Updated: Sep 5, 2019
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.
Educate Yourself and Form Your Own Opinions
Seek out accurate information and form your own opinions and 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 opinions 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 options can improve the "cleanliness" of your pet's diet. And while experts may still disagree about the role this plays in cancer prevention or treatment in dogs and cats, it is certainly not harmful.
Be mindful that "clean" and "natural" are buzz words for marketing strategies right now. These food label claims don't mean much in and of themselves. Do your research, consider the processing methods and ingredients used, and recruit your best common sense to help you determine if the food meets the "cleanliness" goals you have for your pet's diet. More on this on my other blog here.
Short Term Perspective
Understand that, short of severe nutritional inadequacies, most nutritional imbalances will not manifest in clinically significant ways until many months of feeding an unbalanced diet. So if your pet requires or is only accepting certain foods that are not nutritionally balanced, don't panic. There is time to find a workable solution.
There are a plethora of resources and well-intentioned "support groups" for people caring for pets with cancer. The first thing to ask yourself is whether or not, in these support groups, you are actually feeling supported. If not, I suggest seeking out alternative resources that are providing you with the emotional support that is helpful to you. Criticism, negativity and judgmental attitudes are toxic to your already stressed emotional system.
Seek out kind people and information that is focused on empowering you, not scaring you.
Select information resources that focus on positive empowerment, compassion and understanding that is also grounded in evidence.
Evidence may come from the veterinary literature or, because the Veterinary Nutrition and Oncology professions in the US have not recently placed priority on research and clinical trials to identify optimal nutrition for pets with cancer, information may, by necessity, be extrapolated from the human literature.
The most recent relevant veterinary articles I could find were Kazmierski 2001, Mazzafero 2001, Raghavan 2005, Alenza 2008 and Freeman 2012. A list of the literature is available at the end of this blog.
Remember that the love and care you show your pet is the most important aspect to their well-being and enjoyment of life. They only know how they feel every day, and how they experience you. Finding a balanced approach to their care that allows you to feel good about what you are doing and minimizes avoidable stress is an important part of formulating an effective care strategy.
Things to Think About
Information as a Weapon or as a Tool for Compassionate Action?
Rather than using information as a weapon, let's use it to help each other. Find resources that are not based on creating fear, no matter what the source. What you need most right now is support, and positive assistance in determining realistic options. Criticism, whether it is of you or another way of thinking, is not helpful to your emotional state and will only serve to compound the stress you are experiencing. This will impair your ability to think clearly and objectively about the information being presented. Use your own good judgement when evaluating information.
Understanding and Overcoming Irrational Fear or Guilt
Many pet parents express that they are afraid what they fed or didn't feed their pet caused cancer, or that by not changing the diet they are "killing" their pet.
The first and most important thing to understand is that there is not one thing that causes cancer in every pet or person. And food, while I personally believe it is intelligent to consider how we can use food as medicine, is not by itself a singular cause of cancer, nor is it an independent magical cure.
It is true that chronic low dose exposure to carcinogens (many of which have been identified in processed foods, both human and pet) may be a contributing factor for cancer development. It is also true that certain nutritional deficiencies have been identified to contribute to cancer risk. It is, however, also true that many pets live a long life without developing cancer who have eaten a poor quality kibble or diets of fresh foods that would be identified as nutritionally unbalanced based on AAFCO standards.
A balanced perspective is important when considering the best path forward.
Controlling What We Can Control
The environment we live in is much more toxic than it was years ago. This is likely one contributing factor to the rise in cancer we are seeing. Stressing over this is not helpful. But we can ask the question "What do I have control over?"
Food is one of the things we can control. And we do know that many processed foods do contain carcinogenic substances. Although no long term feeding trials have been done in the US to prove a cause and effect relationship between pet food and cancer, or many other carcinogens and cancer in dogs for that matter.
The relevant question in cancer management is ultimately not "Are these chemicals scientifically proven to cause cancer in dogs and cats?", but rather "Is it medically harmful to limit exposure to known carcinogens when possible?" I think we can all agree that it wouldn't be harmful, and may be beneficial, as long as this can be done in a balanced way that is not adding to the stress of cancer management in your pet.
It is equally important not to fall into the trap of guilt or blame around exposure that your pet may have had to these substances in the past.
A Perfect World
In 2016 AAHA published guidelines for small animal oncology based on the consensus of a strong group of leaders in the field of veterinary oncology. In these guidelines the following statement is made about nutrition in cancer patients:
"The nutritional status of all oncology patients should be routinely assessed beginning at diagnosis and throughout treatment. The incidence of cachexia is low in veterinary patients. It is characterized by a distinct set of metabolic changes that are nearly impossible to reverse once they are present, although dietary modifications can slow progression. Diets should be tailored to each individual taking into account their cancer diagnosis, any other disease processes (e.g., pancreatitis or renal disease), and nutritional needs, as well as environmental factors including other pets in the household and an owner’s ability or willingness to feed the diet. The most important dietary consideration for canine and feline oncology patients is that the ration is palatable and eaten, otherwise it has no benefit. Providing a complete and balanced diet, whether commercially available or homemade, is imperative. A variety of diets have been used for veterinary cancer patients. It may be helpful to consult with a veterinary nutritionist who can formulate a diet specific to the patient."
