If they are really allergic to rice, then it will not tolerate COD-HY/FOD-HY. However, often an allergy to rice is assumed based on a positive IgE test. It should be noted that it has been shown that IgE testing for food allergen is not very reliable (Hardy et al 2014), meaning that a positive IgE level to rice does not automatically mean that the dog will show adverse effects when eating rice.

If the dog is however really allergic to rice, then one of the rice-free diets of the SPECIFIC range can be used: CPD, CXD, CGD, CED-DM, CIW-LF, F/C-IN-W, F/C-IN-L, C-BIO-W with beef, C-BIO-W with fish

For cats with real rice allergy the following SPECIFIC diets can be used: FED-DM, FKD, FRD, FXW, FEW-DM, FRW, F/C-IN-W, F/C-IN-L,F-BIO-W with chicken, F-BIO-W with fish

Reference:

Hardy JI et al. Food-specific serum IgE and IgG reactivity in dogs with and without skin disease: lack of correlation between laboratories. Vet Dermatol 2014: 25 : 447-e70

In the product book, it is indicated that SPECIFIC CDD-HY or FDD-HY Food Allergen Management or COD-HY, COW-HY, FOD-HY, FOW-HY Allergen Management Plus can be used as an elimination diet. However, it should be stressed that for diagnosis of adverse food reactions an elimination trial with a home-made diet followed by provocation is still regarded as ‘golden standard’.
However, in practice veterinarians often have the problem that owners do not want to cook for their pet, or that they are just not capable of doing so. In these practical situations where the use of a home-made diet is not feasible, SPECIFIC CDD-HY or FDD-HY Food Allergen Management or Allergen Management Plus diets can be used as elimination diet in order to improve owner’s compliance.

Food allergy can occur at any age. In dogs a range of 4 months to 14 years of age has been reported. However, food allergy is most often diagnosed in young dogs. In 35-50% of the food allergic dogs, first symptoms appeared before the age of 1 year. In cats, signs of food allergy can show from the age of 6 months of 11 years. In almost 40% of the cases, clinical symptoms are seen before the age of 2 years.

Yes, as long as the dog shows allergic reactions towards allergens which cannot be avoided, SPECIFIC Allergen Management Plus or SPECIFIC Skin Function Support can be used to dampen the inflammatory response.

Within the SPECIFIC range CDD Food Allergen Management is recommended because it doesn’t contain wheat and the liver function of the dog with hepatic failure is supported by the diet’s  moderate protein level (to reduce hyperammonemia and hepatic encephalopathy), its high protein digestibility, extra zinc (vs recommendation), added vit C and low purine content ( as some liver problems may increase the risk on purine uroliths)

The diet is not as low in sodium and copper as CKD, but still not very high

The composition of the optimal hypoallergenic diet for an individual dog will depend on the dog’s dietary history of dogs and/or its known food allergens.

If the dog would tolerate both CDD-HY and CDD Food Allergy Management, there is in theory a preference for CDD-HY, since the chance that dog develops a new allergy towards the components of its hypoallergenic diet are smaller on CDD-HY: the salmon protein in hydrolysed and will therefore be too small to provoke an allergic reaction, also in future.

Fatty acids can have an effect on coagulation as being used as precursor for the production of eicosanoids which can effect coagulation. Aggregation of platelets is affected by thromboxanes: TXA2 is produced from arachidonic acid has a strong pro-aggregation effect. TXA3 is produced from EPA and is only very weak in inducing aggregation of platelets.

In literature decreased platelet aggregation was found in humans at high EPA/DHA intakes. However in cats results were mixed. In a study where they used levels of EPA and DHA which were more than twice as high than the highest levels which are present in SPECIFIC Skin Function Support,  there was no effect (Bright et al. 1994). Also in studies with dogs, only very small effects (no clinical relevance) or no effects were found.

We have evaluated the effect of SPECIFIC COD on bleeding time in a study with laboratory dogs which were fed COD for a period of 12 weeks. Bleeding time was not affected by feeding COD. Also in the clinical trial on the effect of COD on atopic dogs, bleeding time of the dogs was measured at the start of the study and after being on the diet for 10 weeks. COD did not increase bleeding time. Even though we did not find any adverse effect of COD on bleeding time in dogs, we indicated at the ‘contraindications’ for COD to be cautious in dogs with coagulation problems. This is just done to be sure, not because we ever found any adverse effects.

Eicosanoids play a key-role in inflammatory reactions. The production of eicosanoids can be affected by the level and type of dietary fatty acids. The high levels of EPA and GLA in SPECIFIC COD and COD-HY will induce the production of beneficial eicosanoids, which can help to dampen the body’s natural anti-inflammatory response.

The production of eicosanoids can also be affected by the use of drugs like corticosteroids and NSAID’s (non-steroid anti-inflammatory drugs as aspirin and ibuprofen). Corticosteroids inhibit the activity of phospholipase A2, the enzyme responsible for the release of arachidonic acid from the cell membrane, yielding free arachidonic acid what can be metabolised into pro-inflammatory eicosanoids. NSAID’s inhibit the activity of cyclo-oxygenase and thereby the production of serie-2 prostaglandines from arachidonic acid.

Thus, the result of EPA and GLA, but also of corticosteroids and NSAID’s is a reduced production of ‘aggressive’ pro-inflammatory eicosanoids from arachidonic acid. In literature has been described that fatty acids and drugs like corticosteroids and anti-histamines work synergistic: the level of corticosteroids or anti-histamines required to suppress clinical signs in atopic dogs can be reduced by the use of EPA and GLA (Saevik et al. 2004) .

In literature there is no univocal information on the incidence of atopy and food allergy. Reported incidence can be affected by several factors like region, type of clinic and diagnostic criteria. Generally atopy is regarded as the second most common cause of canine pruritus, after flea allergy. It has been estimated that 3-15% of the dog population has atopy. Food allergy is the third most common occurring skin allergy, accounting for 1% of all skin diseases in dogs and 10% of all allergic skin diseases in dogs. There is not much information on the incidence in cats.

Pets with food allergy, which are without clinical symptoms on a certain hypoallergenic diet and are switched to another hypoallergenic diet, may show a relapse of clinical symptoms within a period of 2-3 weeks.

In pets currently suffering from symptoms of food allergy, it may take up to 6-10 weeks, before a clear improvement is seen when fed a suitable hypoallergenic diet (especially in case of dermatological clinical signs; gastrointestinal signs of adverse food reactions tend to improve faster). For this reason it is recommended that and elimination trial is performed for a period of at least 8 weeks (Olivry et al 2015).

The beneficial effect of SPECIFIC COD Skin Function Support on skin and coat condition can be ascribed to the increased supply of nutrients like special fatty acids, vitamin A, E, Zn and selenium to the skin and the production of beneficial eicosanoids. For the production of ‘good’ eicosanoids, it is a prerequisite that fatty acids are well absorbed and incorporated in cell membranes. In our studies we found that it will take several weeks before a high, stable level of EPA can be found in the skin. Also in literature, it has been described that it can take several weeks before there is a significant change in eicosanoid production and severity of clinical signs. We therefore advise to use SPECIFIC COD  Skin Function Support for a period of at least 6-8 weeks before the full beneficial effect on skin and coat condition is visible.

It is known that allergic pets are at a higher risk of developing other hypersensitivities. It is therefore quite common that pets are allergic to more than one allergen and that they suffer from a combination of allergies. It has been reported that 20-30% of the cases with food allergy have concurrent atopy or flea allergy. In some studies with dogs with food allergy or atopy even up to 50% suffered from both atopy and food allergy.

Yes, a dog or cat can be fed on high omega-3 diets such as SPECIFIC Allergen Management Plus or Skin Function Support throughout its life. In experimental studies and in a clinical trial with dogs fed on SPECIFIC COD we did not find any adverse effects regarding bleeding time, general blood chemistry, anti-oxidant status or diarrhoea. Despite this finding we do not recommend the diet for dogs which are immune-deficient, or have coagulation abnormalities.

Omega-3 fatty acids have a beneficial effect on skin and coat function, function of the immune system, mobility of joints and kidney function. The intake of high levels of omega-3 fatty acids is especially beneficial in dogs with hyperresponsive inflammatory reactions, because the fatty acids can dampen the inflammatory response. This is for instance important in atopic dogs with an allergic reaction towards allergens, which cannot be avoided.

Yes, it is possible to show an adverse reaction towards sources of omega-3 and omega-6 fatty acids (such as fats and oils). Allergenicity of edible oils and fats is related to the presence of residual protein. It is suggested that in crude edible oils the protein content is in the order of 0.1-0.3 mg/ml; in refined oils this level is reduced about 100-fold. Studies have shown that crude oil can provoke allergic reactions in sensitive allergic individuals; it is assumed that refined oils do not represent a risk of provoking allergic reactions in the majority of allergic individuals.

The types of fat used in hypoallergenic diets should be considered as types of fats and refined oil might contain traces of potential protein allergens.

The pork fat which is coated on the dry SPECIFIC hypoallergenic diets has been shown by means of PCR analysis to be free of pork protein and therefore will not induce an adverse reaction in pets allergic to pork.

The fish oil which is used in hypoallergenic SPECIFIC diets is also tested by PCR-analysis and it free of fish protein, and will therefore not induce an adverse reaction in pets with an allergy towards fish.

Food allergy can only be diagnosed by means of elimination trial, there are no other reliable tests. Thus, in order to set the right diagnosis, the execution of an elimination trial is essential. However, sometimes owners are not willing or capable to perform an elimination trial. In these cases, it is recommend to feed Food Allergen Management or Allergen Management Plus and to evaluate the pet’s response to the diet.
If the pet improves on the hypoallergenic SPECIFIC diet, a diagnosis of food allergy can only be made after relapse of clinical signs after a challenge with the pet’s original diet.

Food allergy can only be diagnosed by means of elimination trial, there are no other reliable tests. Thus, order to set the right diagnosis, the execution of an elimination trial is essential. However, sometimes owners are not willing or capable to perform an elimination trial. In these cases, it is recommend to Food Allergy Management and to evaluate the pet’s response to the diet.

For diagnosis of adverse food reactions an elimination trial with a home-made diet followed by provocation is regarded as ‘golden standard’. In practical situations, the use of a home-made eliminations diet is not always feasible. Preparation of home-made diets can be labour intensive and owners may not be willing to prepare a home-made diet. Furthermore, home-made diets are not complete in all nutrients and are therefore not recommended for suited for young growing pets. In these situations SPECIFIC Food Allergen Management or Allergen Management Plus with hydrolysed salmon are recommended as elimination diet in order to increase compliance of the owner and to better meet the nutrient requirement of growing pets.

The aim of using an elimination diet is to set the diagnosis of food allergy. Food allergy can only be diagnosed if clinical symptoms disappear when fed on an elimination diet and relapse after provocation with the habitual diet. The suitability of an elimination diet depends on the raw materials which are used in the diet and the raw materials to which the dog/cat has been exposed to during its life (as an allergy can only develop after prior exposure to an allergen).  
The raw materials which are used in  SPECIFIC CDD-HY/FDD-HY Food Allergen Management are almost identical to those used in SPECIFIC CΩD-HY/FOD-HY Allergen Management Plus: there is only a difference in the fat sources in the diet: CDD-HY/FDD-HY Food Allergen Management and COD-HY/FOD-HY Allergen Management Plus both contain pork fat and fish oil, but the inclusion levels are different. CDD-HY/FDD-HY Food Allergen Management contains a much larger amount of pork fat and a small amount of fish oil, whereas COD-HY/FOD-HY Allergen Management Plus contains a large amount of fish oil and a much lower amount of pork fat. The only difference in type of raw materials is that COD-HY/FOD-HY Allergen Management Plus contains borage oil, which is not present in CDD-HY/FDD-HY. Because CDD-HY/FDD-HY contains one  raw material less it may therefore be preferred, however the risk of an allergic reaction towards borage oil is very low.

