CBD & Hemp: Legal or Illegal?

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In Part I of our CBD Education Series we discussed the history of cannabis, which dates back over 6,000 years! We know that hemp and marijuana are both types of cannabis and that THC and CBD are just two types of cannabinoids out of over 400 that exist within cannabis. Even though we’re waiting for research to catch up to the popularity of CBD, we explored how CBD works and the different types of cannabinoids that can interact with the endocannabinoid system of humans or pets. However, Hemp and Marijuana plants can be highly toxic. We are going to discuss the safety and legality of cannabis In Part II of our CBD Education Series. In addition, we’ll explore the FDA stance, the Farm Bill, CBD commerce, and other safety measures. Maybe a bit boring at face value, but if you use CBD for yourself or your pet it would be wise to familiarize yourself with the details.

Legality & The FDA 

As it currently stands the FDA has not approved a marketing application for cannabis for the treatment of any disease or condition.9Further, based on the Food, Drug, and Cosmetic Act (FD&C Act) CBD is illegal because it is recognized as a drug for human epilepsy. Based on the historical actions of the FDA, its current status as an approved drug establishes a low likelihood of CBD being approved as a supplement or food ingredient, but this has not stopped companies from using CBD in supplements and treats. The FDA is unlikely to enforce this legality if companies eliminate the use of ‘CBD’ on the label and avoid claims such as ‘cures, treats, prevents or mitigates’ a disease or condition. Many companies have complied, but unfortunately, some companies have continued to use ‘CBD’ on the label, and/or make unsubstantiated claims. As a result, the FDA regularly issues warning letters to companies who make these claims.10 In addition, it is important to note that CBD is not legally able to be included as an ingredient in pet food.

dog sleeping on floor

The rules and regulations for hemp and marijuana are different with each having separate statutory definitions:

  • Marijuana typically refers to plants with high concentrations of THC, the psychotropic drug used for medicinal or recreational purposes.1
  • In contrast, hemp is typically cultivated for use in personal care products, nutritional supplements, and fabrics. It contains higher amounts of CBD, which does not have psychotropic properties.3 THC must remain at a concentration of 0.3% or less on a dry weight basis.

The Farm Bill & Decriminalization Clarification

In 2018 the Hemp Farming Act (part of the Farm Bill), decriminalized hemp and lifted the ban on hemp as an agricultural commodity. The act also removed industrial hemp from Schedule I of the Controlled Substance Act (CSA). However, contrary to popular perception, it did not make hemp products, including CBD and activities surrounding their commerce legal11. Marijuana continues to remain a schedule I substance as of the date of this publication.12 As discussed earlier, the difference between these two being that hemp contains a very low amount of the psychoactive compound THC. The move to decriminalize hemp, and allow for responsible use in veterinary medicine is one that many veterinarians support, as many recognize its potential benefit according to a recent survey.3

Without formal regulation and guidance from organizations such as the American Veterinary Medical Association (AVMA) and the FDA regarding CBD use it leaves a lot of unknowns, and potential room for problems. The AVMA has pressed the FDA for regulatory action and clarification citing its potential therapeutic benefit.13  What many don’t understand is that much of the lack of guidance from these organizations has largely to do with a lack of data and research. The FDA currently is working to support drug development from CBD, and actively collect research surrounding its use. The FDA states, as data become available that are high-quality, reliable, and relevant to our evaluation of CBD products that fall under the FDA’s purview, we will be able to refine – and, perhaps in some cases, revise – our thinking and approaches9.

Toxic Cannabis & Phytoremediation

One of the most glaring problems within the hemp and supplement market is the lack of accountability and product adequacy testing. When it comes to toxic screening, cannabis in all form are of concern, because it can be a highly toxic plant. This is because it performs a process called phytoremediation. Meaning that cannabis absorbs heavy metals and many of the agricultural chemicals in the soil such as pesticides, herbicides, and fertilizers. Many companies like to hide behind proprietary when it comes to analysis or ingredient sourcing, however, it’s not an excuse that holds any weight when it comes to the safety of cannabis, period. Fortunately, the National Animal Supplement Council (NASC) works with some CBD companies to help protect against contaminated CBD products and other supplements from entry to the marketplace. In other words, it is wise to avoid pet supplements without the NASC seal. We’ll explain a bit more about the NASC below.

So How is CBD Allowed on The Market?

In short, it’s not – but there is light for use of CBD in pets. In fact, the National Animal Supplement Council (NASC) works in close communication with the FDA to establish quality and safety guidelines for all supplements, including CBD. This non-profit organization indicates that products with its seal are from companies committed to quality, vigilance, and continuous improvement to promote the well-being of companion animals and horses.  Members (manufacturers of pet supplements) must agree to adhere to NASC’s quality standards, part of which includes an independent audit to ensure conformance with quality system requirements. In order to use the NASC seal, members must follow the guidelines of the organization and demonstrate a commitment to responsible conduct in the industry.14

While CBD products are illegal by FDA definition many companies have been able to offer these products to consumers by working with the NASC and following strict policies to produce them. One of the most important aspects of this relationship is the Adverse Event Reporting System. An adverse event (AE) refers to a complaint involving animal health or nutritional supplement linked to any negative event that may be associated with the use of a product. Each member of the NASC is required to investigate and resolve every AE. Additionally, all AE’s must be reported to the NASC each month. This robust system tracks AEs by ingredient and product, with the system and information being available to the FDA14. 

Because of this system the FDA can view and track potential problems and investigate further if needed. Further, if CBD manufacturers do not use the term “CBD” on the label or make claims referring to the cure, treatment, prevention, or mitigation of any disease or condition it is likely the FDA will not enforce the issue at least at this time. As stated earlier, ongoing research projects and results may influence this in either direction in the future.

Summary

Simply put, CBD supplements and other products are not legal. However, since they are already produced and consumed in such high volume without a large number of adverse effects the FDA has eased enforcement of companies operating safely. The same cannot be said for companies who risk safety by cutting corners with sourcing, labeling claims, and/or adequacy testing. The FDA recognizes that CBD manufacturers who are operating in good faith want regulation and they also recognize that the medical communities are seeing positive results for their patients. However, until quality data are available to support claims and benefits it is unlikely the FDA will budge in its formal stance on the issue.

In Part III we will discuss the data that is and is not available for short and long-term CBD use in pets, as well as information on giving CBD to your pet. We will also explore the documented risks of hemp and marijuana in pets, and what to do if you find that your pet has ingested marijuana. Did you miss Part I in the CBD & Hemp series?

