Food is Love- Veterinarians and Nutrition

Food is Love
As a child, I was a big fan of the Peanuts cartoons. One of my favorite characters was Snoopy, a suave, bipedal beagle who wrote novels and engaged in breathtaking aerial combat with his nemesis, the Red Baron. Though Snoopy was unlike most other beagles I have known, he had one characteristic common to others of his breed, and indeed most dogs. When suppertime arrived, all other activities were forgotten, and he often launched into an exuberant, joyful suppertime dance. Every feeding was a celebration for Snoopy, a celebration not only of food but of the bond between dog and owner.

Few subjects generate the same intensity of emotion in pet owners as the question of what to feed our animal companions. Feeding our pets is the quintessential act of caring and love. And based on how most dogs and cats act at feeding time, it certainly seems like a highlight of the relationship for them! 

There is also a deep sense in most pet owners that choosing a pet food has tremendous significance for the health and well-being of their pets. Everyone wants to give their pets the “best” food, the food that will keep them active and happy and prevent illness for as long as possible. We have all been told most of our lives that what we eat affects our health, so we want to make good, healthy nutritional choices for our pets as well.

The food we give our pets food is also something we have control over. We naturally want to do everything we can to ensure our pets stay healthy, but many factors that influence the risk of disease are beyond our control. Food, at least, is something tangible that we know has an influence on health, and we can make choices about what we feed our pets that give us a sense of actively influencing their health. 

The significance and emotion attached to feeding can be good in that it motivates pet owners to seek information and try to make thoughtful, informed choices about what to feed. However, the pressure to find the “right” food can also make clients vulnerable to irrational decisions, and to exaggerated or unproven claims about nutrition and health. Like most medical subjects, nutrition is complicated and full of uncertainty and nuance, and the desire to find the perfect food to guarantee our pets good health is all too easy to exploit by those selling pet food or promoting particular feeding ideologies. Even smart, rational people can get swept away by enthusiasm or diet fads that may not be based on reliable scientific principles or evidence.

The role of veterinarians in decisions about nutrition is critical. We should be a reliable and convenient resource for owners, supporting rational feeding choices. But are we? Do pet owners rely on their vets for guidance about nutrition, and do we live up to our responsibility to provide it?

Do Clients Trust Us?
Unfortunately, the idea that veterinarians are not reliable sources of nutrition information is widespread. Many voices, from the media and breeders and even some of our colleagues within the profession, are loudly proclaiming that vets know little or nothing about pet nutrition, that what we do know is mere pet food industry propaganda, and that we are more concerned with selling food than with using nutrition to support the health of our patients [see examples below]. 

In general, the public sees vets as pretty trustworthy and likeable, sometimes even more so that other healthcare professionals.1 While there is some variability among studies in the extent to which pet owners trust our advice about nutrition, most show that a majority of clients desire advice from their vet on what to feed and have high confidence in this advice.2–7  However, the full picture is more complicated. The extent to which clients use and trust veterinary advice on nutrition varies with characteristics of owners, the pets they own, and the type of diets they choose to feed.

Not surprisingly, for example, owners feeding non-traditional diets rather than commercial pet food express less confidence in veterinary nutrition advice.4,7,8 One study found that owners feeding raw animal products to their pets were much less confident in veterinary nutrition advice than those not feeding any raw foods.4 About 54% of clients who did not feed raw trusted this advice “very much” while only 13% of raw feeders had this level of confidence. 

This seemed to generalize beyond nutrition to medical advice in general. In one study, advice about topics other than nutrition was considered highly trustworthy by 64% of clients who did not feed raw products, but only 36% of those clients who did.4 Raw feeders are less likely to trust veterinary recommendations about vaccination, flea control and other preventative health interventions.4,9 This suggests that pet owners who feed unconventional diets may have a broader distrust of conventional veterinary medicine and a more favorable view of alternative medicine. 

Such a connection between unconventional nutritional practices and a general distrust of science-based veterinary medicine seems likely given the consistent criticism of vaccines, pharmaceuticals, and other science-based interventions by veterinarians advocating for raw or other unconventional diets.10–12

Even those suspicious of veterinary medicine in general and committed to feeding their pets unconventional diets, however, still have some interest in veterinary nutrition advice. In one survey, 50% of raw feeders trusted veterinary advice in general “somewhat,” and 32% had this level of confidence in the nutrition knowledge of their vet.4 Surprisingly, among cat owners, a majority reported choosing to feed raw was influenced by advice from their veterinarian (58%) or from other veterinary sources (78%).4 This suggests that the problem may not necessarily be a true lack of trust in veterinarians as a source of advice about nutrition so much as a desire to follow veterinary advice so long as it is consistent with other values or beliefs related to pet health. Owners who feed raw or other unconventional diets, for example, often hold beliefs about the health benefits of such diets that have not been scientifically validated and which are unlikely to be affirmed by most veterinarians. However, these beliefs may be supported by vets with alternative philosophies or approaches, and raw feeders are likely to trust such vets more because their views are aligned.4,7–9,13

