Saturday, September 16, 2017

Evaluating Nutrional Research for Pets by Meg Smart DVM, PhD

 How to Evaluate Nutritional Research
The design of the nutritional study determines how significant or relevant the tested diets are in caring for a pet with a specific health problem. The following research designs are listed in order of importance (4). ( http://library.downstate.edu/EBM2/2100.htm ). These have been modified from the original to be applicable to veterinary clinical nutrition .

These guidelines provide both the consumer and the veterinarian with a set of criteria to critically evaluate the research associated with veterinary medical foods and determine if the product is truly efficacious.
Level 1: Randomized Controlled Studies
A group of similar animals housed under the same conditions are fed diets, over the same time frame, one a control diet and the other(s) is(are) intentional modifications of that diet.
In most trials, the animals are randomly assigned to 'control' and 'treatment' groups. Predetermined timed clinical examinations of the animal, and tests measure the clinical and metabolic response of the animals to these diets. The results are then analysed by what is considered to be the most appropriate statistical programme, the results are interpreted and conclusions drawn. Many variations of these trials exist. To eliminate biases, the most common are blind studies where the people who are feeding, collecting and analyzing the data are not aware of the status of the diets.
Level 2: Prospective Studies
In a prospective study, pets with a specific problem that meets a specific set of clinical signs and metabolic changes are selected. These patients are divided into several groups and specific diet(s) are fed. Changes in their clinical and metabolic condition are monitored over a set period using predetermined clinical and analytical criteria established in the research protocol. A control diet or control group may be included. These are pets and are not kept for the trial period in a research facility but at home, so patient/owner compliance becomes an issue.
Level 3: Retrospective Studies
Retrospective studies are common in companion animal nutrition; these studies utilize the owner's recall of events and the medical records of a group that has a similar condition. The history and records are analyzed to determine if common threads are present within this information that can lead to problem identification, associated risk factors. Conclusions are then drawn and eventually solutions found. Formally, these are epidemiology studies and are by far the cheapest to do.
Level 4: Third Person Research
A knowledgeable individual or a group of specialists review, interpret and summarize pertinent published literature on a particular topic. Conclusions are drawn and recommendations made. The findings are published in a Journal as a review article or books. The 2006 NRC nutrient requirements for dogs and cats and the AAFCO nutrient profiles for Dogs and Cats used by the industry to define and develop "complete and balanced" diets are examples of this type of research. "Cooperate biases" can strongly influence literature selection.
Most of the industries preliminary formulations and diets were done using this method. A successful diet or marketing strategy provides the financial resources for further product development.
Level 5: Case-Control Studies
For these studies, the histories of patients with a certain condition are compared to those without that problem. In veterinary medicine, the researcher is dependent on the owners to provide a reliable history for both the study and the control group. Once enough cases are collected and similar results found, the researcher may write a review article following a scientifically proven path, design a prospective, or a retrospective study to support the case findings. Randomized control studies are the next level up where the hypotheses are made from the previous studies and tested in a more controlled environment.
Level 6: A Series of Case Reports or A Single Case Report
These are generally the first step in developing a research hypothesis. They represent a case or a series of cases that are unique and respond to a particular diet. If these are not published as case reports, they are regarded as antidotal evidence and of limited value. These are considered the lowest level of validation.
Level 7: Educated Ideas, Editorials, Opinions
Although not regarded as scientifically sound, initially most veterinary diets were developed and marketed based on these criteria.
For Example In The Beginning:
Hill's Pet Food Company: http://www.hillspet.com
"A company inspired by a guard dog"
In 1939, Dr Mark L. Morris Sr. believed certain diseases in pets could be managed through carefully formulated nutrition.
Iams Company: http://www.iamsco.com
In 1946, Paul Iams, an animal nutritionist, started the company in a small feed mill near Dayton Ohio. His aim was to formulate a diet better than that available in grocery stores.
Nestles Purina: http://www.purina.com
Founded in 1893 by William H. Danforth, a pioneer in the commercial feed industry. His idea was that animals must eat year round. In 1926, Purina developed diets for the hunting and working dogs of their rural clients. In 1950, Danforth started to apply the knowledge of farm animal nutrition to the development of a highly nutritious and palatable dog food sold through grocery stores. In 1957, Purina Dog Chow entered national distribution.
Mars Inc. (Master foods): http://www.mars.com
"Every day a new idea"
One of the largest "small family businesses" in the world. Founded by Frank Mars in 1911, who with his wife Ethel started to sell butter cream candies from their home in Tacoma, Washington.
In 1930, Forrest Mars pioneered the development of the European pet food industry combining modern manufacturing techniques with nutritional science.
Unfortunately the way that these multinationals have set up their pet food branches, the consumer still thinks of them as a small family run business and not as part of a large multinational conglomerate.
Validation of Research
Within the scientific community, none of these research trials is considered valid unless published in a forum that requires peer review and approval prior to publication. This process relies on the integrity and policies of the Journal's editorial board and the reviewers. To accomplish this can take considerable amount of time.
"Cooperate biases" can weaken the validity of nutritional research by promoting studies with a positive effect and ignoring those showing a negative trend or by amalgamating several weak positive studies to produce one strong positive result. Another concern is if the company's Research and Development division is interested in supporting a particular conclusion, studies showing negative results may be excluded. Positive trends rather than statistically sound results are cited as positive research in support of a diet's formulation and efficacy. In order to properly evaluate companies' research, the reader must be satisfied that "cooperate bias" did not exist in the formulation or in the marketing of a veterinary medical food. This may be almost impossible to determine from the information provided by the company.
Confidentiality dictates what research supported by Pet Food Companies is published in peer-reviewed journals. They also bypass this step by holding or sponsoring conferences/symposiums and publishing fact sheets where non-peer reviewed research and the preliminary results of research studies are presented.
Resources: This List is Just a Start and Not Exhaustive
1.  www.learndebating.com
The beginners section of this on-line manual will help you develop and structure your arguments and rebuttals.
2.  Websites and contact persons affiliated with the pet food companies:
These can give you the products they make and the promotional materials they use and if contacted directly they may also give you references in the literature that supports the claim they make in the promotional material and on the bags.
3.  AAFCO: www.aafco.org
This is the organisation that advises government (Federal and State) regulatory bodies on what regulations should be in place.
4.  NRC Nutrient requirements of Dogs and Cats
5.  The Canadian Association of Raw pet food manufacturers: www.carpfm.ca/ and the North American raw pet food associationwww.rawpetfood.org/. These groups act as advocates for raw foods.
6.  The Pet Food Institute: http://www.petfoodinstitute.org/petfoodhistory.htm
The voice of the Industry
7.  The Pet Food Association of Canada pfac.com
8.  American holistic veterinary medical association
9.  The Pet Food Industry magazine on line
11.  CFIA
12.  FDA
13.  The Omnivore's Dilemma
14.  Not Fit for a Dog: The truth about manufactured dog and cat food. In WCVM library.