About the Author: Nicole Cammack

Nicci is the owner of award-winning NorthPoint Pets & Company, in Connecticut. She is also the Founder & CEO of Undogmatic Inc. Her undergraduate and graduate education includes biology, chemistry, business, and nutrition. She has worked in the pharmaceutical industry on multiple R&D projects and has had the privilege to learn from leading international figures in the human and pet health industry. She regularly lectures at national conferences, including federal, state, and municipal K9 events. Her current research involves identifying pathogenic risk factors and transmission among raw fed pets through a comprehensive worldwide survey.

www.northpointpets.com
www.undogmaticinc.com

References

1. Sawler J, Stout JM, Gardner KM, et al. The Genetic Structure of Marijuana and Hemp. PLoS ONE. 2015;10(8). doi:10.1371/journal.pone.0133292

2. Marijuana, the Second Trip. Revised Edition by Bloomquist, Edward R.: Good PAPERBACK | Earthlight Books. Accessed June 3, 2020. https://www.abebooks.com/Marijuana-Second-Trip-Revised-Edition-Bloomquist/22676164305/bd

3. Kogan L, Schoenfeld-Tacher R, Hellyer P, Rishniw M. US Veterinarians’ Knowledge, Experience, and Perception Regarding the Use of Cannabidiol for Canine Medical Conditions. Front Vet Sci. 2019;5. doi:10.3389/fvets.2018.00338

4. Fitzgerald KT, Bronstein AC, Newquist KL. Marijuana Poisoning. Top Companion Anim Med. 2013;28(1):8-12. doi:10.1053/j.tcam.2013.03.004

5. Mackie K. Cannabinoid Receptors: Where They are and What They do. J Neuroendocrinol. 2008;20(s1):10-14. doi:10.1111/j.1365-2826.2008.01671.x

6. Maroon J, Bost J. Review of the neurological benefits of phytocannabinoids. Surg Neurol Int. 2018;9. doi:10.4103/sni.sni_45_18

7. Levinsohn EA, Hill KP. Clinical uses of cannabis and cannabinoids in the United States. J Neurol Sci. 2020;411:116717. doi:10.1016/j.jns.2020.116717

8. Mechanisms of CB1 receptor signaling: endocannabinoid modulation of synaptic strength | International Journal of Obesity. Accessed June 5, 2020. https://www.nature.com/articles/0803273

9. Commissioner O of the. FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD). FDA. Published online March 10, 2020. Accessed June 4, 2020. https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd

10. Commissioner O of the. FDA Warns Companies Illegally Selling CBD Products to Treat Medical Conditions, Opioid Addiction. FDA. Published April 26, 2020. Accessed June 6, 2020. https://www.fda.gov/news-events/press-announcements/fda-warns-companies-illegally-selling-cbd-products-treat-medical-conditions-opioid-addiction

11. How CBD pet product brands avoid federal warnings. Accessed June 12, 2020. https://www.petfoodindustry.com/articles/8793-how-cbd-pet-product-brands-avoid-federal-warnings

12. Drug Scheduling. Accessed June 6, 2020. https://www.dea.gov/drug-scheduling

13. AVMA weighs in at cannabis hearing. American Veterinary Medical Association. Accessed June 17, 2020. https://www.avma.org/javma-news/2019-08-15/avma-weighs-cannabis-hearing

14. FAQs. NASC LIVE. Accessed June 13, 2020. https://nasc.cc/faqs/

15. Resnik DB. Beyond post-marketing research and MedWatch: Long-term studies of drug risks. Drug Des Devel Ther. 2007;1:1-5.

16. Deabold KA, Schwark WS, Wolf L, Wakshlag JJ. Single-Dose Pharmacokinetics and Preliminary Safety Assessment with Use of CBD-Rich Hemp Nutraceutical in Healthy Dogs and Cats. Animals. 2019;9(10):832. doi:10.3390/ani9100832

17. McGrath S, Bartner LR, Rao S, Kogan LR, Hellyer PW. A Report of Adverse Effects Associated With the Administration of Cannabidiol in Healthy Dogs. :5.

18. Commissioner O of the. What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD. FDA. Published online March 3, 2020. Accessed June 12, 2020. https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis

19. Wakshlag JJ, Cital S, Eaton SJ, Prussin R, Hudalla C. Cannabinoid, Terpene, and Heavy Metal Analysis of 29 Over-the-Counter Commercial Veterinary Hemp Supplements. Vet Med Res Rep. 2020;11:45-55. doi:10.2147/VMRR.S248712

 

 

 

 

 

CBD & Hemp: Hemp, CBD (and other) Safety Considerations

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In part I and part II we discussed the history of CBD, how it works, and the legality behind CBD for pets & people. While this can all seem a little overwhelming, especially considering the wide availability of CBD – the main take away is that it is important to be safe when choosing any supplement. One of the reasons I decided to put together such a robust series was to explain why it was so important to look for quality and transparency in products. I can tell you all day that quality and transparency are important, but if I don’t explain the reasoning, it just becomes a hollow message.

Part III dives into the clinical data available for CBD use in pets. We’ll also look at what to do if your pet ingests marijuana. Unfortunately, this is a common incident, and THC within marijuana products is an emergency. Finally, we’ll discuss why there is not more available data on dosing, and just why this may be different for each pet.

Hemp & Marijuana: Available Data, Risks & Clinical Information

No established long-term safety data for Hemp/CBD in pets, however, this is not unlike many pharmaceutical medications and supplements already on the market.15 Recent short term data from a recent small study of cats and dogs given 2mg of CBD twice daily for 12 weeks determined that CBD was not detrimental to complete blood counts (CBC) or biochemistry values. It was determined that CBD in cats is metabolized differently than dogs, and needs further evaluation to determine appropriate dosing.4 Additionally, one cat experienced rising levels of ALT, a liver enzyme, which also requires further investigation.16 Additional studies have shown an elevation in ALP, another liver enzyme, further identifying the need for more research.17 This is in line with findings on the human side regarding use of CBD.18

Marijuana itself does have well-documented risks for pets that stem from THC. Even though this is not used or recommended for pets, exposure is common through the ingestion of their owner’s marijuana supply. The minimum lethal oral dose for dogs for THC is more than 3 g/kg, and has been seen most commonly with the ingestion of THC butter.4 Treatment of THC/marijuana ingestion in animals is largely supportive. Meaning that no specific antidote presently exists for THC poisoning. The majority of dogs experiencing intoxication after marijuana ingestion recover completely without long term effects or deficit.4

Clinical effects of toxic levels of THC/marijuana ingestion are generally seen within 60 minutes. Signs of canine intoxication include depression, hyper-salivation, mydriasis, hypermetria, vomiting, urinary incontinence, tremors, hypothermia, and bradycardia. Higher dosages may additionally cause nystagmus, agitation, tachypnea, tachycardia, ataxia, hyper-excitability, and seizures.4 If you suspect your pet has ingested marijuana seek immediate veterinary care.

Toxin Concerns: Phytoremediation

In our last article, we discussed the lack of accountability and product adequacy testing within the human and pet supplement market. When it comes to toxic screening, cannabis in all form are of concern, because it can be a highly toxic plant. This is because it performs a process called phytoremediation and therefore adds another level of concern to the equation. Phytoremediation means that cannabis absorbs heavy metals and many of the agricultural chemicals in the soil such as pesticides, herbicides, and fertilizers. Many CBD companies like to hide behind the word ‘proprietary’ when it comes to analysis or ingredient sourcing. However, this is not an excuse that holds any weight when it comes to the safety of cannabis, period. Fortunately, the National Animal Supplement Council (NASC) works with some CBD companies to help protect against contaminated CBD products and other supplements from entry to the marketplace. In other words, it is wise to avoid pet supplements without the NASC seal. We discussed the NASC in more detail in Article II.

Dosing for CBD Products

A variety of CBD containing products are on the market for people and pets. These include oral oils, pills, capsules & food products like treats and honey.  There are also balms and other transdermal-type products that are designed for use on skin. Products have varying levels of effectiveness that likely have to do with quality, purity, concentration, and dosage. Exact dosing of CBD dosing for pets is still being established and is largely up for debate. Further complicating this issue is that some hypothesize this could be highly individualized.

Fortunately, CBD containing hemp products, by law, are to have 0.3% THC or less on a dry weight basis, so the risk of overdose from THC is quite low.9 This does not however mean that dosing CBD, hemp products in pets should not be measured or monitored. Always follow veterinarian and/or product label instructions.

