Eosinophilic IBS

Can anyone recommend the best foods for this health issue? I would prefer low carb suggestions. Thanks.

Rona said:

Can anyone recommend the best foods for this health issue? I would prefer low carb suggestions. Thanks.

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Typically people look for novel protein novel carb foods tht the cat hasn't been exposed to before like rabbit, venison etc. See http://www.allfelinehospital.com/inflammatory-bowel-disease.pml

What was the cat eating before?

He was diagnosed 1 year ago at 10 yo. He was eating a few different dry foods, really nothing fabulous for sure. Now I have him on Evo dry (he loves dry) and had him on Primal freeze dried raw turkey and chicken for the past 6 months. I recently purchased Instinct freeze dried raw and Stella and Chewy's but 10 days ago he got really sick with diarrhea so I am no longer doing the raw since he is on budesonide daily and chlorambucil (vet prescribed every other day but I give it once weekly). My vet actually recommends Friskies canned pate stating she sees cats do well on it, but I know it's junk so I avoid it. The problem is I don't know if the eosinophilic IBD is carb related or a protein specific related problem. Btw, he also has a problem with struvite crystals.

Any suggestions will be appreciated.

Thanks,
Rona

Rona said:

He was diagnosed 1 year ago at 10 yo. He was eating a few different dry foods, really nothing fabulous for sure. Now I have him on Evo dry (he loves dry) and had him on Primal freeze dried raw turkey and chicken for the past 6 months. I recently purchased Instinct freeze dried raw and Stella and Chewy's but 10 days ago he got really sick with diarrhea so I am no longer doing the raw since he is on budesonide daily and chlorambucil (vet prescribed every other day but I give it once weekly). My vet actually recommends Friskies canned pate stating she sees cats do well on it, but I know it's junk so I avoid it. The problem is I don't know if the eosinophilic IBD is carb related or a protein specific related problem. Btw, he also has a problem with struvite crystals.

Any suggestions will be appreciated.

Thanks,
Rona

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Wow not only is he on a really strong steroid but the chlorambucil (Leukeran) is usually (but not always) reserved for small cell lymphoma.  Has he had a history of weight loss and has small cell lymphoma been discussed?  In my personal experience when you're on budesonide and Leukeran you;re generally past the point where diet is going to have much effect....

My vet put him on the drugs as soon as diagnosed. No food trials completed. He weighed 19 lbs and I have gotten him down to 14 lbs by limiting his food. His weight is much better now, I definitely believe food will have an effect.

BTW, he is doing really well but I would love to attempt to get him off the meds, if I only knew which food was best.

Rona said:

My vet put him on the drugs as soon as diagnosed. No food trials completed. He weighed 19 lbs and I have gotten him down to 14 lbs by limiting his food. His weight is much better now, I definitely believe food will have an effect.

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I'm confused.  IBS/IBD when it is serious causes weight loss, not gain, but your post makes it sound like you're trying to get him to lose weight.  How was your cat diagnosed and what were his symptoms?

His only symptom was vomiting. He has been overweight for years. Hx of PU surgery for multiple blockages in 01/2011. Bloodwork 9/2014 showed elevate eosinophil level of 1212 (normal 0-1,000). I did not have a biopsy done due to cost. I have a lot of rescues and it gets very expensive. My vet said either way (IBD or lymphoma, the treatment is the same). His most recent bloodwork from 5 days ago was normal. Vet said he looked great when she saw him last week. Budesonide dosage is 1 mg PO daily. I'm really trying to stop the chlorambucil but vet did not say OK or not OK when I told her.

Ultrasound indicated the following:
1. Subserosal bowel thickening, may be incidental, but with eosinophilia, eosinophilic IBD should be considered. Pathology is necsessary to rule out IBD and T Cell lymphoma.
2.Pancreas inflammation in right limb only. There is no indication of acute inflammation.
3. Bold layering of the stomach wall. Often this is associated with metabolic gastritis.
4. There is no lymphadenopathy.
5. There is scant urine in bladder so it is difficult to assess thickened and laminated wall. There is a small amount of mucoid, not solid debris in the lumen.
6. There is no indication of architectural renal change or loss of reserve.

Thanks so much. I appreciate any help or advice. I absolutely don't know what to do about diet for Dylan. Do you think low or high protein?

I don't think high or low protein will have much difference with the IBD, but high protein means less carbs which would be good for if you're trying to help him lose weight. It's really tedious, but the best thing would be to find out what food is causing a reaction, which means feeding him a protein he's never had before (rabbit? venison?) preferably with a carb source that's also new (maybe tapioca or potato) for a few weeks/months until his intestines calm down, then slowly (at least a week between each) adding foods back in and seeing if they cause a reaction. There's not a "best" food, it's really personal based on what your cat's allergic to. It takes a lot of time reading ingredient labels (and keeping up with changes the food companies make!!).

Did they do a biopsy? I wasn't aware you could tell what cell types are involved without biopsy.

Rona said:

His only symptom was vomiting. He has been overweight for years. Hx of PU surgery for multiple blockages in 01/2011. Bloodwork 9/2014 showed elevate eosinophil level of 1212 (normal 0-1,000). I did not have a biopsy done due to cost. I have a lot of rescues and it gets very expensive. My vet said either way (IBD or lymphoma, the treatment is the same). His most recent bloodwork from 5 days ago was normal. Vet said he looked great when she saw him last week. Budesonide dosage is 1 mg PO daily. I'm really trying to stop the chlorambucil but vet did not say OK or not OK when I told her.