Another factor influencing both client feeding choices and their degree of trust in veterinarians as a source of information about nutrition is attitudes towards pet food producers. Pet owners, particularly those feeding unconventional diets, often express significant distrust in the motives and claims of commercial diet manufacturers and in the health value of commercial foods.2,4,8,9

Commercial pet diets are sometimes seen as “junk food,” equivalent in nutritional and health value to human convenience and snack foods because both are “processed.” Pet owners sometimes express concerns about the health effects of grains, organic versus conventional ingredients, genetically-modified ingredients, meat from animals that are ill or have died or been euthanized, and other real or imagined components of commercial diets. There have also been some very serious incidents of real harm to pets from adulterated or contaminated commercial diets, and many pet owners are aware of these.14 Such concerns undermine confidence not only in pet food manufacturers but in veterinarians because we are seen recommending primarily commercial diets and as having potential financial and other conflicts of interest that influence these recommendations.

Should Clients Trust Us?
The arguments against heeding veterinary advice about nutrition are ultimately bad arguments which lead clients to make decisions based on misinformation, fear, marketing propaganda, and other unreliable foundations. Like many bad arguments, however, there is some core of truth to each of them that we have to address in order to protect our clients from being misled. 

What Do Vets Know about Nutrition?
The idea that veterinarians (or at least those practicing conventional science-based medicine) know nothing about nutrition is false. All veterinarians learn about the importance of nutrition and about the effect of food and feeding practices on health in veterinary school. Some of this education is in dedicated nutrition courses, but most of it is incorporated into our education about specific species and health conditions and into our hands-on clinical training. 

However, there is no denying that the quantity and quality of the nutrition education most vets receive is insufficient. Many veterinary schools do not have full-time board-certified veterinary nutritionists on faculty teaching courses in nutrition.15 Surveys of veterinarians consistently find that while we understand the importance of nutrition in health, we rarely feel confident in our training or ability to provide nutritional counseling.15–19 Apart from the small number of board-certified nutritionists, most small-animal veterinarians cannot fairly claim to be experts in pet nutrition. 

So are the critics right? I would argue they are not. While most veterinarians would like more and better training about nutrition than they have, we are still well equipped to offer pragmatic, science-based advice. We have both the general knowledge of physiology and nutrition and the ability to critically evaluate new research and incorporate it into our recommendations. This equips us to offer sound advice about nutrition to our clients.

Crucially, the alternative sources that clients turn to when they don’t trust their veterinarian’s nutrition knowledge are unquestionably less informed and less reliable. Companies marketing unconventional diets, breeders and other lay persons with little or no scientific training, and the information jungle that is the Internet cannot provide the quality or reliability of advice about nutrition that we can as veterinarians. 

Proponents of unconventional feeding practices, including many veterinarians committed to alternative medical approaches, will tell clients and conventional veterinarians that they are nutrition experts because they have “educated” themselves, above and beyond the information most veterinarians receive in school. This “education,” however, is nothing more than seeking and accepting ideas and claims that lack scientific validation but conform to the ideological biases these advocates bring to their search. 

The claim that dogs should eat a “species appropriate” diet extrapolated from what wolves or other wild canids might eat is a common example of this kind of ideologically motivated false expertise. Dogs are not wolves, and they have significant anatomic and functional differences between wolves and domestic dog. Many of these involve their systems for eating and digesting food. For all the millennia dogs have lived with humans, they have scavenged our leftovers and shared our food, and evolution has adapted them to a much more varied and less meat-centered diet than wolves or many other wild canids.20–25

Similarly, unsupported claims about the dangers of grains and carbohydrates,26–31 the benefits of raw32–35 and organic36–40 ingredients, the risks of genetically modified ingredients41–44 and various preservatives or other food additives45, and many other such ideas are frequently identified as examples of advanced knowledge or understanding that most vets lack. However, these do not constitute reliable or scientifically informed advice. Most of these claims are unsupported by good evidence, and many are clearly wrong. Even with the inadequacies in our nutrition training, we are a more reliable source of information and advice for pet owners about nutrition than the alternatives they may turn to if they lose trust in us.

Is all Our Knowledge Just Industry Propaganda
Once again, there is some legitimacy to the claim that the pet food industry has a biased perspective on pet nutrition, and that this industry has entirely too much influence on veterinary education and the veterinary profession. The giving of gifts from industry representatives has been clearly linked to prescribing behavior in physicians,46,47 and it is unlikely that veterinarians are immune to this effect. The common practice of showering students and practitioners with gifts, from coffee mugs to free food to vacations nominally intended as “continuing education,” is a real threat to both the true objectivity of veterinarians and the trust of our clients. Such practices should absolutely be discouraged.