Summary

We’ve all heard the claims of benefits for CBD for both pets and people, however, we now know that those claims are largely unsupported by science and that companies are likely in violation when making these claims. Regarding safety, it appears that there are few adverse events. For CBD have been reported, however, some studies point to a potential for concerns for liver values. This area needs further research, and we’re sure that more data will be available in the near future. If your pet has had or currently has any liver concerns, it is important to discuss CBD use with your veterinarian prior to using it. In addition, if you decide to use CBD it is paramount to ensure the product is NASC compliant. There are also several questions that you can ask your CBD (or any supplement company) which we will discuss in Part IV! Did you miss part I and part II of the CBD & Hemp series?

About the Author: Nicole Cammack

Nicci is the owner of award-winning NorthPoint Pets & Company, in Connecticut. She is also the Founder & CEO of Undogmatic Inc. Her undergraduate and graduate education includes biology, chemistry, business, and nutrition. She has worked in the pharmaceutical industry on multiple R&D projects and has had the privilege to learn from leading international figures in the human and pet health industry. She regularly lectures at national conferences, including federal, state, and municipal K9 events. Her current research involves identifying pathogenic risk factors and transmission among raw fed pets through a comprehensive worldwide survey.

www.northpointpets.com
www.undogmaticinc.com

References
  1. Sawler J, Stout JM, Gardner KM, et al. The Genetic Structure of Marijuana and Hemp. PLoS ONE. 2015;10(8). doi:10.1371/journal.pone.0133292
  2. Marijuana, the Second Trip. Revised Edition by Bloomquist, Edward R.: Good PAPERBACK | Earthlight Books. Accessed June 3, 2020. https://www.abebooks.com/Marijuana-Second-Trip-Revised-Edition-Bloomquist/22676164305/bd
  3. Kogan L, Schoenfeld-Tacher R, Hellyer P, Rishniw M. US Veterinarians’ Knowledge, Experience, and Perception Regarding the Use of Cannabidiol for Canine Medical Conditions. Front Vet Sci. 2019;5. doi:10.3389/fvets.2018.00338
  4. Fitzgerald KT, Bronstein AC, Newquist KL. Marijuana Poisoning. Top Companion Anim Med. 2013;28(1):8-12. doi:10.1053/j.tcam.2013.03.004
  5. Mackie K. Cannabinoid Receptors: Where They are and What They do. J Neuroendocrinol. 2008;20(s1):10-14. doi:10.1111/j.1365-2826.2008.01671.x
  6. Maroon J, Bost J. Review of the neurological benefits of phytocannabinoids. Surg Neurol Int. 2018;9. doi:10.4103/sni.sni_45_18
  7. Levinsohn EA, Hill KP. Clinical uses of cannabis and cannabinoids in the United States. J Neurol Sci. 2020;411:116717. doi:10.1016/j.jns.2020.116717
  8. Mechanisms of CB1 receptor signaling: endocannabinoid modulation of synaptic strength | International Journal of Obesity. Accessed June 5, 2020. https://www.nature.com/articles/0803273
  9. Commissioner O of the. FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD). FDA. Published online March 10, 2020. Accessed June 4, 2020. https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd
  10. Commissioner O of the. FDA Warns Companies Illegally Selling CBD Products to Treat Medical Conditions, Opioid Addiction. FDA. Published April 26, 2020. Accessed June 6, 2020. https://www.fda.gov/news-events/press-announcements/fda-warns-companies-illegally-selling-cbd-products-treat-medical-conditions-opioid-addiction
  11. How CBD pet product brands avoid federal warnings. Accessed June 12, 2020. https://www.petfoodindustry.com/articles/8793-how-cbd-pet-product-brands-avoid-federal-warnings
  12. Drug Scheduling. Accessed June 6, 2020. https://www.dea.gov/drug-scheduling
  13. AVMA weighs in at cannabis hearing. American Veterinary Medical Association. Accessed June 17, 2020. https://www.avma.org/javma-news/2019-08-15/avma-weighs-cannabis-hearing
  14. FAQs. NASC LIVE. Accessed June 13, 2020. https://nasc.cc/faqs/
  15. Resnik DB. Beyond post-marketing research and MedWatch: Long-term studies of drug risks. Drug Des Devel Ther. 2007;1:1-5.
  16. Deabold KA, Schwark WS, Wolf L, Wakshlag JJ. Single-Dose Pharmacokinetics and Preliminary Safety Assessment with Use of CBD-Rich Hemp Nutraceutical in Healthy Dogs and Cats. Animals. 2019;9(10):832. doi:10.3390/ani9100832
  17. McGrath S, Bartner LR, Rao S, Kogan LR, Hellyer PW. A Report of Adverse Effects Associated With the Administration of Cannabidiol in Healthy Dogs. :5.
  18. Commissioner O of the. What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD. FDA. Published online March 3, 2020. Accessed June 12, 2020. https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis
  19. Wakshlag JJ, Cital S, Eaton SJ, Prussin R, Hudalla C. Cannabinoid, Terpene, and Heavy Metal Analysis of 29 Over-the-Counter Commercial Veterinary Hemp Supplements. Vet Med Res Rep. 2020;11:45-55. doi:10.2147/VMRR.S248712

CBD & Hemp: What is CBD and How Does It Work?

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Cannabis: An Ancient Crop with Claims of Health Benefits

The use of cannabis dates back to ancient civilizations, with records of its use dating back to 6,000 years ago.1 Claims of health benefits included constipation, gout, rheumatism, and absent-mindedness.2 However, it wasn’t until recent years that numerous potential therapeutic uses of cannabis for pets have surfaced.

While there is more research for human use of CBD, animal research into CBD is lacking. The minimal research that is available needs significant expansion and validation. It’s important to remember that just because something is published, it doesn’t mean it’s entirely accurate or even applicable to the real world. Therefore, it is essential to understand the regulation, safety, and legality surrounding pet supplements.

Today, there is a plethora of CBD supplements available to people and pets. However, with so much misinformation and dangerous information on the market, it can be challenging to determine what is safe and legal. 

In this multi-part series, we will explore the regulation, how CBD works, and the safety and legality surrounding pet supplements. Since this article serves as our opening to the discussion, we’ll cover the basics: the difference between hemp and marijuana, how CBD works, and how it’s absorbed.

Classification & Cannabinoids

Cannabis can be broadly classified as either hemp or marijuana, and that classification depends on the concentration of the cannabinoid Delta 9-tetrahydrocannabinol (more commonly known as THC) and other cannabinoids they contain.3 The plants contain more than 400 chemicals but the cannabinoid THC is the one with the most recognition for its psychotropic “high” effect.4 Because THC is highly lipid-soluble and is distributed in fat, liver, brain, and renal tissue in the body.

The other cannabinoid that has gained attention is cannabidiol (or CBD), which is the focus of this discussion. It was first isolated from the marijuana plant by Roger Adams in the 1940’s, although it wasn’t chemically described until 1964 by Raphael Mechoulam. Today CBD is commonly used in a variety of human and pet supplements and edibles for pets and people. This cannabinoid has a lot of focus due to its potential, not proven, the ability to help manage anxiety, insomnia, and pain in humans. As already discussed, despite many anecdotal reports and claims more research is needed to determine the effectiveness, dosing, and safety of CBD and other cannabinoids in pets. However, as mentioned earlier, this is also true for many other types of supplements for pets – in fact, a lot of human data is used in order to promote the benefits to pets.

How CBD Works

There are three types of cannabinoids. Like neurotransmitters, all types of cannabinoids work by triggering a response from a receptor. Cannabinoids interact with receptors in the endocannabinoid system (ECS). The main function of the ECS is to maintain body homeostasis— which is biological harmony in response to changes in the environment.5  CBD is known as a phytocannabinoid, which comes from plants. For context, several plants beyond cannabis also produce phytocannabinoids, including cacao and echinacea. All mammals also produce their own cannabinoids, called endocannabinoids. The third type of cannabinoids is synthetic cannabinoids which are made in a laboratory. 