 Summary

Some of the problems associated with Companion Animal Research:

        difficult to standardize/ finding controls/

         Research is expensive

          Animal Care /humane treatment/ non invasive

         duration  critical/ six months or over a life time

         open to interpretation/ statistics

         NRC  vs AAFCO vs "the prey diet"



ssible information that would allow them to make the best food choice for their client’s pets; thus,



Summary:

         Difficult to standardize/finding controls

         Appropriate data collection/ none invasive

         Research is expensive

          Animal Care /humane treatment

         duration  of the trial is critical

         Results are open to interpretation/ statistics

         NRC  vs AAFCO vs "the prey diet

My 50 Year Career as an Academic Teaching Veterinary Students: What Nutrition Means!

Not Fit For a Dog
Marion Smart DVM PhD

I am privileged to be a co-author of “Not fit for a dog! The truth about manufactured dog and cat food.” This book opens a new and exciting chapter in my academic career as veterinary clinical nutritionist. I have always been an academic and I would like to share with you my background and my thoughts about nutrition, the pet food industry, the veterinary curriculum, and our profession.
Nutritional education of veterinary students has changed very little over the last 40 years with the primary emphasis being on food animal production and feed stuffs. At the same time, the demographics of our students and society have changed from rural males to urban females. In keeping with these changes, the veterinary curriculum has adapted to the shifting demographics and the advances made in pharmacology, traditional medicine and surgery. Yet in most veterinary colleges, small animal nutrition is subsidized by — if not wholly dependent on — lectures, brochures, pamphlets and samples from major pet food manufacturers.  

My journey into small animal nutrition began with a study into the link between nutrition and metabolism, specifically an autosomal recessive genetic condition of Chondrodysplasia in Alaskan Malamutes. A new, exciting, winding, backtracking career path was born. My journey continued after receiving my PhD in beef cattle nutrition followed by my development of a small animal nutrition elective - one of the first to be offered in North America. I involved all the major pet food companies and they in turn wined, dined, and educated me about their products.  Alternative nutrition and homemade diets were not a consideration except as a taboo topic, and I was just doing what I had been taught.

