The IBD info in here is excellent. If not already, I would suggest making it a sticky.Ok, I am answering your question from MissMindy's thread here.
And as I find myself writing and writing and writing, I apologize up front for the length of this post.
The stool is yellow pink, not pasty gray/white-ish? Because these indicate two different things.
The pink is likely from fresh blood - this would likely be due to the IBD/colitis.
Yellow is due to the food whipping through her system too quickly, e.g. malabsorption. The volume is a bit concerning though - if it is gray/pasty, that is almost always a sign of EPI (Exocrine Pancreatic Insufficiency) and a lack of proper bile production. But those are usually very large, fluffy poops, not watery or diarrhea. So it sounds like malabsorption, and there are absolutely a number of steps you can take to address that.
I am sharing information that has helped many other IBD kitties. Please bear in mind:
1) My philosophy is to address things with diet and appropriate supplementation first,
2) that is to say, for me, traditional treatment and medications can be very important tools, but are my second choice.
That said, please discuss treatment choices with your vet. But if your vet is ONLY traditional, and unfamiliar with natural approaches, do not expect support. At that point, it is up to you whether to find a new vet that is willing to be your partner, or whether you want to use any of these approaches at all.
- Has she had the cobalamin/folate test done? If her B-12 levels are low, her diarrhea will not resolve without this being restored. B-12 is an incredibly important tool in the management of IBD, and even if her cobalamin levels are "normal," B-12 shots (which can be done at home) usually improve malabsorption, intestinal function, energy and appetite.
- Steroids can be very helpful to control run-away inflammation, but making changes to diet and supplementation may enable you to successfully wean your cat off of them.
Here's my thinking on the subject:
“The main hypothesis for the cause and development of human IBD is that there is a dysregulation of the mucosal immune responses to intestinal microflora and/or dietary antigens. This same abnormal immune response to dietary antigens is often suspected in feline IBD.
…The important point that seems to have been missed is that it is actually the feeding of a species-inappropriate diet that has led to the rise in inflammatory bowel disease in cats and loss of integrity of the gut wall.
By feeding cats inappropriately and not recognising them as obligate carnivores, we have damaged their intestinal tracts… “
This is from Feline Inflammatory Bowel Disease: Nature and Treatment, Feline Nutrition Education Society (FNES) Lyn Thomson, BVSc DipHom March 09, 2012
While there are many vets - especially holistic ones - that support raw feeding in the treatment of IBD, it can be hard to find in print. There are no studies, so the evidence is all anecdotal. And switching to raw does NOT resolve the problem for all IBD kitties. That said, a healthy diet is a healthy diet. If we've been eating pizza all our lives and suddenly start eating salad, our systems are going to be upset too. That does not mean salad is not healthy for us. And is it essential the diet be raw? Probably not. Controlling the ingredients is most likely the most important aspect. That said, we have no idea exactly what happens when cooking and how that impacts a cat. Less unknowns in feeding the food raw. Dr. Lisa Pierson has developed a balance between raw and cooked that no one else employs. It's something to consider ( http://www.catinfo.org/?link=makingcatfood ). But at this point in time, I've seen many cats switched to raw and have formed stools for the first time in, sadly, often years, have their first fully formed stools after their first meal of 100% raw food. Notably, the All Feline Hospital (in Lincoln, NE) notes that they “started trying commercial raw food diets with amazing results.” They further state
"We have had cats with confirmed by biopsy IBD that had severe IBD and significant symptoms that had to be on very high doses of steroids just to have some quality of life. Many of these cats had a complete reversal of signs and symptoms by going to an exclusively raw food diet, and were able to either come off of all medications, or at the very least, drastically reduce their medications."
So there are traditional vets that "get" it. Ooops, edited to add the link: http://www.allfelinehospital.com/site/view/206534_inflammatoryboweldisease.pml
NOW.... sometimes the disease has advanced beyond the point that diet alone will control the problem. Probiotics, IMO, are absolutely critical to IBD cats, as there has been a definitive link made between IBD and gut dysbiosis in people. This may not be the precipitating factor in all cases, but in treating bacterial overgrowth, parasites, what-have-you, almost all cats (and people) with IBD have taken antibiotics - often lots of them - and this has thrown their internal environment completely out-of-balance.
THIS what leads to leaky gut and the "apparent" allergy to some proteins. And THIS is why novel proteins need to be used, at least initially, when first working to heal the damage done from IBD.
To help repair leaky gut and restore normal function to the intestinal lumen, probiotic support is an absolute must, IMO. And not pet probiotics, which are given in doses that are too small, and usually in the form of "fermentation product," which are NOT live CFU, and function as digestive enzymes in that format.
