Once again, we would like to address the topic of Dilated Cardiomyopathy (DCM). This article has been prompted by the recent publication by the FDA titled “FDA Investigation into Potential Link between Certain Diets and Canine Dilated Cardiomyopathy” published June 27, 2019. There are several points in the article that we would like to address that are misleading are simply incorrect. These publications feel like a personal attack on stores like ours’ in which our goal is to provide the best foods for our pets. I will say that we feel powerless against these veterinary factions because they hold so much power over the pet industry, but we cannot just sit by while they destroy the reputation of brands they have no proof against. Correlation is not proof, it is a starting point. If you feed a grain free food and you are happy with the product and have had good results, we encourage you to reach out to these companies that make your dog food and tell them this. All that they are receiving now is negativity but imagine how scared some of them must be for their company, selves, and employees and how difficult it must be to be attacked like this with no substantial evidence against them.

It is stated that “the FDA defines a ‘case’ as an illness reported to FDA involving a dog or cat that includes a diagnosis of DCM [1].” These cases are diagnosed by veterinarians or veterinary cardiologists. It states that many of them contained details about food history and echocardiograms, but not all of them.

One of the biggest issues with this article is the fact that they name specific brands reported in their DCM cases. Included is a chart listing brands of dog foods that could potentially cause DCM. Several articles claim that these foods are causing problems because of the low amount of taurine and when that fails, some other nutrient imbalance causing this health problem [2]. However, “before the July 2018 DCM Update, FDA had tested [several of these] products for minerals and metals (calcium, magnesium, phosphorus, iron, cobalt, copper, zinc, selenium, iodine) and amino acids including taurine, cysteine, and methionine. That product testing did not reveal any abnormalities [1].” This means there were no deficiencies found, including in nutrients that are associated with the heart. Therefore, as of yet there is only correlation linking these foods and DCM even though they proved that what they thought were the causes (imbalanced nutrients/lack of taurine) to be untrue. This, therefore, is a form of slander for these brands, ensuring people feeding these foods will be scared and switch off them. However, even if their chart were to happen 100% accurately, that would be 0.016% of dogs eating Acana (the most common food reported to be correlated with DCM) would be affected, and even fewer (0.0029% of dogs) would die from DCM. That is under 3 dogs in 100,000 eating Acana would die from diagnosed DCM. As a comparison, according to the FDA, about 1 in 1000 dogs die from using the flea medication Bravecto yet that is still widely used. In the recent FDA publication, they also said that they are looking into other potential factors that could have caused these DCM cases, such as genetics or environmental factors [1]. If they are looking into these then that means they have reason to believe these foods are not the primary cause and therefore should not have mentioned the brand names until absolutely certain.

To further support the fact that grain free foods are not the problem, consider the article by Andrea Fascetti and colleagues [3]. Dr. Fascetti et al. studied twelve dogs with low blood or plasma taurine levels and had been diagnosed with DCM. “All 12 dogs were being fed a commercial dry diet containing lamb meal, rice, or both as primary ingredients. Cardiac function and plasma taurine concentration improved with treatment and taurine supplementation [3].” As you can see, this food, which contains rice (a grain) was deficient in taurine and caused DCM. It is also puzzling for a couple of reasons why DCM seems to be isolated to grain free diets in these articles and reports by the FDA. Notice that only high-end grain free diets are included in the graphic displaying specific brand names [1]. Low end products, such as Purina ONE, that do not add taurine and would be sufficiently lower in nutrient density are not included. On the other hand, foods with grains that are made with very low quality ingredients and also no added taurine are also not on the radar for causing DCM. Take a look at the three ingredient lists below and come up with any logical reason that Acana would be the one causing health problems in general.

Acana Meadowlands: Deboned chicken, deboned turkey, chicken liver, turkey giblets, chicken meal, catfish meal, whole red lentils, whole pinto beans, whole green peas, pollock meal, chicken fat, whole green lentils, whole chickpeas, lentil fiber, whole blue catfish, cage-free eggs, rainbow trout, pollock oil, natural chicken flavor, chicken heart, chicken cartilage, whole pumpkin, whole butternut squash, mixed tocopherols (preservative), sea salt, zinc proteinate, dried kelp, calcium pantothenate, kale, spinach, mustard greens, collard greens, turnip greens, whole carrots, whole apples, whole pears, freeze-dried chicken liver, freeze-dried turkey liver, pumpkin seeds, sunflower seeds, copper proteinate, chicory root, turmeric, sarsaparilla root, althea root, rosehips, juniper berries, dried lactobacillus acidophilus fermentation product, dried bifidobacterium animalis fermentation product, dried lactobacillus casei fermentation product.

