Dog Pancreatitis Causes and Treatment
Pancreatitis in dogs can be a serious acute condition, or just a chronic pain.
When your dog shows signs of abdominal pain accompanied by vomiting, pancreatitis is high on the list of possible causes. The worst thing you can do if you suspect your dog has pancreatitis is feed fatty food.
The pancreas is an elongated gland located adjacent to your dog’s stomach and tucked alongside the small intestine. The exocrine portion of the pancreas produces enzymes that aid the digestion of proteins, carbohydrates, and fats.
Internal mechanisms like the passing of partially digested foods into the small intestine, and distention of the stomach, stimulate a dog’s pancreas to produce enzymes, as does external factors like the sight and smell of food. Different mechanisms produce different enzymes; for example, eating fat stimulates a different enzyme than eating protein.
Canine pancreatitis literally means inflammation of the pancreas in dogs. When these enzymes are activated prematurely, they actually begin to digest the pancreas itself, resulting in pain and inflammation.
Dog pancreatitis occurs in two different forms, acute and chronic, and both may be either mild or severe. Acute pancreatitis in dogs occurs suddenly and is more often severe, while chronic pancreatitis refers to an ongoing inflammation that is usually less severe and may even be subclinical (no recognizable symptoms).
Acute Pancreatitis in Dogs
Acute pancreatitis can be extremely painful for dogs, and is life-threatening if the inflammation spreads to surrounding organs and tissues. If your dog is female, old, or obese, they are at higher risk for developing acute pancreatitis. Symptoms commonly include anorexia (loss of appetite), vomiting, weakness, depression, and abdominal pain. Abdominal pain in a dog may be exhibited as restlessness or not wanting to move; a hunched appearance or a “praying position,” with the chest down and the rear raised; or vocalization (crying or whimpering). Additional symptoms may include diarrhea, drooling, fever, shock and collapse.
For mild cases of canine pancreatitis, all that may be needed is to withhold food and water for 24 to 48 hours (no longer), along with administering IV fluids to prevent dehydration and drugs to stop vomiting and control pain. Acute pancreatitis in dogs tends to become more severe with each recurrence. Veterinarians believe the repeated inflammation and the tissue scarring it creates causes the dog’s weakened immune response to compensate, putting the dog at high risk for diabetes.
For moderate to severe cases, hospitalization and intensive treatment and monitoring is required. Supportive treatments for dogs with pancreatitis include intravenous fluids to keep the dog hydrated and restore electrolyte and acid-base balance. Potent pain medication is needed, such as injectable buprenorphine or other narcotic pain relievers. Treatment is generally required for three to five days, and sometimes longer. Surgery may be necessary, particularly if the dog’s pancreas is abscessed or the pancreatic duct is blocked.
Recommended medications that stop vomiting (antiemetics) in dogs with pancreatitis include a metoclopramide infusion and chlorpromazine (once dehydration has been controlled).
Alternatively, dolasetron (Anzemet) and ondansetron (Zofran) – antiemetics developed to combat vomiting that has been induced by chemotherapy – may be used. Cerenia (maropitant) is a new antiemetic drug approved for dogs that some vets are starting to use, though it has a limited track record. Metoclopramide (Reglan), a commonly used antiemetic, may be contraindicated in canine pancreatitis due to concern that it may decrease blood flow to the pancreas (antidopaminergic effect), though this has not been substantiated.
Antibiotics to control infections secondary to pancreatitis may be used, though this complication is not thought to be common in dogs. A plasma transfusion is sometimes given to dogs in moderate to severe cases in the hopes that it will inhibit active pancreatic enzymes and systemic inflammatory response; it also provides clotting factors that can help prevent and treat disseminated intravascular coagulation (DIC), an often lethal potential side effect of pancreatitis.
Antacids have not been shown to have any beneficial effect in the treatment of pancreatitis, though they may be given when vomiting is persistent or severe. Non-steroidal anti-inflammatory drugs (NSAIDs) are not effective for canine pancreatitis and should be avoided due to concerns for gastric ulceration and kidney and liver damage. There are no studies yet to support the use of corticosteroids for treating pancreatitis in dogs.
Your Dog’s Nutrition Requirements During Acute Pancreatitis
Traditionally, the standard recommendation has been to withhold all oral food and water until symptoms subside, in order to allow the pancreas to rest. If symptoms persisted for more than 72-96 hours, nutrition was given parenterally (intravenously, avoiding the stomach and intestines). It was thought that even the sight or smell of food could trigger pancreatic secretions that would make the problem worse.