SPECIFIC CΩD-HY/FOD-HY Allergen Management Plus is a kind of ‘all-in-one diet’, which can be beneficial  in all types of allergic dermatitis food allergy, atopy, flea allergy and any combination of allergies. SPECIFIC  Allergen Management Plus diets are especially recommended in case the veterinarian wants to have most chance to get rid of the clinical signs, without initially setting the exact diagnosis (’black-box approach’)

No, there is no problem to feed these dry hypoallergenic diets since PCR-analyses of the pork fat has shown that the fat does not contain any traces of pork protein. Allergic reactions are in fact towards proteins and since there is no pork protein present in the fat, it is safe to feed these diets to pets with an allergy towards pork.

A primary feature of evening primrose oil is its content of GLA, gamma-linolenic acid. Just as for the omega-3 fatty acids EPA and DHA it has been shown that GLA can be used as a precursor for metabolization of beneficial eicosanoids than can help to support the body’s natural anti-inflammatory response. Besides the high levels of EPA and DHA in SPECIFIC Allergen Management Plus and Skin Function Support, these diets also contain borage oil as a source of GLA.  When using SPECIFIC Allergen Management Plus or Skin Function Support it is thus not necessary to add supplements as evening primrose oil.

There is no general consensus on the exact maximum molecule weight to guarantee absence of allergenicity.

Immunological reactions to food components are usually against glycoproteins, commonly ranging in size from 10.000 to 70.000 Dalton (Cave 2006, Sampson 1993). In some publications even higher minimum molecule weights of food allergens as 14.000 or 18.000 Dalton are stated (Puigdemont et al. 2006, Biourge et al. 2004). In theory, hydrolysation of protein into small peptide fragments will reduce its allergenicity, because offending epitopes will be broken down and will not bind to the IgE receptors on the mast cell surface. Furthermore, mast cell degranulation will only take place after cross-linking of 2 or more IgE molecules are bound to IgE receptors on the mast cell. This means that the allergen must be large enough to bind to 2 IgE receptors. Most publications indicate that a molecule must be at least as big as 10.000 Dalton in order to be able to bind to 2 IgE receptors (Cave 2006).

From a theoretical point of view: the smaller the molecule weight, the less likely that the allergenitic epitope is still intact. However, if the molecule size is very small, the protein hydrolysate might still cause an allergic reaction. Extensively hydrolysed cow milk formulas (with molecule weight of ca. 1500 Dalton) have been successfully applied in the feeding of babies with cow milk allergy. However, even on these extensively hydrolysed protein sources, about 5-20% of the food allergic infants relapse. This can be explained by the presence of minor traces of intact protein in the hydrolysate. It has also been hypothesized that very small peptides, which cannot activate IgE molecules themselves, might still bind to other components and act as haptens, causing an allergic reaction. Adverse food reactions which are not IgE-mediated (thus others than immunological type I reactions) are not necessarily expected to improve after protein hydrolysation.

Extensive hydrolysation to hydrolysates with lower molecules weights might also introduce some side-effects like reduced palatability and increased osmolality with associated loose stools or diarrhoea.

There are not many studies on the efficacy of protein hydrolysates in dogs with well diagnosed food allergy. However, most of them relate to the efficacy of hydrolysates with a maximum molecule weight of 10.000 or 12.200 Dalton. Studies with soy hydrolysates (MW< 12.200 Dalton) in dogs with induced soy hypersensitivity showed a reduced response to hydrolysed soy (in contrast to intact soy) (Beale & Laflamme 2001, Puigdemont et al. 2006). Another study showed that 90% of dogs with food allergy could successfully be maintained on a commercial hypoallergenic diet based on soy hydrolysate with a maximum molecule weight of 10.000 Dalton (Biourge et al. 2004).

Presence of fleas or other parasites, infections with bacteria or yeasts, exposure to allergens, dry skin or stress will all stimulate itching. A food allergic pet or an atopic pet could have concurrent allergies and can best be fed on SPECIFIC Allergen Management Plus, if it cannot be totally controlled on another diet. Flea control, regular brushing, shampooing and avoidance of allergens can contribute to reduce the degree of itching. Immediate treatment of secondary infections can prevent deterioration of clinical signs. If needed, medication can be used to reduce pruritus.

Dechra offers a complete range of pharma and care products which can help to prevent or reduce clinical signs in pet with allergic dermatitis.

Taking into account the presence of food allergy and calcium oxalate urolithiasis the hypoallergenic SPECIFIC CDD Food Allergen Management would be the best option for this dog as the reduced protein level in the diet and the induction of a higher urinary pH will reduce the risk on calcium oxalate (a reduced protein level will reduce the supply of amino acids glycine which can be metabolised into oxalate). For further reduction on the risk on recurrence of Ca-ox (which we know is an issue even on an ‘anti-oxalate diet’), it is recommended to promote the water intake of the dog by adding extra hand-warm water to the diet (feeding as a ‘diner’ type of diet).

The basic composition of SPECIFIC hydrolysed diets is identical (hydrolysed salmon and rice), except for the type and amount of fat sources which have been used. The dry hydrolysed diets, all contain  pork fat and fish oil oil (with Allergen Management Plus having higher levels of fish oil in order to have increased levels of EPA and DHA, fatty acids which can yield eicosanoids that can help to support the body’s natural anti-inflammatory response). The wet Allergen Management Plus diets contain sunflower oil and high levels of fish oil. All Allergen Management Plus diets also contain borage oil, a source of GLA, a fatty acid which can also support the body’s natural anti-inflammatory response.  

Because the hydrolysed diets have similar basic compositions (hydrolysed salmon and rice), food allergic pets can easily be switched between wet and dry versions of  hydrolysed Food Allergen Management and Allergen Management Plus, depending on the preference for wet or dry diets and/or the need for extra fatty acids.

SPECIFIC Skin Function Support and Allergen Management Plus  contain a very high level of EPA. Several studies have shown that this high level of EPA is effective in the control of atopic dermatitis in dogs and has beneficial effects on clinical conditions like poor coat condition, cancer, arthritis, colitis ect. The daily intake of  EPA is much higher when feeding Skin Function Support or Allergen Management Plus in comparison to the amount of EPA which is delivered by fatty acids supplements.

SPECIFIC Skin Function Support and Allergen Management Plus  also contain increased levels of skin-related nutrients like Zn, vitamin A and vitamins of the B-complex and selenium. These nutrients support optimal skin and coat condition.

SPECIFIC  Skin Function Support and Allergen Management Plus are complete, balanced diets with increased levels of EPA, GLA and skin-related nutrients and a n-3:n-6 ratio of 1:1. When fatty acids supplements are added to a pet’s regular diet,  , the n-3:n-6 ratio of the total intake of the pet (diet + supplement) will mainly be determined by the fatty acid composition of the pet’s diet (which generally has an abundance of n-6 fatty acids like linoleic acid) and will remain close to 1:10.

When supplements are  given in addition to a habitual diet  the supplement’s dosage is adjusted according to the weight of the dog. However, often there  are only 3 dosage levels indicated . Feeding complete diets with very high levels of EPA, like SPECIFIC Skin Function Support and Allergen Management Plus assures a tailored dosage to any weight of the dog as the fatty acid composition is balanced to the energy content in the diet.

Many fatty acid supplements  recommend the same dosage to all dogs weighing more than 25 kg. The consequence is that the more the dog weighs over 25 kg, the lower the contribution  of fatty acids from fatty acid supplements  to the total fatty acid intake  of the dog; these large dogs may not get enough fatty acids to see an effect.

It is more convenient to use a diet that provides all beneficial fatty acids and skin-related nutrients (SPECIFIC Skin Function Support and Allergen Management Plus  ), than adding a separate fatty acid supplement to a regular diet. If very large amounts of fatty acid supplements or oils are added to a regular diet, this also adds a lot of extra energy to the pet’s daily intake, with the risk of obesity and dilution of the nutrient intake (on an energy basis), which may put the pet at risk for some nutrient deficiencies.

The hydrolysed salmon was first of all selected on having a molecule weight below 10.000 Dalton (considered to be small enough to prevent allergic reactions).

Further arguments were the high protein quality (good amino acid profile and high digestibility), the freshness of the protein source, the high quality control and traceability of Norwegian salmon. Also the fact that salmon is not of vegetable origin (in contrast to soy and relevant for cats) and less commonly used as raw material in pet food as other commercially available protein hydrolysates (such as chicken-, soy- and egg hydrolysate) were extra arguments to select the hydrolysed salmon as raw materials for the new SPECIFIC hypoallergenic diets. Furthermore fish is a sustainable protein source and fits well in the image and positioning of SPECIFIC.

Intact  salmon protein can be considered as a rather novel raw material in hypoallergenic diets for pets ; however there are commercial diets which contain salmon (e.g. wet cat diets in supermarkets; also in some of our wet SPECIFIC cat diets we use salmon as ingredient). For this reason we prefer to use hydrolysed instead of intact salmon protein in our new hydrolysed diets.

SPECIFIC CDD, CDW and FDW Food Allergen Management are only suited for adult dogs/cats, but SPECIFIC CDD-HY, FDD-HY Food Allergen Management and COD-HY, COW-HY, FOD-HY an FOW-HY Allergen Management Plus diets are specially formulated so that they also meet the nutrient requirements of growing dogs and cats and are thus also suited for puppies and kittens.   

For management of pancreatitis it is generally advised to avoid too much fat and protein in the diet to prevent stimulation of the pancreas.

Guidelines are* :

FOR CATS Fat: 10-15% on DMB and protein between 30-45% DMB  (DMB=dry matter basis)

FOR DOGS Fat: 10-15% on DMB and protein between 15-30% DMB for dogs

In addition: fat < 10% in case of concurrent hyperlipidemia or severe obesity.

Suitable SPECIFIC diets for cats with pancreatitis:

The general recommendation for adult cats with pancreatitis is FDD-HY, FΩD-HY and FXD and for juvenile cats FDD-HY, FΩD-HY and FND

Note: FRD is suited for elderly kittens, if they are able to eat sufficient energy from FRD Note: FDD-HY and FOD-HY are at respectively 29.5 and 29.7% protein, and FQD-F at 15.2% fat which is also acceptable

(FID and FIW are too high in fat)

The presence of other complications will have an impact on the dietary recommendation

For cats with pancreatitis and hyperlipidaemia  FΩD-HY may be first choice as the high level of n-3 may help to reduce the triglycerides and/or cholesterol levels, whilst FRD, with even lower fat levels, is also suitable.

For cats with pancreatitis and (risk on) diabetes mellitus FED-DM is first choice (the protein level of FED-DM is higher at 55% DM, but due to the low carbohydrate level and reduce fat level it is recommended to support cats with DM and pancreatitis).

For cats with pancreatitis and obesity FRD and FRW are recommended.

For cats with concurrent struvite problems: FXD or FCD-L is a good choice.

Suitable SPECIFIC diets for dogs with pancreatitis:

The general recommendation for adult dogs  with pancreatitis is CID-LF, CIW-LF, CDD-HY and CΩW-HY and for juvenile dogs CPD-XL, CDD-HY and CΩW-HY

In case of concurrent hyperlipidaemia, CID-LF and CIW-LF would be the first choice as the high level of n-3 may help to reduce the triglycerides and/or cholesterol level although CRD-2 and  CGD, with lowfat levels, and CΩW-HY, with high level of n-3, will also be suitable.

