Friday, February 17, 2012

Client Information: Nutritional Support for a Pet with Cancer



This Article was written by Meg Smart for the Keeshound Journal Febuary 16th /2012


For Client Information in consultation with their Veterinarian


Tumours require nutrients to grow, the host requires nutrient to maintain their quality of life, and this immediately creates a conflict within the body. Some basic questions arise from this conflict. Can we through nutrition:


  1. Slow the growth or starve a tumour?
  2. Make the tumour more sensitive to our therapies?
  3. Modulate the immune system to control or eliminate the tumour?
  4. Neutralize free radicals without compromising the effectiveness of some treatments?

Cancer can change the host’s metabolism by directing nutrients for its own use thus starving the host resulting in the loss of muscle and fat (Cancer Cachexia) [1]


The most profound changes are seen in carbohydrate metabolism[2]. A variety of malignancies utilize glucose through anaerobic glycolysis as a source of energy. Lactate is the resulting end product which the host then must use energy to convert it back to glucose. To sustain this need for glucose the glycogen stores in the liver are rapidly depleted; then the protein stores (gluconeogenic amino acids) in the muscle are utilized and finally the fat stores depleted. One of the first clinical signs is a loss of the muscles in the forehead.


Objectives of Nutritional Therapies
Nutritional recommendations will vary during the course of the disease. The goal of nutritional therapy is to maximize the quality of life by:
  1. Preventing or reversing nutritional deficiencies
  2. Preserving or restoring lean body mass
  3. Helping to better tolerate treatments
  4. Minimizing treatment related side effects and complications
  5. Maintaining the pet’s strength and energy
  6. Protecting and supporting the immune function
  7. Aiding in tissue repair
Classifying Tumour Related to Nutritional Intervention


Numerous ways are used to classify tumours but for nutritional intervention for pets, I like to use the following which is based  on a human model [3].  Nutritional advise should be given on an individual bases hopefully to improve quality of life and be compatible with or supportive of the treatment.


Group 1: Dogs with active cancer and/or during the treatment associated with:


  • Alterations in haematology and blood chemistry
  • Loss of lean body mass and fat
  • Anorexia and gastro-intestinal signs


Group 2: Dogs recovering from cancer treatment but still have some of the above metabolic changes in Group 1


For these dogs, the goal is to preserve the lean muscle mass and the subcutaneous fat stores. Initially some form of a concentrated protein and fat supplement may be necessary with a 3:1 ratio of Omega 6: Omega 3 fatty acids , with L-arginine, cystine and glutamine added. Aggressive treatment therapies require aggressive nutritional management.


Group 3: Dogs can return to a diet formulated to maintain the quality of life and to minimize further tumour development and growth when:


  • Haematology and blood chemistry panels remain within the normal ranges
  • No clinical signs
  • Loss of fat and lean body mass is stable
Changes in renal, liver, endocrine, or pancreatic function will have to be handled on an individual basis


Whole Food Ingredients vs. Commercial Pet Foods


If you decide to treat your pets with cancer the dietary needs should be discussed with your veterinarian. The information in this article will help you find an appropriate diet. Initially, getting the pet to eat is more important than feeding a “complete and balanced” diet. Try any of the pet’s favourite “table scraps” these must be healthy high in protein and fat with only complex carbohydrates as found in potatoes, squash, or corn. Overly processed foods and treats should be avoided. Small frequent meals throughout the day are advised.


The ingredients in commercial diets canned, kibble, baked or semi moist can be heat processed twice, once during the production of the ingredient and once during the making of the diet. Ingredients labelled meals e.g. Poultry meal, poultry by-product meal are rendered products from the slaughter plants (subjected to high temperatures where the fat is  extracted and the remaining  solids then dried and ground into a meal. Chicken fat, pork fat, and other animal fat sources are also a by product of this process. These fats are vulnerable to peroxidation if anti oxidants are not added at the rendering plant. Vegetable fat is often recycled restaurant oil from deep fryers loaded with trans fats. While benefits can be derived from heat processing, such as the destruction of pathogenic bacteria, improved digestibility and taste; anti nutritional and toxic compounds can also be produced.