However, all of that changed at a kennel club talk on small animal nutrition where I was introduced to the BARF diet after a couple threatened to leave when I started the usual rant about the evils of alternative diets. They talked with passion and with obvious nutritional knowledge about their kennel of imported German Shepherds and their 15 years of feeding raw diets. Although not published in a scientific, peer-reviewed journal, their arguments could not be ignored. So began my journey into thinking critically about how we feed our pets.

In 2001, because of an apparent epidemic of anterior cruciate ruptures in young, large-breed dogs I decided to investigate puppy diets - especially large breed diets and their claims. I found that if the owner followed the manufacturers recommended daily caloric intake calcium intake would be marginal in 30% of the diets, manufactured by three of the four major pet food companies. A reduction in the manufacturers’ suggested caloric intake by 25% resulted in 22% of the diets being deficient in Ca when fed from two months to nine months of age. When I presented this information to the companies, they offered no real explanation other than that the Guaranteed Analysis did not reflect what was in the actual diet, and owners seldom followed the feeding recommendations. They also claimed that all the diets met AAFCO standards in formulation and through feeding trials. All the diets are 1.5 times above the recommended daily allowance for fat and yet meet the recommended daily allowance for protein, so if a veterinarian restricts the caloric intake, the protein, calcium and phosphorous intakes could be compromised.

The major assignment I give to my elective students focuses on a critique of veterinary therapeutic diets and a critical evaluation of the science behind these diets. To evaluate their findings I took a sabbatical leave to do a critical evaluation of veterinary therapeutic diets and the research supporting the claims made by manufacturers. While a number of the claims were unsupported or universal to all diets, other claims were based on biased research financially supported by the manufacturer.  Rather than being peer reviewed the results were often presented or published at the Company’s annual symposium and proceedings. The companies are aware of this weakness and peer reviewed research papers are now being published. Veterinarians must be trained to evaluate critically these papers as the diet formulations and ingredient lists are often lacking or may not be similar to those of the commercial diets

 Convinced the veterinary profession lacked a clear understanding of the pet food industry, I, along with an independent nutritional consultant, Jack Mills DVM MSc, and a marketing specialist, Cory Haggart, wrote the paper: The Pet Food Industry: a Necessary Review for Veterinarians. At the invitation of Paul Pion, this paper was  published as a discussion paper on the Veterinary Information Network (VIN) and formed the focus of a on-line VIN continuing education session on small animal nutrition with an attendance of over 250 (ZNUTR101-0807 Current Issues in Small Animal Nutrition )

What we discovered is that two diametrically opposed views exist today on how capable or knowledgeable a veterinarian is in providing their clients with nutritional advice:

The first is commonly held by the pet food industry, government regulators, the veterinary professionals who work for them, and passively by most veterinarians. This view is that the pet food industry, through its commitment to pet health and nutrition, is providing the public and veterinary profession with regulatory standards, diets, and nutritional information based on the latest research and best knowledge available.  Accepting this, the veterinary profession endorses their products without question.

The second view is supported by some veterinarians and a rising number of pet owners and small pet food producers. This view maintains that the pet food industry has wooed the veterinary profession through sponsorship, allowing this industry to frame the discussion on nutrition while gaining credibility from the profession as an unbiased provider of nutritional education. In this view, veterinarians are considered poorly trained in nutrition and yet are respected by the public as guardians of their pets’ health and welfare. Veterinarians and veterinary associations actively market individual pet food products because they are controlled by the industry. Some proponents even go as far as claiming that a conspiracy exists between the two. In the meantime, the pet food industry has been able to convince the regulators that scientific nutrition is impossible to provide and that the current compromises are sufficient, while convincing the public that this compromise is in fact the best choice for them and their pets.

Both views vary to different extremes, with adherents to the first view pointing to evidence of increased longevity of canine and feline pets over the years as proof of the pet food industry’s success. The second group points to the widespread health problems that may in fact be caused by diet. Unfortunately, the two sides of this argument leave the veterinarian in the middle, as the supposed holder of the truth and as the scapegoat.

After completing the paper in January of 2007, the menu food recall came into effect. Veterinarians and pet owners across the world came to the realization that the pet food industry was not as regulated as perceived. For the sake of profits, they were sourcing apparently high quality but cheap ingredients in a global market. They used private label companies for products we thought they alone manufactured. This quest for increased profits came at our pets’ expense.