Phytocannabinoids, such as CBD work to inhibit the activity of ECS receptors, or in other words; limit activity or turn them off. The endocannabinoid system (ECS) has a role in the regulation of pain, pleasure, digestion, metabolism, inflammation, sleep, movement, neuroprotection, immune function, appetite, body temperature, mood, memory, and cardiovascular function.6,7  

Since CBD influences the ECS, there is potentially a wide range of benefits to the therapeutic use of CBD containing supplements and much of the theory behind CBD comes from this. Many anecdotal and case reports reflect these benefits; however, the problem is that there are few evidence-backed indications of these benefits in the mainstream scientific literature. This is complicated by the fact that many companies and non-scientific blogs continue to make claims of benefit giving the consumer and even retailers the perception of more evidence than there is. This climate has created a lot of trust and transparency issues for medical practitioners and CBD manufacturers.

There are two main cannabinoid receptors in humans and dogs, CB1 found primarily in the central nervous system and CB2 which are peripheral and immune-modulating.4,8 CB1 activity is believed to be responsible for most endocannabinoid clinical effects and benefits. 

Dosing & Absorption

CBD dosing & bioavailability, or the body’s ability to absorb CBD containing products are other factors to consider. There are several different types of products that have varying levels of bioavailability. For example, CBD itself is a fat-soluble cannabinoid, like THC. Since our bodies are mostly water traditional CBD oils not absorbed well in the gut, and therefore only have adequate absorption via the oral mucus membrane. Humans for example would need to hold a traditional CBD oil in their mouth for about 90 seconds for best absorption – not exactly realistic for dogs or cats. 

Fortunately, technology has offered solutions to the absorption challenges of traditional CBD oils. There are companies that have altered their products to be absorbed through liposome (fat) technology or nano-particle technologies that allow for oral use and absorption through the GI tract when consumed. The later technology has the highest bioavailability and allows CBD to cross the blood-brain barrier since the particles are so small. However – most CBD oils, treats, and edibles available are not nano-particle, so it’s important to ask. In addition, edibles, especially dog treats that have traditional oil have likely had a heat process applied (i.e. baking). Heat significantly reduces the bioavailability and therefore effectiveness of the CBD within the product. 

Summary

CBD can come from hemp or marijuana, with hemp lacking enough THC to product the psychotropic “high” effect marijuana is most known for. Although Hemp based-CBD supplements are widely available on the market, the reality is that there is a real lack of information regarding its exact benefit or benefits. However, we know enough about the human and animal endocannabinoid system to theorize how and what these supplements may be useful for. The type of CBD is important when choosing a product because not all are easily absorbed or effective due to a variety of processing techniques. 

This article is part of a Hemp Education Series. Over the course of this series, we will further explore hemp legality, safety, dosing, and how to spot quality from potentially dangerous products. 

For further reading, continue to part II, III, IV

About the Author: Nicole Cammack

Nicci is the owner of award-winning NorthPoint Pets & Company, in Connecticut. She is also the Founder & CEO of Undogmatic Inc. Her undergraduate and graduate education includes biology, chemistry, business, and nutrition. She has worked in the pharmaceutical industry on multiple R&D projects and has had the privilege to learn from leading international figures in the human and pet health industry. She regularly lectures at national conferences, including federal, state, and municipal K9 events. Her current research involves identifying pathogenic risk factors and transmission among raw fed pets through a comprehensive worldwide survey.

www.northpointpets.com
www.undogmaticinc.com

References

1. Sawler J, Stout JM, Gardner KM, et al. The Genetic Structure of Marijuana and Hemp. PLoS ONE. 2015;10(8). doi:10.1371/journal.pone.0133292

2. Marijuana, the Second Trip. Revised Edition by Bloomquist, Edward R.: Good PAPERBACK | Earthlight Books. Accessed June 3, 2020. https://www.abebooks.com/Marijuana-Second-Trip-Revised-Edition-Bloomquist/22676164305/bd

3. Kogan L, Schoenfeld-Tacher R, Hellyer P, Rishniw M. US Veterinarians’ Knowledge, Experience, and Perception Regarding the Use of Cannabidiol for Canine Medical Conditions. Front Vet Sci. 2019;5. doi:10.3389/fvets.2018.00338

4. Fitzgerald KT, Bronstein AC, Newquist KL. Marijuana Poisoning. Top Companion Anim Med. 2013;28(1):8-12. doi:10.1053/j.tcam.2013.03.004

5. Mackie K. Cannabinoid Receptors: Where They are and What They do. J Neuroendocrinol. 2008;20(s1):10-14. doi:10.1111/j.1365-2826.2008.01671.x

6. Maroon J, Bost J. Review of the neurological benefits of phytocannabinoids. Surg Neurol Int. 2018;9. doi:10.4103/sni.sni_45_18

7. Levinsohn EA, Hill KP. Clinical uses of cannabis and cannabinoids in the United States. J Neurol Sci. 2020;411:116717. doi:10.1016/j.jns.2020.116717

References

8. Mechanisms of CB1 receptor signaling: endocannabinoid modulation of synaptic strength | International Journal of Obesity. Accessed June 5, 2020. https://www.nature.com/articles/0803273

9. Commissioner O of the. FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD). FDA. Published online March 10, 2020. Accessed June 4, 2020. https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd

10. Commissioner O of the. FDA Warns Companies Illegally Selling CBD Products to Treat Medical Conditions, Opioid Addiction. FDA. Published April 26, 2020. Accessed June 6, 2020. https://www.fda.gov/news-events/press-announcements/fda-warns-companies-illegally-selling-cbd-products-treat-medical-conditions-opioid-addiction

11. How CBD pet product brands avoid federal warnings. Accessed June 12, 2020. https://www.petfoodindustry.com/articles/8793-how-cbd-pet-product-brands-avoid-federal-warnings

12. Drug Scheduling. Accessed June 6, 2020. https://www.dea.gov/drug- scheduling

13. AVMA weighs in at cannabis hearing. American Veterinary Medical Association. Accessed June 17, 2020. https://www.avma.org/javma-news/2019-08-15/avma-weighs-cannabis-hearing

14. FAQs. NASC LIVE. Accessed June 13, 2020. https://nasc.cc/faqs/

15. Resnik DB. Beyond post-marketing research and MedWatch: Long-term studies of drug risks. Drug Des Devel Ther. 2007;1:1-5.

16. Deabold KA, Schwark WS, Wolf L, Wakshlag JJ. Single-Dose Pharmacokinetics and Preliminary Safety Assessment with Use of CBD-Rich Hemp Nutraceutical in Healthy Dogs and Cats. Animals. 2019;9(10):832. doi:10.3390/ani9100832

17. McGrath S, Bartner LR, Rao S, Kogan LR, Hellyer PW. A Report of Adverse Effects Associated With the Administration of Cannabidiol in Healthy Dogs. :5.

18. Commissioner O of the. What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD. FDA. Published online March 3, 2020. Accessed June 12, 2020. https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis

19. Wakshlag JJ, Cital S, Eaton SJ, Prussin R, Hudalla C. Cannabinoid, Terpene, and Heavy Metal Analysis of 29 Over-the-Counter Commercial Veterinary Hemp Supplements. Vet Med Res Rep. 2020;11:45-55. doi:10.2147/VMRR.S248712

June 2020: Journal of Animal Sciences Grain Free & Heart Disease Summary

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Background & History of DCM Investigation

In June of 2018 a blog titled “A broken heart: Risk of heart disease in boutique or grain-free diets and exotic ingredients” was published on the Tuft’s University blog ‘Petfoodology’. This blog was followed by a commentary article in JAVMA causing increased media and public attention. It’s important to note that neither of these papers were peer reviewed, and the AVMA (American Veterinary Medical Association) disseminated it as gospel.  This is unfortunate considering 80% of veterinarians believe or look at AVMA as a source of truth even if an article does not contain true or accurate science content.

