Chronic diarrhea in dogs may have simple or complex causes. An integrative approach that combines allopathic and alternative therapies helps manage complicated cases.
Chronic diarrhea in dogs is distressing, especially when they have ongoing episodes in the house or at night. To add to the problem, chronic diarrhea (CD) often causes dogs to experience vomiting, appetite and weight loss, and pruritus.
CD has a long list of causes. Understanding the potential triggers, diagnostic approaches, and management options is crucial. Integrative treatment for chronic diarrhea in dogs can be an effective way to deal with this common and often debilitating problem.
What causes chronic diarrhea in dogs?
- Primary gastrointestinal causes include infectious disease (i.e. intestinal parasites, viruses), mechanical issues (i.e. foreign bodies), toxicities, non-infectious inflammatory problems, and neoplasia. Non-infectious inflammatory problems include food sensitivities, dysbiosis, and idiopathic immune-mediated diseases.
- Secondary gastrointestinal disorders include diseases affecting the liver, kidneys, exocrine pancreas, cardiovascular system, central nervous system, and endocrine glands.
Fast fact: The majority of CD cases in dogs result from dysregulated intestinal inflammation, currently termed chronic inflammatory enteropathy (CIE).
For perspective, one report found that 90% of canine CD cases were primary enteropathies. The majority of these (79%) had an inflammatory basis. Of these cases, 66% were food responsive, 23% were idiopathic, and 11% were antibiotic responsive.
Researchers identified infectious disease in only 13% of the primary enteropathy cases, followed by neoplasia at 4%. They diagnosed only 10% of the total cases as secondary in origin.
The roles of dietary therapy, nutritional supplements, and herbs
Most dogs with CD have a primary gastrointestinal issue with inflammation, and a dysregulated immune response. This means a coordinated, multiprong approach for managing inflammation is critical.
From an integrative perspective, support therapy should be directed at the contributors to intestinal inflammation. These contributors can include a disrupted epithelial barrier, dysbiosis, and abnormal mucosal immunity. Gut regulation as well as stress and anxiety management are also important.
Fast fact: Work with an integrative veterinarian before changing your dog’s food or introducing new supplements or herbs to his diet.
Dietary therapy
The majority of dogs with CIE have a food responsive enteropathy. This means they should be placed on an appropriate limited-ingredient diet, a balanced home-prepared diet, or a hydrolyzed diet for at least two to four weeks, then reassessed.
The selected diet can be continued another two to four weeks if improvement is noted. If it isn’t, the diet should be changed. Keep in mind that complying with the specified food is critical for success.
Nutritional supplements
- Chronic gastrointestinal disease has been associated with deficiencies of vitamin B12. Low vitamin B12 levels have been reported in 19% to 54% of dogs with CIE. This deficiency may result from small intestine disease and/or dysbiosis. These dogs may have a predisposition to intestinal inflammation and may respond poorly to other therapies, such as hydrolyzed diets. Vitamin B12 is essential for mucosal regeneration and reducing inflammation.
- The majority of dogs with CIE have low serum levels of vitamin D. This vitamin has an effect on modulating immune responses and inflammation. Experts currently believe that low levels contribute to the initiation of intestinal inflammation. Base vitamin D supplementation on serum level measurements. Follow-up measurements should be performed at eight- to ten-week intervals to determine if appropriate serum levels have been reached.
- Support for the intestinal epithelial barrier should be incorporated into the therapeutic plan. This includes the use of glutamine, which plays an important role in the health and metabolism of intestinal epithelial cells. Glutamine promotes intestinal epithelial cell proliferation, has anti-inflammatory effects, and regulates tight junction proteins. The intestine uses about 30% of the body’s total glutamine, and as much as 75% of ingested glutamine.
Fast fact: You can support the large intestine epithelial barrier through soluble fiber and supplements like arabinogalactan. These increase levels of short chain fatty acids, improving the barrier’s integrity and offering immune-modulating effects to help reduce inflammation.
- Reactive oxygen species (ROS) and reactive nitrogen species (RNS) can be a major factor in initiating and contributing to inflammation in the gastrointestinal tract. They have damaging effects on cell membranes, increasing cell permeability, causing DNA damage, and inducing cell death. ROS and RNS also upregulate genes associated with immunity in the gastrointestinal tract.
The intestinal tract is a significant source of reactive species. While some contribute to health, continuous excess production and inadequate removal can promote chronic inflammation.
Adding whole food ingredients with antioxidant properties, such as polyphenolic compounds and carotenoids, benefits the gut. These improvements in oxidative status can lead to positive changes in the microbiota.
Herbs
Consider herbs like curcumin (Curcuma longa), ginger (Zingiber officinale) and green tea (Camellia sinensis) for their antioxidant properties. Many herbs also have anti-inflammatory properties that can help manage inflammation associated with CIE.
Herbs such as marshmallow root (Althaea officinalis) have antioxidant properties, anti-inflammatory effects, and provide a protective mucilaginous coating for inflamed mucosa.
Fast fact: Carefully selected Chinese herbs can also be beneficial.
In summary, chronic diarrhea in dogs is a complex and challenging problem. You must have your vet perform a complete workup and understand the precipitating and contributing factors. Also recognize that most dogs with CD have a dysregulated immune response that propagates intestinal inflammation.
Optimal support for these dogs relies on a methodical and encompassing integrative treatment plan.
Chronic diarrhea in dogs requires a correct diagnosis
If your dog has persistent or recurring diarrhea, take him to the veterinarian for a full checkup to pinpoint the cause. When a complete diagnostic workup has been done, and the cause identified, treatment can begin.
For example, dogs with giardia should receive the appropriate therapies. Those with secondary enteropathies like liver disease should receive supportive care, and medications and herbs with hepatic side effects should be discontinued, if appropriate.
Dietary considerations also need to be incorporated into the plan. For instance, a dog with pancreatitis may benefit from a low-fat diet. Dogs with toxicities, foreign bodies, intestinal neoplasia, infectious diseases, or dietary indiscretions need to have these particular issues addressed.
Managing intestinal dysbiosis
The intestinal microbiota is a complex ecosystem that influences health in numerous ways. Studies show a link between CIE, intestinal dysbiosis, and intestinal inflammation.
Managing intestinal dysbiosis is challenging and often requires a multistep approach. This includes dietary changes, probiotics, fecal transfer, prebiotic substances, and adding organisms that suppress pathogens. It’s also important to identify factors that impact the digestive tract microenvironment.
You can alter the microbiota by adding protein toppers and reducing carbohydrates. Increasing fiber can also help make necessary changes. Additionally, incorporating food ingredients and herbs with antioxidant properties reduces ROS and RNS, promoting beneficial alterations.
When choosing a probiotic, consider the number of colony-forming units (CFU), microorganism species, types of organisms (e.g., soil microbes, animal origin), and inclusion of prebiotic compounds.
Some authorities recommend one to ten billion CFU per day, but this can depend on the individual dog. Sometimes, a combination of products is necessary and includes prebiotic substances like fructooligosaccharide (FOS).
Altering the diet and using probiotics help change the microenvironment. However, it’s important to recognize that the microenvironment is also affected by the pH of gastric fluid, the quantity and quality of pancreatic fluid and digestive enzymes, bile acid secretions, and the regular motility of the digestive tract.
Herbs may promote beneficial changes in the microenvironment. For example, milk thistle (Silybum marianum) and dandelion (Taraxacum officinale) can increases bile production.
Work with your veterinarian to choose the right probiotics or herbs for your dog.
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