Similarly, there is good evidence that industry funding influences the outcomes of clinical research in ways that is often in favor of the funder’s products.48,49 The concern that the scientific foundations for our recommendations about nutrition may reflect the biases of industry are not unfounded. Fortunately, the impact of such sponsorship bias on research can be mitigated with appropriate methods for controlling bias50, from trial registration and a priori publication of research protocols to strict policies banning any involvement by the funder in the design, conduct, and analysis of research studies. Ideally, more independent funding from academic institutions, non-profit organizations, and government entities would also help to reduce the influence of industry on research, though such funders have, of course, their own biases.

Once again, however, we must understand that these legitimate concerns about potential bias in the information veterinarians receive and provide concerning pet nutrition does not validate the dismissal of veterinary advice nor the acceptance of alternative information sources. We cannot simply declare all nutrition research worthless due to industry bias and make up whatever alternative theories or facts suit us. All data in science comes with limitations, and all conclusions are provisional and must be altered over time as the quality of our data improves. Such evidence is still, however, far superior to the unsubstantiated theories, intuition, and uncontrolled personal experience usually cited in support of alternative nutritional practices. 

It is also often overlooked that all scientific research incorporates biases of others kinds as well, beyond simply that of funding source, and that this influences research results as much or more than the funding source.51 Studies funded by companies producing unconventional diets or conducted by dedicated evangelists for such diets, are no less susceptible to bias than those funded by conventional pet food companies. 

Concerns raised in 2018 about potential negative health effects of grain-free and other unconventional diets52–54, for example, were recently strongly challenged in a narrative literature review.55 This review generated some controversy when the authors turned out to have financial ties to a prominent manufacturer of grain-free dog food. Conflict of interest and bias are ubiquitous and not limited to research supporting conventional or commercial diets. We must evaluate all claims and all evidence critically and be mindful of potential bias while not giving up on evidence-based medicine, which has proved its superiority to anecdote and opinion beyond question.

Veterinarians’ understanding of nutrition science and the physiology of our patients is sound The evidence for many specific nutritional interventions is quite strong;56 certainly stronger than that for the sort of claims offered by those who claim our knowledge is biased and worthless. Tens of thousands of dogs and cats thrive on conventional diets for many years, and while we will likely discover ways to significantly improve how and what we feed through future research, the notion that these diets are grossly inappropriate or harmful is nonsense. Until the alternatives to these diets can generate evidence at least as good as that for current practices, it is disingenuous to dismiss veterinary nutrition counseling on the basis of perceived industry bias.

Do Vets Care More About Selling Food than Patient Health?
I suspect no one will be surprised that my answer to this question is an emphatic “No!” Veterinarians do make money selling pet food, especially therapeutic diets intended for management of medical conditions such as chronic kidney disease, urinary tract stones, food allergies, and others. This is changing as online sales grow, and far more pet food is purchased from sources other than veterinary clinics and hospitals.57 However, food is a revenue stream just as are all the other medications, procedures, and services we provide for our patients. 

While financial incentives can influence the behavior of veterinarians and other healthcare providers, the idea that this is central motivation or that we would sacrifice patient health for profit is nonsense. Veterinarians are individuals committed to animal welfare, and there is no question we could make far more money in much easier jobs if that were our primary concern. Given the training, hard work, stress, and debt we take on to be part of this profession, none of us are the sort of people who would sacrifice our patients or our ethics for the revenue we get from selling pet food. Very few of my clients buy their food from my hospital, and I routinely direct owners to reliable sources for fresh commercial and balanced homemade diets formulated by veterinary nutritionists. 

Unfortunately, the folks who are likely to believe vets are greedy and unconcerned about their patients’ welfare aren’t likely to be swayed by any argument or evidence. I will, however, point out that once again the alternatives to conventional diets also nearly all make money for someone, whether they are manufactured alternative diets, books written by veterinarians to promote such diets, or consultation fees these vets charge for the time they spend teaching clients about their views on nutrition. No one taking any position on what constitutes healthy nutrition for dogs and cats is doing so without some sort of bias, and potential financial bias is as likely on either side of the debate.

How Can We Best Help Our Clients?
The bottom line is that veterinarians have useful, reliable information to offer clients about nutritional choices for their pets. There is good scientific evidence to support many of our recommendations, from low-calcium and reduced calorie diets for large-breed puppies58–64 to specially formulated renal diets for elderly cats with chronic kidney disease65. As general practitioners, our fundamental understanding of physiology and nutrition is sound and useful even though we are not nutrition specialists, just as our understanding of heart disease and diabetes is sound and useful even though we are not boarded cardiologists or internists. We must recognize our own strengths and use what we know to support our clients in making well-informed choices.

