Whole patient care is about more than just treating symptoms or the clinical presentation. It’s about planning for wellness and preventing future issues, even for the geriatric patient. As integrative veterinarians, we are able to combine the best of everything – the optimal tools for patient health, regardless of the branch of medicine they are derived from.
One of my first and top responses to any set of symptoms involves food. Medication through nutrition (whole foods) not only treats health issues; it heals and prevents future issues – without side effects. A comprehensive integrative exam always includes a full discussion about food – nutrition, health, and longevity.
Geriatric patients need the best nutrition for the best health. Best nutrition comes from best quality food. This is done with foods we control – real food, “people food”. While each patient may have different health issues, most geriatric animals will have the same underlying issues – general organ system decline or failure. These issues include a weakened immune system, arthritis, kidney dysfunction, heart dysfunction and others, either separately or in combination.
Feeding the geriatric patient for health may seem daunting, since older animals are often quite fragile, but real food diets are not that complicated and work with even very compromised pets. Simple, uncomplicated recipes that reduce overall inflammation do the most good, and are quite cost effective for the client. Fears that we won’t provide enough trace nutrients can be alleviated by feeding a variety of foods, just as with humans.
Another common concern is that switching foods will lead to diarrhea or will not be accepted by the animal. Most pets have no more trouble with diarrhea from eating different foods than people do. Anyone who sneaks people food to their dog will find the transition quick and easy. Converting cats is not always as easy, especially in older, geriatric cats – baby steps and lots of warm broth with a sprinkling of powdered high quality kibble on top may be the start to a late life food change for these patients.
RAW OR COOKED?
The meat in the above recipes can also be served raw, but that depends on what the patient can tolerate.
• For some older animals, especially those who have eaten kibble all their lives, raw is too hard to digest. Other patients have no problems with it.
• Feeding raw meat comes with pluses and minuses. Raw meat is ideal for the cancer patient – it is cooling from a TCVM perspective, which counteracts the heat of cancer.
• Which cut of meat to serve raw is also a concern: ground meats should not be served raw because the bacteria from the outside of the meat has been ground in.
• For easier digestion, most vegetables should be cooked or pureed – vegetables are harder to digest and cooking starts the digestion process. In the wild, most vegetable matter comes from the stomach and intestines of the prey, which chewed and partially digested it. Absorption of vegetable matter takes place in the intestines. The transit time in dogs and cats is too short to absorb any vegetable chunks. You have all seen corn in stools!
RATIONALE FOR DIFFERENT FOOD CHOICES
For the patient who is always cold, sleeping under the covers, substitute chicken for beef. For the patient who just can’t cool off, even in winter, substitute fish, like trout or cod.
Add ¼ tsp turmeric (curcumin) for anti-inflammatory effects. Or ¼ tsp cinnamon for digestive upset.
As recipes become more varied, the general rule of thumb for dogs is 33% meat (muscle and organ), 33% carbohydrates (legumes or root vegetables), and 33% vegetables and/or fruit. For cats, the ratio is 80% to 90% meat (muscle and organ), and 10% to 20% vegetables, fruits and seeds. For the patient who is losing weight, increase the carbohydrates. Weight loss is common on real food diets (and usually this is our goal).
Beef is neutral in temperature – a good starting point. Low fat puts less stress on the gall bladder, thus on the digestion. Sweet potato helps moisturize the intestines, pumpkin even more so. Substitute canned pumpkin for constipation or diarrhea, issues. Spinach is good for building blood. Most green vegetables will substitute well.
Because we are trying to feed these dogs and cats for longevity, we want to provide a variety of recipes or ingredients. The variety provides balanced nutrition, and also helps meet environmental changes, mainly seasonal changes. In the summer, when squash is abundant, use that for the vegetables. In winter, when eggplant or Brussels sprouts are available, use them. The foods that are available in a given season are the ones that are healthful for that season. Throw in berries when they are in season – blueberries, strawberries and mulberries all have great medicinal, blood-building effects. If cats will eat all the extra fruits and vegetables, that is wonderful; however, cats are best served with meat-based meals, with minimal supplements for the minor nutrients not found in meat.
THE PROTEIN QUESTION
There is a theory that geriatric patients, especially cats in renal failure, should be fed low protein diets because less protein in means less protein out. Protein is the building block for muscle. Dietary protein intake balances the muscle catabolism of old age. While geriatric cats on high protein diets will lose more protein in their urine than those eating a protein restricted diet, they will still have more foundation for muscle health (including the heart muscle). If protein is removed from the diet and replaced with carbohydrates (grains), inflammation is increased.
Here’s an option for the geriatric cat in renal failure:
Bone Broth Bones from a chicken or turkey 1-2 tbs apple cider vinegar Water to cover Break long bones in half to expose the marrow and minerals. Boil lightly for four to six hours. Add water as needed. Add the broth to any meal, or serve instead of water for renal failure cats.
Portion sizes are always a challenge. The sample dog recipe in this article usually provides enough calories for one meal for a 60lb dog. However, if the geriatric patient is particularly energetic, it may not yield enough calories. This is a bigger problem for those who feed raw meats without vegetables. Vegetables, especially roots like sweet potato, provide carbohydrates, a calorie source. For some lower energy geriatric dogs, this recipe will provide too many calories – in this case, remove 25% of the sweet potato. Regardless of the type of food (real, canned or dry), any time a dietary change is made, the body condition should be checked every two to four weeks.
Portion sizes are not linear (see table). A 30lb dog does not eat half as much as a 60lb dog. A rule of thumb: if the patient is eating high quality kibble, feed as much real food as the portion of kibble used to be.
There really are only a handful of truly dangerous foods. Chocolate, raw onions, grapes and raisins, and xylitol are examples. Long lists of other foods that can be poisonous can be found on the Internet, but these foods are toxic in only certain circumstances. For example, consider garlic or macadamia nuts. In order to make a dog truly ill, you’d need to feed him an enormous quantity of either of these foods. Most of us could not afford to feed our dogs enough macadamia nuts to make them ill. Practicality says that anything in small amounts, except for the few foods listed at the beginning of this paragraph, are safe to eat. Even moderate amounts of avocado flesh are safe; it’s the pits and skins that are poisonous to some animals (birds).
Real food is the fastest way to better health, regardless of the patient’s age. Fundamental recipes and basic food group proportions are the starting point.