Today, though, there is growing evidence in both humans and animals that recovery time is reduced and survival rates increased when patients are fed early in the recovery from pancreatitis. It is now accepted that prolonged withholding of oral food and water for more than 48 hours (including the time before the dog was brought in for treatment) can lead to increased intestinal permeability (“leaky gut”), atrophy of the digestive cells in the small intestine, and sepsis (blood poisoning). In turn, sepsis can contribute to multiple organ failure and decreased survival rates.
Without oral nutrition, the intestines starve, even if nutrition is provided to the rest of the body through IVs. This is because the intestines receive their nutrition only from what passes through them. Enteral feeding, in which nutrition is provided through the digestive system, is thought to decrease the potential for bacterial infection caused by intestinal permeation, and may reduce the time the dog needs to be hospitalized.
Because most dogs with pancreatitis are unwilling to eat, a liquid diet may be fed via a tube placed through the nose, esophagus, or stomach. Dogs may tolerate nasoesophageal feeding even when vomiting persists. There is evidence that pancreatic secretions are suppressed during an attack of pancreatitis, so food delivered in this manner stimulates the pancreas less than we used to believe, and helps to maintain the health of the gastrointestinal tract and decrease inflammation and side effects such as those listed above.
The ideal composition of this diet has not yet been determined. It is possible that the addition of omega-3 fatty acids, pancreatic enzymes, medium-chain triglycerides, and the amino acid l-glutamine to the liquid nutrition may also help with recovery, though this must be done with caution.
Medium-chain triglycerides (MCTs) are a form of fat that does not require pancreatic enzymes for digestion, so it is well tolerated by dogs with pancreatitis, EPI, and other forms of malabsorption. MCTs can be used to increase calories and help with the absorption of fat-soluble vitamins for dogs who cannot tolerate other forms of fat. MCTs may help reduce triglyceride levels in the blood and prevent pancreatitis that is caused by hyperlipidemia, though it does not lower cholesterol levels. Feed your dog virgin coconut oil for an excellent source of MCTs.
Probiotics, however, are not recommended for dogs with acute pancreatitis. A recent human study showed an increased death rate for patients with severe acute pancreatitis when probiotics were administered, possibly due to reduced blood flow to the small intestine.
Enteral (tube or oral) feeding should begin after 48 hours without food. Vomiting can be controlled with antiemetics and pain medication. The goal of nutrition in the short term is to improve barrier function (stop leaky gut syndrome) rather than to supply total caloric needs.
Parenteral (IV) nutrition should be used only when absolutely necessary, due to persistent, uncontrolled vomiting. Survival rates improve when it is combined with enteral nutrition. A tube can be placed into the jejunum (part of the small intestine) if needed to provide enteral nutrition when vomiting cannot be controlled.
Chronic Pancreatitis in Dogs
Chronic pancreatitis refers to a continuing, smoldering, low-grade inflammation of the pancreas. Symptoms such as vomiting and discomfort after eating may occur intermittently, sometimes accompanied by depression, loss of appetite, and weight loss. In some cases, signs may be as subtle and nonspecific as a dog not wanting to play normally, being a picky eater, or skipping a meal from time to time. Chronic pancreatitis may periodically flare up, resulting in acute canine pancreatitis.
Dogs with chronic pancreatitis often respond favorably to a low-fat diet. Pain medication can be helpful in relieving the symptoms of chronic pancreatitis and may speed recovery.
Chronic pancreatitis is often subclinical and may be more common than is generally realized, with symptoms blamed on other diseases. It may also occur concurrently with conditions such as IBD (inflammatory bowel disease) and diabetes mellitus.
A Dog’s Pancreatic Functions
In addition to digestive enzymes (exocrine function), the pancreas also produces insulin (endocrine function). Dogs who are diabetic may have an increased risk for pancreatitis. Conversely, a dog whose pancreas is damaged due to pancreatitis may develop diabetes, which can be either temporary or permanent; 30 percent of diabetes in dogs may be due to damage from chronic pancreatitis.