One of the most useful insights we can offer many clients is that there is no “perfect” diet that will guarantee only good health for their pets, and there are few diets that are egregiously “toxic” and certain to lead to illness. Health is a complex and multifactorial state, and while nutrition is unquestionably important, simplistic notions or good and bad foods or ingredients and excessive anxiety about finding the “right” foods do more harm than good. An unhealthy obsession with selecting very specific or extreme diets for perceived health values is now widely recognized as an eating disorder in humans, usually referred to as “orthorexia.”66 Pet owners may be subject to a similar unrealistic obsession with nutrition as a means of warding off disease in their pets.

Helping pet owners to make good choices about nutrition includes helping reduce the pressure they feel that every choice is critical and will make or break their pets’ health. This is an understanding we have as healthcare professionals and which we can share with our clients.

We must also, as always, strive to do better in the area of nutrition as in all aspects of our work. Practitioners should see pursuing continuing education in nutrition from reputable sources as a necessary part of our professional development. Veterinary schools should make nutrition a stronger element of the curriculum. And we should recognize the limits of our expertise and be prepared to refer clients when they need nutritional guidance we cannot provide. Board-certified nutritionists in academic and private practice can be excellent resources in developing optimal nutritional plans for individual patients and in countering the ubiquitous myths and misinformation our clients may be exposed to. 

Finally, we should acknowledge the legitimate elements in the criticism of our knowledge and practices. While the pet food industry produces many healthful products and generates much useful resources, profit motives do influence the evidence and the education associated with industry. Clinicians need to be less eager to accept gifts and favors from representatives of industry, and we need to incorporate a recognition of potential funding bias in our critical evaluation of research evidence in the area of nutrition. The best answer to our critics and those promoting unsubstantiated and unscientific alternative approaches to evidence-based nutrition advise is not to cede the field but to work harder to meet our responsibilities to our clients and our patients.

References
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55.      McCauley SR, Clark SD, Quest BW, Streeter RM, Oxford EM. Review of canine dilated cardiomyopathy in the wake of diet-associated concerns. J Anim Sci. 2020;98(6). doi:10.1093/jas/skaa155

56.      Davies M. Veterinary clinical nutrition: success stories: an overview. Proc Nutr Soc. 2016;75(03):392-397. doi:10.1017/S002966511600029X

57.      An Uptick in Clicks and Bricks for Pet Food: An Omnichannel Perspective – Nielsen. Nielsen.com. https://www.nielsen.com/us/en/insights/article/2018/an-uptick-in-clicks-and-bricks-for-pet-food-an-omnichannel-perspective/. Published 2018. Accessed September 7, 2020.

58.      Schoenmakers I, Hazewinkel HA, Voorhout G, Carlson CS, Richardson D. Effects of diets with different calcium and phosphorus contents on the skeletal development and blood chemistry of growing great danes. Vet Rec. 2000;147(23):652-660. doi:10.1136/VR.147.23.652

59.      Dobenecker B. Influence of Calcium and Phosphorus Intake on the Apparent Digestibility of These Minerals in Growing Dogs. J Nutr. 2002;132(6):1665S-1667S. doi:10.1093/jn/132.6.1665S

60.      Dämmrich K. Relationship between Nutrition and Bone Growth in Large and Giant Dogs. J Nutr. 1991;121(suppl_11):S114-S121. doi:10.1093/jn/121.suppl_11.S114

61.      Kasström H. Nutrition, Weight Gain and Development of Hip Dysplasia. Acta Radiol Diagnosis. 1975;16(344_suppl):135-179. doi:10.1177/0284185175016S34412

62.      Hedhammar A, Krook L, Whalen JP, Ryan GD. Overnutrition and skeletal disease. An experimental study in growing Great Dane dogs. IV. Clinical observations. Cornell Vet. 1974;64(2):Suppl 5:32-45. http://www.ncbi.nlm.nih.gov/pubmed/4826269. Accessed September 11, 2020.

63.      Kealy RD, Lawler DF, Ballam JM, et al. Five-year longitudinal study on limited food consumption and development of osteoarthritis in coxofemoral joints of dogs. J Am Vet Med Assoc. 1997;210(2):222-225. http://www.ncbi.nlm.nih.gov/pubmed/9018356. Accessed September 11, 2020.

