Creating a Metabolic Shift
Ketogenic feeding is a lifestyle change which is meant to shift the body's metabolism from sugar-using to fat-using. This may be a powerful therapeutic intervention for cancer treatment and recovery in some dogs but takes a dedicated approach that requires strict adherence to calorie restriction, weight management and home-prepared raw feeding. Additionally, it is important to recognize that not every dog receiving this diet will experience notable anti-cancer effects. In the most recent research update from KetoPets Sanctuary 55% of dogs finished the 4 month induction period and there seemed to be a positive response in tumor control in 30%. These dogs were also receiving hyperbaric oxygen treatments concurrent with the ketogenic feeding regimen. We are still learning about this approach to feeding in dogs who have been diagnosed with cancer. I strongly recommend working with a veterinarian familiar with ketogenic feeding to help you navigate this process safely and effectively. Here you will find some resources for ketogenic feeding which can be used in conjunction with the guidance you are receiving from your veterinarian.
What is a Ketogenic Diet?
A Ketogenic Diet is a therapeutic diet which causes the body to shift into a state known as ketosis. In this state, the mitochondria in the cells, which generate energy, shift their fuel source from sugar to fat. When this occurs, ketone bodies in the blood increase and blood sugar decreases. The belief is that this creates an environment in the body which stresses cancer cells because they prefer glucose (sugar) to generate energy and are, generally, not as metabolically flexible as normal cells in the body.
A ketogenic diet requires these key lifestyle components to be used as a cancer therapy:
1) calorie restriction
2) lean body condition
3) daily exercise
4) high fat
5) low to moderate protein
6) very low carbohydrates
7) raw feeding
Key Steps to Metabolic Ketosis
shifting metabolism to make the body a less hospitable environment for cancer growth
Twice daily rigorous exertion to increase metabolism and encourage appetite.
Two 20 minute sessions daily
Calorie restriction and strict adherence to the ketogenic diet.
Daily monitoring of blood glucose and blood ketones at home to make sure ketosis is being achieved, then weekly once reliable ketosis is achieved
A lean body condition is important for success. Weekly weight monitoring is required in the initial stages to ensure proper nutritional support
Are There Risks to
There are certain risks to ketogenic feeding, although with education and strict adherence to safe food handling practices, carbohydrate restriction and blood monitoring these are very manageable. Your veterinarian can help you make sure you understand the ins and outs of ketogenic feeding.
The main risks to be aware of are:
1) Low blood sugar without accompanying elevation in ketones if ketosis is not achieved
2) Foodborne illness as a result of improper handing of raw foods and dishes
3) Pancreatitis which can result from feeding cooked fats and/or too much carbohydrate
4) Diarrhea may be seen for a few days after transitioning to this diet
5) Loss of muscle mass or body condition if appropriate recipe transitions are not followed
6) Electrolyte and Mineral Imbalances
7) Fatty Liver changes
*Additionally, prednisone or steroid use will cause changes in blood glucose (sugar) that may make achieving a state of ketosis very difficult or impossible. If your pet requires steroid therapy this type of feeding may not be an effective option.
What You Need to Know
Safe Transtions to a Ketogenic Lifestyle
None of the dogs at the Keto Pets sanctuary developed pancreatitis from their ketogenic diet. These dogs were closely monitored, are fasted for 48 hours prior to slow introduction of the new diets, had strict carbohydrate restriction, did not receive extra treats, exercised daily, and were fed raw food which had not been processed with heat. Pancreatitis seems to be related to feeding high fat with high carbohydrates (sugars). It has also been seen when dogs receive the ketogenic diet cooked. We think this may be because of the changes fats undergo when exposed to heat. For these reasons, when feeding an extremely high fat diet like a ketogenic diet, strict adherence to the recipe and calorie restriction is very important. Dogs should not receive other foods, including treat foods.
Preventing a Hypoglycemic Crisis
Hypoglycemic (low blood sugar) crisis is rare but can occur if blood sugar drops as a result of low carbohydrates and ketone bodies do not rise to take their place as a fuel source for the brain and normal body cells. Dogs do not usually achieve measurable ketone levels as high as people, likely because they utilize these “ketone bodies” more efficiently. With the ketogenic diet we expect to see a decrease in blood sugar, often between 50-60, while good energy levels are maintained. This indicates that we have achieved ketosis even if ketone blood levels are not measuring very high. You will purchase a ketone meter and glucose meter and monitor your dog’s blood levels at home daily to every other day during the initial transition into ketosis. If energy levels dwindle or your dog is lethargic, the diet will need to be adjusted to include more carbohydrates.
Safe Raw Food Handling
When preparing raw meat diets, safe food handling practices are important to prevent food-borne illness. Use stainless steel or glass bowls and food preparation surfaces that can be sterilized after each meal. Handle all raw meats using the same common sense safety measures you use when preparing raw chicken or hamburger for your human family. Wash hands and all food preparation surfaces before and after handing raw meat. Use the freshest meats possible and do not allow the meat to stay unused in the refrigerator for an extended period of time. (I usually advised no longer than 3 days.) Also, I do not recommend feeding raw pork, as this meat can contain an infectious organism called trichonella. If immune compromised people or young children live in the household, there is theoretically an increased risk of transmission of bacteria. However in all the studies I am aware of that have been done to date, transmission of pathologic bacteria to people from pet dogs has not been documented. While this threat remains theoretical, it is wise to exercise caution. And in these households raw feeding might not be advised.
