Nutritional therapy

Role of nutrition

It is common knowledge that gut health is affected by food eaten every day, yet the role of nutrition in digestive disorders management is often undervalued, especially in comparison to pharmacological therapy. This happens regularly in veterinary and human medicine and it limits the patients to an incomplete, unsuccessful therapy.

Some of the common canine digestive disorders symptoms are vomiting and diarrhoea due to acute and chronic infections or inflammations (like gastroenteritis and inflammatory bowel diseases – IBD). In therapy and management, it is essential to develop an adequate nutritional strategy. This can include withholding food or feeding with highly digestible food and smaller but frequent meals that will limit gastric acid secretion and distension. 

Oral rehydration with salts, amino acids and glucose is obligatory. Given the fact that prolonged digestive disorders lead to nutritional deficiencies, supple-menting the diet with glutamine, vitamins, minerals, essential fatty acids and probiotics is also essential.

Tailored nutritional strategies

Of course, general nutritional strategies can be further re-evaluated and tailored to the needs of the patient. For example, vomiting may result from food that prolongs gastric retention, such as food high in fat, soluble fibre or poorly digestible starch. On the other hand, small, low-fat, easily digestible meals can suppress vomiting while providing nutrients vital for gut immunity. 

In the case of acute gastroenteritis (vomiting is present) or enterocolitis (diarrhoea is present), the standard strategy is to withhold food for 24-48 hours in order to provide bowel ‘rest’ and afterwards to feed smaller frequent meals of bland food like boiled chicken and white rice. This strategy was challenged by studies that have shown that strict fasting can do more harm than good, leading to further loss of nutrients and aggravation of symptoms. 

Other studies showed that the suitable, complex food and nutrients provide an anti-inflammatory support necessary for intestinal recovery. Thus the concept of ‘minimal luminal nutrition’ was proposed: patients should be immediately orally fed 25% of their resting energy requirements three times a day, while the other 75% is given parenterally (intravenously).

Most suitable food

The food given in the management of digestive disorders should be highly digestible, low fat, with hypoallergenic protein and a limited amount of total dietary fibre. 

Carbohydrates

Boiled white rice is considered to be the best carbohydrate source for dogs with vomiting and diarrhoea since it is highly digestible and less likely to be allergenic in dogs. Other good carbohydrate sources include potatoes, corn or tapioca. 

Proteins

Proteins should be derived from one source, easily digestible (intact or hydrolyzed) and novel – in other words, not previously included in the dogs diet. Proteins are hydrolyzed to limit their antigenicity and also to increase digestibility. Diets with chicken, soy, fish or potato hydrolyzed proteins have shown great results in the cases of IBD, acute enteritis, food hypersensitivity and exocrine pancreatic insufficiency. Some of the drawbacks of these diets are the higher cost of production, persistent immunogenicity and high osmolality – which could promote diarrhoea in some cases. Still, findings in dogs imply that this is very rare. The usually recommended intact protein sources are cottage cheese, lamb or tofu, but the choice should be adjusted according to the dog’s previous diet.

Fats

In choosing the protein, one must also evaluate whether priority should be given to feeding a restricted fat diet over new protein (antigen). Restricted fat is necessary due to possible malabsorption and maldigestion that worsen diarrhoea. 

Fibres

Dietary fibres are beneficial in various digestive disorders and especially in fibre-responsive diarrhoea. Fermentable fibres like oligosaccharides have positive effects on gut microbiota and are used as prebiotics. However, insoluble fibres (e.g. cellulose and lignin) change the digestibility of nutrients while soluble fibres may worsen diarrhoea if introduced too rapidly in the diet. Fibres should be increased gradually and up to 10% of total dietary fibre on a dry-matter basis. 

Complex

Clearly, nutrition management of digestive disorders is complex and should be developed gradually and individually in order to create a suitable diet for each patient on the basis of its nutritional status and diagnosis. On the whole, this approach to digestive disorders can lead to a successful therapy and a healthy gut – a prerequisite for a happy dog.