64.      Lauten SD. Nutritional risks to large-breed dogs: from weaning to the geriatric years. Vet Clin North Am Small Anim Pract. 2006;36(6):1345-1359, viii. doi:10.1016/j.cvsm.2006.09.003

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66.      Cena H, Barthels F, Cuzzolaro M, et al. Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eat Weight Disord. 2019;24(2):209-246. doi:10.1007/s40519-018-0606-y

Examples of Negative Propaganda about Vets and Nutrition
Don’t listen to what your vet has to say about feeding your dog: vets know virtually nothing about animal nutrition… Most veterinarians have ZERO training in nutrition.

My education came from the food company representatives; those that sponsored events while I was a student, and later the food reps that visited the veterinary practices I worked in.

The dog food industry is now dominated by large multinational consumer corporations who, in my opinion, are far more interested in profit than the health of your pet. The entire pet food industry is not on the whole very ethical. Not only do they produce some pretty unhealthy stuff, they also do some pretty unethical things.
Andrew Jones, DVM
Pets Naturally Magazine
March, 2016

Because nutrition isn’t viewed as an integral part of disease management, many vet students graduate not recognizing the monumental role nutrition plays in overall health. They don’t have enough knowledge to institute innovative nutritional protocols to manage degenerative disease in their patients.

Worse still is that at many of the veterinary schools in North America, the instruction vet students DO receive comes from the biggest pet food producers in the business. Needless to say, the “training” the students receive from these companies is heavily slanted in favor of the products they sell, which are inevitably highly processed. Currently, none of the major pet food companies sell biologically appropriate diets, so these foods are portrayed as dangerous.

Unfortunately, the majority of board-certified veterinary nutritionists have also been schooled primarily about processed pet diets, and believe it or not, major pet food manufacturers frequently pay the tuition for DVMs studying to become veterinary nutritionists. So when a veterinary nutritionist recommends X, Y or Z food — or discourages feeding raw or homemade diets, which is common — keep in mind that many practicing veterinary nutritionists are obligated in some way to a pet food manufacturer.

Karen Becker, DVM
Healthy Pets, Mercola.Com
July, 2017

The problem with your average veterinarian giving you nutritional advice is that they have had very little nutrition training… Most vets get their information from other biased or uninformed vets, they believe what they read in the vet publications sponsored by kibble companies, they get their info from sales representatives of the big kibble companies or from limited private reading. I am sure you understand why kibble companies do not make the best reference source as they are only interested in selling their products and are not open to alternative diets even if that might be actually needed.

Jennifer Carter
Volhard Dog Nutrition
January, 2020

How much do veterinarians learn about nutrition? The sad answer is not a lot, and often our information is biased…the doctors graduating from veterinary schools are biased at best. At worst, they are very “anti-natural” and rabid fans of these national brands…Most well-known pet food companies have been sold to mega conglomerates like Colgate-Palmolive, who often add plant and animal by-products and various chemical preservatives, additives, flavorings, and colorings to the products. 

Doctors must strike out on their own to seek a more balanced approach to diet and nutrition.  But they are not inclined to do this unless they are driven to expand beyond conventional medicine. Since most are satisfied with the status quo, it is hard to find a veterinarian who is not afraid to challenge his long-held beliefs and actually look at other dietary and nutritional options for his patients. 
Shawn Messonier, DVM
Animal Wellness Magazine
2008

Hills, Purina, and Iams are ingrained into the consciousnesses of every veterinarian from their professional infancy to their grave. Processed food is in our blood – Yuck. How can you expect a veterinarian to be open to the idea that real, raw food is anything but dangerous for pets?


Veterinary students learn about dog and cat nutrition from a book written by a major pet food company. The nutritionist that teaches them has usually had their education underwritten by a major pet food company. Major pet food companies provide free food for vet students and also the teaching hospitals where they are learning about veterinary norms.

Who has money to fund research into pet nutrition? You guessed it, the major pet food companies. Most continuing education for veterinarians regarding nutrition is sponsored by pet food companies. 

My hope is that the grassroots, raw pet food movement will cause more vets to see the light as they encounter healthy animals being fed these diets. Perhaps the conventional nutrition programming can be unlearned and the eyes of veterinarians opened to the truth.

Doug Knueven, DVM
Blog Post
May, 2014

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14 Responses to Food is Love- Veterinarians and Nutrition

  1. Jazzlet says:

    You convinced me to stop feeding raw meat to my dogs, I had started as a new owner because that was what the breeder of my first dog recommended. It took a while, not just because I appeared to see good results, but also because I had to convince my husband. As well as being scientifically the better course of action it’s a hell of a lot easier, so thank you for what you do – it does have tangible results.

