Updated: Oct 15
Pet parents are expressing an increasing interest in feeding interventions for their pets after a diagnosis of cancer. Contributing significantly to pet parent stress after a diagnosis of cancer are the varied strong opinions regarding feeding of cancer patients and the focus on fear-based approaches to defending these opinions. Additionally, our cultural addiction to and fascination with fear and conflict has established a strong "feartopia" around pet feeding which appears to be growing by the day.
This all can lead to a situation in which anxiety, stress and financial distress can further decompensate an already fragile human emotional system that is trying to adjust to the recent diagnosis of cancer in a beloved pet and the accompanying fear and worry.
Here, I'll share
reflections and opinions based on observations from a clinical oncology practice perspective
some ways to think compassionately and logically about personalized feeding options for your pet with cancer
how to think logically about the jungle of opinions you may encounter on your quest for accurate information
A list of 25 available scientific articles related to cancer and nutrition in veterinary medicine (which is what I was able to find from 1990 to now), and others including 32 recent relevant human articles you may find informative
Educating yourself is important in being able to make informed decisions.
Empowerment is effective and helpful.
Fear is counterproductive and harmful.
Balance, in all things, is ideal.
Compassion, for yourself and others, is essential.
Manifestations of the Food "Feartopia"
The number of pet parents coming in to see me who express significant fear and anxiety over the food they are feeding their pets has increased significantly over the past few years. I can tell you, this is exceptionally heartbreaking.
For example, just this past week I had a concerned pet parent come in who was literally bawling because she was afraid to feed kibble but couldn't afford to do a nutritionally balanced fresh food diet. Despite a lengthy conversation including diet options at her integrative oncology consultation the week prior, she had started feeding her dog a two ingredient home cooked meal, that isn't remotely close to being nutritionally balanced, based on the recommendations of an on-line community. When we discussed other options she cried, sincerely concerned, about putting her pet back on kibble based on what she had been told by this "support group". Fortunately, because we checked in with her about her pet's diet at his visit, we were able to discuss other options that were financially feasible for her and better nutritionally supporting her pet while not discounting her concerns.
Another scenario that I often see is that pets just won't eat what we would like them to eat. I have a kitty patient, for example, whose refusal to eat anything but a very limited array of processed foods is causing her "mom" significant anxiety. Her "mom" really wants to feed a less processed diet but he just won't accept the other balanced foods that are being offered. In these situations, a processed balanced food is comparably better than eating, for example, a diet comprised of 100% baby food. But finding a balance among the intense emotions arising from fear, including anxiety, guilt and blame, can be very challenging.
Pet Parent Concerns and Beliefs About Food
A 2016 study from an oncology referral service showed that 90% of pet parents made diet changes after a diagnosis of cancer. Of these changes, 63% involved exclusion of a conventional diet and 54% involved inclusion of a homemade component. In this study, out of Ontario, Canada, 85% of owners highly valued the opinion of their veterinarian and 51% expressed some distrust of conventional diets, with only 28% agreeing that conventional pet food companies place high priority on pet health and wellbeing.
100% of pet parents replied that the quality of the ingredients used in their pet's food was important to them and that they believed nutrition plays an important role in their pet's health. Interestingly, 80% said they trusted their veterinarian's recommendations regarding nutrition for their pet and 80% also believed a change in their pet's nutrition may be necessary after a diagnosis of cancer. When asked about the quality of ingredients in their pet's diet, only 22% believed that grains were good sources of nutrition for dogs, only 12% believed that ingredients used in conventional pet foods were wholesome and nutritious, and 60% felt that a home prepared diet may provide the best nutrition for their pet.
These results suggest that veterinarians have a key role in providing nutritional guidance for pets with cancer. It also suggests that being willing to discuss options outside of conventional diets is key to having effective nutritional conversations that address pet parent concerns about the quality of nutritional components and the importance of food in their pet's health after a diagnosis of cancer in order to optimize satisfaction, compliance and health.
For diet-motivated pet parents, identifying consistent and reliable information on feeding options specifically related to healthful feeding of pets with cancer is frequently confusing, unrewarding and/or overwhelming.
We can see from the results of the above study that pet parent perceptions and practices may not be in alignment with the predominant conventional veterinary nutrition mindset and practices. This creates fertile ground for differing opinions, lack of effective communication and information seeking outside the conventional veterinary medical field.
The Current Reality of the Food "Feartopia"
Pet parents are more commonly seeking advice from sources outside the veterinary field. Contributing to and complicating this matter is a growing consumer distrust of the pet food industry and veterinary recommendations around feeding commercial foods, or lack of support from the veterinary profession in discussing alternative feeding options when those are desired by the pet parent.
A number of articles have been published from the veterinary nutrition community, including this one, citing the nutritional inadequacy of home-cooked or commercial fresh food diets marketed for pets with cancer. This article is helpful and important in the sense of bringing to light the nutritional deficiencies that can occur, and are currently present, within many of the home-prepared diet recipes and commercially available foods marketed for pets with cancer. However, it is also disempowering, as it provides ample criticism without offering actionable alternatives for pet parents and veterinarians seeking alternatives to highly processed diets, short of individual consultation with a board certified veterinary nutritionist for every patient. For veterinarians in clinical practice looking for science-based information on alternative feeding options to assist and empower pet parents, the clinical utility of this kind of information is limited.
