Dr. Brendan Clarke, senior vice president of The Raw Feeding Veterinary Society addresses diseases of the pancreas and reveals how to monitor your Westie long-term.
Pancreatitis is seen as generally an under diagnosed condition and in milder forms is often mistaken for inflammatory bowel disease, live and gall bladder problems, gastritis, and undefined colic.
It can appear to come and go and in long term, low grade pancreatitis may result in scarring and a lack of digestive enzyme production (maldigestion) and poor insulin production which may cause diabetes mellitus.
Most interestingly following many scientific papers around the turn of the century it has been shown that high blood triglycerides are often fuelled by starch and sugar rich food metabolism.
The pancreas is an organ that is found in the abdomen of dogs and sits resting between the stomach and small intestine (duodenum). Its main function is to produce enzymes to aid the digestion of fats and proteins, but it also releases chemical signals (hormones) into the blood stream to influence how energy is used or stored in the body. This hormone is insulin, and we will discuss this more in the monitoring of pancreatitis later.
In order to enable the enzymes to digest food and not the body itself they are produced in a bound or wrapped form which is inactive and only activates in the intestine on being secreted out of a duct into the duodenum close to the secretion of bile from the gallbladder of the liver. This is timed to coincide with the stomach emptying food broken down by the acid to form chyle.
The production and release of the enzymes and bile is influenced by the detection of food types and presence in the stomach.
Diseases of the Pancreas
These generally reflectinflammation due to infection, immune mediated conditions, inflammation in other tissues close by, injury from an accident or growths within the organ itself. The result of such disease can result in the devastating activation of the digestive enzymes in the wrong place and cause the self-destruction (autolysis) of the pancreas’s own tissues leading to a cascade of further inflammation and further enzyme activation. The results of this devastation can be pain, colic, fever, vomiting and diarrhea. If left uncontrolled it may lead to dehydration, blood clots, organ failure and death.
Pancreatitis is seen as generally an under diagnosed condition and in milder forms is often mistaken for inflammatory bowel disease, live and gall bladder problems, gastritis, and undefined colic. It can appear to come and go and in long term, low grade pancreatitis may result in scarring and a lack of digestive enzyme production (maldigestion) and poor insulin production which may cause diabetes mellitus.
How Pancreatitis is Diagnosed
It is diagnosed by following symptoms and then blood testing and imaging the pancreas with ultrasound. Although your vet may be suspicious of pancreatitis if there are raised liver enzymes, raised digestive enzymes (amylase and lipase), raised white blood cells and ultrasound shows a brighter pattern to the pancreas. An active level of disease can only be identified by a specific canine pancreatic lipase (cPL) or DGGR Lipase found to be raised in a current bout of acute Pancreatitis. If this enzyme is within normal limits, then other causes of the symptoms must be ruled out. The reader should note that reliable blood tests require a standard sample of blood after 12 hours of fasting and preferably tested in the morning.
Causes of Pancreatitis
These are often cited as high fat diets causing raised cholesterol and blood triglycerides. However, treatment remains symptomatic as no one cause has been identified. Conditions due to chronic inflammatory conditions including gingivitis and leaky gut syndromes through to immune mediated or autoimmune conditions, infections and tumors. Also, high blood levels of triglycerides, calcium or zinc have been identified as possible reasons for episodes of Pancreatitis. Most interestingly following many scientific papers around the turn of the century it has been shown that high blood triglycerides are often fueled by starch and sugar rich food metabolism. It is therefore important to understand why the myth of high fat diets having an effect on Pancreatitis is still considered important to this day.
It is thought that during an acute crisis the feeding of fats may stimulate more fat digesting enzymes to be produced by the pancreas. If the pancreas is inflamed, then these will also be activated in the inflamed tissues and add to the burden of damage in and around the pancreas. Read further for appropriate nutrition.
If Your Dog has Pancreatitis
Firstly, check with your vet for appropriate pain relief and supportive therapy as they may need medication and intravenous fluids to avert a crisis. Once stabilized then re-establishing nutritional support is important and for the reasons above considered support for easily digestible protein and lower fat (less than 10%) is considered appropriate with some support with vitamins and prebiotics. Other useful additions also considered in the support of chronic Pancreatitis and/or poor pancreatic activity are the replacement of pancreatic enzymes either through the feeding of raw pancreas or as found in digestive enzyme supplements. Further support for reducing gut inflammation and the promotion of friendly healing gut flora is the use of bone broth. These are really dosed in small amounts frequently to allow quick transition through the stomach and limit the evocation of pancreatic stimulation. More support can be given through remedies such as Iris Vers in low potency 6x to 6c three times daily. Consider other organ support as often the liver and kidneys can be affected by the level of tissue damage so herbal support with milk thistle, dandelion and berberis tinctures can be helpful. Also, the anti-inflammatory effects of Turmeric or Boswelia can assist and some of these are even included in mainstream veterinary treatments.
In the longer term as any acute bouts fade then general advice is to return to a biologically appropriate diet based around raw foods which are easier to digest and use than processed foods. Consider the reduction of starches and sugars in the diet as these can cause raised blood triglycerides. Supplements with digestive enzymes and if appropriate antioxidant and microbiome support will reduce generalized inflammation and be sure to take care of their teeth.
Monitoring for the Long Term
This should include the monthly check of urine samples for signs of diabetes mellitus, liver and kidney problems. Check faecal consistency does not show up excess fats or loose faeces. Blood tests can be considered if there is any suspicion of relapse or secondary complications and your vet can consider trypsinogen like immunoreactivity (TLI) to look at poor pancreatic enzyme production alongside cPL and general liver and kidney monitors.