For dogs with pancreatitis and (risk on) diabetes mellitus; CED-DM and CRD-2 are first choice (CED-DM is slightly higher in protein than guideline, but due to low carbohydrate recommended for dogs with pancreatitis and DM)

For dogs with pancreatitis and obesity CID-LF, CIW-LF are first choice although CRD-2 is also suitable

For dogs with pancreatitis and IBD, where food allergy may also play a role CID-LF and/or CIW-LF are recommended.

There is an increasing knowledge on the beneficial effect of n-3 fatty acids on a variety of clinical conditions. This knowledge is derived from studies in humans, laboratory animals and sometimes also cats or dogs. 

In a rat model of colitis, addition of 8% fish oil to the diet reduced the severity of clinical symptoms and shortened the course of the colonic disease (Vilaseca et al.1990). In double-blinded, placebo-controlled studies with human patients with ulcerative colitis, long-term supplementation with fish oil (300-450 mg EPA/MJ) reduced the required dose of corticosteroids (Hawthorne et al. 1992) and also reduced the level of the inflammatory mediator LBT4 and improved the histological appearance of the colon (Stenson et al. 1992).

For pets with IBD it is recommended to feed a hypoallergenic diet, since it is expected that there might be a food-allergic component involved in the aetiology of IBD. Since also omega-3 fatty acids have proven to be effective in reducing clinical signs of colitis / inflammatory reactions in the GI-tract, SPECIFIC Allergen Management Plus is recommended for pets with IBD, due to its hypoallergenic composition and uniquely high level of EPA & DHA.

Beta-1,3/1,6-glucans are naturally occurring glucans found in the cell wall of fungi and yeast (glucans are carbohydrate polymers consisting of a chain of glucose molecules). The beta-1,3/1,6-glucan molecule has a long main chain of beta-1,3- linked glucose molecules with side chains composed of beta-1,3-linked glucose molecules. Beta-1,3/1,6-glucans have a high ability to enhance the immune system.

White blood cells, which are in the front line of the immune defence, have receptors which can bind to invading pathogens. On their surface they also have receptors to bind to beta-1,3/1,6-glucans. Binding of beta-1,3/1,6-glucans to the specific receptor induces the activation of the macrophage, enhancing the non-specific immune system. However, binding of beta-1,3/1,6-glucans also stimulates the macrophage to produce ‘alarm signals’ (such as cytokines) that alert the cells of the specific immune system (B and T cells). This leads to a higher immune status and higher production of immunoglobulins.

Studies  have shown that oral supplementation with beta-1,3/1,6-glucans reduced plasma concentrations of the pro-inflammatory cytokines IL-6 and TNF-alpha and increased the concentration of the anti-inflammatory cytokine IL-10. In this way, beta-1,3/1,6-glucans can have a damping effect on inflammatory reactions.

Thus, supplementation with beta-1,3/1,6-glucans can have beneficial health effects through two modes of action; it can lead to an enhanced immune status and it affect the body’s natural inflammatory response.

Supplementation with beta-1,3/1,6-glucans increased the levels of antibodies after vaccination and improved the resistance to several infections. In weaned piglets, challenged with E.coli, supplementation with beta-1,3/1,6-glucans reduced the duration and severity of diarrhoea and the susceptibility to colonisation with E. Coli . In a study with laying hens suffering from chronic enteritis, beta-1,3/1,6-glucan supplementation significantly reduced inflammatory cell infiltration and improved general health indicators in the hens.

SPECIFIC FOD-HY Allergen Management Plus can best be used for a young cat with IBD and struvite urolithiasis:

The diet is hypoallergenic (based on hydrolysed salmon protein and rice). For pets with IBD a hypoallergenic diet is often recommended, since it is expected that IBD can have a food allergic origin

The diet has high levels of omega-3 fatty acids from fish, which can dampen inflammatory reactions (in studies in humans and rats, high intake of n-3 reduced the severity of colitis)

The diet is suited for all ages, thus also for young growing cats

The diet is formulated to prevent struvite through the induction of a low urinary pH (< 6.4)

For diabetic cats with pancreatitis SPECIFIC FED-DM is recommended because it has a very moderate level of fat for support in case of pancreatitis

In case of mild to moderate constipation in cats, diets with a high level of insoluble fiber, such as cellulose, (e.g. SPECIFIC FRD/FRW Weight Reduction) can be beneficial. Insoluble fibers increase fecal bulk, which can improve peristalsis and normalize motility, on the condition that the cat is well hydrated and consumes sufficient water. 

However, in cats with more severe, chronic or recurrent constipation (obstipation) and megacolon it is not recommended to provide high levels of insoluble fibre. As these cats are often dehydrated with associated increased water absorption from the colon, high intake of insoluble fibre in these cats may result in an even larger amount of even more firm and drier fecal mass in the colon. Instead, it is therefore recommended to feed a highly digestible diet to reduce the amount of feces in the colon. A moderate amount of soluble fibre can help to increase the water content in the colon. Psyllium is a soluble gel-forming fiber which can soften the feces and help retain water in the colon.  Fermentable soluble fibers, such as beet pulp, inulin and FOS, can be metabolised into short-chain fatty acids (SCFAs), important nutrients for the colonocytes. Fermentation and production of SCFAs can promote colonic motility and increase fecal water as a result of  the osmotic effect of the metabolites. Within the SPECIFIC range, SPECIFIC FID and FIW Digestive Support are highly digestible diets with added soluble and fermentable fibres (psyllium, beet pulp, FOS, MOS, XOS), which can especially be recommended for cats with chronic constipation, obstipation and megacolon. As sufficient water intake is essential, especially the wet diet FIW is recommended, but water can also be added to the dry kibbles and intake of drinking water stimulated by providing multiple water bowls or water fountains.  

Depending on the response of the individual cat, additional use of a laxative as lactulose can be considered, with the dose titrated to reach the desired effect. 

 In general any change of diet can lead to some degree of temporary digestive disturbance. Of course this can be due to a nutritional inadequacy or a defect in the new diet but even the change itself may require some adaptation of digestive enzymes and intestinal microflora. A gradual switch mixing more and more of the new diet into the old one in the feeding bowl until the change is complete should be done over a period of 7-10 days. This is important for any change of diet and the pet owner should be properly informed about this. Exceptions to this procedure would be clearly acute cases where a therapeutic diet must be introduced as quickly as possible, e.g. a digestive or recovery diet. 

If digestive problems are seen/reported in conjunction with a diet change it should always be investigated first whether any other factors could be the cause. Have any other factors in the life of the pet changed recently? Has the pet had access to other sources of food or things to ingest? Did the pet’s feeding or eating routine change in any way?

For dogs with chronic diarrhoea associated with severe protein loosing enteropathy or lymphangiectasia SPECIFIC CID-LF/CIW-LF Digestive Support Low Fat is recommended. The unique combination of the use of hypoallergenic ingredients and the low dietary level of fat make the Digestive Support Low Fat diets perfectly suited for these clinical indications. The major part (about 66%) of dogs with chronic enteropathies are diet-responsive, meaning that they show improvement on a hypoallergenic diet. However, for several of these cases also a low-fat dietary fat level is required for management of clinical signs.

In addition to the hypoallergenic ingredients and the low fat content, SPECIFIC Digestive Support Low Fat diets also contain fermentable fibers, beta-glucans, relatively high levels of fish oil, AuraGuard and nucleotides to support a healthy gut microbiome, immune response and gut barrier function.  

For management of pancreatitis it is advised to avoid too much fat and protein in the diet to prevent stimulation of the pancreas.

The guidelines for diets for dogs with pancreatitis is a fat level of 10-15% on dry matter basis and a  protein level 15-30% dry matter. For severe cases of pancreatitis or cases with concurrent hyperlipidaemia or severe obesity an even lower dietary fat level (below 10% in dry matter) is recommended.

Within the SPECIFIC range the general recommendation for dogs with pancreatitis is CID-LF/CIW-LF Digestive Support Low fat (7% fat in DM) or CID/CIW Digestive Support, CDD-HY Food Allergen Management or COW-HY Allergen Management Plus (these diets have fat levels between 10 and 15% DM)

Depending on the condition and potential concurrent clinical conditions of an individual dog, another diet might be preferred. Please click on the link for recommended diets for dogs with pancreatitis and concurrent conditions.
 

Pancreatitis diet reccomendations - click here

For nutritional management of pancreatitis is it generally advised to prevent too much fat and protein in the diet to prevent stimulation of the pancreas. The guideline is to provide a diet with a moderate level of fat (10-15% on dry matter) and a protein level between 15-30% dry matter. For more severe cases or in case of concurrent hyperlipidaemia or obesity, an even lower fat content below 10% dry matter is recommended. For support of kidney failure it is essential to provide a diet with a restricted level of P and also protein is preferably reduced.Unfortunately the kidney diets are somewhat too high in fat to meet the guidelines for pancreatitis (CKD 17.5 and CKW 16.4% fat on DMB).

From the list of suitable SPECIFIC dog diets for pancreatitis (fat and protein in requested range), CGD Senior (13.4 g protein/MJ, P 0.35 g/MJ) and  CDD Food Allergen management (protein 10.1 g/MJ and P 0.34 g/MJ) ,can be used for dogs with pancreatitis and concurrent renal failure.  The phosphorus levels in these diets are still higher compared to the kidney diets. A phosphorus-binder could be added to these diets in order to keep plasma phosphorus levels within the desired range.

When further reduction of the dietary fat, phosphorus or protein level would be required for individual cases, extra rice could be added to CGD or CDD. A recipe for a balanced, complete diet can be provided on request, when needed.   

Exocrine pancreatic insufficiency is characterized by greatly reduced secretion of pancreatic digestive enzymes. Consequently, maldigested food remains in the gastrointestinal tract and this can lead to diarrhoea, flatulence and bacterial overgrowth. For the management of exocrine pancreas insufficiency highly digestible diets as SPECIFIC CID/W Digestive Support are recommended.  Also the hypoallergenic diets based on hydrolysed salmon protein and rice (SPECIFIC CDD-HY Food Allergen Management and COD-HY/COW-HY Allergen Management Plus are highly digestible and therefore recommended for dogs with exocrine pancreas insufficiency. Despite the fact that the diets are highly digestible, it is recommended that pancreatic enzyme preparations (such as for instance Primazym) are used in additional to these highly digestible diets.ons.

For dogs with pancreatitis it is recommended to give a diet with a moderate level of fat and protein in order not to stimulate the pancreas too much. Rule of thumb is a fat level from 10-15% on a dry matter basis and a protein level of 15-30% on dry matter basis.

For management of IBD and also for allergenic skin reactions, hypoallergenic diets are recommended and high levels of EPA and DHA from fish can help to support the body’s natural anti-inflammatory response.

SPECIFIC CID-LF / CIW-LF Digestive Support Low Fat meets all these criteria and is recommended for dogs with pancreatitis with concurrent IBD and allergic skin reactions.
The presence of fermentable fibers, beta-glucans, AuraGuard and nucleotides furthermore help to support a healthy gut microbiome, immune response and gut barrier function.

 Multi disorder cases like this cannot be easily managed nutritionally. The major consideration will be to balance the acuteness and risk of the different disorders with the possibility of nutrition to make a difference.

- In this case most attention should be given to the kidney disease and pancreatitis: Life expectancy of kidney patients has been shown to be considerably affected by a diet with low P and reduced protein. Low protein diet is also recommended for liver disease. Pancreatitis calls for moderate dietary fat and protein levels for minimal stimulation of the pancreas. (Rule of thumb for dogs: Fat level of 10-15% on dry matter basis and protein 15 -30% DMB.)

- Arthritis, though painful, is not life threatening, but closely connected into a vicious circle with the overweight. Both will improve if the dog loses weight and gets dietary GAGs and high levels of omega-3.