These articles were composed by Lisa Freeman, a board-certified veterinary nutritionist from Tufts University in order to warn the public and veterinary community about the imminent danger from ‘BEG’ foods. This blog caught the media by storm followed by the FDA launching an investigation into the matter. As a result, the FDA launched an investigation which was complicated by sampling bias, overrepresentation of subgroups and confounding variables. For the past two years, despite additional commentary articles, scarce and vague scientific data and inconclusive FDA reports, information regarding DCM has been incomplete at best. Lack of information has been accompanied by abbreviated synopses of case studies with multiple variables and treatments, incomplete medical information and conflicting medical data and opinions from veterinary nutrition influencers.1  

The reality is that there are many variables that may, or may not, impact the onset, disease process and outcome of DCM. Available studies lack evaluation of isolated variables in a controlled environment free from sampling bias. For example, many unknowns exist surrounding numerous nutrients, genetics, hypothyroidism, myocarditis, arrhythmias and other diet-related etiologies.1

Critical Part of the Conversation: DCM Disease Process & Role of Nutrition

One of the largest points of contention within this investigation is that pet owners and even some within the veterinary community are unaware of the multiple etiologies and the complex relation of nutrition to DCM. Causative factors behind DCM have been oversimplified to blame grain-free foods – which is fundamentally incorrect and is a disservice to the field of nutrition and the health and wellbeing of pets. 

Any self-respecting nutritionist knows that nutrients, not ingredients, make up a well-formulated diet. Nutrition is far more complex than this 2-year conversation has given credit to – and this review acknowledged that. At the same time, this paper also cited the importance of having a general knowledge of the incidence, clinical manifestations, diagnostics and potential treatments required before digging into the rest of the DCM conversation. Let’s have a look:

Incidence & Genetics

The most common cardiovascular disease in canines is chronic degenerative valve disease (approx. 75%), followed by DCM as the second most common. The incidence of DCM appears to be 0.5 and 1.3% of the population, with the majority of cases being an inherited, genetically linked condition.1  In context, the estimated population of dogs in the United States equals 77,000,000 which suggests a minimum of 308,000 to 1,001,000 dogs in the United States have DCM at any given time. Certain breeds and male dogs are often reported to have a higher incidence of DCM – with most cases appearing in middle age to older dogs.1  It was thought that mixed breed dogs had a greater protection against developing genetically linked types of DCM, however statistics show this is not the case. The authors highlight the need for more research in both purebred and mixed breed dogs and the genetic relationship to DCM.

Manifestation & Diagnostics

Clinical manifestation, or presentation of the disease is elusive in many cases. Most dogs have no outward symptoms in the beginning stages of the disease. If undiagnosed DCM progresses on to include decreased efficiency and effectiveness of the heart muscle leading to exercise intolerance, congestive heart failure (CHF), syncope (passing out), and even sudden death. Unfortunately, sometimes there are no outward symptoms, and sudden death is the only sign, especially in Doberman Pinschers1.

The smallest section of the paper titled “Histopathological Manifestation” has one of the most interesting facts in the entire review: “Histopathological changes vary from myocardial samples in dogs with DCM, reflecting the numerous underlying etiologies.” Simply put, biopsies, or samples of heart muscle from various dogs are showing multiple and variable changes to the cardiac tissue that indicate differing causative factors. These factors could include arrythmia, genetics, hypothyroid disease, doxorubicin (chemotherapy), myocarditis, digestive impairment, low protein diets, high fiber diets and deficiencies of l-carnitine, taurine, sulfur amino acids – among many others.1

While the gold standard of diagnostics in humans, cardiac muscle biopsy is rarely conducted in canines due to the invasive nature and high cost of the procedure.  Traditional diagnostics used to rule out other diseases and arrive at a DCM diagnosis include, but are not limited to radiograph(x-ray), echocardiogram, electrocardiogram (EKG), 24-Holter monitoring, and cardiac biomarkers (blood testing). Often, many of these options are limited due to accessibility due to location and the cost prohibitive nature of some of these tests.

Presumptive Diagnosis & Misdiagnosis

As a result of limited access to testing for various reasons, presumptive diagnosis and misdiagnosis are of concern. For example, both left and right sided valve disease may lead to characteristics that could lead to pathologies that resemble DCM. In addition, neoplasia, CHF, pericarditis and left atrial rupture can all cause pericardial effusion which leads to increased silhouette of the heart.1 Ignoring these other potential disease pathologies could lead to misdiagnosis and result in inadequate treatment.

Treatment of DCM

As we’ve learned within the past two years treatment of cases of DCM vary widely, and are complicated by accompanying disease states, age and nutritional status – among other factors. In general, treatment of DCM depends largely on the severity of disease. Treatment for primary DCM can involve use of pharmaceutical drugs, management of arrythmias, l-carnitine supplementation, taurine supplementation, and diet change. Management of secondary DCM may focus on treating the underlying condition in addition to the treatments listed above.1

Nutrition Considerations:

Choline – an abundant nutrient having several important roles within the body and potentially several that may influence DCM in different ways. In humans, choline is important for the regeneration from methionine from homocysteine. When choline is deficient elevated homocysteine elevations occur which likely increases risk of cardiovascular disease. Additional risks related to choline may be indicated by its involvement in the production of trimethylamine N-oxide (TMAO) which promotes inflammation and cardiovascular disease development in humans.1

This review states that choline is deserving of more research to determine if there is a relationship to DCM in canines. It’s important to call out that much of the information in the discussion on choline is from human data highlighting the knowledge gap in this area.

Methionine and Cysteine – These are sulfur containing amino acids which are involved in the synthesis of taurine. There are multiple factors that influence the synthesis of taurine from these two precursors. These influences include low bioavailability, thermal processing of food, diet formulation, deficiency of methionine which is a limiting amino acid – among others. In addition, sulfur amino acid requirements may vary between breed and size of dogs.1

Again, we need more research to determine breed, size and potentially age specific requirements for these nutrients.1 It’s also important to note that we lack the ability to measure functional adequacy of these nutrients highlighting another knowledge gap.

Taurine – Another sulfur containing amino acid, is not considered essential in dogs. This is because canines can synthesize taurine on their own. Taurine is an essential amino acid for cardiovascular function, skeletal muscle, nervous system function and as a component bile acids. Since the initial DCM investigation taurine has been questioned as being essential, however insufficient data exist to make any conclusions.1  That being said, canines with various cardiovascular diseases have been found to have low taurine levels. Further research is needed to determine if low bioavailability of taurine, low taurine synthesis and/or increased requirement of taurine are factors in these pathologies.

Taurine status is also deserving of more research. It is likely that various breeds, and disease states have different taurine requirements. In addition, several factors may influence bioavailability and synthesis of this amino acid. Variables affecting these factors need to be studied in a controlled environment.

Carnitine – Another nutrient that has been given attention is carnitine. This is because carnitine is beta-oxidized to generate continued energy, and 60% of cardiac energy production is through beta-oxidation. Therefore, deficiency or increased need of carnitine may cause cardiac dysfunction leading to cardiac disease such as DCM.1  Like other nutrition considerations discussed, functional assessments for carnitine status are lacking through blood testing. In order to accurately measure carnitine, biopsy of the heart muscle is required. 

