Dietary Management of Gastrointestinal Disease

Clinical Nutrition Assessment Animal Diet Feeding Method

GI Functions Diet types Acute GI disease Chronic GI disease Dietary Management - GI Disease GI Functions Diet types Acute GI disease Chronic GI disease

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

Highly digestible Fiber enhanced Hypoallergenic Fat restricted Diet Types Highly digestible Fiber enhanced Hypoallergenic Fat restricted Gluten-free Lactose-free

Diet digestibility is a function of: Highly Digestible Diet digestibility is a function of: Ingredients Processing Meal size Animal’s GI function

Starch Digestibility in Dogs Highly Digestible Starch Digestibility in Dogs Corn Rice Barley Oats Walker, et.al., 1993. J. Animal Sci. 100 75 50 25 99.4 99.5 98.8 98.5

Nutrient profile (dog) Highly Digestible Nutrient profile (dog) Increased digestibility > 90% Moderate protein < 30% Moderate fat < 15% Low fiber < 1%

Nutrient profile (cat) Highly Digestible Nutrient profile (cat) Increased digestibility > 90% Moderate protein < 35% Moderate fat < 25% Low fiber < 1%

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

Fiber Complex carbohydrate Resistant to mammalian digestive enzymes Fiber-enhanced Fiber Complex carbohydrate Resistant to mammalian digestive enzymes Found in plants

Fiber-enhanced Carbohydrates Simple sugars (Monosaccharides, dissacharides) Complex carbohydrates (Polysaccharides, oligosaccharides) Starch (a bonds) Fiber (b bonds)

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

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)

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

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

Moderately Fermentable Fiber-enhanced pectin Rapidly Fermentable guar gum soy fiber bran beet pulp soybean hulls Moderately Fermentable peanut hulls cellulose Slowly Fermentable

Prebiotic fibers FOS MOS GOS Lactosucrose Lactulose Inulin Fiber-enhanced Prebiotic fibers FOS MOS GOS Lactosucrose Lactulose Inulin

Fiber VFA → nutritive to mucosa Normalizes motility (insoluble) Fiber Enhanced Fiber VFA → nutritive to mucosa Normalizes motility (insoluble) Acidifies contents → change flora

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

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

Hydrolyzed protein (protein hydrolysates) Native protein Denatured protein Protein hydrolysate

Hydrolyzed protein (protein hydrolysates) Inhalation Transdermal Ingestion Injection Allergen Chymase Tryptase Leukotriene Histamine Cytokines TNF-α Mast cell/Basophil

Hydrolyzed protein (protein hydrolysates) No cross linkage No degranulation

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

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

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

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

Lactose-Free Diets Lactose-free diets Brush-border lactases often deficient in intestinal disease Lactose osmotic diarrhea

Lactose-Free Diets Salivary Gastric Enterocyte Pancreatic Amylase HCI Lactase Sucrase Maltase Isomaltase Pancreatic Amylase

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

Acute gastroenteritis Gastric dilatation-volvulus Acute GI Disease Acute gastroenteritis Gastric dilatation-volvulus

Most common GI disease Causes: Parasites Diet indiscretion Acute Gastroenteritis Most common GI disease Causes: Parasites Diet indiscretion Infectious diseases Toxins

Dietary management Reduce stimulus for vomiting NPO 12-24 hrs Acute Gastroenteritis Dietary management Reduce stimulus for vomiting NPO 12-24 hrs Reduce/resolve diarrhea no food 12-24 hrs

Gastric Emptying Nutrients - Fats, Proteins Acute Gastroenteritis Hormonal Secretin CCK Gastrin Neural Myogenic Autonomic Nutrients - Fats, Proteins

Acute Gastroenteritis

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

Appropriate emergency medical/surgical management Acute Gastric Dilation-Volvulus Appropriate emergency medical/surgical management Dietary management = acute gastroenteritis

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

Dietary management - prevention Acute Gastric Dilation-Volvulus Dietary management - prevention Reduce aerophagia Multiple daily feedings Highly digestible diets

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

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)

Dietary management of EPI Maldigestion Dietary management of EPI Small frequent meals Highly digestible diet Avoid high fiber diet

Inflammatory/infiltrative Psychogenic Colon Disorders Parasites Inflammatory/infiltrative Psychogenic

Appropriate pharmacologic management Colon Disorders Definitive diagnosis Appropriate pharmacologic management Dietary management

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

Neuromuscular disease Constipation Environmental Pain Colonic obstruction Neuromuscular disease

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

Flatulence Swallowed air Intestinal gases 99% no odor = H2, CH4, CO2 1% odor = NH3, H2S, VFA’s, indoles/skatoles Maldigestion/malabsorption Constipation

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

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