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Question about creatinine level and recommended diet

Gene&Janet

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Hello,

I’m seeking some input on a low protein diet and next steps for our dog Andy.
Andy is about 9.5 years old. He is a neutered small spaniel chihuahua mix and weighs approximately 13lbs.

He has no other health concerns but his recent annual blood test showed creatinine at 2.1mg (attached) and the bun was 30 mg/dl.

Our vet suggested a restricted protein diet and referred us to a local company called Just Food For Dogs (JFFD) as a diet consideration, followed by a retest in 6 months. JFFD makes prescription and non prescription fresh frozen dog foods and they have a formula for kidney health. Lamb is the key ingredient in the prescription dog food from JFFD. Andy really doesn’t like it. (I’ve attached an image with a list of ingredients).

Andy is a little bit more picky about what he eats. He likes what we cook best of all. He didn’t like raw food when we gave that a try and he doesn’t like lamb. He does love broccoli and romaine lettuce as well as other vegetables. We purchase some of the regular fresh frozen JFFD recipes and we cook some food, using lean meats, mostly beef and turkey with vegetables and rice or barley. Sometimes I add some beef liver or beef kidney to the mix.

Andy is due for rabies in 2 years, and did have bordatella at the last exam. We try to limit exposures to other toxins such as flea products but did use them sparingly in years past. His beam is good, and is he playful and affectionate. He enjoys barking at squirrels and playing with our two other dogs of similar size and age (Marty/10 yrs and Molly/ 12 yrs). Water input and urine output seem the same, no changes. Urine looks clear.

Andy has a somewhat anxious demeanor with strangers and when walking, but he is very affectionate with family. He likes to lay on the heating pad and in the sun. He is very furry, but currently has short hair due to battle with fleas. We have numerous wild animals visiting our yard, and Andy has had several skunk encounters. Other than an aversion to skunks, he is very sweet and sensitive.

He rescued us when he was about 2 months old, and has been with us since. I would appreciate any input on this and diet. I noticed a book mentioned in another post related to this by Don Hamilton, and I will follow through with that.

Does Andy need a very specific diet and can we or should we make it? Are there some supplements to consider and homeopathic remedies? What other questions should I be asking our local vet? Thank you.​


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Dr. Jean Hofve

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Hi, do you know what the urine specific gravity was at the time they took the blood test? It is necessary to have that data to accurately analyze BUN and creatinine.

Personally I am not a fan of restricted protein diets, especially in early renal disease like this. I don't even consider them until BUN is up to 80 or 90, and even then its main use is to control symptoms.

The evidence for protein restricted diets has never been that great, and the tide is starting to turn against them even in human medicine. Too little protein causes the body to catabolize itself to get the amino acids it needs, leading to muscle wasting and weight loss. This is more devastating for older animals than the kidney disease itself.

Protein is really not the problem in CKD, phosphorus is. So adding a phosphorus binder to a normal (not high) protein diet can be helpful.

JFFD is a pretty good diet, but of course Andy has to eat it willingly! There are good homemade recipes that are lower protein, or you can "dilute" the protein in any food by adding a little rice, sweet potato, or other low-protein veggies. Using eggs instead of some meat is also a way to lower the phosphorus.

Herbal medicine and homeopathy have the best record in working with CKD, so I'm sure the other vets will pop in with suggestions for those modalities.
 

Dr. Jeff

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I am not a fan of restricted protein diets
Me neither!
Does Andy need a very specific diet and can we or should we make it?
No, he doesn't need any specific diet and yes, you can make it.

Dr. Claire Middle wrote a lovely little book about making diets based on TCM recommendations. Jan Allegretti's Fresh and Flexible book is also great:


Are there some supplements to consider and homeopathic remedies?
Azodyl, AminAvast, Renafood, Rx Renal (from Rx Vitamins), CoQMax Omega, etc. are a few of the potentially useful supplements.

The homeopathic medicines would need to be individualized and managed by a vet homeopath to be most helpful.
What other questions should I be asking our local vet? Thank you.
Great question! Lots! How about starting with asking about the urinalysis that Dr. Jean recommended and maybe asking about repeating the blood tests at a reference lab like Idexx. They can do much for extensive and informative testing.

And perhaps your local vet can refer you to an internal medicine specialist and trained vet homeopath so you can dive deeper into Andy's care.

The other happiness and quality of life actions are the same ones that we have discussed in the past.
 

Gene&Janet

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This is great information.
Hi, do you know what the urine specific gravity was at the time they took the blood test? It is necessary to have that data to accurately analyze BUN and creatinine.

Personally I am not a fan of restricted protein diets, especially in early renal disease like this. I don't even consider them until BUN is up to 80 or 90, and even then its main use is to control symptoms.

The evidence for protein restricted diets has never been that great, and the tide is starting to turn against them even in human medicine. Too little protein causes the body to catabolize itself to get the amino acids it needs, leading to muscle wasting and weight loss. This is more devastating for older animals than the kidney disease itself.

Protein is really not the problem in CKD, phosphorus is. So adding a phosphorus binder to a normal (not high) protein diet can be helpful.

JFFD is a pretty good diet, but of course Andy has to eat it willingly! There are good homemade recipes that are lower protein, or you can "dilute" the protein in any food by adding a little rice, sweet potato, or other low-protein veggies. Using eggs instead of some meat is also a way to lower the phosphorus.