- Struvite problems in dogs are very often caused by urinary tract infections, so this should be investigated prior to any dietary considerations.

Unfortunately the kidney diets are somewhat too high in fat to meet the guidelines for pancreatitis (CKD 17.5 and CKW 16.4% fat on DMB).

In the list of suitable dog diets for pancreatitis (fat and protein in requested range), some diets could be considered (CGD 13.4 g protein/MJ, P=0.35 g/MJ), CDD protein 10.1 g/MJ and P 0.34 g/MJ), but in fact these P levels are still quite high compared to the kidney diets (0.16 g P/MJ).

DIETARY RECOMMENDATION:

Since there is no single ideal diet for this case, it is recommended  to adapt the kidney diets somewhat by mixing them with CGD (low fat, relatively low P and protein diet) or with cooked rice (providing primarily carbohydrates, thus reducing the % of protein and fat in the diet). A benefit of using CGD is that this is also a complete diet- so all nutrients are present in sufficiently high amounts. Benefit of using the rice is that you can get to some lower P levels, but also other nutrients are somewhat diluted (not expected to cause  problems caused by this), however by using a mix with CGD the level of omega-3 levels remains higher which is beneficial for kidney and joints.

Just evaluate which recipe looks best for this individual dog (dependent on breed size, price preference for CKD versus CKW – or palatability)

Mixing CKW with CGD-M:

Mix per 100 g CKW 20 grams CGD_M

This mixture will contain 11.2 g protein/MJ and 0,23 g P/MJ. Protein = 18.9% on DMB, Fat = 13.7% DMB. Feeding advice: give 61% of recommended feeding amount of CKW (feeding table) and add 20% of this amount as CGD

(example: 14 kg dog: CKW recommendation is 660 g/day (feeding table). Thus give 61% = 400 g CKW and mix this with 0.2*400=80 g CGD-M)

Mixing CKD with CGD:

Mix per 100 g CKD 75 grams CGD-M

This mixture will contain 10.3 g protein/MJ and 0,23 g P/MJ. Protein = 16.9% on DMB, Fat = 14.2% DMB. Feeding advice: give 60% of recommended feeding amount of CKD (feeding table) and add 75 % of this amount as CGD

Mixing CKW with cooked rice (weight of rice = weight after cooking)

Mix per 100 g CKW 30 gram cooked rice

This mixture will contain 8.7 g protein/MJ and 0.14 g P/MJ. Protein = 14.3% on DMB, Fat = 12.6% DMB. Feeding advice: give 78% of recommended feeding amount of CKW (feeding table) and add 30% of this amount as cooked rice

Mixing CKD with cooked rice (weight of rice = weight after cooking)

Mix per 100 g CKD 85 gram cooked rice

This mixture will contain 7.7 g protein/MJ and 0.14 g P/MJ. Protein = 12.7% on DMB, Fat = 14% DMB. Feeding advice: give 82% of recommended feeding amount of CKD (feeding table) and add 85% of this amount as cooked rice

For dogs with hyperlipidaemia / high cholesterol levels we recommend a diet with a reduced fat level as CID-LF/CIW-LF Digestive Support Low Fat, CRD-1/CRW-1 Weight Reduction, CRD-2 Weight Control or CED-DM Endocrine Support.

The fat level of CED-DM is not as low as in the other recommended diets, but still just low enough to comply with the maximum level of fat  indicated as essential nutritional characteristic for management of hyperlipidaemia (legislation for therapeutic diets, R 2020/354). In Digestive Support Low Fat and Endocrine Support diets a major part of the fat in the diet is derived from fish oil, which is also beneficial to reduce triglycerides and cholesterol.

A cat which was suffering from chronic diarrhoea and vomiting is now successfully maintained on SPECIFIC FID DIgestive Support. However the owner noticed that on the packaging it is indicated that the diet can only be fed for 12 weeks. Must the cat be switched to another diet?

The indication for the time of use, as indicated on the label of SPECIFIC FID DIgestive Support, is mandatory according the EU legislation for therapeutic diets (R 2020/354). The declaration of the recommended period of use indicates a range of time within which the nutritional purpose should normally be achieved. The purpose of this legal indication is that after this period a vet evaluates how the cat is doing on the diet and based on that will decide to continue the feeding of the diet or not.
On the packaging of FID to following indication of recommended time of use is given:
‘Initially up to 12 weeks and lifetime in case of chronic pancreatic insufficiency’

If this cat has been fed the SPECIFIC FID Digestive Support for this recommended period of use, and the cat is doing fine on the diet, the vet can recommend to continue to feed the diet. SPECIFIC FID Digestive Support is a diet, which meet the nutrient recommendations for all cats and can thus be fed for long-term.
Just as for all cats and dogs on any diet, it is recommended to monitor the pet's health and nutritional status on a regular basis, and adapt the diet if the nutritional assessment indicates that the diet should be adapted due to changes in the pet's condition or presence of concurrent clinical conditions.

For support of IBD a highly digestible diet is recommended. As an adverse food reaction may playa role in the development of IBD, a hypoallergenic diet will be preferred. Both IBD and osteoarthritis are inflammatory conditions which can benefit from the intake of high levels of imega-3 fatty acids EPA and DHA from fish oil, as these fatty acids can help to support the body’s natural anti-inflammatory response. From all nutraceuticals which are used for support of osteoarthritis, the efficacy of omega-3 fatty acids is best proven in controlled clinical trials.

SPECIFIC FOD-HY / FOW-HY Allergen Management Plus diets are hypoallergenic, highly digestible and contain high levels of EPA and DHA of fish oil and are therefore recommended for nutritional management of cats with IBD and concurrent osteoarthritis.

Nucleotides are organic molecules which form structural building blocks of DNA and RNA. They consist of a base (adenine, thymine guanine or cytosine in DNA and uracil in RNA), bound to a sugar and a phosphoric acid molecule.

Nucleotides have an important role in metabolism on cell level and can provide energy.

As building block of DNA and RNA, there is a high need on nucleotides in fast dividing cells (where new DNA and RNA is produced), such as in the intestinal mucosa (where cells are renewed within a few days) and immune cells. Nucleotides can be derived from de novo synthesis, but can also be derived from re-use from nucleotides from dead cells or derived from the food. Under normal conditions there is no need to provide extra nucleotides through the diet (de novo synthesis and re-use of nucleotides will be sufficient), but in periods of increased need (during stress, disease, vaccination, growth) there can be a higher demand for nucleotides and supplementation of nucleotides has shown to be beneficial.
It has for instance been shown that supplementation of nucleotides is associated with an increase in villi height and crypt depth in the intestinal mucosa, which is associated with an increase in absorptive surface, better absorption, improved growth and improved feed conversion rate. Nucleotide supplementation also supports the immune response, for instance by increasing the production of IgE after vaccination.

SPECIFIC CDD-HY and COD-HY contain the same hypoallergenic ingredients (based on hydrolysed salmon and rice). Both diets contain pork fat and fish oil, but the levels of the fat sources are different: CDD-HY contains more pork fat and COD-HY contains more fish oil. As eosinophilic enteritis is an inflammatory condition, SPECIFIC COD-HY will be preferred; the high levels of EPA and DHA from fish oil in COD-HY can help to support the body’s anti-inflammatory response.

For management of pancreatitis it is generally advised to avoid too much fat and protein in the diet to prevent stimulation of the pancreas.

Guidelines are* :

FOR CATS Fat: 10-15% on DMB and protein between 30-45% DMB  (DMB=dry matter basis)

FOR DOGS Fat: 10-15% on DMB and protein between 15-30% DMB for dogs

In addition: fat < 10% in case of concurrent hyperlipidemia or severe obesity.

Suitable SPECIFIC diets for cats with pancreatitis:

The general recommendation for adult cats with pancreatitis is FDD-HY, FΩD-HY and FXD and for juvenile cats FDD-HY, FΩD-HY and FND

Note: FRD is suited for elderly kittens, if they are able to eat sufficient energy from FRD Note: FDD-HY and FOD-HY are at respectively 29.5 and 29.7% protein, and FQD-F at 15.2% fat which is also acceptable

(FID and FIW are too high in fat)

The presence of other complications will have an impact on the dietary recommendation

For cats with pancreatitis and hyperlipidaemia  FΩD-HY may be first choice as the high level of n-3 may help to reduce the triglycerides and/or cholesterol levels, whilst FRD, with even lower fat levels, is also suitable.

For cats with pancreatitis and (risk on) diabetes mellitus FED-DM is first choice (the protein level of FED-DM is higher at 55% DM, but due to the low carbohydrate level and reduce fat level it is recommended to support cats with DM and pancreatitis).

For cats with pancreatitis and obesity FRD and FRW are recommended.

For cats with concurrent struvite problems: FXD or FCD-L is a good choice.

Suitable SPECIFIC diets for dogs with pancreatitis:

The general recommendation for adult dogs  with pancreatitis is CID-LF, CIW-LF, CDD-HY and CΩW-HY and for juvenile dogs CPD-XL, CDD-HY and CΩW-HY

In case of concurrent hyperlipidaemia, CID-LF and CIW-LF would be the first choice as the high level of n-3 may help to reduce the triglycerides and/or cholesterol level although CRD-2 and  CGD, with lowfat levels, and CΩW-HY, with high level of n-3, will also be suitable.

For dogs with pancreatitis and (risk on) diabetes mellitus; CED-DM and CRD-2 are first choice (CED-DM is slightly higher in protein than guideline, but due to low carbohydrate recommended for dogs with pancreatitis and DM)

For dogs with pancreatitis and obesity CID-LF, CIW-LF are first choice although CRD-2 is also suitable

For dogs with pancreatitis and IBD, where food allergy may also play a role CID-LF and/or CIW-LF are recommended.

There is an increasing knowledge on the beneficial effect of n-3 fatty acids on a variety of clinical conditions. This knowledge is derived from studies in humans, laboratory animals and sometimes also cats or dogs. 

In a rat model of colitis, addition of 8% fish oil to the diet reduced the severity of clinical symptoms and shortened the course of the colonic disease (Vilaseca et al.1990). In double-blinded, placebo-controlled studies with human patients with ulcerative colitis, long-term supplementation with fish oil (300-450 mg EPA/MJ) reduced the required dose of corticosteroids (Hawthorne et al. 1992) and also reduced the level of the inflammatory mediator LBT4 and improved the histological appearance of the colon (Stenson et al. 1992).

For pets with IBD it is recommended to feed a hypoallergenic diet, since it is expected that there might be a food-allergic component involved in the aetiology of IBD. Since also omega-3 fatty acids have proven to be effective in reducing clinical signs of colitis / inflammatory reactions in the GI-tract, SPECIFIC Allergen Management Plus is recommended for pets with IBD, due to its hypoallergenic composition and uniquely high level of EPA & DHA.

Beta-1,3/1,6-glucans are naturally occurring glucans found in the cell wall of fungi and yeast (glucans are carbohydrate polymers consisting of a chain of glucose molecules). The beta-1,3/1,6-glucan molecule has a long main chain of beta-1,3- linked glucose molecules with side chains composed of beta-1,3-linked glucose molecules. Beta-1,3/1,6-glucans have a high ability to enhance the immune system.

White blood cells, which are in the front line of the immune defence, have receptors which can bind to invading pathogens. On their surface they also have receptors to bind to beta-1,3/1,6-glucans. Binding of beta-1,3/1,6-glucans to the specific receptor induces the activation of the macrophage, enhancing the non-specific immune system. However, binding of beta-1,3/1,6-glucans also stimulates the macrophage to produce ‘alarm signals’ (such as cytokines) that alert the cells of the specific immune system (B and T cells). This leads to a higher immune status and higher production of immunoglobulins.