Purina ONE Chicken and Sweet Potato: Chicken (Source of Glucosamine), Poultry by-Product Meal (Source of Glucosamine), Cassava Root Flour, Canola Meal, Pea Starch, Animal Fat Preserved with Mixed-Tocopherols, Pea Protein, Dried Egg Product, Brewers Dried Yeast, Dried Beet Pulp, Sweet Potatoes, Animal Digest, Mono and Dicalcium Phosphate, Potassium Chloride, Salt, Calcium Carbonate, Vitamin E Supplement, Choline Chloride, Zinc Sulfate, Ferrous Sulfate, Manganese Sulfate, Niacin, Vitamin A Supplement, Copper Sulfate, Calcium Pantothenate, Pyridoxine Hydrochloride, Vitamin B-12 Supplement, Thiamine Mononitrate, Riboflavin Supplement, Vitamin D-3 Supplement, Calcium Iodate, Menadione Sodium Bisulfite Complex (Source of Vitamin K Activity), Folic Acid, Biotin, Sodium Selenite.

Ol’ Roy Dog Food: Ground Yellow Corn, Soybean Meal, Meat and Bone Meal, Wheat Middlings, Animal Fat (preserved with mixed tocopherols), Corn Gluten Meal, Ground Wheat, Animal Digest, Calcium Carbonate, Salt, Garlic Oil, Added Colour (Red 40), Zinc Sulfate, Ferrous Sulfate, Choline Chloride, Niacin, Vitamin E Supplement, Copper Sulfate, L-Lysine monohydrochloride, Manganese Sulfate, Calcium Pantothenate, Riboflavin Supplement, Thiamine Mononitrate, Biotin, Vitamin A Supplement, Pyridoxine Hydrochloride, Sodium Selenite, Vitamin B-12 Supplement, Calcium Iodate, Vitamin D-3 Supplement, Folic Acid, Menadione Sodium Bisulfite Complex (source of Vitamin K).

The FDA notes that “the vast majority of the reports were submitted after the agency notified the public about the potential DCM/diet issue in July 2018 [1].” However, before their report, a veterinarian by the name of Lisa Freeman published an article in June of 2018 and included a direct link to report DCM to the FDA. In this article, one paragraph talks about how DCM and taurine deficiency seem to be high in golden retrievers, cocker spaniels, and a few other breeds, and is often associated with genetics and diets that include “lamb, rice bran, high fiber diets, and very low protein diets [4].” This makes sense. However, in the next paragraph she states that DCM is being seen in dogs fed boutique or grain-free diets, and those using exotic ingredients [4]. There are no citations listed to support any of her statements in her articles to the public. In this same article she also states that “it’s not yet clear if diet is causing this issue (DCM). The first thought was a deficiency of an amino acid called taurine [4].” Still, in an article published November of 2018, she writes that “most dogs being diagnosed with DCM do not have low taurine levels [5].” Even further along, in another article she published on December 1, 2018, she states that you should test your dog’s taurine level if you are feeding a grain free boutique food if your dog develops DCM even though they do not think taurine is the culprit [2]. As you can see, these articles, written by the same veterinarian, are extremely contradicting. Since these foods have been shown several times to not be deficient in taurine maybe other factors should be looked at instead. Let me direct you to another quote from the December article: “Notably, however, some dogs improved after a diet change from one grain-free diet to another, and this finding, along with the differences identified between dogs fed various BEG diets, suggested that DCM was not necessarily tied to the grain-free status of the diet [2].” This emphasizes the fact that there is no clear link between grain free diets and DCM.

An important factor in this debacle is the fact that Dr. Freeman, as well as the University she works at, Tufts University, has been sponsored by several of the veterinary food brands, including Purina, Royal Canin, and Hill’s [2,6]. This is stated on her December, 2018 article, as well as directly on Tuft University’s website [2,6]. In fact, as of 1997, over 27 vet colleges had been sponsored by Hill’s Pet Nutrition, owned by Colgate-Palmolive Co [7]. You can imagine how many are now sponsored by them since this was over twenty years ago, but we were unable to find an exact number. Is it a coincidence that an article that is causing thousands of people to switch to veterinary foods was written by someone sponsored by those brands on several degrees?