Herbal medicine and homeopathy have the best record in working with CKD, so I'm sure the other vets will pop in with suggestions for those modalities.
Thank you
Hi, do you know what the urine specific gravity was at the time they took the blood test? It is necessary to have that data to accurately analyze BUN and creatinine.

Personally I am not a fan of restricted protein diets, especially in early renal disease like this. I don't even consider them until BUN is up to 80 or 90, and even then its main use is to control symptoms.

The evidence for protein restricted diets has never been that great, and the tide is starting to turn against them even in human medicine. Too little protein causes the body to catabolize itself to get the amino acids it needs, leading to muscle wasting and weight loss. This is more devastating for older animals than the kidney disease itself.

Protein is really not the problem in CKD, phosphorus is. So adding a phosphorus binder to a normal (not high) protein diet can be helpful.

JFFD is a pretty good diet, but of course Andy has to eat it willingly! There are good homemade recipes that are lower protein, or you can "dilute" the protein in any food by adding a little rice, sweet potato, or other low-protein veggies. Using eggs instead of some meat is also a way to lower the phosphorus.

Herbal medicine and homeopathy have the best record in working with CKD, so I'm sure the other vets will pop in with suggestions for those modalities.

This is very helpful to know. I will check on the urine analysis and get more info. It sounds like I need to learn more about the role of phosphorus. Thank you so much Dr. Hofve! I think Andy would like a homemade diet
 

Gene&Janet

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Me neither!

No, he doesn't need any specific diet and yes, you can make it.

Dr. Claire Middle wrote a lovely little book about making diets based on TCM recommendations. Jan Allegretti's Fresh and Flexible book is also great:



Azodyl, AminAvast, Renafood, Rx Renal (from Rx Vitamins), CoQMax Omega, etc. are a few of the potentially useful supplements.

The homeopathic medicines would need to be individualized and managed by a vet homeopath to be most helpful.

Great question! Lots! How about starting with asking about the urinalysis that Dr. Jean recommended and maybe asking about repeating the blood tests at a reference lab like Idexx. They can do much for extensive and informative testing.

And perhaps your local vet can refer you to an internal medicine specialist and trained vet homeopath so you can dive deeper into Andy's care.

The other happiness and quality of life actions are the same ones that we have discussed in the past.
Dr. Jeff,

I will order these books tonight, and read up on the supplements. And follow through on the urine And blood tests. As usual I’ve got a lot to learn. I’m very grateful for Holistic Actions. Thank you, thank you.
 

Dr. Jeff

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YW!
 

Dr. Jean Hofve

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Honestly, we all have a lot to learn, even those of us who have been doing this a long time! I just spent 2 days in a continuing education seminar on pet nutrition, and there is SO much new information coming out all the time... I felt pretty darn ignorant! So we are where we are, and we do our best! Just stay curious and keep learning!
 

Dr. Jeff

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Ooh! What'd you learn??
 

Dr. Jean Hofve

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OMG, mostly I learned that I am way out-of-date on molecular biology! It was really overwhelming... I will need to listen to the lectures over again to really "get it."

One of my big takeaways was actually about an Amazon tribe compared to people living in Sao Paulo, Brazil. They ate about the same amount of carbs but the tribe actually ate way less fiber... I have a *thing* about fiber (like so many things I have a *thing* about)... there is such an emphasis now on more and more fiber, but it isn't natural for humans and certainly not for carnivores! I have seen a lot of damage done to constipated cats by too much fiber!

As I absorb more, I'll report on it! :)
 

Dr. Jeff

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out-of-date on molecular biology
YES! You and me both. There's so much amazing research (like the exposome and mitochondria stuff) that it is really hard to keep up in all the areas. I guess that's why scientists usually specialize in one small ("molecular") piece.

Modern science has virtually explained most of the molecular mechanisms of the body.

IMHO tho, without the energetic paradigm and a broader definition of susceptibility, we can never reach the scientific wellness goal of P4 medicine.




 

Dr. Jean Hofve

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No doubt! I've been reading a lot about mitochondria, they are assuming a very outsized role in my mind as the basis of metabolism. They do so many things, and are--as you mention--susceptible to so many things!

Science is good at explaining mechanisms, but the "why"--the energetic influences--remain far out of reach. Physics has got part of it, but those concepts aren't really connecting to biology, which has a long way to go to really *understand* what's going on here! o_O
 

Gene&Janet

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So much to learn! It can be overwhelming. I’m reading Jan Allegretti’s book now. Her explanation of the history of dog food and the industry is informative. The commercial dog food industry became a thing in the 50s and 60s. Back then I remember my mom making our dogs’ dinner every night. She cooked their dinner of meat and vegetables before making ours!

I’ve been kind of brainwashed into thinking that I can’t make a balanced meal for my dogs that meets all of their needs. One thing that really makes sense is the benefit of variety and diversity in diet and that no one food will provide all that is needed—
 

Dr. Christina

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Just remember - there is no one right answer. All the molecular knowledge, all the comparison of tribal to modern, etc, is much less important than 1. fresh 2. prepared with love 3. Happiness 4. EXERCISE, mental and physical, 5. most importantly observation about what makes the most difference to that specific individual

Learning new things and new approaches is "that make good intuitive sense to me, now how does my animal respond to it?"

Dr. Christina
 

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