Studies  have shown that oral supplementation with beta-1,3/1,6-glucans reduced plasma concentrations of the pro-inflammatory cytokines IL-6 and TNF-alpha and increased the concentration of the anti-inflammatory cytokine IL-10. In this way, beta-1,3/1,6-glucans can have a damping effect on inflammatory reactions.

Thus, supplementation with beta-1,3/1,6-glucans can have beneficial health effects through two modes of action; it can lead to an enhanced immune status and it affect the body’s natural inflammatory response.

Supplementation with beta-1,3/1,6-glucans increased the levels of antibodies after vaccination and improved the resistance to several infections. In weaned piglets, challenged with E.coli, supplementation with beta-1,3/1,6-glucans reduced the duration and severity of diarrhoea and the susceptibility to colonisation with E. Coli . In a study with laying hens suffering from chronic enteritis, beta-1,3/1,6-glucan supplementation significantly reduced inflammatory cell infiltration and improved general health indicators in the hens.

SPECIFIC FOD-HY Allergen Management Plus can best be used for a young cat with IBD and struvite urolithiasis:

The diet is hypoallergenic (based on hydrolysed salmon protein and rice). For pets with IBD a hypoallergenic diet is often recommended, since it is expected that IBD can have a food allergic origin

The diet has high levels of omega-3 fatty acids from fish, which can dampen inflammatory reactions (in studies in humans and rats, high intake of n-3 reduced the severity of colitis)

The diet is suited for all ages, thus also for young growing cats

The diet is formulated to prevent struvite through the induction of a low urinary pH (< 6.4)

For diabetic cats with pancreatitis SPECIFIC FED-DM is recommended because it has a very moderate level of fat for support in case of pancreatitis

In case of mild to moderate constipation in cats, diets with a high level of insoluble fiber, such as cellulose, (e.g. SPECIFIC FRD/FRW Weight Reduction) can be beneficial. Insoluble fibers increase fecal bulk, which can improve peristalsis and normalize motility, on the condition that the cat is well hydrated and consumes sufficient water. 

However, in cats with more severe, chronic or recurrent constipation (obstipation) and megacolon it is not recommended to provide high levels of insoluble fibre. As these cats are often dehydrated with associated increased water absorption from the colon, high intake of insoluble fibre in these cats may result in an even larger amount of even more firm and drier fecal mass in the colon. Instead, it is therefore recommended to feed a highly digestible diet to reduce the amount of feces in the colon. A moderate amount of soluble fibre can help to increase the water content in the colon. Psyllium is a soluble gel-forming fiber which can soften the feces and help retain water in the colon.  Fermentable soluble fibers, such as beet pulp, inulin and FOS, can be metabolised into short-chain fatty acids (SCFAs), important nutrients for the colonocytes. Fermentation and production of SCFAs can promote colonic motility and increase fecal water as a result of  the osmotic effect of the metabolites. Within the SPECIFIC range, SPECIFIC FID and FIW Digestive Support are highly digestible diets with added soluble and fermentable fibres (psyllium, beet pulp, FOS, MOS, XOS), which can especially be recommended for cats with chronic constipation, obstipation and megacolon. As sufficient water intake is essential, especially the wet diet FIW is recommended, but water can also be added to the dry kibbles and intake of drinking water stimulated by providing multiple water bowls or water fountains.  

Depending on the response of the individual cat, additional use of a laxative as lactulose can be considered, with the dose titrated to reach the desired effect. 

 In general any change of diet can lead to some degree of temporary digestive disturbance. Of course this can be due to a nutritional inadequacy or a defect in the new diet but even the change itself may require some adaptation of digestive enzymes and intestinal microflora. A gradual switch mixing more and more of the new diet into the old one in the feeding bowl until the change is complete should be done over a period of 7-10 days. This is important for any change of diet and the pet owner should be properly informed about this. Exceptions to this procedure would be clearly acute cases where a therapeutic diet must be introduced as quickly as possible, e.g. a digestive or recovery diet. 

If digestive problems are seen/reported in conjunction with a diet change it should always be investigated first whether any other factors could be the cause. Have any other factors in the life of the pet changed recently? Has the pet had access to other sources of food or things to ingest? Did the pet’s feeding or eating routine change in any way?

For dogs with chronic diarrhoea associated with severe protein loosing enteropathy or lymphangiectasia SPECIFIC CID-LF/CIW-LF Digestive Support Low Fat is recommended. The unique combination of the use of hypoallergenic ingredients and the low dietary level of fat make the Digestive Support Low Fat diets perfectly suited for these clinical indications. The major part (about 66%) of dogs with chronic enteropathies are diet-responsive, meaning that they show improvement on a hypoallergenic diet. However, for several of these cases also a low-fat dietary fat level is required for management of clinical signs.

In addition to the hypoallergenic ingredients and the low fat content, SPECIFIC Digestive Support Low Fat diets also contain fermentable fibers, beta-glucans, relatively high levels of fish oil, AuraGuard and nucleotides to support a healthy gut microbiome, immune response and gut barrier function.  

For management of pancreatitis it is advised to avoid too much fat and protein in the diet to prevent stimulation of the pancreas.

The guidelines for diets for dogs with pancreatitis is a fat level of 10-15% on dry matter basis and a  protein level 15-30% dry matter. For severe cases of pancreatitis or cases with concurrent hyperlipidaemia or severe obesity an even lower dietary fat level (below 10% in dry matter) is recommended.

Within the SPECIFIC range the general recommendation for dogs with pancreatitis is CID-LF/CIW-LF Digestive Support Low fat (7% fat in DM) or CID/CIW Digestive Support, CDD-HY Food Allergen Management or COW-HY Allergen Management Plus (these diets have fat levels between 10 and 15% DM)

Depending on the condition and potential concurrent clinical conditions of an individual dog, another diet might be preferred. Please click on the link for recommended diets for dogs with pancreatitis and concurrent conditions.
 

Pancreatitis diet reccomendations - click here

For nutritional management of pancreatitis is it generally advised to prevent too much fat and protein in the diet to prevent stimulation of the pancreas. The guideline is to provide a diet with a moderate level of fat (10-15% on dry matter) and a protein level between 15-30% dry matter. For more severe cases or in case of concurrent hyperlipidaemia or obesity, an even lower fat content below 10% dry matter is recommended. For support of kidney failure it is essential to provide a diet with a restricted level of P and also protein is preferably reduced.Unfortunately the kidney diets are somewhat too high in fat to meet the guidelines for pancreatitis (CKD 17.5 and CKW 16.4% fat on DMB).

From the list of suitable SPECIFIC dog diets for pancreatitis (fat and protein in requested range), CGD Senior (13.4 g protein/MJ, P 0.35 g/MJ) and  CDD Food Allergen management (protein 10.1 g/MJ and P 0.34 g/MJ) ,can be used for dogs with pancreatitis and concurrent renal failure.  The phosphorus levels in these diets are still higher compared to the kidney diets. A phosphorus-binder could be added to these diets in order to keep plasma phosphorus levels within the desired range.

When further reduction of the dietary fat, phosphorus or protein level would be required for individual cases, extra rice could be added to CGD or CDD. A recipe for a balanced, complete diet can be provided on request, when needed.   

Exocrine pancreatic insufficiency is characterized by greatly reduced secretion of pancreatic digestive enzymes. Consequently, maldigested food remains in the gastrointestinal tract and this can lead to diarrhoea, flatulence and bacterial overgrowth. For the management of exocrine pancreas insufficiency highly digestible diets as SPECIFIC CID/W Digestive Support are recommended.  Also the hypoallergenic diets based on hydrolysed salmon protein and rice (SPECIFIC CDD-HY Food Allergen Management and COD-HY/COW-HY Allergen Management Plus are highly digestible and therefore recommended for dogs with exocrine pancreas insufficiency. Despite the fact that the diets are highly digestible, it is recommended that pancreatic enzyme preparations (such as for instance Primazym) are used in additional to these highly digestible diets.ons.

For dogs with pancreatitis it is recommended to give a diet with a moderate level of fat and protein in order not to stimulate the pancreas too much. Rule of thumb is a fat level from 10-15% on a dry matter basis and a protein level of 15-30% on dry matter basis.

For management of IBD and also for allergenic skin reactions, hypoallergenic diets are recommended and high levels of EPA and DHA from fish can help to support the body’s natural anti-inflammatory response.

SPECIFIC CID-LF / CIW-LF Digestive Support Low Fat meets all these criteria and is recommended for dogs with pancreatitis with concurrent IBD and allergic skin reactions.
The presence of fermentable fibers, beta-glucans, AuraGuard and nucleotides furthermore help to support a healthy gut microbiome, immune response and gut barrier function.

 Multi disorder cases like this cannot be easily managed nutritionally. The major consideration will be to balance the acuteness and risk of the different disorders with the possibility of nutrition to make a difference.

- In this case most attention should be given to the kidney disease and pancreatitis: Life expectancy of kidney patients has been shown to be considerably affected by a diet with low P and reduced protein. Low protein diet is also recommended for liver disease. Pancreatitis calls for moderate dietary fat and protein levels for minimal stimulation of the pancreas. (Rule of thumb for dogs: Fat level of 10-15% on dry matter basis and protein 15 -30% DMB.)

- Arthritis, though painful, is not life threatening, but closely connected into a vicious circle with the overweight. Both will improve if the dog loses weight and gets dietary GAGs and high levels of omega-3.

- Struvite problems in dogs are very often caused by urinary tract infections, so this should be investigated prior to any dietary considerations.

Unfortunately the kidney diets are somewhat too high in fat to meet the guidelines for pancreatitis (CKD 17.5 and CKW 16.4% fat on DMB).

In the list of suitable dog diets for pancreatitis (fat and protein in requested range), some diets could be considered (CGD 13.4 g protein/MJ, P=0.35 g/MJ), CDD protein 10.1 g/MJ and P 0.34 g/MJ), but in fact these P levels are still quite high compared to the kidney diets (0.16 g P/MJ).

DIETARY RECOMMENDATION:

Since there is no single ideal diet for this case, it is recommended  to adapt the kidney diets somewhat by mixing them with CGD (low fat, relatively low P and protein diet) or with cooked rice (providing primarily carbohydrates, thus reducing the % of protein and fat in the diet). A benefit of using CGD is that this is also a complete diet- so all nutrients are present in sufficiently high amounts. Benefit of using the rice is that you can get to some lower P levels, but also other nutrients are somewhat diluted (not expected to cause  problems caused by this), however by using a mix with CGD the level of omega-3 levels remains higher which is beneficial for kidney and joints.

Just evaluate which recipe looks best for this individual dog (dependent on breed size, price preference for CKD versus CKW – or palatability)

Mixing CKW with CGD-M:

Mix per 100 g CKW 20 grams CGD_M

This mixture will contain 11.2 g protein/MJ and 0,23 g P/MJ. Protein = 18.9% on DMB, Fat = 13.7% DMB. Feeding advice: give 61% of recommended feeding amount of CKW (feeding table) and add 20% of this amount as CGD

(example: 14 kg dog: CKW recommendation is 660 g/day (feeding table). Thus give 61% = 400 g CKW and mix this with 0.2*400=80 g CGD-M)

Mixing CKD with CGD:

Mix per 100 g CKD 75 grams CGD-M

This mixture will contain 10.3 g protein/MJ and 0,23 g P/MJ. Protein = 16.9% on DMB, Fat = 14.2% DMB. Feeding advice: give 60% of recommended feeding amount of CKD (feeding table) and add 75 % of this amount as CGD

Mixing CKW with cooked rice (weight of rice = weight after cooking)

Mix per 100 g CKW 30 gram cooked rice

This mixture will contain 8.7 g protein/MJ and 0.14 g P/MJ. Protein = 14.3% on DMB, Fat = 12.6% DMB. Feeding advice: give 78% of recommended feeding amount of CKW (feeding table) and add 30% of this amount as cooked rice

Mixing CKD with cooked rice (weight of rice = weight after cooking)

Mix per 100 g CKD 85 gram cooked rice

This mixture will contain 7.7 g protein/MJ and 0.14 g P/MJ. Protein = 12.7% on DMB, Fat = 14% DMB. Feeding advice: give 82% of recommended feeding amount of CKD (feeding table) and add 85% of this amount as cooked rice

For dogs with hyperlipidaemia / high cholesterol levels we recommend a diet with a reduced fat level as CID-LF/CIW-LF Digestive Support Low Fat, CRD-1/CRW-1 Weight Reduction, CRD-2 Weight Control or CED-DM Endocrine Support.