  2. zyrcona says:

    Thanks Skeptvet for another well-written article. I think I should say, though, that like good and well-intentioned vets, good breeders often take a lot of flak, and sometimes it comes from the veterinary profession, and in the case of some vets there needs to be more mutual respect. Of course, there are breeders around who are not knowledgeable and tell their pups’ owners never to vaccinate their dogs and to feed them home-made food that is probably nutritionally imbalanced, but there are also breeders who give good advice, are knowledgeable about their breeds, and will always tell owners to consult the vet and decide what’s best for the owner and the animal with veterinary advice.
    For example, when a dog developed a medical condition that is believed to be more common in its breed, although isn’t unheard of in other breeds or non-breeds, the breeder and a breed club health representative told the owner accurately that the condition was manageable with medicine and the dog should have a normal lifespan and quality of life, and that symptoms the dog was having since its diagnosis was likely because the dosage of medicine to treat it was too high (this had been widely reported and researched in peer-reviewed papers) and the owner needed to go back to the vet and discuss this. When the owner did go back to the vet, the vet said this was nonsense and the dose did not need to be re-evaluated, and the dog was just ill because of the condition and would likely not live past its 6th birthday. The vet also unfortunately implied that the breeder was a scumbag for having bred a puppy that went on to develop a medical condition and should kill off the bloodline despite the other dogs in it being healthy. That owner went away and reduced the dog’s dose against the vet’s advice, to find the symptoms resolved once the right dose was found, and the dog is now older than 6.
    Good breeders and good vets should aim to work together for the benefit of owners and animals. 🙂 Vets have training in how to treat animals that breeders and owners need, but they have to treat so many different species they can’t be experts in everything. Experienced breeders have breed-specific knowledge that complements that.

  3. skeptvet says:

    There is no doubt that many breeders are very knowledgeable about their breed and dog health and husbandry in general. Some make the effort to familiarize themselves with he scientific literature regarding their breed and to find and engage with health experts. I applaud this. I think the major conflicts between vets and breeders come down to two differences in perspective.

    First, breeders are naturally interested in producing animals with characteristics that are desired or expected for that breed, often following standards set by AKC and other organizations. Sometimes these standards conflict with the health and welfare of the animals, as is most easily seen in bracycephalic dogs. This is disturbing to vets who have to manage health problems created largely in pursuit of human aesthetic standards. While I don’t doubt that most breeders love and care for their dogs well, there is a fundamental conflict between what consumers and breeders may want in a dog and what vets feel is best in terms of health and welfare, and there is no easy resolution to that difference in views.

    The other problem comes from the fact that breeders, like all other human beings, place great importance on their personal experiences and those of others they trust in evaluating health issues. Much of what a breeder knows about health issues in their breed is the result of years of experience and the opinions of other experienced breeders. While this experience is valuable, sometimes it conflicts with scientific evidence, and breeders are no better than anyone else at accepting the need to abandon anecdotal beliefs when better evidence shows them to be false. Just like older vets, older breeders often have rigid views on specific health issues that have been inconsistent with scientific evidence for many years, yet they cling to these views and dismiss attempts to update their understanding. One of the primary purposes of this blog is to try and challenge this natural human tendency to cling to our opinions despite contrary evidence, in vets and in pet owners and breeders. Most of my rare conflicts with breeders have stemmed from this issue, in situations where they refused to take sound, science-based medical advice because of reliance on anecdote and personal experience.

    That said, I have plenty of clients who breed and who take a responsible and evidence-based approach to caring for their dogs, and I certainly respect their perspective and knowledge.

  4. tetraodontidae says:

    I would be very interested to hear your take on “Big Kibble” https://www.amazon.com/Big-Kibble-Dangers-Commercial-Industry/dp/1250260051

  5. skeptvet says:

    I’ll put it on my list. Preliminarily, I think it is telling that the promotional reviews are from celebrities, with no veterinary nutrition experts at all. JFFD has a problematic history, and while their foods are now nutritionally balanced since they hired a nutritionist consultant to fix their formulations, their marketing claims are completely untested and unproven ideology, not science. I would not be surprised if the same turns out to be true of the book.

  6. Jen Robinson says:

    Personally I am skeptical of my vet’s nutritional offerings in the lobby, all well advertised, relatively expensive imports (I’m in New Zealand). I see no evidence that they are better than locally made products that cost less than half as much and are nutritionally complete. That said, when vets ask me what the dog eats and I name the local brand, I’ve never been told that the imported stuff would be better.
    Where I am skeptical is end of life care. At some point, it becomes clear to me that the dog hasn’t got long to live (this has happened to two of my dogs this year, one with severe ascites, one with apparent osteosarcoma… in both cases the result of the first round of tests was ambiguous). Vets generally want to perform expensive, and sometimes invasive tests. When I ask if the findings are likely to significantly prolong life or lead to a cure, the answer is ‘no’. Probably it could add a few months, but not pleasant ones. At this point I ask for palliative care or ‘the green dream’.
    I am science trained and understand completely the urge to pinpoint the cause of an illness. But I don’t want to foot the bill for major intervention in a system that is clearly breaking down.
    The skepticism engendered by unnecessary or inappropriate testing tends to spill over to other areas, including raw feeding. Whilst I agree that totally raw diets are likely to go wrong nutritionally, hard bones can crack teeth, and poorly handled raw stuff may contain pathogens, I see no evidence that spicing up the diet of a fussy eater with a few carefully managed chicken necks is going to do any harm.