Working with several feline IBD support groups, we are finding that in many, many, many cases, the use of S boulardii is stopping diarrhea dead in its tracks. Now - that is when the primary problem is bacterial overgrowth, not "just" rampant inflammation. But it is safe, and as a yeast-based probiotic, can be co-administered with antibiotics. In fact, that is how it is often used in humans, as adjunct therapy in the treatment of antibiotic-resistant Clostridium difficile in hospital settings.
The addition of MOS (mannan oligosaccharides) improves the performance of S boulardii, and thus we're recommending people use the Jarrow Brand (if you're in the U.S.). Many cats do not like the taste, so often you need to administer in pill form. The Jarrow capsules are too large, and the cat dose is half a capsule twice a day anyway for the therapeutic dose. But to use for "stop diarrhea," buy size 3 empty gel caps, and fill those. Give them every 2 hours or so while you're home and awake. You can safely do this for up to three days. If it doesn't help by then, it's not going to, but you should continue to give the S boulardii, just move to the twice a day, 2.5 billion CFU (half the jarrow capsule).
S boualrdii does not colonize the gut, thus it must be given twice a day. It clears the system entirely within 36 hours.
This is why S boulardii is such an important tool in IBD:
Simply explained in the Biocodex FDA submission (last link), S boulardii is not digested and absorbed in the gut and does not exert its effect systemically. Instead, S boulardii acts locally in the lumen of the gut. During its passage through the intestine, S boulardii mimics the physiological effects of the digestive flora, stimulating healthy immune response and reducing inflammation.
Saccharomyces boulardii prevents enteritis from Clostridium difficile infection
http://archives.focus.hms.harvard.edu/2006/091506/research_briefs.shtml
"Saccharomyces boulardii in Gastrointestinal Related Disorders," Point Institute Technical Report (2008) http://www.pointinstitute.org/wp-co...s-Boulardii-in-GI-related-disorders-paper.pdf
Saccharomyces boulardii effects on gastrointestinal diseases, (Zanello et al. 2009) http://www.horizonpress.com/cimb/v/v11/47.pdf
Review article: anti-inflammatory mechanisms of action of Saccharomyces boulardii, (Pothoulakis 2009) http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2009.04102.x/pdf
"Systematic review and meta-analysis of Saccharomyces boulardii in adult patients," (McFarland 2010) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868213/
Anti-inflammatory effects of Saccharomyces boulardii mediated by myeloid dendritic cells from patients with Crohn’s disease and ulcerative colitis, (Thomas et al. 2011) http://ajpgi.physiology.org/content/ajpgi/301/6/G1083.full.pdf
Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders, (Kelesidis & Pothoulakis 2012) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296087/pdf/10.1177_1756283X11428502.pdf
New Dietary Ingredient Notification for S boulardii (FDA submission) by Biocodex (Florastor) (includes summary table and references) http://www.fda.gov/ohrms/dockets/dockets/95s0316/95s-0316-rpt0301-04-vol239.pdf
Other tools to help stop leaky gut, and to manage a flare-up crisis:
Stop whatever you're feeding. Use a novel protein for your cat - if turkey is new, either buy organic turkey thigh from Whole Foods or somewhere, if you can find it, OR use Beech Nut turkey baby food (NOT GERBER: gerber contains corn starch, and this can be an irritant to IBD cats). If turkey is not a novel protein for your cat, you can buy duck or pork - pork is likely leaner, and fat can be a problem for IBD kitties. So buy a low fat cut like loin and trim it well. Poach it, and feed it with ALL the water it was cooked in, that has valuable nutrients in it. You can shred it or toss it in a food processor. Feed this for up to a week unbalanced. After that, you need to think about either introducing and SLOWLY transitioning to balanced raw, or balancing the home cooked food. It's not hard. There are recipes in the Raw & Home Cooked Cat forum, just use the desktop view and find links to the threads in the Resource threads stickied at the top of the forum.
In the meantime, make bone broth.
According to Dogs Naturally, “Bone broth is a long forgotten superfood that’s inexpensive, nutrient packed and easy to make.” This is just as true for cats as it is for dogs. The article outlines the reasons to provide bone broth to your pet:
1) Bone Broth is Good for Joints
2) Bone Broth Helps the Liver Detox
3) Bone Broth Promotes a Healthy Gut
4) Bone Broth is Great Nutrition for a Sick Pet
The “healthy gut” section states:
The lining of the intestines is [sic] contains millions of tiny holes that allow the passage of digested nutrients to enter the body. Stress, poor diet and bacterial overgrowth can cause more holes to open or to become bigger…this is called leaky gut.
The problem with those big holes is that things can pass through that aren’t meant to, including undigested food matter, toxins and yeast. The body will notice those undigested food particles as foreign invaders and start to attack them. This is how allergies and food sensitivities develop.