The fat level of CED-DM is not as low as in the other recommended diets, but still just low enough to comply with the maximum level of fat  indicated as essential nutritional characteristic for management of hyperlipidaemia (legislation for therapeutic diets, R 2020/354). In Digestive Support Low Fat and Endocrine Support diets a major part of the fat in the diet is derived from fish oil, which is also beneficial to reduce triglycerides and cholesterol.

A cat which was suffering from chronic diarrhoea and vomiting is now successfully maintained on SPECIFIC FID DIgestive Support. However the owner noticed that on the packaging it is indicated that the diet can only be fed for 12 weeks. Must the cat be switched to another diet?

The indication for the time of use, as indicated on the label of SPECIFIC FID DIgestive Support, is mandatory according the EU legislation for therapeutic diets (R 2020/354). The declaration of the recommended period of use indicates a range of time within which the nutritional purpose should normally be achieved. The purpose of this legal indication is that after this period a vet evaluates how the cat is doing on the diet and based on that will decide to continue the feeding of the diet or not.
On the packaging of FID to following indication of recommended time of use is given:
‘Initially up to 12 weeks and lifetime in case of chronic pancreatic insufficiency’

If this cat has been fed the SPECIFIC FID Digestive Support for this recommended period of use, and the cat is doing fine on the diet, the vet can recommend to continue to feed the diet. SPECIFIC FID Digestive Support is a diet, which meet the nutrient recommendations for all cats and can thus be fed for long-term.
Just as for all cats and dogs on any diet, it is recommended to monitor the pet's health and nutritional status on a regular basis, and adapt the diet if the nutritional assessment indicates that the diet should be adapted due to changes in the pet's condition or presence of concurrent clinical conditions.

For support of IBD a highly digestible diet is recommended. As an adverse food reaction may playa role in the development of IBD, a hypoallergenic diet will be preferred. Both IBD and osteoarthritis are inflammatory conditions which can benefit from the intake of high levels of imega-3 fatty acids EPA and DHA from fish oil, as these fatty acids can help to support the body’s natural anti-inflammatory response. From all nutraceuticals which are used for support of osteoarthritis, the efficacy of omega-3 fatty acids is best proven in controlled clinical trials.

SPECIFIC FOD-HY / FOW-HY Allergen Management Plus diets are hypoallergenic, highly digestible and contain high levels of EPA and DHA of fish oil and are therefore recommended for nutritional management of cats with IBD and concurrent osteoarthritis.

Nucleotides are organic molecules which form structural building blocks of DNA and RNA. They consist of a base (adenine, thymine guanine or cytosine in DNA and uracil in RNA), bound to a sugar and a phosphoric acid molecule.

Nucleotides have an important role in metabolism on cell level and can provide energy.

As building block of DNA and RNA, there is a high need on nucleotides in fast dividing cells (where new DNA and RNA is produced), such as in the intestinal mucosa (where cells are renewed within a few days) and immune cells. Nucleotides can be derived from de novo synthesis, but can also be derived from re-use from nucleotides from dead cells or derived from the food. Under normal conditions there is no need to provide extra nucleotides through the diet (de novo synthesis and re-use of nucleotides will be sufficient), but in periods of increased need (during stress, disease, vaccination, growth) there can be a higher demand for nucleotides and supplementation of nucleotides has shown to be beneficial.
It has for instance been shown that supplementation of nucleotides is associated with an increase in villi height and crypt depth in the intestinal mucosa, which is associated with an increase in absorptive surface, better absorption, improved growth and improved feed conversion rate. Nucleotide supplementation also supports the immune response, for instance by increasing the production of IgE after vaccination.

SPECIFIC CDD-HY and COD-HY contain the same hypoallergenic ingredients (based on hydrolysed salmon and rice). Both diets contain pork fat and fish oil, but the levels of the fat sources are different: CDD-HY contains more pork fat and COD-HY contains more fish oil. As eosinophilic enteritis is an inflammatory condition, SPECIFIC COD-HY will be preferred; the high levels of EPA and DHA from fish oil in COD-HY can help to support the body’s anti-inflammatory response.

Yes, SPECIFIC^TM Joint Support can be used in combination with NSAIDs.

In humans with arthritis, supplementation with fish oil reduced the required dose of NSAIDs to control pain (Kremer et al. 1995, Lau et al. 1993). Also in a study by Fritsch et al 2010, it was found that a diet enriched with fish oil (Hill’s j/d) could reduce the required dose of NSAIDs in dogs with OA.

It should be noted that it will take several weeks before the full benefit of SPECIFICTM Joint Support will be obtained and the required dose of NSAIDs can be settled.

There is an increasing knowledge on the beneficial effect of n-3 fatty acids and e.g. the n-6 fatty acids GLA on a variety of clinical conditions. This knowledge is derived from studies in humans, laboratory animals and sometimes also cats or dogs. Below a small selection is given.

In human studies, several double-blinded studies proved that EPA-supplementation improved the clinical signs of rheumatic arthritis. The improvement of the patients was associated with a reduction in LTB4 and an increase in LTB5 (Kremer et al. 1985, 1987). Similar beneficial effects have also been shown for GLA (Leventhal et al 1993, Zurrier et al. 1996). Fish oil supplementation does not only reduce the inflammatory response through production of less-inflammatory eicosanoids. It also reduces in a dose-dependent manner cartilage degeneration (Curtis 2002, Hansen 2008).

In dogs with arthritis, dogs supplemented with fish oil had less clinical signs than dogs from the control group (Schoenherr 2005). Also studies performed by Hill’s show beneficial effect of high intakes of omega-3 fatty acids on clinical signs of arthritis in dogs (Fritsch 2010, Roush 2010)

Curtis et al (2002) Pathologic indicators of degradation and inflammation in human osteoarthritic cartilage are abrogated by exposure to n-3 fatty acids. Arthritis & Rheumatism 46: 1544-1553.

Fritsch DA et al. (2010) A multicenter study on the effect of dietary supplementation with fish oil omega-3 fatty acids on carprofen dosage in dogs with osteoarthritis. J Am Vet Med Assoc 236: 535-539.

Hansen RA et al. (2008) Fish oil decreases matrix metalloproteinases in knee synovia of dogs with inflammatory joint disease. J Nutr Biochem 19: 101-108.

Kremer JM, Jubiz W, Michalek A, Rynes RI, Bartholomew LE, Bigaouette J, Timchalk M, Beeler D, Lininger L (1987) Fish-oil fatty acis supplementation in acive rheumatoid arthritis. A double-blinded, controlled, cross-over study. Ann Int Med 106 (4): 497-502.

Kremer JM Michalek AV, Lininger L, Huyck C, Bigauoette J, Timchalk MA, Rynes RI, Zieminski J. (1985) Effect of manipulation of dietary fatty acids on clinical manifestations of rheumatoid arthritis. Lancet 26: 184-187.

Leventhal LJ et al. (1993) Treatment of rheumatoid arthritis with gammalinolenic acid. An Intern Med 119: 867-873.

Roush JK et al. (2010 ) Multicenter veterinary practice assessment of the effects of omega-3 fatty acids on osteoarthritis in dogs. J Am Vet Med Assoc 236: 59-66.

Zurier RB et al. (1996) Gamma-linolenic acid treatment of rheumatoid arthritis. Arthritis Rheum 39: 1808-1817.

NSAIDs are indeed effective in the reduction of pain and inflammation. Their efficacy can be ascribed to the inhibition of the activity of the enzyme cyclo-oxygenase and thereby the production of prostaglandins. Although this will reduce the pain and the inflammation in the joint, it does not directly affect the degradation of cartilage.

SPECIFIC^TM Joint Support does not only contain components that can affect the pain and the inflammation, but also components that can reduce the degradation of cartilage:

- EPA can, in a dose-dependent way, reduce the activity of cartilage degradating enzymes.

- GAGs can reduce the degradation of cartilage and increase the synthesis of cartilage.

- high levels of antioxidants can scavenger free radicals and prevent them from further damaging the joint.

Furthermore, the moderate energy density of SPECIFICTM Joint Support contributes to the maintenance of ideal body weight and thereby eliminates one of the major risk factors of OA. In practice the most optimal management of OA is achieved by a multi-approach, including NSAIDs, diet, gentle exercise and potentially complementary treatment like physiotherapy or acupuncture.

It is not recommended to give CJD Joint Support to very young, fast growing pups, since CJD does not meet the protein and mineral needs of a young pup. However, when the pups are somewhat older is is certainly recommended to feed CJD Joint Support to provide nutritional support to the joints

Depending on the age and breed of the pup CJD Joint Support it is recommended to supplement with a mineral mix like Gistocal;

For large breed pups and pups that have not reached half of their adult weight, it is recommended to increased the calcium and phosphorus intake by adding 0.5 gram of Gistocal to 100 g CJD Joint Support.

For small breed pups which have already reached half of their adult weight, it is not required to add extra minerals and CJD Joint Support can just be given exclusively.

Recommendation for feeding amount of CJD Joint Support for pups:

Follow the feeding advice for CJD for the thin adult dog and multiply this with factor 1.5 until the pup reaches ca. 80% of the final bodyweight

From 80-100% of final weight multiply thin dog * factor 1.2

For 100% final weight on: follow normal feeding advice (depending on the condition of the dog)

NB for all stages: adapt ‘ standard advice’  to condition of the dog

Yes, SPECIFIC^TM CJD Joint Support is a complete diet which supplies as all the nutrient requirements of adult dogs. It can therefore also be used as maintenance diet for normal dogs without osteoarthritis (OA), but is specially suited for adult dogs without OA, which have an increased risk on the development of OA. An increased risk on the development of OA can be related to the dog’s breed, history of joint problems (hip dysplasia, luxations, abnormal joint formation, osteochondrosis), trauma caused by injuries and accidents, history of vigorous exercise and overweight. SPECIFIC^TM CJD Joint Support can support the maintenance of healthy joints and mobility in these dogs at risk.

Use of collagen supplementation in dogs with osteoarthritis: Difference between hydrolysed collagen peptides in SPECIFIC CJD Joint Support and UC-II in Flexadin Advance

Background

At the dog relaunch in December 2019, SPECIFIC CJD Joint Support has been optimised by the addition of Petagile® (hydrolysed collagen peptides), beta-1,3/1,6-glucans and an increased level of chondroitin sulphate (replacing glucosamine). Already existing dietary characteristics as a moderate energy density, high levels of EPA & DHA, added GLA, and increased levels of antioxidants and manganese remained unchanged. Flexadin Advanced (Vetoquinol) is a dietary supplement for support of dogs with osteoarthritis (OA), which contains UC-II (undenatured type 2 collagen), omega-3 fatty acids, Boswellia Serrata and vitamin E. Although SPECIFIC CJD and Flexadin both contain collagen, the collagen components and their working mechanism in both products are different.