Exocrine pancreatic insufficiency (EPI) in dogs, when the pancreas is no longer able to produce digestive enzymes, can also result from chronic pancreatitis, leading to weight loss despite consuming large amounts of food. When a dog’s pancreas is damaged, diabetes is likely to show up several months before EPI. For a detailed look at EPI, see “Exocrine Pancreatic Insufficiency in Dogs,” (WDJ, March 2009).
Causes of Pancreatitis in Dogs
Pancreatitis is often blamed on high-fat diets, though there is little scientific evidence to support this. Active, working dogs, such as sled dogs, can eat as much as 60 percent fat in their diets without developing pancreatitis, but too much fat may cause trouble for middle-aged, overweight, relatively inactive dogs, who are the ones most commonly affected by pancreatitis. Too much fat can also cause problems for some dogs with chronic pancreatitis.
Dietary indiscretion, such as eating rancid fatty scraps from the garbage, can also lead to pancreatitis, particularly when a dog accustomed to a low- or normal-fat diet ingests high-fat foods. That’s why canine pancreatitis incidents are thought to increase after Thanksgiving, when people may feed their dogs a meal of turkey skin and drippings.
Low-protein diets have also been shown to predispose dogs to pancreatitis, especially when combined with high fat intake. Some prescription diets may be a concern, such as those prescribed to dissolve struvite bladder stones, to prevent calcium oxalate, urate, or cystine stones, and to treat kidney disease - especially for breeds prone to pancreatitis.
Several medications have been associated with canine pancreatitis, most recently the combination of potassium bromide and phenobarbital used to control epilepsy. This combination has a much higher risk of causing pancreatitis in dogs than phenobarbital alone (no studies have been done on the use of potassium bromide by itself).
Many other medications have been linked to pancreatitis, though the relationship is not always clear. These include certain antibiotics (sulfa drugs, tetracycline, metronidazole, nitrofurantoin); chemotherapy agents (azathioprine, L-asparaginase, vinca alkaloids); diuretics (thiazides, furosemide); other antiepileptic drugs (valproic acid, carbamazepine); hormones (estrogen); long-acting antacids (cimetidine, ranitidine); Tylenol (acetaminophen); and aspirin (salicylates).
Corticosteroids, such as prednisone, are especially controversial: while veterinarians have long considered them to be the most common drug to cause pancreatitis, recent human studies have discounted this link. Based on anecdotal evidence, however, I believe the association does exist in dogs. I personally know dogs who developed pancreatitis within days of being given corticosteroids. Toxins, particularly organophosphates (insecticides used in some flea control products), as well as scorpion stings and toxic levels of zinc, may also lead to canine pancreatitis.
Certain conditions may predispose a dog to pancreatitis. These include diabetes mellitus (though it is not clear whether pancreatitis precedes diabetes), acute hypercalcemia (high levels of calcium in the blood, usually from a calcium infusion or poisoning rather than diet or supplements), hyperlipidemia (high fat content in the blood, again usually due to metabolic disorder rather than diet), hypothyroidism, and Cushing’s disease (hyperadrenocorticism).
Both diabetes and hypothyroidism can affect fat metabolism and lead to hyperlipidemia, which may predispose a dog to pancreatitis. Miniature Schnauzers are prone to developing hyperlipidemia and thus may have an increased risk of pancreatitis. Obesity predisposes dogs to pancreatitis, and the disease is often more severe in dogs who are overweight.
Pancreatitis can occur in dogs of any age, breed, or sex. That said, most dogs with pancreatitis are middle-aged or older, overweight, and relatively inactive. Cavalier King Charles Spaniels, Collies, and Boxers have been shown to have an increased relative risk of chronic pancreatitis, and Cocker Spaniels an increased relative risk of acute and chronic pancreatitis combined. Dachshunds have been reported to be predisposed to acute pancreatitis.
Other breeds mentioned as having an increased risk for pancreatitis include the Briard, Shetland Sheepdog, Miniature Poodle, German Shepherd Dog, terriers (especially Yorkies and Silkies), and other non-sporting breeds.
People sometimes develop autoimmune chronic pancreatitis, and it is theorized that dogs may as well. German Shepherd Dogs have been shown to develop immune-mediated lymphocytic pancreatitis, which predisposes them to pancreatic atrophy.
Pancreatitis has been associated with immune-mediated diseases, which may include IBD, though the cause-and-effect relationship is not understood. While there is no scientific evidence to support this, some doctors have suggested that food allergies could be a rare cause of recurrent or chronic pancreatitis. I think IBD could possibly be both a cause and an effect of pancreatitis, or that an underlying autoimmune disease or food allergy could cause both.
