I started to write this almost one year ago. Things have moved on since then, but I'll publish this anyway then bring us up to the present with the next instalment...
Ok, so this is day 7 of Polly's kidney support diet. I know, we've jumped ahead a bit... but, although it's all going really well - I think - I'm so confused - I've grasped the basics, put together some basic recipes, which I'll share further down the page, but now we're down to the actual, well she's on this stuff for the rest of her life, I have to make sure it's nutritionally sound, it fills her up, keeps her weight stable, gives her energy, gives her the right nutrients....keeps the phosphorus low (important bit) and so on, and so on. My back aches from sitting here for so long, but she's worth it. She, being Polly, who now has a full belly and is snoozing on her sofa (yes, HER sofa).
I've been researching this for one whole month and what I've discovered so far is that nutritional values are a minefield. Not one single site gives you the same information. So how do you know which one to trust?
I've decided to just vary her diet as much as possible and tailor 6 or 7 recipes so that if one is not so good, perhaps the other will balance it out, si?
I haven't even got to the part where I explain why I decided to do this myself, but I'll save that for another day. In a nut shell, branded Chronic Kidney Disease (CKD) dog foods are a disaster if you want to keep your dog healthy and prolong her life through renal failure. Manufacturers are using way out-dated research and producing food that can potentially cause your beautiful pup more harm than good. They recommend low protein which can have detrimental effects, when, apparently, the real culprit is phosphorus. I don't need to mention any brands names. Other websites who site well-researched evidence do this, there are links below.
At this point it is very important to tell you I AM NOT A VET. Nor am I trained in any way shape or form to give a dog or anyone else a special diet and I am not advocating that you do this unless you are completely convinced, through your own research, as I am, that it is the best thing for your pet. I am simply sharing what I have learned, in the hope that it will make life easier for others who have chosen to do the same. This is a purely trial and error exercise. I'm prepared to take that risk with my dog because I firmly believe this is the best chance she's got of being with us a while longer than if i did nothing and fed her a dried prescription kidney diet.
So week one has been great for Polly, stressful for me. I love cooking so that's not an issue. What worries me is that I don't have enough info, to get this right quickly enough. Polly went from Stage 1 renal failure in early November, 2018 to stage 2 renal failure 3 weeks ago. At stage 1 we were told there was no need to change her diet yet and given some very sound advice on how to do so should she reach stage 2. Well now that she has reached stage 2, I am discovering the inadequacies of the ready made prescription diets for dogs like Polly.
Another issue for Polly, which makes her protein intake even more important, is that she has Spondylosis, which is a degenerative bone condition affecting her spine and her feet. The only treatment advised from her veterinarian, is to keep her exercise levels up in order to maintain her muscle mass sufficiently to be able to support the skeleton. She is an extremely active dog. Although she is almost twelve years old, we live and work in the English Lake District for a large part of the year. We are out on the fells most days and since we've been exercising Polly this way, her stiffness and symptoms have all but disappeared and she no longer needs painkilling medicine. What she does need though, is sufficient protein to allow her muscles to recover and maintain mass. A low protein diet will not allow for this and would have detrimental effects upon her health.
So what type of diet does a dog with kidney failure need? From all the reading I've done, it would seem that phosphorus is key.
Phosphorus and Your CKD Diet | National Kidney Foundation. 10 Jan 2017
"Normal working kidneys can remove extra phosphorus in your blood. When you have chronic kidney disease (CKD), your kidneys cannot remove phosphorus very well. High phosphorus levels can cause damage to your body. Extra phosphorus causes body changes that pull calcium out of your bones, making them weak."
https://www.kidney.org/atoz/content/phosphorus
Same for people and dogs. Apparently. So this is where I started.
Recommended phosphorous levels depend on severity of diagnosis.
50 pound dog: 340 - 900 mg (up to 1364 mg in very early stages)
http://dogaware.com/health/kidneydiet.html#phosphorus
As Polly diagnosis jumped from stage 1 in October 2017, to Stage 2 in January 2018, and this is still classed as early (symptom-free) but not very early, I'm working with a figure of 800mg as a starting point.
Enough protein to maintain healthy muscle mass, (measured at 1g of protein per pound of healthy body weight - so that is what the body weight should be). Look this up, it's pretty much standard information available on many reliable dietary websites. Considering Polly is an active, healthy pointer x lab, weighing in at 23.5kg, or 52lbs, with virtually no body fat, this is her healthy weight, and so I went with a minimum of 52g of protein per day. In actual fact, she has 80g of protein a day.
Note: grams of protein are not the same as grams of meat or other source of protein. The protein content of a food is largely dependent on the amount of fat also contained within it.
For example,
100g cooked lean chicken breast contains 31g protein
100g raw 20% fat minced beef contains 17g protein.
100g egg white (approx. 3 eggs) is 11g.
These three sources also have varying amounts of phosphorous, and this needs to be considered too.