Taurine, carnitine and a variety of other nutrients and amino acids require specific balances of vitamins and minerals in bioavailable forms for proper function. Examples include, but are not limited to zinc, iron, selenium and niacin. This means that adequate levels of carnitine or taurine could be present but be unable to be utilized properly by the body.

Thiamine – Insufficient evidence exists regarding thiamine deficiency and cardiac function in canines. However, thiamine does play a role in the metabolism of carbohydrates, fats and specific amino acids. Thiamine can also be rendered unavailable by the presence of certain enzymes in some foods. In short, more research is needed to determine if thiamine deficiency, or lack of bioavailability, potentially contributes to the disease process of DCM in dogs. 

Copper – Copper is known to play an important role of many enzyme functions, hemoglobin synthesis, nerve structure and function, blood vessels and various tissues. Copper deficiency on cardiac health has been studied in other species, but not dogs. While copper is routinely supplemented, it’s status could be negatively impacted by excess zinc and/or iron.1 This again indicates another knowledge gap in the area of canine nutrition and DCM. 

Vitamin E – Vitamin E is a potent antioxidant which has links to cardioprotective mechanisms. Dogs with DCM have been found to have lower vitamin E in comparison to healthy dogs.

Selenium – Selenium deficiency may be related to reduced ability for cysteine synthesis. In addition, selenium deficiency results in increased oxidative stress, and decreases other antioxidant activity. Further, decreased bioavailability of selenium may inhibit the absorption of other metabolic constituents creating further complications. Additional research is needed to determine the involvement of selenium in the pathology of DCM.

Heavy Metals & Other Toxin Considerations:

Heavy metals and various toxins have well documented roles of nutrient interference in humans, canines and other species:

  • Cyanide can increase the sulfur amino acid requirement
  • Certain raw foods (fruits/vegetables) can inhibit iodine function and increase risk of hypothyroid disease
  • Heavy metals such as arsenic, cadmium and mercury increase taurine requirements since taurine detoxifies these metals

Limitations in Current Available Data:

We know that DCM in dogs is not a new concern. Given that, we also know there are significant limitations to research studies currently available due to small sample sizes, sample bias, sample parameter inconsistencies, lack of complete data and known genetic predisposition. Extrapolating data from a small sample size to a large population can be highly inaccurate because subsets of populations are likely to skew results. 

In addition, confounding variables and lack of control for independent variables can infer correlation when none exists. 

The FDA Reports & Sample:

The sample population from the FDA reports resulted from a call for submission of DCM cases in dogs eating suspect (boutique, exotic, grain-free) diets. This resulted in a polluted data set for multiple reasons, including breed reporting, media attention, lack of all confirmed and suspect DCM cases reported, and other confounding factors such as health status of the dog. These confounding factors include obesity and other underlying conditions and diseases.

Summary:

As discussed, DCM has many etiologies, and many variables affecting disease manifestation. Considerable research is needed into these etiologies, and this paper largely serves as a call to action. While researchers state no definitive link can be found between DCM and ‘BEG’ diets, the largest points are that all etiologies of DCM need more investigation and science of nutrition is complex, and oversimplifying suspicions can lead to misguided and incorrect conclusions.

Nicole Cammack

Nicci is the owner of award-winning NorthPoint Pets & Company, in Connecticut. She is also the Founder & CEO of Undogmatic Inc. Her undergraduate and graduate education includes biology, chemistry, business, and nutrition. She has worked in the pharmaceutical industry on multiple R&D projects and has had the privilege to learn from leading international figures in the human and pet health industry. She regularly lectures at national conferences, including federal, state, and municipal K9 events. Her current research involves identifying pathogenic risk factors and transmission among raw fed pets through a comprehensive worldwide survey.

www.northpointpets.com
www.undogmaticinc.com

Link to article: https://academic.oup.com/jas/article/98/6/skaa155/5857674?fbclid=IwAR3A8FdX_DBMbEsi8CGh3tyBgNmSoy712FQf-sUkt4k2n2Ch_larxBQ0aJw

1.         McCauley SR, Clark SD, Quest BW, Streeter RM, Oxford EM. Review of canine dilated cardiomyopathy in the wake of diet-associated concerns. J Anim Sci. 2020;98(6). doi:10.1093/jas/skaa155

NorthPoint Pets team

How to Ensure Quality and Transparency in Pet Products

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The Importance of Transparency in the Pet Industry

Transparency is a buzzword that has been used frequently in recent years, especially by companies within the pet industry. However, it’s important to note that transparency is not just a feel-good term – it’s a crucial aspect that should be present in all pet products, including food and supplements. The lack of transparency in the pet industry can have severe consequences for both pets and their owners.

The Dangers of Poor Transparency

Many pet products, including food and supplements, lack transparency, quality control, and accountability. This means that there may be toxins, poor sourcing, and formulation errors that can potentially harm pets. In the past, there have been recalls of pet food and supplements due to vitamin D and melamine recalls, pathogen recalls, and other contamination and formulation issues.

The Lack of Accountability and Standards in the Pet Industry

Pet food and supplement manufacturers often cut corners and do not do their due diligence because there are no set standards and accountability measures in place. Major organizations such as the FDA, AAFCO, WSAVA, and PNA have minimal standards, and these standards can be influenced by corporate funding. As a result, it’s often difficult for these organizations to police everyone all the time.

There are minimal requirements for foods, supplements, and other pet products to come to market. Some organizations allow these products to come to market without any adequacy testing, digestibility, or feeding trials. Unfortunately, animals often become sick or die before red flags are raised and an investigation is initiated. This underscores the need for more transparency and accountability in the pet industry.

reading a pet food ingredient label

Ask Questions Verifying Pet Food Quality:

  • Do you conduct a 3rd party nutrition analysis on all of your finished products?
    • Do your products meet an AAFCO profile?
    • Are you willing to provide a copy of that analysis? Note that most companies are deceptive and provide Target analysis, which is predicted. This does not equal a typical analysis, be careful
  • Do you conduct 3rd party digestibility studies for each of your formulas?
    • Do you make those publicly available?
  • Do you source any ingredients from China? Are you willing to provide certificates of origin? 
    • Note that ingredients from China are not necessarily bad as long as they are well-sourced, they are ensuring and verifying quality and purity via analysis and contamination testing. 
  • Do you complete analysis of your final product to ensure the formulation is correct and ensure there are not any contamination issues?

Keep in mind that digestibility and typical nutrient analysis mean nothing without the other. Digestibility shows the amount of nutrients absorbed. The analysis shows the amount of nutrients contained within a product.

Beware of the word proprietary – this does not hold a strong argument and may imply a lack of testing, or inadequate testing.

Ask Questions Verifying Supplement Quality:

When looking for any supplement for yourself or your pets you must ask the manufacturing company the following questions:

  • Do you inbound test your raw and/or concentrated ingredients for contaminants such as heavy metals, fertilizers, and other agricultural chemicals?
  • Do you test your ingredients, specifically active ingredients to ensure their concentrations are correct?
  • Do you source any ingredients from China? 
    • Are you willing to provide certificates of origin? 
    • Note that ingredients from China are not necessarily bad as long as they are well-sourced and they are verifying quality and purity. 
  • Do you complete analysis of your final product to ensure the formulation is correct and ensure there are not any contamination issues? This is important to ensure that active ingredients match the label.
    • Are you willing to provide an analysis for each lot/batch of your final product?
  • Do your company and products meet requirements to utilize the NASC (National Animal Supplement Council) seal?
    • I would not recommend supplement companies that are not members of the NASC, especially CBD companies.