Dogs with immune-mediated pancreatitis may respond well to corticosteroids such as prednisone, which suppress the immune system, even though this drug has also been thought to cause acute pancreatitis.
Trauma to the pancreas, such as from a dog being hit by a car, can lead to inflammation and pancreatitis. Surgery has also been linked to pancreatitis in dogs, probably due to low blood pressure or low blood volume caused by anesthesia. Gallstones (choleliths) can block the bile duct, and thus the flow of digestive enzymes from the pancreas and can lead to pancreatitis in people; it is likely that the same would be true for both species (pancreatitis can also block the flow of bile from the gall bladder).
Other theoretical causes include bacterial or viral infections, vaccinations, obstruction of the pancreatic duct, reflux of intestinal contents up the pancreatic duct, impaired blood supply to the pancreas due to shock, gastric-dilatation volvulus (bloat), or other causes; and hereditary factors. In rare cases, a tumor in the pancreas causes pancreatitis.
In most cases with dogs, the cause is never found. In people, pancreatitis is most commonly caused by alcohol abuse.
Confirm Your Dog’s Pancreatitis Diagnosis
Some dogs’ blood test results are suggestive of pancreatitis, but not definitive. Substantially elevated (three to five times the normal level), lipase and amylase offer strong support for a diagnosis of pancreatitis, but the absence of these signs does not rule it out; lipase and amylase may be normal in as many as half of all dogs with pancreatitis. With chronic canine pancreatitis, blood tests are often completely normal, and may be so with acute pancreatitis as well, particularly if it is not severe enough to cause complications.
In 2005, IDEXX Reference Laboratories developed a blood test called Spec cPL (canine pancreas-specific lipase), based on the cPLI (canine pancreatic lipase immunoreactivity) test developed at Texas A&M University. There are three types of lipase: pancreatic, hepatic, and gastric. Standard blood tests cannot differentiate between them, but the Spec cPL measures only pancreatic lipase. Spec cPL is now considered the best choice for quick and accurate canine pancreatitis diagnosis, with results available in 12 to 24 hours. The cPLI test is equally accurate, but not as readily available and the results take longer.
IDEXX claims that the Spec cPL test has a sensitivity greater than 95 percent, meaning almost every dog with pancreatitis will test positive (fewer than 5 percent false negatives), and a specificity also greater than 95 percent, meaning fewer than 5 percent of dogs who don’t have pancreatitis will have a false positive result. In comparison, the cPLI test has 82 percent sensitivity and 98 percent specificity.The Spec cPL test can be repeated every two or three days to help judge response to therapy, and after returning home, to confirm recovery. It can also be used to monitor response to changes in diet and other treatment for dogs with chronic pancreatitis.
The Spec cPL test is recommended for any dog whose symptoms include vomiting, anorexia, or abdominal pain. It can also be used to monitor dogs with chronic pancreatitis, or those with conditions or whose medications predispose them to pancreatitis. In the future, this test may be done as part of standard blood work on normal, seemingly healthy dogs, to identify chronic pancreatitis that may be subclinical (not causing recognizable symptoms).
In 2007, IDEXX introduced the SNAP cPL, a version of the Spec cPL test that can be done in-house by your veterinarian and return results in 10 minutes. If the SNAP cPL test results are abnormal, IDEXX recommends that you follow up with a Spec cPL test to establish a baseline cPL concentration and to monitor treatment.
Radiographs detect only 24 to 33 percent of cases of acute pancreatitis, but are also used to identify other causes of vomiting and anorexia, such as intestinal obstruction.
An experienced ultrasound practitioner can detect two-thirds of acute canine pancreatitis cases. Ultrasound may also be used to look for signs of peritonitis, pancreatic abscess or cyst, and biliary obstruction. Neither x-rays nor ultrasound can identify chronic pancreatitis. Biopsy of the pancreas can be used to identify pancreatic cancer. Biopsy may be an unreliable method of diagnosing pancreatitis, as often only part of the pancreas is affected.
TLI (trypsin-like immunoreactivity) is a blood test that has only 33 percent sensitivity for pancreatitis, but it is very accurate for diagnosing EPI (exocrine pancreatic insufficiency). Dogs with chronic gastrointestinal problems should have TLI, cobalamin, folate and Spec cPL testing done to look for EPI, SIBO (small intestine bacterial overgrowth, also called ARD, or antibiotic-responsive diarrhea), and chronic pancreatitis. Dogs with EPI usually have lower-than-normal Spec cPL results, but TLI is considered more accurate for diagnosing EPI.