Ultrasound indicated the following:
1. Subserosal bowel thickening, may be incidental, but with eosinophilia, eosinophilic IBD should be considered. Pathology is necsessary to rule out IBD and T Cell lymphoma.
2.Pancreas inflammation in right limb only. There is no indication of acute inflammation.
3. Bold layering of the stomach wall. Often this is associated with metabolic gastritis.
4. There is no lymphadenopathy.
5. There is scant urine in bladder so it is difficult to assess thickened and laminated wall. There is a small amount of mucoid, not solid debris in the lumen.
6. There is no indication of architectural renal change or loss of reserve.

Thanks so much. I appreciate any help or advice. I absolutely don't know what to do about diet for Dylan. Do you think low or high protein?

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Thanks this is great info and I can see why your vet made a tentative Dx of IBD. And your vet is correct, the treatment for IBD and SCL is the same, but chlorambucil (leukeran) is usually reserved for very serious cases of IBD when the cat no longer responds to steroids usually Prednisolone but in your case budesonide. That's when most vets start chlorambucil although some think it's best to start them at the same time, but this is almost always when the cats illness is so serious that he's loosing weight even thigh eating well This is normally never done if the cats weight is stable and is responding to gentler treatments like diet, etc.

Personally if I had a cat who was a bit overweight with IBD I'd be glad because it's money in the bank so to speak for when and if the disease progresses and he's loosing weight and you can't arrest it. That's when you'll be glad he has a few pounds to spare. I've been through all of this with my cat.

As Samus said above its not about high protein or low protein, it's about finding a novel protein that the cat doesn't react to, the best being the prescribed versions of venison, duck, rabbit etc, and these are generally more pure than of the shelf versions..

I have always questioned why my vet put Dylan on chlorambucil. I fought her on it at the beginning but she convinced me. She is strictly a cat vet with 30 years experience and really knows her stuff but I was not thrilled with the chlorambucil idea. She put him on budesonide because prednisone has so many side effects and budesonide is better for GI problems. Because Dylan is on budesonide, doing food trials is not helpful. The medication basically decreases his inflammatory response so I have no way of knowing which food(s) he is allergic/sensitive to.. I was wondering if high carb foods could be the cause of the IBD although I found no research on this. I did try feeding him venison, duck and rabbit but gave up on that since I had no way of knowing if that was the answer. He didn't like duck or rabbit but tolerated the venison a bit more.

Thank you for your help and advice!

Rona said:

I have always questioned why my vet put Dylan on chlorambucil. I fought her on it at the beginning but she convinced me. She is strictly a cat vet with 30 years experience and really knows her stuff but I was not thrilled with the chlorambucil idea. She put him on budesonide because prednisone has so many side effects and budesonide is better for GI problems. Because Dylan is on budesonide, doing food trials is not helpful. The medication basically decreases his inflammatory response so I have no way of knowing which food(s) he is allergic/sensitive to.. I was wondering if high carb foods could be the cause of the IBD although I found no research on this. I did try feeding him venison, duck and rabbit but gave up on that since I had no way of knowing if that was the answer. He didn't like duck or rabbit but tolerated the venison a bit more.

Thank you for your help and advice!

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Most cases of IBD start relatively mildly, and so treatment starts incrementally and conservatively. First you do food trials.  If that doesn't work, or only works partly then you move on to mild treatments like Flagyl (Metronizafole) if its diarrhea, B12 injections to increase nutrient absorption, and anti nausea drugs like pepcid or cerenia for vomiting.  Only when all these treatments stop working do you move onto drugs like steroids for the reason you mention, side effects, and you ideally don't want to be on steroids longer than needed and if you start steroids sooner than needed you are going to be on it longer than necessary by definition.

I am not aware that Budesonide has less side effects then Pred, all i know is it is stronger and generally not the first choice.  All steroids have side effects because they suppress the immune system but some reasserch ive done agrees with your vet that the overall side effects is reduced with budesonide (see http://veterinarycalendar.dvm360.co...tinal-lymphoma-cats-proceedings?rel=canonical for a great article on IBD and a comparison between Pred and Budesonide)

chlorambucil (Leukeran) is chemo therapy although relatively mild compared to others is usually given when vets suspect that the IBD has changed to small cell lymphoma although vets often feel it is a good treatment for severe IBD that is no longer responding to steroids, although as i said before some vets like to use it with steroids in order to push the IBD into remission earlier in treatment.

My question is why did your vet seem to jump directly into the most intense treatments while skipping the earlier more conservative treatments that might have worked for quite some time.  I think you can have a calm and rational discussion with your vrt on this topic, discuss the possibility of reverting to milder treatments, and also possibly getting a second opinion.

To your question about carbs, high carb foods are not  associated with the development of IBD.  The underlying causer of IBD, in other words the reason why cats react badly to certain foods is not well understood, but the reaction can be to any ingredient in a food, but whether its a specific ingredient in a food (like a preservative or additive etc) in the end its about proteins, and their body reacting badly, almost allergically to proteins.

Back to the idea of reverting to milder treatments, one option would be to slowly taper the steroid and the chlorambucil while on a novel protein/carb diet and see what the reaction is.  If the reaction is poor, then you go back to the stronger drugs.

Is your cat's weight stable?   A cat who is losing weight with IBD is in big trouble, and the number one reason why the cat is on steroids or chlorambucil.