  7. skeptvet says:

    Vets generally want to perform expensive, and sometimes invasive tests.

    I think this may be a misunderstanding. Vets are obliged to discuss all the options, along with their potential risks and benefits. It is up to you to choose whether the information or possible clinical benefits of further testing and treatment are “worth it” or not, both because you are the caregiver and because this isn’t really a medical decision but a values decision. I have clients who decline testing when I think it would be worth doing and clients who insist on testing and treatment when I explain there there is likely no benefit to be had at all. It isn’t that vets “want” to do tests, but that we have to give you all the options since we can’t assume you would choose the same way we might.

    The key is good communication. A vet should always discuss the likely outcomes, good and bad, and the degree of uncertainty about these. It is not unusual, and not a sign of incompetence, to acknowledge that test results may be inconclusive and that we can’t always predict whether or not treatments will work. Uncertainty is inherent in medicine. The fault is when we fail to communicate clearly about the range of options. It is the owner’s responsibility to ask questions, including about cost, and to make the ultimate decision about what they want and what seems to make sense for them and their pets.

  8. Alison says:

    I always appreciate your science and data-based approach to these topics. I’ve been scouring your site trying to figure out what to do for my kittens. Unfortunately I’m in a remote area and the vet is elderly and outdated in much of his treatment knowledge. Two kittens that I found (approx 9 mos) have large amounts of struvite crystals, no infection, but a problem with inappropriate urination. I’ve been told that they will be on C/D canned food for life. I’m curious if there is a better maintenance option given their young age, but I can’t find good, reputable info and the other vets I know dabble a bit too much in the holistic and alternative medicine realm.

    I welcome any suggestions of diet, treatment, or just other good sources of info so I can educate myself better on dealing with this for 15+ years.

  9. skeptvet says:

    Struvite crystals in the urine aren’t necessarily abnormal, and we often see them in cats with no urinary tract disease, so a special diet may not be necessary. More important are the urine specific gravity and the pH, at least in terms of the potential for stone formation. Canned food or dry food with water added can make the urine more dilute, which can reduce crystal formation, but again I think we overreact to crystals and I’m not sure dietary therapy is always needed. Unfortunately, I can’t help you with specific advice for your cats without seeing them myself, so it’s hard when you can’t find a vet you trust.

  10. Alison says:

    Thank you for taking the time to reply ! More than ten years ago I worked as a vet tech and hospital manager in both day practice and then for internal med and veterinary surgeons. I can’t believe this is the first time I’m hearing that the crystals may not be abnormal, but it makes sense.

    Is there any research you can point me to they discusses why the crystals may not be a big deal? I’d just like to be better educated on it.

    I found a research paper discussing how easily they form when the urine sits after collection, so I also want to find out how my vet handled it. I’ll also keep an eye on the pH and specific gravity.

    I appreciate this feedback and feel heartened that we may not be subjected to 15-20 years of a prescription diet!

  11. skeptvet says:

    Here are some sources pointing out that crystalluria is not necessarily abnormal and often occurs in animals with no urinary tract symptoms.

  12. Alana says:

    I’m 100% for evidence-based medicine both for humans and animals, but I understand the skepticism some people feel, in particular when it comes to animals who can’t directly tell us how they’re feeling and aren’t as heavily protected by regulations.

    When I was a child we had a dog who would eat her food, but was never that enthusiastic about it. Every now and then though we’d give her a packet of “moist & meaty” and she’d get very excited and gobble it up instantly. As I got older one day I just happened to decide to look at the ingredients. I was HORRIFIED to discover its primary ingredients include corn syrup and wheat flour. So, in other words, the same thing twizzlers are made of. I was feeding my dog meat twizzlers. And purina was all too happy to sell them to me packaged as if they’re normal healthy things to feed to a dog. Never mind that sugar isn’t very healthy for anyone, let alone an animal that doesn’t brush its teeth and absolutely never tolerated me doing it for her no matter how hard I tried.

    I don’t feed my dog store bought soft dog treats because pretty much every one I look at has sugar in some form or another as a primary ingredient. I get it, that probably helps keep them soft, preserve them, and dogs love sweets. But they never advertise it as candy to be fed in moderation or that you should brush your dogs’ teeth after feeding it to them. Why should they? That might scar people away.