Acute Pancreatitis Recovery for Dogs
Whether in the hospital or at home, once vomiting is under control, water is slowly introduced, with a few laps or ice cubes every hour or so. If the dog keeps this down, liquids are tried next, followed by soupy, low-fat, high-carbohydrate foods. Frequent small amounts are less likely to cause problems than larger quantities, particularly in the beginning. Dogs who have been hospitalized can return home once they can keep food down without vomiting.
Dogs are often sent home with pain medication, such as a Fentanyl patch or Tramadol. Controlling pain is important during recovery, so ask your vet for help if you feel your dog is uncomfortable.
Veterinarian-Prescribed Dog Food
Dogs recovering from acute pancreatitis are frequently maintained on an easily digestible, fat-restricted prescription diet, particularly if they are overweight or have hyperlipidemia. Low fiber is recommended for dogs in the initial recovery stages of acute pancreatitis as well. While I am not a fan of these products due to their low-quality ingredients, I think that sometimes it is easier to follow your vet’s advice, as long as your dog is willing to eat this food and does not react adversely to it. You can later transition your dog back to a better quality commercial or homemade diet.
Two common veterinarian-prescribed dog foods are Hill’s I/D (intestinal diet) dog food, and Purina EN (Gastroenteric). Hill’s I/D is designed for inflammatory bowel disease (IBD) but is often veterinarians’ first choice in treating any gastrointestinal problem. In fact, foods considered soothing to IBD are generally good for pancreatitis too. Purina EN is low in fat and fiber and contains extra medium-chain trigycerides, making it easily digestible. See “Veterinarian-Prescribed Dog Foods,” (WDJ, October 2002) for more information.
But what if your dog won’t eat the prescription food, or reacts poorly to the food, or you just can’t bring yourself to feed a commercial food after feeding a homemade diet for so long? What should you feed your dog in that case?
Homemade Low-Fat Dog Food Diets to Treat and Prevent Pancreatitis
Preparing your dog’s food at home is a good way to ensure the quality of ingredients they’re getting, and to control the balance of fats, protein, and carbs. Your low-fat homemade dog food diet should consist of about half carbohydrates, and half low-fat protein. Make sure the protein is mostly meat, but eggs and non-fat dairy is good too. The percentage of carbs can be decreased and the amount of meat increased if you use very low-fat cuts, or boil them to remove most of the fat.
The carbohydrates you feed your dog should be starchy: rice, oatmeal, barley, quinoa, pasta, potatoes, sweet potatoes, pumpkin, and winter squashes provide low-fat calories. Leafy vegetables like broccoli are fine, but they supply less calories and should supplement - not replace - starchy carbs.
The other half of the diet should be low-fat meats and a little egg or dairy. Skinless chicken breast is very low in fat, but other parts can be used as long as you remove the skin and visible fat. Turkey, venison, goat, buffalo, and rabbit are low in fat, while lamb and pork are generally high in fat. Ground beef comes in varying levels of fat.
Homemade dog food diets should include organ meat, and most organs are low in fat. Liver and kidney should be fed in small amounts only, no more than 5 to 10 percent of the total diet (around 1 to 1.5 ounces of organ meat per pound of food). Beef heart is quite low in fat and is nutritionally more of a muscle meat, so it can be fed in larger quantities if your dog tolerates it.
See “Healthy Low-Fat Diets for Dogs with Special Dietary Needs,” (WDJ, December 2008) to learn more about low-fat dog diets.
Preventing Pancreatitis Recurrences in Dogs
Pancreatitis is both more common and more severe in overweight dogs. Inactivity may also be a contributor, so weight loss and exercise are both important.
Many weight loss diets for dogs are extremely high in carbohydrates, with low fat and low protein – in fact, some have even less fat than the prescription diets that are recommended for dogs recovering from pancreatitis. A low-fat diet is not required for dogs to lose weight, and higher protein helps dogs lose fat, while low protein can lead to muscle loss.
Avoid low-protein diets, as they can increase the risk of both hyperlipidemia and pancreatitis. Dogs get more nutritional value from protein than from carbohydrates, so it’s better to feed a diet that has higher protein and moderate amounts of fat and carbohydrates to help your dog lose weight. See “Helping Your Dog Lose Weight,” (September 2009).