Advice to Consumers

This is not a comprehensive list by any stretch. The key take away is that consumers should start asking questions of manufacturers in order to encourage change. The reality is that very few companies can answer these questions because most do not adequately test their products at all stages. By opening up a dialogue about the importance of doing so can help prevent future issues within the industry.

If companies are unwilling to transparently answer these questions or use the excuse of information being proprietary I would strongly suggest that you find another brand. Not being transparent or testing products when it comes to ensuring safety is unacceptable. Brands that are not meeting these standards could potentially be poisoning the market for other companies who do their due diligence. As consumers demand better.

About the Author: Nicole Cammack

Nicci is the owner of award-winning NorthPoint Pets & Company, in Connecticut. She is also the Founder & CEO of Undogmatic Inc. Her undergraduate and graduate education includes biology, chemistry, business, and nutrition. She has worked in the pharmaceutical industry on multiple R&D projects and has had the privilege to learn from leading international figures in the human and pet health industry. She regularly lectures at national conferences, including federal, state, and municipal K9 events. Her current research involves identifying pathogenic risk factors and transmission among raw fed pets through a comprehensive worldwide survey.

www.northpointpets.com
www.undogmaticinc.com

Journal of Animal Science Article Full Summary, Volume 98, Issue 6, June 2020

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BACKGROUND & HISTORY OF DCM INVESTIGATION

In June of 2018, Lisa Freeman, a board-certified veterinary nutritionist from Tufts University published a blog titled “A broken heart: Risk of heart disease in boutique or grain-free diets and exotic ingredients.” This blog warned pet owners and veterinarians that ‘BEG’ (boutique, exotic, grain free) diets were causing heart disease in dogs. This left professionals and the public scrambling for more information, which was further fueled by media frenzy. As a result, the FDA launched an investigation which was complicated by sampling bias, overrepresentation of subgroups and confounding variables. For the past two years, despite additional commentary articles, scarce and vague scientific data and inconclusive FDA reports, information regarding DCM has been incomplete at best. Lack of information has been accompanied by abbreviated synopses of case studies with multiple variables and treatments, incomplete medical information and conflicting medical data and opinions from veterinary nutrition influencers.1

The reality is that there are many variables that may, or may not, impact the onset, disease process and outcome of DCM. Available studies lack evaluation of isolated variables in a controlled environment free from sampling bias. For example, many unknowns exist surrounding numerous nutrients, genetics, hypothyroidism, myocarditis, arrythmias and other diet-related etiologies.1

[vc_single_image image=”3552″ img_size=”full”]

CRITICAL PART OF THE CONVERSATION: DCM DISEASE PROCESS & ROLE OF NUTRITION

One of the largest points of contention within this investigation is that pet owners and even some within the veterinary community are unaware of the multiple etiologies and the complex relation of nutrition to DCM. Causative factors behind DCM have been oversimplified to blame grain-free foods – which is fundamentally incorrect and is a disservice to the field of nutrition and the health and wellbeing of pets.

Any self-respecting nutritionist knows that nutrients, not ingredients, make up a well-formulated diet. Nutrition is far more complex than this 2-year conversation has given credit to – and this review acknowledged that. At the same time, this paper also cited the importance of having a general knowledge of the incidence, clinical manifestations, diagnostics and potential treatments required before digging into the rest of the DCM conversation. Let’s have a look:

 

Incidence & Genetics

The most common cardiovascular disease in canines is chronic degenerative valve disease (approx. 75%), followed by DCM as the second most common. The incidence of DCM appears to be 0.5 and 1.3% of the population, with the majority of cases being an inherited, genetically linked condition.1 Certain breeds and male dogs are often reported to have a higher incidence of DCM – with most cases appearing in middle age to older dogs.1 It was thought that mixed breed dogs had a greater protection against developing genetically linked types of DCM, however statistics show this is not the case. The authors highlight the need for more research in both purebred and mixed breed dogs and the genetic relationship to DCM.

 

Manifestation & Diagnostics

Clinical manifestation, or presentation of the disease is elusive in many cases. Most dogs have no outward symptoms in the beginning stages of the disease. If undiagnosed DCM progresses on to include decreased efficiency and effectiveness of the heart muscle leading to exercise intolerance, congestive heart failure (CHF), syncope (passing out), and even sudden death. Unfortunately, sometimes there are no outward symptoms, and sudden death is the only sign, especially in Doberman Pinschers1.

The smallest section of the paper titled “Histopathological Manifestation” has one of the most interesting facts in the entire review: “Histopathological changes vary from myocardial samples in dogs with DCM, reflecting the numerous underlying etiologies.” Simply put, biopsies, or samples of heart muscle from various dogs are showing multiple and variable changes to the cardiac tissue that indicate differing causative factors. These factors could include arrythmia, genetics, hypothyroid disease, doxorubicin (chemotherapy), myocarditis, digestive impairment, low protein diets, high fiber diets and deficiencies of l-carnitine, taurine, sulfur amino acids – among many others.1

While the gold standard of diagnostics in humans, cardiac muscle biopsy is rarely conducted in canines due to the invasive nature and high cost of the procedure. Traditional diagnostics used to rule out other diseases and arrive at a DCM diagnosis include, but are not limited to radiograph(x-ray), echocardiogram, electrocardiogram (EKG), 24-Holter monitoring, and cardiac biomarkers (blood testing). Often, many of these options are limited due to accessibility due to location and the cost prohibitive nature of some of these tests.

 

Presumptive Diagnosis & Misdiagnosis

As a result of limited access to testing for various reasons, presumptive diagnosis and misdiagnosis are of concern. For example, both left and right sided valve disease may lead to characteristics that could lead to pathologies that resemble DCM. In addition, neoplasia, CHF, pericarditis and left atrial rupture can all cause pericardial effusion which leads to increased silhouette of the heart.1 Ignoring these other potential disease pathologies could lead to misdiagnosis and result in inadequate treatment.

 

Treatment of DCM

As we’ve learned within the past two years treatment of cases of DCM vary widely, and are complicated by accompanying disease states, age and nutritional status – among other factors. In general, treatment of DCM depends largely on the severity of disease. Treatment for primary DCM can involve use of pharmaceutical drugs, management of arrythmias, l-carnitine supplementation, taurine supplementation, and diet change. Management of secondary DCM may focus on treating the underlying condition in addition to the treatments listed above.1

[vc_single_image image=”3555″ img_size=”full”]

NUTRITION CONSIDERATIONS:

Choline – an abundant nutrient having several important roles within the body and potentially several that may influence DCM in different ways. In humans, choline is important for the regeneration from methionine from homocysteine. When choline is deficient elevated homocysteine elevations occur which likely increases risk of cardiovascular disease. Additional risks related to choline may be indicated by its involvement in the production of trimethylamine N-oxide (TMAO) which promotes inflammation and cardiovascular disease development in humans.1

This review states that choline is deserving of more research to determine if there is a relationship to DCM in canines. It’s important to call out that much of the information in the discussion on choline is from human data highlighting the knowledge gap in this area.

Methionine and Cysteine – These are sulfur containing amino acids which are involved in the synthesis of taurine. There are multiple factors that influence the synthesis of taurine from these two precursors. These influences include low bioavailability, thermal processing of food, diet formulation, deficiency of methionine which is a limiting amino acid – among others. In addition, sulfur amino acid requirements may vary between breed and size of dogs.1

Again, we need more research to determine breed, size and potentially age specific requirements for these nutrients.1 It’s also important to note that we lack the ability to measure functional adequacy of these nutrients highlighting another knowledge gap.

