Pancreatitis is a painful condition where the pancreas becomes severely inflamed; this usually occurs when the pancreas has been damaged somehow thus causing a release of digestive enzymes that are usually held within the pancreas. This release then harms the pancreas where by the enzymes begin to digest the pancreas itself. The patient may then have vomiting, diarrhea, loss of appetite, severe abdominal pain and a reluctance to walk.
The exact reason this occurs is not fully known, but there are a number of contributing factors that can trigger pancreatitis:
- Hyperlipidemia: patients who have consistently high levels of fat in their blood are prone to pancreatitis attacks.
- Obesity: overweight pets are much more likely to develop pancreatitis and fatty meals can trigger an episode.
- Infections: eating contaminated food can cause viral or bacterial infections of the pancreas
- Trauma: abdominal trauma (ie. a pet hit by a car) can potentially trigger the release of enzymes by the pancreas thus causing an attack.
- Tumours: cancer of the pancreas affects the normal function of the organ.
So how do we nutritionally support these patients?
Selecting an appropriate diet:
The goal of dietary management for pancreatitis patients is reducing the secretions from the pancreas, to prevent the self-digestion of the pancreas and to provide nutritional support to allow for the repair and recovery of the tissues. In addition to this, maintaining hydration to correct any dehydration and electrolyte or acid-base imbalances.
When treating any medical condition, we use Key Nutritional Factors to determine the right food and feeding plan for the pet. Key Nutritional Factors give us a guide as to what to look for in a food to treat or maintain remission of symptoms. For patients with acute or chronic pancreatitis, these are:
Fat
≤15% for non-obese and non-hypertriglyceridemic dogs, ≤ 25% for non-obese and non-hypertriglyceridemic cats
≤10% for obese and/or hypertriglyceridemic dogs, ≤15% for obese and/or hypertriglyceridemic cats
Protein
15 to 30% for dogs, 30 to 40% for cats
*Nutrients expressed on a dry matter basis. (Small Animal Clinical Nutrition, 2019)
Based on these factors, we can evaluate the previous or current diet the pet is getting and determine if it is still ideal for long term management. For pets that are obese, you will also need to consider the amount of fibre in the diet as these patients will do better with a high fibre, low fat diet both to stimulate weight loss and reduce fat intake.
So what do we do during an acute episode?
Fasting/NPO: Some vets suggest withholding food for the first few days however there is so much debate on this, and we currently lack animal studies to determine the appropriate plan for pancreatitis patients. Most Board Certified Veterinary Nutritionists recommend early nutrition and tube feeding as best practice for recovery, and providing strong anti-emetics and introducing food as soon as possible, as it helps reduce gastric acid and maintain gut motility during an attack. Based on the human studies we have, it also shows better recovery on early enteral nutrition.
Provide oral re-hydration solutions: liquids such as Lectade or Oralade (available from your vet) to maintain hydration, especially if vomiting and diarrhea is present. Most pets will also be on intravenous fluid therapy while hospitalised.
Offer liquid/soft foods: For patients who aren’t wanting to eat, it may be necessary to place a feeding tube in the short term and offer liquid diets. Hill’s A/d can be used in the short term (2-3 days) if the patient is not obese and there is no hyperlipidemia present. Hills I/d low fat can be blended into a slurry and used as an alternative if obesity and hyperlipidemia are present. ProPlan EN can also be used. If you live in a country with access to Royal Canin GI low fat liquid, this be used for tube-fed patients and has an ideal texture for small bore tubes like nasogastric tubes. Provide these diets across multiple small meals throughout the day.
Reintroduce solid foods slowly: If liquid foods are tolerated and no more vomiting is present, it is safe to slowly return to solid food if using I/d low fat or EN, gradually reduce the amount of water added until the patient is comfortably eating the food without water added.
Continue to feed GI diet for at least 7-10 days following the attack: you can start gradually reintroducing the old diet (if it’s to be used at all) however ensure the old diet has been assessed to determine if it meets the KNFs for the patient. If the old food is the reason the pet is currently experiencing an attack, it’s safer to consider a long term gastrointestinal diet for these patients. Majority do not relapse if maintained on the GI diet and are not fed any other treats.
Patients that do relapse despite carefully controlling diet, should also be reevaluated for any evidence of pancreatic pseudocysts, pancreatic necrosis or abscesses.
How do we avoid a relapse?
- Avoid high fat snacks such as peanut butter, cheese, or fatty cuts of meat.
- Avoid sudden diet changes without a transition in between, or alternating between different diets, consistency is key.
- Feed multiple small meals throughout the day, or allow free access to food if patient is not overweight.
- Avoid feeding high fat commercial foods (<20% DM) such as supermarket foods or “performance” diets that are high in oils and fats.
- Discuss any supplements with your vet before administering, as oil or fatty-acid based supplements may be counter-intuitive if feeding a low fat diet.
- Do not feed table scraps or human foods as these usually are very high in calories and are a common trigger of relapse.
- Treats can be given if they are low fat and make up less than 10% of the overall daily dietary intake, 5% if the patient is overweight. I recommend Royal Canin Educ treats, as they are low calorie and easy on the stomach. Alternatively you can offer the pet’s own food as a treat throughout the day.
- Avoid home-cooking diets for pancreatitis patients as the balance of fats and fibre is difficult to control outside of a prescription or commercial diet. If your client insists on feeding home-made diets, refer them to a Board Certified Veterinary Nutritionist or direct them to BalanceIt.com
As with every medical case, every patient is an individual so always take into account the pet’s unique nutritional needs when determining a feeding plan. What experience have you had with treating pancreatitis? Did your vet recommend NPO or did they feed through the condition to recovery? Let us know in the comments below!
**Please note: I am not a Vet, I am a Registered Veterinary Nurse and advice given here is of a general nature for veterinary professionals to assist in their nutritional care planning for pancreatitis patients. If you suspect your pet has pancreatitis, please take them to your Vet immediately.
References
American College of Veterinary Nutrition – Today’s Veterinary Practice Nutrition Notes ‘To Feed or Not To Feed? ‘
Mark Morris Institute (2019) Small Animal Clinical Nutrition, 5th Edition[pdf] Available online at: http://www.markmorrisinstitute.org/sacn5_download.html