After this recall and subsequent ones, it became apparent that veterinarians must provide detailed and scientifically proven dietary advice. To accomplish this, veterinarians must understand both the current scientific, commercial, and regulatory environment surrounding nutritional claims. Armed with this information, practicing companion animal veterinarians will be able to give better advice to their clients and research veterinarians may be able to better identify the numerous gaps in our current knowledge and discern how we can move forward.

Our book “Not Fit for a Dog” addresses these issues by utilizing the unique perspectives and experiences of each author.

Dr. Michael Fox is well-known internationally as an author and columnist for the Washington Post. He supports the superior nutritive value of organically certified produce, both plants and animals. He questions the safety of the antinutrients in genetically modified soy and corn and the presence of glycophosphate and glucosinolate residues in herbicide resistant crops. He has concerns about some of the “crazy stuff” being done to animals to make them ever more supportive of our increasingly pathetic, pathologically degenerate conditions.

Dr. Elizabeth Hodgkin’s is a lawyer and veterinarian who has a life-long interest in cats, their nutrition and health. She is an author of “Your Cat: Simple New Secrets to a Longer Stronger Life”. Her basic message is that veterinarians have not done due diligence about commercial pet foods and neither have governments. As a result, our profession has become unwitting purveyors of often-substandard foods we would never endorse if we had all the information.

I have chosen to dedicate my career to academia, which is not really the sheltered utopia or ivory tower that those working in the “real world” think; in fact, it is much better! We are responsible for shaping the careers of future veterinarians and of the profession, a responsibility we do not take lightly. Unfortunately, little progress had been made incorporating nutrition and alternative medicine into the core curriculum. These fields are often taught as electives by interested faculty or the pet food industry (nutrition).

Many opponents of the pet food industry advocate that they should not be allowed access to veterinary students. My belief is that veterinary students should be trained to be critical of the industry and it is best to expose them rather than deny them the opportunity to form their own opinions. It is my responsibility as an academic to give the students the knowledge and tools to be able to determine fact from fiction, or science from non-science. It is my hope that they will become knowledgeable consumers and challenge the industry rather than to accept, without question, what the industry is telling them.

Major pet food companies influence the veterinary schools by offering free or cheap food to the students and for resale through the veterinary teaching hospital. These same companies offer free educational programs to the students and much-needed research funding. Independent or public funding for small animal clinical nutrition research is scarce unless the research involves an animal model for human nutrition. The independence of our professional associations is compromised by financial sponsorships of conferences and partnerships. The schools and associations need this support but the money should go into an independent fund and upon application dispersed by an independent professional panel, similar to The Canadian Orthopaedic Association.

Dogs and cats have been intimately associated with the human food chain since dogs as scavengers lived off scraps and cats found a reliable source of rodents in mans’ stored winter food supplies.  Now by utilising by-products from the agricultural and human food industry the pet food industry claims they have diverted waste from landfills and are producing a value-added product. As global demand increases for the primary products, more by-products will become available. Unfortunately, with rising fuel prices and the emergence of bio-fuels the cost of these by-products is escalating.

The June issue of National Geographic features an article on the looming or present global food crisis. The article indicates that we are in need of another green revolution as the past green revolution has seen our rain forests destroyed to grow food, fuel and cosmetics. Our aquifers are being depleted through irrigation, and our remaining water supplies contaminated with pesticides and herbicides. Inappropriate irrigation has caused soil salinization. High-yielding, dwarf varieties of grains, genetically modified corn, and soybeans all require synthetic fertilizer, chemical pesticides and herbicides to maintain optimum yields. As a result, our soils are depleted of nutrients and organic matter, which decreases long-term productivity and sustainability. With rising crop input costs there is a global decline in crop yields. The demand for milk, meat (animal and fish) and eggs has seen the growth of aquaculture, factory farms and feedlots. Pigs, once considered an important part of sustainable agricultural practices or mortgage lifters, are now raised on large industrial farms, genetically selected for rapid growth, and fed a computer-generated mixture of corn and soybean meal and supplements. Over the next 20 years, China will require more than two hundred million hogs to keep up with demand. Where is the grain necessary to raise these pigs going to come from?