Taurine – Another sulfur containing amino acid, is not considered essential in dogs. This is because canines can synthesize taurine on their own. Taurine is an essential amino acid for cardiovascular function, skeletal muscle, nervous system function and as a component bile acids. Since the initial DCM investigation taurine has been questioned as being essential, however insufficient data exist to make any conclusions.1 That being said, canines with various cardiovascular diseases have been found to have low taurine levels. Further research is needed to determine if low bioavailability of taurine, low taurine synthesis and/or increased requirement of taurine are factors in these pathologies.

Taurine status is also deserving of more research. It is likely that various breeds, and disease states have different taurine requirements. In addition, several factors may influence bioavailability and synthesis of this amino acid. Variables affecting these factors need to be studied in a controlled environment.

Carnitine – Another nutrient that has been given attention is carnitine. This is because carnitine is beta-oxidized to generate continued energy, and 60% of cardiac energy production is through beta-oxidation. Therefore, deficiency or increased need of carnitine may cause cardiac dysfunction leading to cardiac disease such as DCM.1 Like other nutrition considerations discussed, functional assessments for carnitine status are lacking through blood testing. In order to accurately measure carnitine, biopsy of the heart muscle is required.

Taurine, carnitine and a variety of other nutrients and amino acids require specific balances of vitamins and minerals in bioavailable forms for proper function. Examples include, but are not limited to zinc, iron, selenium and niacin. This means that adequate levels of carnitine or taurine could be present but be unable to be utilized properly by the body.

Thiamine – Insufficient evidence exists regarding thiamine deficiency and cardiac function in canines. However, thiamine does play a role in the metabolism of carbohydrates, fats and specific amino acids. Thiamine can also be rendered unavailable by the presence of certain enzymes in some foods. In short, more research is needed to determine if thiamine deficiency, or lack of bioavailability, potentially contributes to the disease process of DCM in dogs.

Copper – Copper is known to play an important role of many enzyme functions, hemoglobin synthesis, nerve structure and function, blood vessels and various tissues. Copper deficiency on cardiac health has been studied in other species, but not dogs. While copper is routinely supplemented, it’s status could be negatively impacted by excess zinc and/or iron.1 This again indicates another knowledge gap in the area of canine nutrition and DCM.

Vitamin E – Vitamin E is a potent antioxidant which has links to cardioprotective mechanisms. Dogs with DCM have been found to have lower vitamin E in comparison to healthy dogs.

Selenium – Selenium deficiency may be related to reduced ability for cysteine synthesis. In addition, selenium deficiency results in increased oxidative stress, and decreases other antioxidant activity. Further, decreased bioavailability of selenium may inhibit the absorption of other metabolic constituents creating further complications. Additional research is needed to determine the involvement of selenium in the pathology of DCM.

[vc_single_image image=”3556″ img_size=”full”]

Heavy Metals & Other Toxin Considerations:

Heavy metals and various toxins have well documented roles of nutrient interference in humans, canines and other species:

  • Cyanide can increase the sulfur amino acid requirement
  • Certain raw foods (fruits/vegetables) can inhibit iodine function and increase risk of hypothyroid disease
  • Heavy metals such as arsenic, cadmium and mercury increase taurine requirements since taurine detoxifies these metals
Limitations in Current Available Data:

We know that DCM in dogs is not a new concern. Given that, we also know there are significant limitations to research studies currently available due to small sample sizes, sample bias, sample parameter inconsistencies, lack of complete data and known genetic predisposition. Extrapolating data from a small sample size to a large population can be highly inaccurate because subsets of populations are likely to skew results.

In addition, confounding variables and lack of control for independent variables can infer correlation when none exists.

 

The FDA Reports & Sample:

The sample population from the FDA reports resulted from a call for submission of DCM cases in dogs eating suspect (boutique, exotic, grain-free) diets. This resulted in a polluted data set for multiple reasons, including breed reporting, media attention, lack of all confirmed and suspect DCM cases reported, and other confounding factors such as health status of the dog. These confounding factors include obesity and other underlying conditions and diseases.

 

SUMMARY

As discussed, DCM has many etiologies, and many variables affecting disease manifestation. Considerable research is needed into these etiologies, and this paper largely serves as a call to action. While researchers state no definitive link can be found between DCM and ‘BEG’ diets, the largest points are that all etiologies of DCM need more investigation and science of nutrition is complex, and oversimplifying suspicions can lead to misguided and incorrect conclusions.

 

1. McCauley SR, Clark SD, Quest BW, Streeter RM, Oxford EM. Review of canine dilated cardiomyopathy in the wake of diet-associated concerns. J Anim Sci. 2020;98(6). doi:10.1093/jas/skaa155

Summary Journal of Animal Science Article, Volume 98, Issue 6, June 2020

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In 2018 a blog from a veterinary nutritionist sparked a controversy between ‘BEG’ diets and heart disease in dogs. For the past two years, despite an FDA investigation, scarce and vague scientific data has created major issues for pet owners and the pet industry. For clarity, ‘BEG’ diets are known as Boutique, Exotic protein or Grain Free.

A recent article published in the Journal of Animal Science titled, “Review of canine dilated cardiomyopathy in the wake of diet-associated concerns” that appeared to be a saving grace for many advocates of ‘BEG’ diets. This paper investigated a potential association between grain-free pet food and dilated cardiomyopathy (DCM) in dogs. The authors state, “based on this review of the current literature, there is no definitive relationship between these implicated diet characteristics and DCM.” Despite this statement, realize the purpose of this paper was to identify numerous knowledge gaps surrounding DCM and nutrition, rather than to draw conclusions. While no link between ‘BEG’ (boutique, exotic, grain-free) was found, this does not mean that nutrition and other considerations are not at play.

ARTICLE HIGHLIGHTS:

Background of DCM & Diagnostics:
  • Approximately 75% of all heart disease in dogs is chronic degenerative valve disease, with second most common being DCM.
  • Genetics play a significant role in purebred and mix breed dogs. In addition, various genes are implicated. Certain breeds have a greater genetic predisposition than others.
  • Studies investigating the incidence rate of DCM date back to 1988 until recently. Consistently, the incidence appears to remain between 0.5-1.3% of the canine population. This is inclusive of available FDA data.
  • Diagnosis can be limited by accessibility and affordability of various diagnostic tools. Because of this, other types of heart disease could be misdiagnosed as DCM based on similar presentation.
Multiple Causations & Secondary Factors of DCM:
  • Biopsy of heart tissue shows numerous underlying causes of DCM – including but not limited to infection, inflammation, endocrine disease, heart arrhythmia, toxins and various nutritional deficiencies.
  • Nutritional considerations include fiber content, potassium, choline, methionine, cysteine, taurine, carnitine, thiamine, copper, Vitamin E and selenium. It’s important to note that a deficiency of one or more of these nutrients in direct relation to DCM is an oversimplification and fundamentally incorrect to assume. As discussed below, nutrients have varying and complex roles when it comes to metabolism.
  • Other considerations for consideration include cyanide exposure from food (cassava, tapioca), goitrogenic foods (suppress function of thyroid gland), and heavy metals.
FDA Report Considerations:
  • Boutique pet food manufacturers and exotic protein sources are likely not associated with DCM per current available data and publications.
  • Grain-free foods are also likely not associated with canine DCM, and current data shows any nutritional relationship is likely far more complex than has been portrayed.
  • More research is needed to determine risk factors for DCM including, but not limited to, infection, inflammation, endocrine disease, arrythmias, toxins and various nutritional deficiencies.
  • The FDA data pool was polluted. Meaning that it was a biased data set with subgroups (like golden retrievers, and dogs eating grain-free food being overrepresented) leading to biased conclusions.