I agree with this statement. It is my preference that patients would all receive a personalized formulated fresh food diet working with a board certified veterinary nutritionist who is familiar with and willing to work with the treatment and dietary goals we have that are specific for a pet who has been diagnosed with cancer, including the recent human literature on the potential benefits of focusing on carbohydrate sources that pack the most phytonutrient and antioxidant "punch" and have shown some anticancer activity. In this way we can leverage the nutritional power of the foods our pets eat as "medicine".
In reality, while many pet parents express concern about optimal nutrition, they are often, paradoxically, averse to paying the consultation fees associated with this type of personalized nutrition. And many are not able/willing to home prepare food. Some of this likely has to do with the increased expense of formulating a balanced fresh food diet. Some of this has to do with the convenience of ready-made dog foods and the wide availability of fresh cooked or frozen raw AAFCO balanced diets in pet stores. Additionally, free information available on the internet may be perceived as being less bias than information from the veterinary community (but is also frequently less informed or accurate regarding nutritional requirements).
For these reasons, open and respectful communication between pet parents and veterinarians is vitally important in order to identify the obstacles to balanced feeding and to come to solutions which take into consideration the concerns and goals of the pet parent as well as the nutritional needs of the patient.
Realistically, in clinical practice, we have to work with the realities of each family situation. And, in the end, a diet which allows low stress feeding (whether that stress is time, effort, financial, emotional or nutritional) is priority.
The Importance of a Compassionate and Logical Perspective: Opinions versus Facts
Opinions are not facts. Even opinions that are based on facts, or scientific data points, are still opinions. They may be educated opinions, but they are still opinions. Opinions change and evolve based on changing information, or at least opinions based on facts do. Facts are reliant on the current state of understanding and available information on a particular topic at the moment. Opinions about food are going to be heavily biased based on cultural conditioning, previous educational and life experiences, personal lifestyle and values, belief system, and ability of the individual to look logically and objectively at all the currently available facts.
Here is some perspective which may be helpful
based on Logic and Debate, in which I have some training
Lets first look at some definitions from Webster's dictionary:
"a science that deals with the principles and criteria of validity of inference and demonstration : the science of the formal principles of reasoning"
a) "the act of passing from one proposition, statement, or judgment considered as true to another whose truth is believed to follow from that of the former"
b) "the act of passing from statistical sample data to generalizations (as of the value of population parameters) usually with calculated degrees of certainty"
"a piece of information presented as having objective reality"
Scientifically validated information available in published peer-reviewed research articles is the current standard, in the western biomedicine medical community, for determination of and source of "fact". This modern system of medicine is about 200 years young.
"something that is neither derivative nor dependent but exists necessarily"
All "facts" related to the complex conditions of a living biological system are necessarily highly dependent on multiple factors related to environment and individual variables. This makes ultimate determination of immutable facts related to living complete biological systems difficult to achieve and is the reason for confounding factors and disparate results in scientific research. This is why a fact is not, necessarily, the same as reality.
a) "A view, judgment, or appraisal formed in the mind about a particular matter"
b) "A formal expression of judgment or advice by an expert"
Short of having the answers to the Universe, we are left with evaluating available information and using our best judgement and logic to formulate educated opinions. This is the reason you can find variable opinions from educated and highly intelligent individuals, which are all supported by the "facts" used to arrive at those opinions.
All this means is that it is up to each one of us to determine our own opinions based on the information that is presented to us. In this day and age, disempowerment is high. It's for each of us to seek the most accurate information we can and to, from there, come to our own educated conclusions. If we can each do this, and then find the strength within ourselves to be kind and accept that others may have come to their own differing conclusions, we can then engage in interesting, respectful and effective conversations that lead us to greater understanding.
It is through this type of respectful communication that new ideas are born, new questions formulated, and evolution of our understanding then occurs. It isn't about being right. It is about what we can do to better understand our world and our place in it. It is about how we can cooperate with each other to reach higher states of understanding. I will say, satirically, that only when one has achieved ultimate knowledge of All Things, can one claim to be "right" and another "wrong". Otherwise all one can claim is that they have a strong opinion based on the facts they understand and their logical evaluation of them.
Integrity: "the quality of being honest and having strong moral principles; moral uprightness."
From this space, of doing our best to be responsible, respectful and kind, we can communicate effectively with each other and help each other understand things better. This is the way I approach my practice. I have a degree of expertise and understanding. Based on that expertise and understanding, these are my opinions. I am happy to share those with you with the intention of helping. If you don't agree, lets talk respectfully about it. Maybe together we can find a solution or arrive at a more accurate understanding. Anything less than that is not compassionate and, more importantly, is not effective.
Veterinary-Relevant Research on Diet and Cancer:
Roles of Caloric Restriction, Ketogenic Diet and Intermittent Fasting during Initiation, Progression and Metastasis of Cancer in Animal Models: A Systematic Review and Meta-Analysis. (Guillermo, 2014)
Veterinary Research on Diet and Cancer
Sampling of Recent Human Literature on Diet and Cancer:
Circulating bile acids in healthy adults respond differently to a dietary pattern characterized by whole grains, legumes and fruits and vegetables compared to a diet high in refined grains and added sugars: A randomized, controlled, crossover feeding study. (Ginos, 2018)