Bone broth is loaded with a gooey substance that can plug up those leaky holes: gelatin!
https://www.dogsnaturallymagazine.com/reasons-your-dog-love-bone-broth/
“Leaky gut” is technically known as dysbiosis, mentioned above. According to “Dysbiosis in the Pathogenesis of Pediatric Inflammatory Bowel Diseases,” (Comito and Romano, 2012, International Journal of Inflammation),
"A condition of “dysbiosis”, with alterations of the gut microbial composition, is regarded as the basis of IBD pathogenesis. The human gastrointestinal (GI) microbial population is a complex, dynamic ecosystem and consists of up to one thousand different bacterial species. In healthy individuals, intestinal microbiota have a symbiotic relationship with the host organism and carry out important metabolic, “barrier,” and immune functions. Microbial dysbiosis in IBD with lack of beneficial bacteria, together with genetic predisposition, is the most relevant conditions in the pathogenesis of the pediatric IBD."
Bone broth, full of collagen and gelatin, is a very healing and soothing food for your kitty, especially if kitty has IBD. I don't have references for it, but I believe the function of the collagen is as an anti-inflammatory.
This is an article and video recipe by Dr. Karen Becker of the Healthy Pets blog (Mercola):
http://healthypets.mercola.com/sites/healthypets/archive/2013/12/02/pet-bone-broth.aspx
This is the same instructions in PDF format:
http://mercola.fileburst.com/PDF/HealthyPets/DrBecker-BoneBroth.pdf
Another article on the benefits of bone broth, this one written by Susan Thixton (of Truth About Pet Food):
http://www.theorganicview.com/recipes-health/cook-your-pet-a-healthy-broth/
The discussion of the role of dysbiosis in IBD (in humans)
Comito , D and Romano C. 2012. Dysbiosis in the Pathogenesis of Pediatric Inflammatory Bowel Diseases, Intl. Jour of Inflammation Vol 2012, Article ID 687143, 7 pages. http://www.hindawi.com/journals/iji/2012/687143/
Other helpful things.
Slippery elm bark powder. This is also healing, soothing, and helps address over-acid stomachs which many IBD kitties experience.
http://www.littlebigcat.com/health/slippery-elm/
Ongoing Probiotic Therapy. Including an acidophilus+bifidus supplement, to help restore important strains of healthy bacteria that populate the gut. My cats do not have IBD, but I use Natural Factors double-strength acidophilus+bifidus and give 1/2 a capsule 2x a day. I alternate this with Nexabiotic every-other day. Nexabiotic is the only probiotic supplement in the U.S. that I know of that contains lactobacillus, bifidobacterium AND S boulardii. When (if) your kitty's diarrhea resolves, Nexabiotic is an excellent maintenance probiotic for long term use vs. the Jarrow. Especially because most cats eat it just sprinkled on food. Please note, Natural Factors is not lactose-free, which is important for some IBD cats. And note that Nexabiotic contains maltodextrin, which can be a problem for some IBD kitties.
Digestive Enzymes. After ensuring your kitty does not have EPI, digestive enzymes absolutely help improve metabolism and digestive function. Use plant-based enzymes, they work in a much wider pH environment. Many have good success with Prozyme or Prozyme Plus (Prozyme Plus is lactose free).
Medical tools I think every IBD kitty parent should have on hand:
Appetite stimulant (Cypro or mirtazipine. There are far fewer adverse reactions to cypro, but it must be given 2x a day vs. once every three days)
Anti-nausea medication. If slippery elm isn't cutting it, you may need pepcid a/c (famotidine). If that doesn't help, try ranitidine (zantac), it has additional motility function. If that doesn't cut it, then cerenia. Directions for pepcid or zantac at Tanya's CRF website: http://www.felinecrf.org/nausea_vomiting_stomach_acid.htm#treatments
B-12 shots. See above.
Consider sub-q fluids. With IBD that presents with diarrhea, kitty is often dehydrated. Sub-q fluids given at home REALLY improve how they feel.
I might have forgotten stuff.
If you want to consider transitioning to raw, consider using Rad Cat. Tiki cat when converted to a per pound basis costs about $8.00 per pound. The problem with Rad Cat is that it is not easily available in many locations, and they only have chicken, turkey, and lamb. Rad Cat usually costs $9 - $10 per pound, but over time should save you plenty in vet bills. Also, cats fed raw typically need to eat 10% - 30% less, and that is not reflected in a comparison when just looking at cost per pound. Though making your own cat food is not difficut, and if you've been feeding Tiki cat, Weruva, and Nature's Variety Instinct, it will definitely cost you less.
Just to mention ... the symptoms of IBD are highly variable. For instance, my cat never had diahrea - only chronic vomiting. Cerenia helped - unfortunately it cannot be given long-term. And usually the flre-ups are cyclical. Just when you think your cat never looked better - they can quickly spiral downhill.
LDG... and everyone contributing to our understanding of this awful malady .... a heartfelt thankyou and gratitude for your time and effort. We are in this together for the benefit of our very close furry friends.
God bless you all.