The First World Agricultural Forum and Asian Round Table (March 2009 Thailand) gathered global leaders in agriculture who are committed to both innovation and positive change to address the growing need for food, fuel and fibre. The sponsors of this Forum were:
·       Novus International a global leader in science based health and nutrition solutions whose mission is to “feed the world affordable wholesome food”
·       Monsanto Company committed to producing more food per acre  while conserving the world’s natural resources
·       NSF CMi leading international food safety and assurance company
·       Liuhe Group Co. Ltd involved in feed manufacturing, meat processing , animal breeding , veterinary drugs and biology products

What will this crisis in feeding our population mean to the pet food industry, which is becoming more sophisticated in diet formulation (Nutrigenomics) and in the marketing of its products to a growing number of pet owners? Pet food as a value added product will have globally more by products available that are not suitable for the human food chain. Many of these will be from the factory farms and genetically modified crops, which may enhance or alter the nutritive value. Pet foods that are not value added will be in direct competition the human’s need for food. The whole food pet diets will only be profitable locally where there is a surplus of ingredients that are too expensive to transport to where a human need exists.

A veterinarian must be educated about the industry and nutrition in order to critically evaluate the diets they are recommending to their clients As a practicing clinician the veterinarian will be too busy to do extensive product evaluation and comparisons, but this can be done in an academic setting were the student is taught the definition of nutrition. Nutrition is physiology, biochemistry, pathology, toxicology, pharmacology, medicine and surgery. Nutrition is the very essence of being.

As a final note, I am often asked, “What do I look for in an ideal pet food?
·       Honest advertising and promotional materials no embellishments
·       Companies that have knowledge of nutrition and nutritional requirements and the ability to apply these principles to product development
·       Offer full disclosure as to the source and proof of the quality of their ingredients
·       An open door policy when it comes to inspection or plant tours by the lay public
·       Have quality control procedures in place to insure nutritional quality and the safety of the foods they are manufacturing
·       Have labels that can be used to evaluate the nutritional adequacy of the product i.e. energy density and average or actual analysis rather than the guaranteed analysis.
·       Source their ingredients as close to home as possible and offer full disclosure as to ingredient sources.


Tuesday, March 7, 2017

Nutrition: Is it Directed by Modern Science, Ancient Code or Both? Meg SmartDVM, PhD


To understand nutrition a nutritionist must keep an open mind and be familiar with many of the disciplines that impact on or are influenced by nutrition. The following is an incomplete list:
·       Soil and plant sciences
o   Factors that impact on nutrient availability
·       Animal science:
o   behaviour
o   environment, climate, housing
o   water quality and supply
·       Veterinary Medicine
o   livestock and pet wellness
o   toxicology
o   immunology
o   physiology and patho- physiology  
·       Cellular  biology
·       Microbiology
·       Genetics

The following definitions apply to the topics that I will be covering in this paper (These definitions with much more detail can be found in Wikipedia):
·       Epigenetics:
o   “Functionally relevant changes to the genome that do not involve a change in the nucleotide sequence. Examples of mechanisms that produce such changes are DNA methylation and histone modification, each of which alters how genes are expressed without altering the underlying DNA sequence. Gene expression can be controlled through the action of repressor proteins that attach to silencer regions of the DNA. These epigenetic changes may last through cell divisions for the duration of the cell's life, and may also last for multiple generations even though they do not involve changes in the underlying DNA sequence of the organism instead, non-genetic factors cause the organism's genes to behave (or "express themselves") differently”

·       Nutrigenomics:
o    the scientific study of the interaction of nutrition and genes, especially with regard to the prevention or treatment of disease
o   is the study of the effects of foods and food constituents on gene expression
·       Metabolomics:
o   The scientific study of the set of metabolites present within an organism, cell, or tissue.  
o   is the "systematic study of the unique chemical fingerprints that specific cellular processes leave behind"
o    The metabolome represents the collection of all metabolites in a biological cell, tissue, organ or organism, which are the end products of cellular processes
·       Generational effects of nutrition
All natural ecosystems experience variability in food availability necessitating organisms to adapt to these times of shortages through phenotypic plasticity depending on the life stage involved especially during a juvenile state and can cause irreversible changes in them in adult hood or even further into the next generation.
·       Nutriepigenomics:
Is the study of food nutrients and their effects on human health through epigenetic modifications. There is now considerable evidence that nutritional imbalances during gestation and lactation are linked to non-communicable diseases, such as obesity, cardiovascular disease, diabetes, hypertension, and cancer. If metabolic disturbances occur during critical time- windows of development, the resulting epigenetic alterations can lead to permanent changes in tissue and organ structure or function and predispose individuals to disease