Dr. Freeman is now one of the veterinarians that the FDA is consulting with on DCM and grain free foods even though she constantly contradicts her own statements and is sponsored by veterinary food brands that directly benefit from her articles.

Let’s explore an important question, are these vet-recommended foods actually better? In January, 2019, and again in March and May, Hill’s Pet Nutrition recalled several of their wet dog food cans due to toxic levels of vitamin D. This excessive level of vitamin D caused vomiting, diarrhea, excessive thirst, constant begging, and even death [8]. While the company claims to have been unaware of the issue, nine other companies with foods made in the same facility had done recalls for elevated vitamin D in November and December of 2018 [9]. This means that the manufacturer had been putting too much vitamin D in their foods for several months before Hill’s decided to do a recall. In fact, as reported by CBS News, “as early as February of 2018, dog owners began to complain that Hill's Specialty Dog Foods were causing their pets to display symptoms consistent with vitamin D poisoning [8]. However, Hill's disputes the notion that it delayed warning consumers [8].” In addition, Purina has had several lawsuits due to their quality control leading to dog deaths [10].

Now that we know their quality control is questionable, let’s explore their ingredients. Below is a list of ingredients found in Prescription foods, with their potential side effects. These are the foods that they are recommending over high-end grain free foods.

Magnesium Oxide: magnesium deficiency because cannot efficiently absorb, nausea, vomiting, slow reflexes, change in heart rate, flushing or faintness

Powdered Cellulose: can interfere with pet’s ability to digest and assimilate important proteins and minerals

TBHQ: increases instance of tumours, vision disturbances, liver enlargement, neurotoxic effects, convulsion, paralysis, behavioural changes

Manganese Oxide: magnesium deficiency because cannot efficiently absorb, impaired growth, impaired reproduction, skeletal abnormalities, impaired glucose tolerance, altered carb and lipid metabolism

Zinc Oxide: magnesium deficiency because cannot efficiently absorb, dry skin, eczema, white tongue coating, impaired immune function, behavioural abnormalities

That’s only including potentially harmful ingredients. There are several that are sub-par in quality, such as corn gluten meal, brewer’s rice, soybean meal, by-product meal, hydrolyzed poultry by-products aggregate (feathers), etc.

To demonstrate even more of the hypocrisy, in Dr. Freeman’s article published in June, 2018 she states “They also noticed that both the typical and atypical breeds were more likely to be eating boutique or grain-free diets, and diets with exotic ingredients – kangaroo, lentils, duck, pea, fava bean, buffalo, tapioca, salmon, lamb, barley, bison, venison, and chickpeas. Even some vegan diets have been associated [4].” Notice how many of these ingredients are not exactly “exotic” and are in fact quite common in all levels of pet food, such as salmon, lamb, barley and peas. The ironic part is that many of the Prescription diets do include these “exotic” ingredients or are vegetarian (...note that taurine comes from meat). For example, Purina Pro Plan Veterinary Diets has an HA Vegetarian food. Hill’s has a Potato and Salmon diet (grain free), a Rice and Lamb food (which also includes barley), a Potato and Duck food (grain free), a Potato and Venison diet (grain free). As well, Royal Canin also has a vegetarian food, a hypoallergenic diet that contains duck, and also one that contains kangaroo. All of these Prescription foods meet the criteria that they laid out for foods to be avoided. As a side note, the most common animal proteins, as reported by the FDA, in these foods associated with DCM is chicken, which completely contradicts what Dr. Freeman says about exotic meats being the main culprits [1,2].

In 2014 and 2015, there was only 1 case of DCM reported to the FDA in dogs each year. There were two reported cases in 2016, and three in 2017. Suddenly, in 2018, after Dr. Freeman’s first article was published (June 4, 2018), there were 320 reported cases of DCM. Already in 2019 (up until April 30), there have been 197 reported cases. What is more likely, that these foods that have always contained peas and lentils are suddenly dangerous, or that the vets are changing their diagnoses based on this article? Is it possible that the same heart condition is being called DCM if a dog is being fed grain free food, and something else if being fed a food with grains? Let me pose a scenario for you to ponder. If the FDA told everyone that bananas cause heart disease even though they contain nothing to cause the issue, then everyone who ate bananas would go to the doctor thinking they might have heart disease. Similarly, the doctors would also see a patient with heart disease symptoms and then ask the patient if they ate bananas. No matter if there is an actual link or not, the patient and doctor would assume that the heart disease was caused by the bananas even though it is only a correlation, and not a proven cause.