Commercial Kibble Recommendations


The major protein, fat and carbohydrate sources should be present in the first five (5) ingredients listed..All the protein sources should from animal origin. They should be added whole and not as pre-processed by products for example:
  • Meat/chicken, meat/chicken by-products not meat/chicken/by-product meals


Whole foods: 
  • Liver, eggs 
  • Whole grains, wheat, oats, barley, corn etc. not flour, brewer’s rice, corn flour 
  • Whole vegetables, not pomace or dehydrated
Fats are a problem as fat is generally sprayed on at the end of the manufacturing process along with heat sensitive amino acids and vitamins. These fats are generally the by-products of the rendering industry. The fat sources should be identifiable  such as pork, chicken, and beef fat


Other Commercial Diets


Raw Food Diets
These diets contain unprocessed whole ingredients that are similar to a dog’s primitive or natural diet. Some are balanced to AAFCO’s minimum and maximum nutritional standards, others the nutrient intake is balanced over time. If the dog is neutropenic or showing signs of immune suppression, these diets can be cooked. Appropriate hygienic precautions must be taken when handling and feeding raw foods.


Dehydrated or Freeze dried Diets
The meats sources are often cooked prior to final processing but the vegetables are mostly raw. Bacteria can still survive in the meat or vegetable components. These foods can also be cooked before feeding.


 Recommendations for Whole Foods or Homemade Diets:
Protein sources with a high biological value are recommended. Arginine, glycine, cysteine and glutamine may be of value therapeutically and are abundant  in fresh meat Whole grains contain the germ, bran and endosperm and are not refined. Whole grains are rich in fibre (soluble and insoluble), vitamins, minerals, antioxidants, phenols, lignans, phytoestrogens and saponins. Forty studies were combined and the risk of cancer was reduced 34% in people who ate large amounts of whole grains compared to those that ate very little[4].


The “red family” are a group of fruits (tomatoes, watermelon, pink grapefruit, papaya and pink guava) that contain a Carotenoid lycopene and other similar compounds that are potent antioxidants with anti cancer potential. These compounds are released upon processing.[5].


Soy foods such as tofu, soymilk, soybeans, miso, tempeh, soy burgers and soynut butter contain isoflavones, saponins, phenolic acid, phytosterols, and protein kinase inhibitors which appear to have anticancer effects. Soy products tend to produce flatulence  which may be reduced by “Bean O” drops on the food prior to feeding. [6]


Garlic or the Alliums family (onions, leeks, scallions) contain many anti cancer substances. These compounds have been shown to slow or stop the growth in tumours of the prostrate, bladder, colon, stomach, and lungs. [7]  Unfortunately onions can be toxic to dogs.


Flax seed[8] contains lignans (phytoestrogens) which mimic estrogens in the body. The oil does not contain lignans but an Omega 3fatty acids alpha-linolenic acid (ALA) which is converted in the body to Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA).A debate exists as to the site where DHA is manufactured by the dog, if at all. If DHA is available in the dog it’s likely produced by the tissues that utilizes it. Fish Oils can oxidize rapidly and become rancid. Cold water fish contain EPA and DHA.  Other oils Omega 6 fatty acids linoleic (LA) and gamma-linolenic (GLA) are found in evening primrose, borage and black current oils. Conjugated-linolenic acid (CLA) is found beef fat and dairy products.        


Dark green leafy vegetables are excellent sources of fibre, Folate, and numerous Carotenoids such as lutein, and zeaxanthin, along with saponins and flavonoids. These are potent free radical scavengers[9].


Cruciferous vegetables are broccoli, cauliflower, cabbage, Brussels sprouts, book Choy and kale. Glucosinolates (isothiocyanates), crambene, and indol-3-carbinol are all linked to a lower cancer risk for many type of cancer. These vegetables have beneficial effects on cellular metabolism.[10]
Berries are a good source of fibre and Vitamin C. Strawberries and raspberries rich in ellagic acid. The mode of action is twofold as they deactivate specific carcinogens and slow the reproduction of cancer cells. Strawberries contain flavonoids and blueberries contain a potent antioxidant, anthocyanosides [11]
Beans or legumes (seeds) the active anticancer compounds are saponins, protease inhibitors and phytic acid. Beans are also rich in fibre. In the laboratory saponins inhibit reproduction and the growth of cancer cells. Protease inhibitors block the proteases produced by tumours to destroy nearby cells. Phytic acid can slow the progression of tumour calls. [12]
Aloe Vera plants contain a glycoprotein Acemannan a glycoprotein which increases the body’s production of immune-modulating chemicals