Collagen

Collagen is a fibrous protein which is present in connective tissue, skin, bone etc, providing strength and firmness to tissues. Collagen has a complex structure of long peptide chains composed of primarily glycine, proline and hydroxyproline. There are different types of collagen with differences in the composition of the peptide chains. Collagen type I is the most prevalent type of collagen in mammals, which is present in skin, tendons, ligaments and bones. Type 2 is the most prevalent type of collagen in cartilage.

Collagen peptides (PETAGILE®) in SPECIFIC CJD Joint Support

SPECIFIC CJD Joint Supports contains 1.8% PETAGILE®. PETAGILE® is a mixture of specific bioactive collagen peptides of predominantly type I collagen with an average molecule weight of approximately 6000 Dalton for support of osteoarthritis. These collagen peptides are highly digestible, can be absorbed as amino acids, di-peptides and to some extend in molecular intact form and accumulate in cartilage tissue (Oesser et al. 1999). In in-vitro studies with porcine, bovine or canine chondrocytes, PETAGILE® collagen peptides increased biosynthesis of cartilage matrix and reduced inflammatory cytokines, activity of proteases and cartilage degradation (Oesser & Seifert 2003, Schunck et al 2009, Schunck et al. 2017). In a study with inbred mice (STR/ort), which spontaneously develop osteoarthritic lesions, PETAGILE® collagen peptides were able to slow down or even halt cartilage destruction (Oesser et al. 2007). In clinical trials with dogs with osteoarthritis, hydrolysed collage peptides reduced lameness and improved mobility (Weide 2004, Beynen et al. 2010, Schunck et al. 2017). The observed reduction in lameness and increased mobility of the dogs receiving collagen peptides was associated with significantly decreased plasma levels of MMP-3 (matrix metalloprotease-3; a biomarker for cartilage degradation) and increased levels of TIMP-1 (tissue inhibitor of metalloprotease-1; inhibits with high affinity MMP-3) (Weide 2004).

 Undenatured type II collagen (UC-II) in Flexadin Advanced

The collagen in Flexadin Advanced is type 2 collagen, which has not been treated with high temperatures or chemicals, and thereby kept its original structure. It has been demonstrated that undenaturated type-II (UC-II) improved function and reduced deterioration of articular cartilage in a rat model of OA (Bagi et al. 2017), improved symptoms in human knee OA (Lugo et al. 2016) and reduced inflammation and pain (D’Atilio et al 2007, Gupta et al. 2011) and mobility ( Stabile et al. 2019) in dogs with OA. During OA, collagen in cartilage will get damaged and will be regarded as ‘foreign protein’, which will be attacked by the body’s immune system. It has been hypothesized that UC-II functions through oral tolerance, which takes place in the small intestine where food is being absorbed. After intake of a small amount of UC-II, a T-cell response in activated at the level of the Gut-Associated-Lymphoid-Tissue (GALT), in the Peyer’s patches. After this stimulation, regulatory T helper 2 and 3 (TH2 and TH3) cells migrate from the GALT through the lymphatic system into the peripheral circulation and, when they match the type 2 collagen as antigen (as in the arthritic joints), they secrete cytokines (such as TGF-b, IL-4, IL-10) that results in the downregulation of the TH1 cells (which are involved in producing the inflammation and destruction of collagen in OA) (Gupta et al. 2011, Stabile et al. 2019). 

PETAGILE® in SPECIFIC CJD Joint Support vs (UC-II) in Flexadin Advanced

Not only the type of collagen in CJD and Flexadin is different, also the amount required for a beneficial effect on OA is different. Studies on PETAGILE® in dogs with OA have shown that improvement of mobility were obtained at an intake of about 1 gram PETAGILE® per 5 kg body weight. SPECIFIC CJD Joint supports contains 1.8% PETAGILE® in order to supply 1 gram of PETAGILE® per 5 kg body weight. Studies on UC-II in dogs with arthritis used 40 mg UC-II, which contains 10 mg undenatured UC-II, per day (Gupta et al. 2011, Stabile et al. 2019). The dose of denatured UC-II in Flexidin Advanced is similar to this amount. Although the daily intakes of the collagen components through CJD or Flexadin are very different, it can be concluded that both for CJD as Flexadin the product supplies the required amount of the specific collagen component which proved to be effective in clinical studies in dogs with OA.

Besides the collagen components SPECIFIC CJD and Flexadin Advanced contain also other components to support OA in dogs:

SPECIFIC CJD Joint Support contains per 100 g: 0.76 g EPA, 0.74 g DHA, 0.1 g GLA, 0.12 g beta-1,3/1,6-glucans, 0.23 g chondroitin sulphate, 82 mg vit E, 2.6 mg manganese, 16.8 mg vit C

Flexadin contains per chew: 95 g total n-3 fatty acids, 9.3 mg EPA, 21 mg vit E, Boswellia Serrata (dose unknown; no controlled studies on efficacy in dogs with OA)

In Table 1, a comparison of the daily intake of relevant components for support of OA in SPECIFIC CJD and Flexadin Advanced is shown. The products provide different types of collagen, but each at a proven effective dose for the specific type of collagen component. The amount of total omega-3 fatty acids, EPA and vitamin E in Flexadin Advanced is almost negligible compared to the levels provided through SPECIFIC CJD. Especially for EPA, studies have shown that EPA improves mobility in dogs with OA (Miller et al. 1992, Roush 2010, Fritsch et al. 2010) by reducing the activity of cartilage degrading enzymes and reduction of inflammatory mediators. In contrast to Flexadin Advanced, SPECIFIC CJD Joint Support also contains beta-glucans and chondroitin sulphate that can improve mobility in dogs with OA and manganese and vitamin C, which are important for the synthesis of cartilage.

Table 1. Comparison of relevant components for support of OA in dogs in SPECIFIC CJD Joint Support and Flexadin Advanced (daily intake for an average adult dog of 20 kg*)

SPECIFIC Joint Support: 285 g/day;  Flexadin Advanced: 1 chew/day

For fatty acids we know that it will take about 6-10 weeks before there is a new steady state of the fatty acid composition in cell membranes. In human studies on fish oil supplementation, it took up to 12 weeks before major effects could be seen. Also for GAGs it took up to 70 days (McCarthy et al. 2007) before a significant improvement could be detected. It is only for NSAIDs that improvement of clinical signs can be seen earlier (14-42 days, study McCarthy et al. 2007). For SPECIFIC^TM CJD Joint Support we therefore advice to feed the diet for a period of 10 weeks to notice the full effect of the diet.

In a field trial the efficacy of SPECIFIC CJD Joint Support was evaluated in dogs with clincial signs of osteoarthritis. Already after 3 weeks significant improvement in severity of clinical signs could be observed. However, the clincial signes improved even further when SPECIFIC Joint Support was fed for a longer period. Therefore it is recommended to feed CJD Joint Support for a period of up to 10 weeks to see the full effect.

In literature there is discussion on the use of GAGs in individuals with diabetes. It is hypothesized that diabetic patients can better not use GAGs as this may reduce insulin sensitivity. There are however other articles indicating that GAGs can just be used by diabetics. In order to avoid any risk, we decided not to add GAGs to SPECIFICTM CED Endocrine Support, since this diet is also indicated for dogs with diabetes and other endocrine diseases associated with poor control of blood glucose levels.

This will depend on the dose of GAGs, which a vet wants to prescribe for an individual dog with osteoartritis (OA). Some vets prescribe Cosequin (from Nutramax; most frequently used preparation of glucosamine and chondroitin sulphate) for dogs with OA. For Cosequin it is advised to start on a high initial dose (around 300 mg GLU + 250 mg CS/MJ), which can then further be stepwise reduced until the required dosing is achieved. The level of glucosamine + chondroitin sulphate in SPECIFIC^TM CJD Joint Support is 150 mg/MJ. This level is lower than the initial dose of Cosequin. However, if the dose of Cosequin is reduced to maintenance levels (which can vary for individual dogs), the level of GAGs provided through SPECIFIC^TM CJD Joint Support is quite similar and additional Cosequin is not be needed anymore.

For individual cases, where the vet wants to prescribe higher maintenance levels of GAGs, the required dose of Cosequin can be reduced because a major part of the GAGs will already be provided through the diet.

(Please note that SPECIFIC^TM CJD Joint Support does not only have GAGs as effective component. The presence of other active components like fish oil and antioxidants will contribute to the beneficial effect of the diet and may reduce the required dose of Cosequin as well).

Dogs with hip dysplasia have an increased risk on osteoarthritis (OA), as almost all joint problems finally result in OA. It is therefore advised to feed SPECIFIC^TM CJD Joint Support for support of maintenance of healthy joints and mobility in these dogs at risk. Furthermore it is also advised to prevent additional risk factors for OA as much as possible, meaning that overweight of the dog should be prevented as well as vigorous exercise. Regular, gentle exercise will aid in keeping the joints and the rest of the locomotor system in good condition.

The composition Royal Canine Mobility C2P+ has changed considerably regarding the effective components in comparison to the original Mobility diet:

• No green lipped mussel included anymore
• No glucosamine & chondroitin included anymore
• The level of EPA & DHA is reduced compared to Mobility Larger Dogs (whereas omega-3 fatty acids from fish oil were evaluated as being the only nutraceuticals with clearly scientifically proven efficacy in the control of osteoarthritis in dogs in the review by Vandeweerd et al. 2012)
• Instead, the efficacy of Mobililty C2P+ is to a great extend ascribed to the combination of:
• Curcumin
• Hydrolysed collagen
• Green tea extract

For efficacy of the mix of curcumin, hydrolysed collagen and green tea extract a reference is made to an in-vitro study from Comblain et al (2015). In this study curcumin and also the mix of curcumin, hydrolysed collagen and tea extract shows a significant difference in the effect on metabolism of chondrocytes in monolayer versus the control. Production of nitric oxide and prostaglandin E2 and enzyme activities (all indicators related to progression of OA) reduced on curcumin and the mix of curcumin, hydrolysed collagen and green tea. However, hydrolysed collagen or green tea alone was not significantly different from the control.

As also indicated in the article from Combain, it is difficult to extrapolate of the results from the in-vitro study to an in-vivo situation with dogs with OA orally being fed the mix of curcumin, hydrolysed collagen and green tea. Especially the bioavailability of the oral supplement can be an issue and may lead to other in-vivo results. Especially for curcumin it is indicated that it has a poor availability (whereas in the in-vitro tests especially curcumin seems the most essential part of the mix of the 3 substances). It is indicated that oral intake of 4-8 g curcumin per day will result in serum levels of 0.7 to 1.8 μM, whereas the concentrations used in the in-vitro study were up to 10 μM. Royal Canin Mobility C2P+ contains only 1.6 g curcumin/kg diet, thus an average 25-kg dog, eating 300 g Mobility C2P+, will only have an oral intake around 0.5 g curcumin per day.

In marketing materials Royal Canin also the results from a multicentre study in dogs with OA fed on the new Mobility C2P+ and another study performed at the university of Luik, Belgium are shown. Since not many details are given on the methodology (reference to data on file), it is difficult to evaluate these studies. For many joint diets is has been shown that a switch to the joint diet will reduce clinical signs in dogs with OA. In the presentation of selected results, significance is indicated for the difference between scores at the start of the study and after 21 and 42 days on Mobility

C2P+. However, no significance is indicated when results on Mobility C2P+ are shown versus the control diet (name of control joint diet is not given). It is likely that the difference in improvement of mobility between Mobility C2P+ and the control diet is not significantly different as the difference is not large. Full details on the study would be needed in order to be able to evaluate the outcome of the studies more accurately. Also in the presentation of the first studies on Hill’s j/d only the significant differences were presented, whereas there were many parameters measured which were not significantly different.