Which of these do you believe is the probable cause of the rise in DCM reports?
1) The real issue causing DCM, or DCM itself, was not well understood or misdiagnosed until now
2) Because these articles came out, DCM is on everyone’s mind and as a result an unsubstantiated correlation between grain free diets and heart disease was made; There is no real way to substantiate these claims as of yet since no studies have been done to prove it.
3) The same heart condition is being classified as DCM in a dog that is being fed grain free food and as something else if being fed a food with grains
4) For some reason a genetic cause has become exponentially more common in the last year and a half
5) Something is affecting the peas and lentils in these foods (such as a pesticide), starting a year and a half ago, but for some reason is only affecting less than 1 in every 30,000 dogs that eat it and is not affecting cats; this is technically unlikely since problems with taurine absorption would show up faster in cats than dogs due to their complete inability to produce their own taurine
6) There is a new medical procedure or medication that is affecting dog’s hearts

Honestly, with all of the evidence we have right now, there is no right answer. More studies need to be done in order to find an actual cause instead of relying on correlations as legitimate scientific basis. A correlation between DCM and grain free foods/taurine deficiency has been discussed several times, but no other correlations have been looked at for the cause of DCM as of yet. This must be explored to get a full picture.

A vast majority of animals do not get autopsied when they pass, so exact cause of death is rarely confirmed. Usually, it is up to the interpretation of the vet and never proven by a third party like in humans. Other causes of DCM include genetics, infection, Diabetes, thyroid disease, and drugs. In the FDA report, it is mentioned that male dogs are diagnosed with DCM more often than female dogs, which is consistent with genetic findings as well [1].

Many of the companies listed by the FDA have been making grain free pet food for many decades. Why then has this issue just came to light last year? You would think it would have been noticed a long time ago since it is this serious. In addition, it is puzzling as to why the issue of DCM has become so important when there are much more serious health problems that are potentially more statistically significant. For example, certain dyes in treats and foods causing cancer, recalls such as with Hill’s foods; why are these other matters not receiving the same scrutiny by the FDA as this topic? Don’t get me wrong, foods causing health problems is very important and devastating for those it affects. However, the level of fear it has raised seems disproportionate to the threat.

Due to the fact that there is no scientific evidence showing that the brands listed by the FDA are causes of DCM, this is a form of slander and risk a law suit from these companies. Whether intentional or not, it still hurts the reputation of these businesses and helps brands sold to veterinarians. These Prescription foods are the only products allowed to make health claims without having to prove their efficacy, in humans and animals. The FDA appears to be biased in this topic due to their unwillingness to use third party investigators. What if this is orchestrated to direct sales towards veterinarians and the brands that they sell? Are veterinarians, therefore, the best ones to be consulted on the matter? It may be harsh, but one must take into account that these articles do not recommend feeding foods with grains, they only recommend feeding brands of foods that are also sold at vet clinics, such as Hill’s, Royal Canin, and Purina [11]. These are the same food brands that sponsor veterinary colleges and veterinarians. Too many coincidences certainly makes you fear for the possibility.

The FDA is reaching out to people in the animal health community in order to better understand the subject. FDA’s veterinarians are also working with other veterinarians, including Lisa Freeman, to gather clinical information and responses to attempted treatments for DCM. They are also talking directly to pet owners that have/had pets with DCM. In addition, they are exploring “any other factors that could have potentially contributed to development of DCM, such as environmental factors like heavy metal exposure or poisonous plant ingestion. [1]” Necropsies and histopathology of tissues of deceased animals that are suspected to have died of DCM are also being investigated. They are also looking at echocardiograms, blood, feces and urine tests of dogs with DCM at 1-2 months and 6 months after initial diagnosis. Any treatment or dietary change will be documented. The FDA is also continuing to test foods for levels of various nutrients.

A potential solution to the possible bias is to use a third party that has not received support from dog food brands sold at veterinary clinics. The signs and symptoms of DCM are comparable in humans and pets. Consulting with human cardiologists could eliminate the concern for bias. Autopsies could be done of dogs to ensure that they have DCM and to ensure it is not misreported. Misdiagnoses should be handled as they are in human medicine, with a potential fine and loss of license to practice. If all of these dogs do have legitimate DCM then all potential causes must be investigated to determine the cause, including genetic, infection, drug side effects, pesticides, etc.