What to look for in a cancer diet:


In a Commercial Diet
  • All animal, poultry, fish based protein ingredients, no plant based protein sources
  • A Guaranteed Analysis of :
    • In a Kibble:   
      • Protein % no less than 60%
      • Fat % no less than 35%
      • Carbohydrates % no more than 5%
    • In a canned food: 
      • Protein % no less than14%
      • Fat% no less than 8.5%
      • Carbohydrates% no more than 1.2%


 A Homemade Diet


Protein and Fat 69% of total diet


1 cup whole milk small curd Cottage cheese (145g)                          


1 large egg (with shell) hard boiled (50g)


100 gm chicken liver lightly sautéed


200gm chicken breast meat with cartilage chopped cooked


½ c raw firm tofu (calcium sulphate) (126g)


Total: 621g or 69%


Protein/ Fat substitutions:


Red meat fat not trimmed for liver, chicken, ½ tofu = 262g


Yogurt for cottage cheese


Liver and kidney other species for chicken liver


Add 1 egg in exchange for 50g of another source of protein


Carbohydrate Sources 30% total diet (These are complex carbohydrates)


¼ c ground apple skins and seeds (31g)


¼ c blueberries (37g)


¼ c broccolis cooked (23g)


½ c carrots (64g)


½ c baked sweet potato with skin (78g)


1 clove of garlic (3g)


¼ c winters squash, skin, flesh, seeds (29g)


Total: 265g or 30% total diet


=30%


Carbohydrate Substitution:


Mixed fruit and vegetables plus a citrus fruit must be complex carbohydrates, chose different colours, cooked rice for sweet potatoes





Other supplements***


1 tsp olive oil (4g)


1 tsp salmon oil (4g)


1 tsp ground flax seed (2g)


Total: 10g=1%


Over all totals: 896g


***Can add on a daily bases Juka Organic’s Ground Work and Inside Trac a probiotic (Available this summer)


All ingredients can be ground (chopped) and mixed raw and cooked in loaf trays 350oF for 30 minutes or


Can feed meat raw, grind or coarsely chop carrots, broccoli, apples, blue berries, feed raw, but cook rice and potatoes


Diet supplies 111 Kcal/100gm, 76% moisture, 5.5% Carbohydrates, 12% Protein, 5%fat


How much to feed


If your dog’s ideal weight is 30 kg his caloric intake should be


=[(Body Weight in kg)*30)+70]* adjustment f


if overweight AF is 1 ;want to gain weight factor is 2; maintain weight factor is 1.8.


Assume at ideal weight then he requires approx 670 kcal/d he requires 670/1.11=600-605 gm diet per day


[1] Ogilvie G K, http://www.archive.org/web/20010602233344/http://www.cvmbs.colostate.edu/cancercure/nutrition.htm
[2] Ogilive G.K. Care beyond a cure: Nutrition and cancer therapy; 2009  Proceedings of the 2009 Annual Conference of the AHVMA,:293-303
[3] Nutritional Support in cancer patients: A brief review and suggestions for standard indication criteria. Gerson Peltz 2002. Nutrition Journal 1:1 (http://www.nutritionj.content1/1/1).
[4] Http://www.aicr.org/site/PageServer?pagename=dc_foods_wholegrains
[5] http://www.aicr.org/site/PageServer?pagename=dc_foods_tomatoes
[6] Http://www.aicr.org/site/PageServer?pagename=dc_foods_soy
[7]
Http://www.aicr.org/site/PageServer?pagename=dc_foods_garlic
[8]
Http://www.aicr.org/site/PageServer?pagename=de_foods_flax
[9]
Http://www.aicr.org/site/PageServer?pagename=de_foods_ greens
[10]
Http://www.aicr.org/site/PageServer?pagename=de_foods_cruciferous
[11]
Http://www.aicr.org/site/PageServer?pagename=de_foods_berries
[12]
Http://www.aicr.org/site/PageServer?pagename=de_foods_beans

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