The other macro nutrients we need to consider are:
FAT
CARBOHYDRATES
plus micro nutrients, vitamins and minerals, which added together will total no more than Polly's required calorific intake to maintain her current healthy weight, on an active lifestyle.
How many calories a dog or cat should eat a day?
"Most dogs need about 25 to 30 calories per pound per day to maintain their weight. You need to figure in, if you dog is a spud or an athlete, whether you need to add or subtract that to that amount. That means, on average, a 30 lb dog needs around 800 calories daily, and an average cat needs 250 to 300 calories a day."
https://www.embracepetinsurance.com/.../article/how-many-calories-should-pet-eat-daily
Considering larger dogs need fewer calories to maintain weight than smaller dogs do (you see their tiny little legs galloping at 90 to the dozen to keep up with the big guys?), but Polly is VERY active and is outside for most of each day, I went for the upper figure and calculated calorie requirement at
30 x 52 = 1560 calories.
So you see, this was going to get complicated. Anticipating much maths and time consuming macro and calorie counting, I decided that a spread sheet was the best way forward. Hello Geeky Fortnight........
I designed the spread sheet to enable me to interchange ingredients in Polly's food, so I could give a variety of nutrients (she really doesn't care about taste, but your pet might), without having to go through all the calculations each time. The spreadsheet does all of the maths for me, totals up calories, fat, protein, phosphorous and saves me loads of time. If you would like a copy of the spreadsheet for your own personal use, please email me. At this point, another timely reminder, I am NOT a vet, OR a nutritionist and I will cite ALL of my information sources as accurately as possible. There is some very credible research out there, well worth a read.
So to sum up, so far: Polly, weighing 52 (lean) lbs, requires a minimum daily allowance of
52g protein, but I'm going with 80g because of all the exercise Polly gets.
Polly's progress so far:
She loves the food. Who wouldn't? She is feasting on 4 meals a day. One day's food consists of the following:
300g cooked white rice - low in phosphorus
240g cooked butternut squash / sweet potato - same
240g fatty pork/beef mince - protein with lots of fat needed to maintain weight
40g raw kidney or liver (no more than 10% of her diet to avoid Vitamin A overdose)
2 cooked egg whites - excellent quality, very low phosphorus protein more accessible when cooked
1500mg Omega 3 in fish BODY oil (important) NOT liver oil, same reasons as above.
parsley and green beans for Vitamin C
half a teaspoon of eggshell for to bind the phosphorous she does consume.
B complex vitamins Extra added fat such as butter if she loses weight (note, dairy is usually high in phosphorus)
No wonder she is asleep, she's stuffed. She gets weighed tomorrow. she'll probably want to skip breakfast.
Anyway, we're working on other recipes and getting the quantities and calories right. The main issues (that I have learned of,) with a kidney diet are these:
> it's hard to get enough calories because most calorie loaded foods, such as grains, carbs and legumes (beans etc) contain lots of phosphorus, which as we know is bad. > it's hard to get correct amounts of other minerals and vitamins right because all the leafy greens and other good stuff contain high levels of phosphorus too.
> to maintain weight and keep phosphorus levels down we need fat, but too much has unwanted consequences.
> omega 3 is good, omega 6 is not, it is inflammatory. More often foods contain both.
> all the foods with low phosphorus we need are soft and soggy, nothing to chew!
>bones are a fantastic source of calcium but are very high in phosphorous
>bones are essential to keep a dog's mouth healthy!
> a dog on a kidney diet needs four meals a day, not two.
> raw is best for vitamin and mineral content, how is that going to work in the summer heat? I'll have flies and buzzards circling my backpack?
> who likes to chop up pig hearts?
> I get sick of typing phosphorus......
You can see where this is going. I'm off for walkies. I'll pick up tomorrow, but before I go I need to update you with the remarkable benefits I've noticed so far:
> After one week on this diet Polly is just as fit and active as ever.
> Her water consumption has dropped to around 25% of her normal daily intake, because she isn't eating dry food.
> Because of this we're not getting up through the night to let her pee (YAY!)
> The dry skin she always suffered with on her back has disappeared completely.
> Her bad breath (and boy was it bad) has also disappeared.
> She is self regulating to four meals a day and sleeping soundly in between walks and meals. > She seems more satisfied and is not constantly on the scrounge (lab trait).
All in all, I'm very happy with her progress. Weigh in tomorrow will be interesting, but the thing I'm simultaneously looking forward to and also dreading, is her repeat blood test for Creatinine and urea levels next month, as that will be the main indicator of whether this is doing any good. All I know is, right now, my dog has kidney disease and whatever happens to her in the future I will know I've done the very best for her. Polly will be 12 years old next month.
Here are links to the information sources I have found to be reliable in that they site no fewer than 19 scientific studies to back up their research and evidence. In particular:
https://drtims.com/blogs/news/why-is-the-ash-level-in-a-pet-food-important
https://rawdoghawaii.com/blogs/news/53705349-is-a-low-protein-diet-desirable-or-necessary-for-dogs-with-kidney-disease
http://dogaware.com/health/kidneytable.html