For now it remains difficult to predict how the efficacy of the new Royal Canin Mobility C2P+ versus SPECIFIC CJD Joint Support and other joint diets will be.

Based on the nutrient composition and the scientific proof for the different dietary measures SPECIFIC CJD (as well as FJD and FJW) Joint Support has an outstanding composition versus competitor joint diets:

• It has the highest level of EPA (with the exception of Virbac Articulation – which many not be available in all markets selling SPECIFIC)
• It has the second lowest energy density (only Hill’s Metabolics + Mobility is lower in energy, but this diets is much lower in EPA and glucosamine and chondroitin)
• It has the highest level of glucosamine & chondroitin

Royal Canin Mobility C2P+ scores considerably less on these dietary characteristics and efficacy of the diet should primarily come from the mix of curcumin, hydrolysed collagen and green tea. However, as indicated no published (or public) in-vivo studies are available yet.

Since EPA reduced the activity of cartilage degradating enzymes in an in-vitro study in a dose-dependent way (Curtis et al. 2002), the higher level in CJD Joint Support can be a benefit compared to competitor diets (there are no studies which describe the relationship between the dietary EPA level and the EPA level found in the synovium, but higher dietary levels of EPA are associated with higher serum level of EPA).

In a study by Hansen et al. (2008), fish oil supplementation (with 480 mg EPA+DHA/MJ) reduced the level of cartilage degradating (pro)enzymes, but not at all time points during the study. The authors suggested that a higher level of EPA and DHA may be more effective.

Unfortunately there are not many publications on an in-vivo dose-effect study on the efficacy of EPA on the improvement of clinical signs of osteoarthritis (OA), but in the study of Fritsch et al. 2010 (attached) dose-titration effects of fish oil in osteoarthiritic dog were studied.

In the study by Fritsch et al. 3 different diets with different fish oil levels were tested:

• Diet A: (Hill’s j/d) containing 0.8% EPA + DHA on DMB (dry matter basis)
• Diet B: containing 2 % EPA & DHA on DMB
• Diet C: containing 3% EPA & DHA on DMB

 FYI: SPECIFIC CJD contains 1.5% EPA & DHA on DMB)

In a double blinded study dogs with clinical signs and radiographic proof of OA were included (ca 60 per group). They were allocated to one of the 3 diets and followed for 90 days.

At the start and at day 21, 45 and 90 severity of clinical signs was scored by the vet and on day 90 progression of arthritis and overall OA condition were scored by the vet with input from the owner.

Blood samples were taken at day 0, 21, 45 and 90 and analysed for fatty acids.

There was a very clear relationship between the fatty acid composition of the diet and the fatty acid composition in serum from the dogs.

The higher the level of EPA & DHA in the diet, the higher the level of EPA & DHA in the dog serum and the lower the level of arachidonic acid in dog serum (which would mean more precursors for anti-inflammatory mediators/eicosanoids and less precursors for pro-inflammatory mediators).

Clinical signs (lameness, weight bearing, range of motion, reluctance to hold up contralateral limb, pain on palpation of affected joint) were scored on a scale from 1 to 4. There was a significantly lower score for diet C vs diet A for lameness and weight bearing.

The overall scores (progression of arthritis and overall arthritic condition) were significantly lower for diet C versus diet A. There was no significant difference between diet B and diet A, although the values for the scores for diet B for the overall scores were lower than for the group fed diet A. In the results no statistical analysis was presented on the presence of a linear effect of the fish oil dose, but based on the values this can be expected: the higher the fish oil dose, the lower the overall scores. In the discussion section of the article it is indeed indicated that regression analysis indicated a close relationship between the amount of added fish oil in the 3 foods and decreases in the 2 overall scores. This certainly would mean that better results can be expected on higher fish oil dose.

At the end of the article it is indicated that the changes in the scores were relatively modest and it is hypothesized that this might have been due to subjectiveness of the scores combined with the relative insensitivity of the scales. Taken this into account, it can be questioned if not more significant differences between diet B and C versus diet A would be found if more sensitive scoring would be used.

Thus, it seems certainly beneficial to have higher levels of EPA in the diet than the EPA level in Hill’s j/d.

Update of SPECIFIC CJD Joint Support 2019

The composition of SPECIFIC CJD Joint Support has been updated for optimized support of healthy joints and mobility:

New added features:

• Added hydrolysed collagen peptides (PETAGILE®)
• Added beta-1,3/1,6-glucans
• Increased chondroitin level and removal of glucosamine

At the update of SPECIFIC CJD Joint Support, already existing supportive characteristics were maintained:

• Moderate energy density
• High level of omega-3 fatty acids from marine sources (fish meal, fish oil and Krill)
• Increased levels of antioxidants
• Ample supply of manganese

Comparison of SPECIFIC CJD Joint Support with other commercial diets in the vet channel for nutritional support of healthy joints and mobility in dogs

When compared with the other dry joint diets SPECIFIC CJD Joints Support has:

• The highest level of omega-3 fatty acids EPA & DHA
• One of the lowest energy densities - Except for Hill’s Metabolic & Mobility, SPECIFIC CJD Joint Support has – together with Hill’s j/d reduced calorie and Virbac HMP Joint and Mobility- one of the lowest energy contents.
• The highest level of GAGs (sum of glucosamine and chondroitin sulphate)
• On top of outstanding levels of EPA & DHA, energy density and GAG-content, SPECIFIC CJD Joint Support also contains additional beneficial components that contribute to the support of healthy joints:
  • Hydrolysed collagen peptides
  • Beta-glucans
  • GLA (gamma-linoleic acid)

Overweight is an important risk factor for osteoarthritis and it has been shown in several studies (Impellizeri et al. 2000, Mlacnik et al. 2006 and the SPECIFIC field study on weight reduction of obese dogs with SPECIFIC^TM CRD-1 Weight reduction) that weight reduction in overweight dogs with OA can significantly improve clinical signs. It is therefore very important that this dog will reduce body weight until an ideal body condition score is reached. If a dog is very obese, weight reduction will be most effective when using SPECIFIC^TM CRD-1 Weight reduction (energy density 1334 kJ/100 g). If the dog approaches its ideal weight, it can be switched over to SPECIFIC^TM CJD Joint Support (1568 kJ/100g).

If a dog with OA is slightly overweight (up to approximately 10-15% overweight), it can be switched to SPECIFIC^TM CJD Joint Support immediately and reduce body weight on SPECIFIC^TM CJD Joint Support (in the table with the feeding advice on the package and in the handbook, there is also a column for weight reduction).

SPECIFIC^TM CJD Joint Support is positioned as a complete diet which supports healthy joints and mobility in adult and senior dogs. It has a moderate energy density, and high levels of EPA, GAGs and antioxidants for optimal support of healthy joint. Osteoarthritis (OA) is a common problem in dogs, affecting 20% of the adult dogs. Although the prevalence of OA increases in elderly dogs, OA is also commonly seen in adult dogs which have not reached the senior age yet. The dietary phosphorus and protein level in SPECIFIC^TM CJD Joint Support is not very high, but not reduced to the levels as in SPECIFIC^TM CGD Senior. The phosphorus and protein levels in SPECIFIC^TM CJD Joint Support are not that far reduced, since the diet will also be positioned for adult dogs with OA. The diet has however several characteristics which are beneficial for senior dogs in general; a moderate energy density to prevent obesity, high levels of fish oil to support kidney function and skin and coat and high levels of antioxidants to scavenger increased levels of radicals. If a senior dog is healthy and has no increased risk on joint problems, then it can be advised to feed SPECIFIC^TM CGD Senior. For senior dogs with joint problems or an increased risk on joint problems, SPECIFIC^TM CJD Joint Support will be preferred. Whenever a senior dog has a reduced kidney function, the preferred diet will be SPECIFIC^TM  Heart & Kidney Support, if kidney function gets seriously reduced. For dogs with a combination of kidney failure and joint problems, there is a clear preference for SPECIFIC^TM Heart & Kidney Support, because the high level of fish oil in the diet will also have beneficial effects on the joints. For kidney patients a reduced P level in the diet is essential.

Multi disorder cases like this cannot be easily managed nutritionally. The major consideration will be to balance the acuteness and risk of the different disorders with the possibility of nutrition to make a difference.

In this case most attention should be given to the kidney disease and pancreatitis: Life expectancy of kidney patients has been shown to be considerably affected by a diet with low P and reduced protein. Low protein diet is also recommended for liver disease. Pancreatitis calls for moderate dietary fat and protein levels for minimal stimulation of the pancreas. (Rule of thumb for dogs: Fat level of 10-15% on dry matter basis and protein 15 -30% DMB.)

Arthritis, though painful, is not life threatening, but closely connected into a vicious circle with the overweight. Both will improve if the dog loses weight and gets dietary GAGs and high levels of omega-3.

Struvite problems in dogs are very often caused by urinary tract infections, so this should be investigated prior to any dietary considerations.

Unfortunately the kidney diets are somewhat too high in fat to meet the guidelines for pancreatitis (CKD 17.5 and CKW 16.4% fat on DMB).

In the list of suitable dog diets for pancreatitis (fat and protein in requested range), some diets could be considered (CGD 13.4 g protein/MJ, P=0.35 g/MJ), CDD protein 10.1 g/MJ and P 0.34 g/MJ), but in fact these P levels are still quite high compared to the kidney diets (0.16 g P/MJ).

DIETARY RECOMMENDATION:

Since there is no single ideal diet for this case, it is recommended  to adapt the kidney diets somewhat by mixing them with CGD (low fat, relatively low P and protein diet) or with cooked rice (providing primarily carbohydrates, thus reducing the % of protein and fat in the diet). A benefit of using CGD is that this is also a complete diet- so all nutrients are present in sufficiently high amounts. Benefit of using the rice is that you can get to some lower P levels, but also other nutrients are somewhat diluted (not expected to cause  problems caused by this), however by using a mix with CGD the level of omega-3 levels remains higher which is beneficial for kidney and joints.

Just evaluate which recipe looks best for this individual dog (dependent on breed size, price preference for CKD versus CKW – or palatability)

Mixing CKW with CGD-M:

Mix per 100 g CKW 20 grams CGD_M

This mixture will contain 11.2 g protein/MJ and 0,23 g P/MJ. Protein = 18.9% on DMB, Fat = 13.7% DMB. Feeding advice: give 61% of recommended feeding amount of CKW (feeding table) and add 20% of this amount as CGD

(example: 14 kg dog: CKW recommendation is 660 g/day (feeding table). Thus give 61% = 400 g CKW and mix this with 0.2*400=80 g CGD-M)

Mixing CKD with CGD:

Mix per 100 g CKD 75 grams CGD-M

This mixture will contain 10.3 g protein/MJ and 0,23 g P/MJ. Protein = 16.9% on DMB, Fat = 14.2% DMB. Feeding advice: give 60% of recommended feeding amount of CKD (feeding table) and add 75 % of this amount as CGD

Mixing CKW with cooked rice (weight of rice = weight after cooking)

Mix per 100 g CKW 30 gram cooked rice

This mixture will contain 8.7 g protein/MJ and 0.14 g P/MJ. Protein = 14.3% on DMB, Fat = 12.6% DMB. Feeding advice: give 78% of recommended feeding amount of CKW (feeding table) and add 30% of this amount as cooked rice

Mixing CKD with cooked rice (weight of rice = weight after cooking)

Mix per 100 g CKD 85 gram cooked rice

This mixture will contain 7.7 g protein/MJ and 0.14 g P/MJ. Protein = 12.7% on DMB, Fat = 14% DMB. Feeding advice: give 82% of recommended feeding amount of CKD (feeding table) and add 85% of this amount as cooked rice