatory bowel disease Gluten-sensitive enteropathy
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Exocrine Pancreatic Insufficiency (EPI)
Maldigestion Exocrine Pancreatic Insufficiency (EPI) 100 DM Digestibility (%) 50 Normal EPI + Enzymes Normal EPI + Enzymes Commercial diet Veterinary diet Pidgeon, JAVMA 181 (1982)
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Dietary management of EPI
Maldigestion Dietary management of EPI Small frequent meals Highly digestible diet Avoid high fiber diet
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Inflammatory/infiltrative Psychogenic
Colon Disorders Parasites Inflammatory/infiltrative Psychogenic
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Appropriate pharmacologic management
Colon Disorders Definitive diagnosis Appropriate pharmacologic management Dietary management
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Diet type Effect Highly digestible “Hypoallergenic” Fiber enhanced
Colon Disorders Diet type Highly digestible “Hypoallergenic” Fiber enhanced Effect Decreased ingesta to colon Decreased exposure to antigens VFA normalizes motility change flora
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Neuromuscular disease
Constipation Environmental Pain Colonic obstruction Neuromuscular disease
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Appropriate pharmacologic and surgical management
Constipation Appropriate pharmacologic and surgical management Highly digestible diet High fiber diet (multiple small meals) Decreases stool density Normalizes transit time
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Flatulence Swallowed air Intestinal gases 99% no odor = H2, CH4, CO2 1% odor = NH3, H2S, VFA’s, indoles/skatoles Maldigestion/malabsorption Constipation
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Control aerophagia Multiple small meals Highly digestible diet Avoid
Flatulence Control aerophagia Multiple small meals Highly digestible diet Avoid High fiber diets High protein diets Vegetables Vitamin supplements Garbage
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Multiple diet types are suitable for dietary management of GI disease
Summary Multiple diet types are suitable for dietary management of GI disease Appropriate dietary management requires diagnosis Acute GI disease = highly digestible diet
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