For example, information on the specific diets evaluated and evaluation of which of the evaluated "balanced" commercial diets did best meet nutritional requirements, and/or how to modify them to balance the noted deficiencies, would be interesting and clinically useful information in guiding evidence-informed recommendations for veterinarians seeking to empower clients with options. I realize there are many reasons nutritionists would say this would be difficult to generalize.
In a perfect world personalized recipes for every patient would be ideal. However, in clinical practice, getting every pet parent to pursue a nutritional consultation for a home-cooked nutritionally balanced diet and maintaining compliance is difficult to implement for a number of reasons. Finding a balanced minimally processed fresh food diet that is commercially available is often the best option for pet parents (and veterinarians) with an interest in minimizing the chemicals and carcinogens found in processed foods.
This has all contributed to an environment of conflicting opinions within the veterinary community between veterinary nutritionists, veterinarians following conventional guidelines and veterinarians that share the perspective and general prevailing values and beliefs held by pet parents as reflected by the 2016 article cited above.
Additionally, anyone who is looking for guidance through internet and social media avenues is bombarded with widely disparate and often blatantly hostile opinions and statements about feeding fresh foods, raw foods and processed foods, depending on the source of information.
The important question here then becomes: "How do we find an effective path forward that empowers us to do what is best for our patients, clients and pets?"
Learning to think, talk, and act respectfully and effectively around these issues is desperately needed in a compassionate care model of veterinary medicine.
Moving Out of Fear to a Place of Empowerment
The most basic way to shift into a place of empowerment is to change the question we are asking.
Instead of "What should I NOT do?", a more effective approach would be to ask "What CAN I do?" Within that question lies empowerment. And it helps us move away from making decisions based on fear and into an emotional atmosphere of making decisions based on positive action.
It is important to maintain perspective when integrating the information which is, and is not, available into a feeding plan in a real patient in real life. Every patient is an individual and every family situation is unique. These lifestyle, financial and individual patient factors need to be considered during a compassionate, realistic and empowering discussion of dietary interventions. And, above all else, finding a diet that is accepted by the pet, is as nutritionally ideal as possible, and which can be fed with minimal stress by the family should be of highest priority.
10 Empowerment Strategies
Think Long Term and Be Realistic
Find a diet that you can realistically maintain long term.
This includes understanding the realities of your finances, lifestyle, time-constraints, other life stressors and your pet’s personality and willingness to eat certain diets.
When seeking out commercially available diets, be sure to select those that are intended as complete and balanced diet. Diets labeled for “intermittent feeding” do not meet AAFCO minimum requirements for a balanced diet. (AAFCO is an industry standard for minimum dietary requirements.)
If you are interested in feeding a lower carbohydrate food, you can calculate carbohydrate content based on the food label, because carbohydrate content itself is not required to be listed on the pet food bag. "Grain free" foods are often still quite high in carbohydrates, especially kibble varieties.
If you are interested in feeding a less processed diet, look for one that indicates that low-heat processing methods were used. Cooked foods will be"slow baked". Shelf stable "raw" foods will be "air dried", "freeze dried" or "dehydrated".
All foods, not just raw, should undergo processes and testing to address potential bacterial contamination. (Bacteria contamination food recalls have occurred with both raw food and dry kibble foods.)
Consider Supplemental Options
There is a growing body of evidence, in human medicine,
If you are unable to pursue a nutritional consultation to formulate a balanced home-prepared fresh food diet, supplementing your pet’s diet with nutrient dense foods (for example broccoli sprouts or cruciferous vegetables or green leafy vegetables) or administering carefully selected supplements (such as rosemary and turmeric or fish oil and arginine) may be a manageable way to provide phytonutrients that are not available in highly processed pet foods and that have some evidence of potential benefit in cancer nutrition.
Seek out accurate information and form your own points of priority in your pet’s nutrition.
Understand where the information is coming from and biases or agendas that may be influencing the information so that you are able to make informed decisions based on the information you acquire.
Bring your concerns about nutrition and your dietary goals to a veterinarian you trust to help you in the discernment process and assist you in making decisions about your feeding options within the context of your personal situation and your pet's individual health priorities.
Focus on Well-Being
In the absence of consistent facts and thorough scientifically-substantiated nutritional approaches for pets with cancer, your pet’s outward signs of well-being are a helpful measure to determine the impact of the nutrition they are receiving. Increased energy, good body condition (lean and well-muscled), shiny hair coat and healthy skin are all good outwardly visible measures of overall wellness.
If you are concerned about ongoing carcinogen exposure and toxic stress, being mindful to limit chemicals, coloring and preservatives as well as process contaminants (these are substances like Acrylamide and Heterocyclic Amines which are liberated during processing) can be helpful in minimizing the toxic load on your pet's system. Even if you are unable to feed all organic unprocessed foods, making more informed choices in pet treats and pet food op