Underlying metabolic diseases such as hypothyroidism, hyperadrenocorticism (Cushing’s disease), and diabetes mellitus may be associated with increased risk of canine pancreatitis and should be managed appropriately. Hypothyroidism can contribute to obesity and may affect fat metabolism. Not all dogs who are hypothyroidic have the classic signs, such as dry skin and hair loss. A full thyroid panel is more accurate than a simple screening test. Even dogs whose results are in the low normal range may benefit from thyroid supplementation. Noted thyroid specialist Dr. Jean Dodds at Hemopet will consult with you or your vet regarding test results for a small fee.
If your dog is prone to hyperlipidemia (increased blood levels of cholesterol or triglycerides, even when fasted for 12 hours before the test), there are several things you can do to try to lower these levels and reduce the likelihood of pancreatitis. Feeding a moderately low-fat diet, giving fish oil supplements, and treating hypothyroidism, which is often the underlying cause, are all helpful in reducing lipid levels in the blood. In addition, dogs prone to hyperlipidemia may benefit from the use of human statin medications, such as Lipitor, to control lipid levels. Though no studies have yet been done, anecdotal reports from vets who have tried this on an experimental basis have been positive.
Not all dogs who have had acute pancreatitis, or who have EPI, need a low-fat diet. Some low-fat recipes for dogs are excessively low in fat, replacing most of the meat content with starches. Diets that are too low in fat can lead to deficiencies of fat-soluble vitamins and problems with the skin and coat; they can also leave your dog feeling tired and hungry all the time. It’s important to feed adequate fat unless your dog absolutely cannot tolerate it. In that case, you can add easily digestible fat in the form of medium-chain triglycerides (MCTs), found in coconut oil and MCT oil.
Every so often, veterinarians will recommend a vegetarian diet to treat canine pancreatitis. Whole Dog Journal does not advise feeding your dog vegetarian, regardless of the quality or supplementation. See “Home-Prepared Dog Food,” (April 2007) to learn why vegetarianism for dogs can cause serious deficiencies.
Whether too much fat was the initial cause of your dog’s pancreatitis or not, high-fat foods may trigger a recurrence, particularly if the pancreas was damaged. Be sure that your dog does not have access to your trash bin (use locking lids or an alarm if needed), and don’t feed high-fat foods or treats such as pig ears. Make sure that your dog does not get fatty treats from other family members, friends, or neighbors. If your dog is totally unwilling to eat prescribed low-fat foods, try adding a little low-fat canned or fresh foods, or low-sodium nonfat broth, to make the food more attractive.
Don’t try to tempt your dog with high-fat foods and additives if he doesn’t want to eat; this may be good advice even for dogs who have not had pancreatitis, unless you’re certain that the inappetence is not caused by pancreatitis nor a condition that would predispose a dog to it.
Avoid medications that may be linked to pancreatitis, particularly any that may have contributed to the initial attack. If possible, find alternative therapies for dogs taking drugs known to cause pancreatitis, such as using Keppra (levetiracetam) in place of or in combination with potassium bromide or phenobarbital for seizures.
In people, vaccinations have sometimes been associated with pancreatitis. Avoid overvaccinating your dog. The American Animal Hospital Association now acknowledges that there is no need for yearly “boosters” for most vaccines. (See “Vaccinations 101,” August 2008, for more information on current vaccination recommendations.)
Periodic monitoring with the Spec cPL test may be helpful in preventing recurrent pancreatitis, especially after a change in diet.
Supplements for Treating Canine Pancreatitis
Certain supplements can help reduce the risk of acute pancreatitis or control the effects of chronic pancreatitis.
Digestive enzyme supplements that contain pancreatin may be helpful for dogs who have had acute pancreatitis or suffer from chronic pancreatitis. It is theorized that these may reduce the load on the pancreas and inhibit pancreatic secretion.
These supplements are sold over-the-counter for humans or dogs; the prescription-strength enzymes needed by dogs with EPI can also be tried to see if they seem to reduce pain from chronic pancreatitis. Note that enzymes seem to help some dogs, but not others. If your dog does not respond well to one brand, you can try adjusting the dosage or using a different brand, but don’t continue to give them if they cause any problems.