If anyone has any ideas as to how to fight back against the targeting of grain free foods, please don’t be silent. We encourage you to reach out. This topic is very important to us, but we are not sure what to do about it. We cannot set the precedence that when a significant issue like this comes to light that it doesn’t need to be supported by hard evidence before they begin attacking their competition. If your veterinarian posts about DCM, please at least respond with the quote below from the FDA’s article:

“Before the July 2018 DCM Update, FDA/Vet-LIRN had tested multiple products for minerals and metals (calcium, magnesium, phosphorus, iron, cobalt, copper, zinc, selenium, iodine) and amino acids including taurine, cysteine, and methionine. That product testing did not reveal any abnormalities. The average percent protein, fat, total taurine, total cystine, total methionine, total methionine-cystine, and resistant starch content on a dry matter basis (in other words, after removing all moisture content) were similar for both grain-free labeled and grain-containing products [1].”

[1] FDA Investigation into Potential Link between Certain Diets and Canine Dilated Cardiomyopathy, https://www.fda.gov/animal-veterinary/news-events/fda-investigation-potential-link-between-certain-diets-and-canine-dilated-cardiomyopathy?fbclid=IwAR3t4_U_jeGClOAJocFmjhuuyy8_rihjMpDohv23-eKypWMYCsfbkBG39Kc#diet

[2] Diet-associated dilated cardiomyopathy in dogs: what do we know?, https://avmajournals.avma.org/doi/full/10.2460/javma.253.11.1390?fbclid=IwAR1xrYjH39Gjyu3A0MFmtijDH1RGjARpllTX-P0mM5sOMOKzoUJwz8iCkLA

[3] Taurine deficiency in dogs with dilated cardiomyopathy: 12 cases, https://avmajournals.avma.org/doi/abs/10.2460/javma.2003.223.1137

[4] A broken heart: Risk of heart disease in boutique or grain-free diets and exotic ingredients, https://vetnutrition.tufts.edu/2018/06/a-broken-heart-risk-of-heart-disease-in-boutique-or-grain-free-diets-and-exotic-ingredients/

[5] It’s Not Just Grain-Free: An Update on Diet-Associated Dilated Cardiomyopathy, https://vetnutrition.tufts.edu/2018/11/dcm-update/?fbclid=IwAR2DzclEVbQxEu-xzThmEkpGAvZjE0w4D-QRaiAPpZzRASIs8Eu6WBXJ79g

[6] Donors to Tufts at Tech, https://vetmed.tufts.edu/tufts-at-tech/donors/?fbclid=IwAR3IbZUVFo9Z9ZdvJJIEm4IDDomvTSQmYJqZmbBbjYEiFdomt2OxYMKsfWc

[7] Colgate Gives Doctors Treats For Plugging Its Food Brands, https://www.wsj.com/articles/SB878509979865406000?fbclid=IwAR0V2QNUaXz8Fxngquq3gJABIQJ6ZEympZEIn111SxURDdq-yoJfCyFZxeU

[8] Pet food maker faces mounting legal woes over dog deaths, https://www.cbsnews.com/news/hills-dog-food-recall-pet-food-maker-faces-mounting-legal-woes-over-dog-deaths/?fbclid=IwAR1gK9sZTVKcdEEh9MbKnGviTfICi11W6wLiNOFwdRrvfC-idA6QAv7LzAQ

[9] Pet owners file civil suits against Hill’s Pet Nutrition in relation to dog deaths, https://www.foodsafetynews.com/2019/02/pet-owners-file-civil-suits-against-hills-pet-nutrition-in-relation-to-dog-deaths/?fbclid=IwAR0y-nY-PNNoWavcJRYbIiczpCRU5iPUOWZwcGCwWBgwulOvpE7NCn7X3lo

[10] Thousands of dogs killed by Purina pet food: suit, https://nypost.com/2015/02/25/thousands-of-dogs-killed-by-purina-pet-food-suit/?fbclid=IwAR1CKmG-9y8mWufB2OZjmzreYgAUv8IGQIOhDsJ4THFX9G-Gwi7wjOm5lcU

[11] REDUCED SODIUM FOODS, https://vetmed.tufts.edu/wp-content/uploads/reduced_sodium_diet_for_dogs.pdf