    Other foods act like they’re good for your pet but you read the ingredients and find a lot of their protein comes from pea or other plant protein. You go to the pet store or even walmart and you see cedar shavings sold as pet bedding despite how terribly harmful it can be. You go to a petco and right where they sell leopard geckos they RECOMMEND calcium sand as a substrate even though it can cause impaction, especially in young geckos. They also sell reptile carpet but I suppose something you have to constantly buy more of is a better money maker. They sell tiny fish bowls you can put a goldfish in and watch it slowly suffocate to death on its own urea, then shrug your shoulders and say “I guess goldfish just don’t live very long.” You can buy cages for rabbits and guinea pigs with grates on the bottom that hurt their feet. The list goes on and on.

    All this is to say I feel people have reason to feel like they can’t trust the word of people trying to make money off of pet products. It’s downright negligent to not do your own research when getting a pet because your ignorance could cause that animal a great deal of suffering. When you learn about all these pet products you can buy that are actually harmful to your pet, you feel like you can’t just walk in and take people’s word for it anymore.

    Of course, a vet isn’t just anyone, they’re educated and care about the health and well-being of animals. But they’re not always right. A little while back I had to fight my vet to get my dog on an NSAID for her arthritis. Some years ago she had previously had a reaction to one NSAID, so they were hesitant to try a different one. I actually commented on one of your posts back in July about how uncomfortable I felt trying to confront my vet over the lack of efficacy for the glucosamine and how she told me in an authoritative manner that it would prevent further joint degeneration and just added gabapentin.

    After reading your reply and seeing for myself a lack of improvement I was able to go back to the vet and see a different vet there that time (who I personally prefer and I feel is better at listening and responding to concerns). He prescribed previcox and it’s made a world of difference, my dog rarely limps now and seems a whole lot more comfortable and mobile. I understand why they were hesitant to prescribe something they feared might cause a reaction, but on the other hand I don’t see much point prescribing something else that doesn’t help just because it’s less likely to do something bad. A placebo might make me feel better, but it does nothing for my dog.

    It’s not that I don’t trust my vets but experiences like this really make me empathize with people who feel like they can’t just take their vets’ word for it when they see no improvement after following vet recommendations and they feel a need to find some other source to verify what their vet is saying. I was lucky that I had you as a resource and was able to get evidence-based treatment for my dog, but not everyone is as lucky and they might in their attempts to find better information stumble into one of the many many sources of less reliable information. There’s not always a great deal of accessible, easy to find resources for laypeople out there and it’s frustrating.

    For example I really love dog food advisor and I feel like they do a good job doing evidence-based reviews of dog food, but I haven’t been able to find anything anywhere nearly as helpful for cat food. I settled for catinfo.org because there were at least breakdowns of the protein, fat, and carb contents of various brands of cat food and guidelines for trying to understand the labels, but that site aside from being smaller and more limited very much pushes the idea that cats absolutely must be on wet or homemade food (although they do provide a recipe that has all the appropriate nutrients at least).

    Given we know there are bad actors out there like purina with moist and meaty, we know there are good foods and bad. I can’t imagine vets have the luxury of time to personally examine and research every brand of dog or cat food out there, and if they’ve had experiences like mine where they found their vet is in fact not omniscient and capable of being wrong just like anyone else I can see why people would go from there and in the course of doing their own research they end up on sites with unreliable or incorrect information. I’m not trying to devote my life to finding only the best of the best world class food for my pets so they’ll live into their 40s and break world records, I just want to make sure I’m not accidentally giving my pets twizzlers.

  13. skeptvet says:

    There is a balance between recognizing that expertise is real and blindly following the word of authority figures. The problem is that most of us aren’t qualified to judge the expertise of people outside of our own fields. When two airline pilots disagree about how to land a plane, how do I decide which one is right? By reading a few web posts or watching some YouTube videos? It’s fair to say we should be “educated” consumers, but all that means for most people these days is scanning the internet until they find someone who agrees with what they already think and then using that source to “prove” they were right all along.

    Dog Food Advisor is a classic example. It is run by a retired dental surgeon and social media entrepreneur with no formal expertise, training, or credentials in veterinary nutrition, a “self-taught”: and self-proclaimed “nutritionist” with, again, no veterinary training or credentials, who sells his own raw diet, and a veterinary internist with a fondness for “holistic” medicine. The opinions are expressed with confidence well out of proportion to the scientific evidence behind them (which is effectively absent). When people “do their research” and end up looking at sites like these, they are getting a perspective not consistent with that of science or the opinions of actual experts in nutrition, and they are often being misled.

    The challenge is being thoughtful and critical about al the information you see, and weighting information based on the quantity and quality of scientific ebvodence behind. That’s a lot of work, though, and most people simply choose a source to trust and then ignore all the others. We’ve seen how well that works out in politics, and it’s no better an information management strategy in pet health.

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