You can also try feeding small amounts of raw pancreas, giving pancreatic glandular supplements, such as Pancreatrophin from Standard Process, or giving plant-derived digestive enzymes, which may be helpful if your dog has trouble digesting carbohydrates.
Fish body oil, such as salmon oil or EPA oil (not cod liver oil), can help to lower blood lipid levels (both triglycerides and cholesterol) in dogs with hyperlipidemia. Studies have also found it to be beneficial in treating acute pancreatitis, while its effects on chronic pancreatitis are unknown. The dosage needed to treat hyperlipidemia may be as high as 1,000 mg of fish oil (supplying 300 mg combined EPA and DHA) per 10 lbs of body weight. Dogs with normal lipid levels should do fine on that amount per 20 to 30 lbs of body weight daily, preferably split into two doses. If you use a supplement with more or less EPA and DHA, adjust the dosage accordingly. Vitamin E should always be given whenever you supplement with oils – give around 5 to 10 IUs per pound of body weight daily.
Probiotics are beneficial bacteria that live in the intestines and help to keep bad bacteria in check. While probiotics are not recommended for dogs with acute pancreatitis, their effect on chronic pancreatitis is unknown. As they are known to help with some gastrointestinal problems, and since their population may be depleted during acute pancreatitis, I think it makes sense to give them once your dog has recovered. You can use products made either for dogs or for people.
Prebiotics are indigestible carbohydrates that feed the beneficial bacteria in the intestines and are often included in probiotic supplements. Certain prebiotics called oligosaccharides have been shown to decrease triglyceride and cholesterol blood levels, which can be helpful for dogs prone to hyperlipidemia. These ingredients may be listed on the label as fructooligosaccharides (FOS), oligofructose, inulin, or chicory. (See “Probing Probiotics,” August 2006, for more information on both probiotics and prebiotics.)
Dogs fed a very low-fat diet may become deficient in the fat-soluble vitamins A and E. Adding fish oil and coconut oil to the diet can help with this. Dogs with damage to the pancreas may also suffer from vitamin B12 (cobalamin) deficiency – in this case, monthly injections may be needed if the dog is unable to absorb B12 when given orally. Chronic pancreatitis may interfere with absorption of vitamin B, so supplementing with B-complex vitamins makes sense.
Human studies suggest that antioxidants, which are found mostly in fruits and vegetables, may help protect against pancreatitis, and reduce the pain of chronic pancreatitis. Vitamin E and selenium (which work synergistically), vitamin C, beta-carotene, and methionine have been found to be effective in helping to prevent pancreatitis in human studies.
Other natural antioxidants sometimes recommended for chronic pancreatitis, though evidence is lacking, include SAM-e (S-adenosyl methionine); alpha lipoic acid (not recommended for diabetics); OPCs, found in grapeseed extract and pycnogenol; resveratrol; and milk thistle. There are a number of combination antioxidant products made for dogs, such as Small Animal Antioxidants and Immugen from Thorne Veterinary, and Cell Advance made by Vetri-Science.
In their book, All You Ever Wanted to Know About Herbs for Pets, Greg Tilford and Mary Wulff-Tilford suggest herbs to support the liver and digestive system. “Dandelion, burdock root, or Oregon grape can help improve digestion and reduce pancreatic stress by gently increasing bile and enzymatic production in the liver.
...Yarrow is said to help reduce pancreatic inflammation and improve blood circulation to the organ.”
Canine Pancreatitis Overview
In conclusion, the best way to prevent your dog from developing pancreatitis is to provide a complete and balanced diet and sufficient exercise. Keep your dog from gaining excess weight by resisting the urge to feed table scraps, and by diligently monitoring your dog around “people food.” If your dog is already obese, get them on an exercise schedule and cut back calories (remember, fat calories, not protein!).
Contact your vet right away if your dog has persistent vomiting, can't keep water down, or appears to have abdominal pain. Know the signs and act on them before the condition has time to worsen. Have your dog’s blood tested to rule out other possible causes.
Discuss feeding options with your vet if your dog must be hospitalized for pancreatitis for more than a couple of days. It's important that your dog not go longer than that without food. Feed a low-fat diet until your dog is fully recovered, then slowly transition back to a normal diet if your dog can tolerate it.
Mary Straus researches canine health and nutrition topics as an avocation. She is the owner of DogAware.com. She lives in the San Francisco Bay Area with her 16½-year-old dog, Piglet.