Maintaining Good Body Condition
With a ketogenic lifestyle there are stages to the feeding program. In the first stage your dog will receive a higher fat, lower carbohydrate, low protein diet in order to create a metabolic shift into ketosis. The duration of this stage varies from dog to dog. If this stage is extended too long, loss of muscle mass will occur. If you notice your dog is losing muscle mass, this means that the diet recipe needs to be adjusted. Many dogs will lose weight, which is desired for pets who are overweight at the start of the protocol. Target weight loss should be no more than 0.5-1lb per week. A body condition score of 3/9 is the goal for pets on a ketogenic lifestyle regimen. The long term maintenance phase, while still calorie restricted, contains relatively more carbohydrate and protein than the diet fed when getting the body into a metabolic ketosis. It is important to work with your veterinarian to monitor body weight, muscle mass and body condition in order to engage with this dynamic, therapeutic feeding process that is part of the ketogenic lifestyle.
Many dogs can experience transient diarrhea when transitioning to a ketogenic diet because of the high fat content. This is typically short-lived, resolving in about 3 days. Fasting for 24-48 hours prior to introducing the ketogenic diet can help decrease diarrhea severity. Digestive enzymes, probiotics, prebiotics and fiber supplements can also help maintain normal stools. Chia seeds are another food supplement that is often added to support normal bowel movements. Dogs who are particularly sensitive may require a more gradual transition into ketosis with an altered feeding protocol. Starting with a lower fat ratio can help some dogs transition more smoothly.
What to Know About Fatty Liver Changes
Fatty Liver is a condition where fat accumulates in the liver. On the high fat ratio phases of the diet (Phase 2 and Phase 3), which are the therapeutic ones, dogs at the Keto Pets Sanctuary did develop changes on ultrasound consistent with fatty liver. Interestingly, these changes were not accompanied by elevations in liver enzymes on bloodwork and no dog developed clinical signs associated with liver disease. Most patients were on this high fat phase of the diet for 120 days. After they were transitioned to the maintenance phase these ultrasound changes resolved. This fat deposition in the liver does not appear to be clinically relevant, although if your pet has underlying liver disease this may be an issue that you and your veterinarian will have to monitor very closely with frequent bloodwork and abdominal ultrasound.
The Importance of Daily Exercise
In order to find success with a ketogenic lifestyle for your dog, daily vigorous exercise is key. The pets at Keto Pets Sanctuary were exercised for 20 minutes daily, with vigorous sustained running either through play or on a tread mill. This exercise conditioning is vital to attaining metabolic health, shifting into a state of ketosis, maintaining good body condition and muscle mass, and maintaining a healthy appetite. Remember, these patients all had cancer, so they were exercised to their capacity. A ketogenic lifestyle is not just about the type of food (raw) or the macronutrient ratios (fat:protein:carbs) but also about attaining and maintaining a lean body condition. That means calorie restriction, daily rigorous exercise, and no cheating! The good news is your dog is not a person! They don't have to practice self control. You do that for them. It's the most important part of your job in helping them heal when embarking on a Ketogenic Lifetyle.
Addressing Food Aversion
In people eating a ketogenic diet food aversion can occur, particularly to the high fat portion of the diet. This is not seen as often in dogs as they seem to find fats very palatable based on some published research on Instinctual diets. When food aversions occur, changing the sources of fat (ie: coconut oil, red palm oil, grass-fed butter, etc) can be helpful. Regular rotation of the food ingredients in the diet can also provide more varied nutrition and may be a good idea for dogs who can tolerate these regular food changes.
Preventing Electrolyte and Mineral Imbalances
As insulin decreases in response to decreased blood glucose and shift into ketosis, the kidneys will excrete more water. Within this excreted water are electrolytes and minerals, increasing your dog's requirement for mineral and electrolyte. A good quality electrolyte and mineral supplement is necessary to provide the needed electrolytes and minerals your dogs needs. The food ingredients alone are not enough. Some pets need sea salt added to their food as well. This is another reason it is important to work with your veterinarian to manage this dynamic process of transitioning into and maintaining ketosis in a safe and healthful way. Managing Magnesium, Potassium and Sodium are the main parameters to follow.
Ketogenic Diet Resources
Keto Pets has published a free resource on ketogenic feeding for pet parents.
Read this before you do anything else with ketogenic feeding.
This food calculator provides a resource to help you calculate food quantities for ketogenic feeding for your dog. It also provides links to some commercially available pre-prepared ketogenic food options for those who would prefer to purchase an already balanced diet.
This documentary is a good investment in understanding feeding for wellness. Rodney Habib and Dr. Karen Becker manage to create a documentary that presents solid science challenging the current medical thinking on how we feed cancer, while maintaining an attitude focused on positive empowerment and bringing people together. The last episode is a great segment on how to practically implement a ketogenic diet, including step by step instructions on how to test your dog’s blood.
Keto Pets Early Research
Learn More About the Results of a Ketogenic Lifestyle in Dogs with Cancer
This video is from the early days of Keto Pets sanctuary (from July 2016 after about 19 months of research), but it provides some nice information about their approach and the early results they were seeing with this type of feeding. The first 30 minutes is specifically about their project feeding dogs with cancer a ketogenic diet.
Keto Pets Research update 2017
See updates on the results of dogs treated at KetoPets Sanctuary with Ketogenic Diet, exercise and Hyperbaric Oxygen Therapy
This video is from February 2017. The first 12 minutes are specifically about their project evaluating 40 shelter dogs with cancer enrolled in the KetoPets Study.