Nutrition & Wellness for the Senior Dog

Nutrition & Wellness for the Senior Dog

Those of us fortunate enough to have a good dog grow old alongside us know just how special those sugar-faced years truly are. As the exuberance of puppyhood and the highlights of their prime fade into steadiness and comfort, the bond between yourself and your dog only grows as you learn to navigate the subtle changes in behavior and the differences in needs. Stiffness here and there but still excited for the routine of a walk, just with more contemplative moments in the sunshine with their face turned up towards the sun, gently sniffing. Longer naps and shorter hikes; a bit of cloudiness in his eyes and a little less tolerant of strange dogs- nothing we don’t feel ourselves as we, too, age. 

And age, being a senior, doesn’t have to mean ill or weak; I know many senior dogs- my own included!- who wear their dignified salt-and-pepper snouts and are still spitfires! When we approach the care of the senior dog, we aren’t assessing the age itself. We’re assessing the dog, taking into consideration his genetics, his environment, the life he’s lived thus far, his individual temperament, and so on. Aging is a multifactorial process. 

The physical and mental health of the dog overlap, and changes will occur to one if the other is out of balance- consider emotional stress from traveling causing gastrointestinal upset, or grief from the loss of another family pet causing inappetance. We should approach the care of the senior dog holistically, keeping in mind the dog as a whole. When we work holistically, we look to combine veterinary science, natural healing (herbs, nutrition, aromatherapy), complementary therapy (reiki, massage, hydrotherapy, etc.), and psychological care (such as with a professional behaviorist). We also bear in mind not only their internal environment, but their external environment as well. 

This article is going to touch on age-related physiological changes, nutritional modifications, and some common conditions and diseases that we are more likely to see in our senior canines. Before diving into those, there are some general considerations that can be applied to nearly every senior dog. 

longevity care for seniors

One of the most important aspects of the care for your senior dog will be regular veterinary check-ups with complete senior wellness testing: CBC, serum biochemistry profile, urinalysis, and, depending on your veterinarian’s recommendations, thyroid testing. To better help your veterinarian during the appointment, consider doing your own weekly at-home checks. Check their eyes for cloudiness or new discharge; their skin for lumps; their fur for coarseness, mats, or hair loss; their ears for build-up or mites. There are symptoms that are commonly overlooked by owners that can be indicating something more sinister: increased thirst, coughing, exercise intolerance, shallow or rapid breathing, and weight loss can all be explained away in the moment but should be considered when visiting your veterinarian’s office. Depending on your dog’s breed and any symptoms, your veterinarian may recommend further diagnostic testing for your senior, such as chest x-rays or an abdominal ultrasound; this is because the function or dysfunction of many organs do not “show up” on bloodwork!

We want to maintain an ideal weight. 40-45% of dogs ranging from 5-11 years of age are obese- and obesity dramatically shortens a dog’s life span (it’s thought up to two years!). In addition to a general decline in longevity, obese dogs are more at risk for cancer, diabetes, heart diseases, arthritis, bladder stones, hypertension, and joint degeneration. However, one must be mindful of going too lean. Our seniors should stay fit and well-exercised, but as seniors become more susceptible to illnesses, having a modest reserve isn’t a terrible idea.

The exercise for seniors should be appropriate and mindful of any current conditions, such as arthritis. A senior dog’s thermoregulation capabilities will gradually decline, making them more at risk for overheating in the summer and becoming chilled in the winter. Be cognizant of the temperature and consider cooling vests for summer months and coats in the winter.

In addition to physical activity, mental stimulation is just as important! Working your senior dog’s brain through training, puzzle feeders, games, and exploratory walks can help to slow down cognitive decline. After all, it’s never too late to teach an old dog new tricks! There are companies like Nina Ottosson that specialize in dog puzzle games and toys of various levels of difficulty- or, you can make your own!

Some seniors can also benefit from new environmental considerations, such as orthopedic beds, ramps for couches, carpet runners for traction, and more frequent bathroom breaks. If you notice a decrease in your dog’s thirst drive, consider placing bowls in new places, or investing in “fountains” that keep the water fresh and moving.

 

Sweet Chip, my own sugar-faced boy, asking very nicely for a treat.

PHYSIOLOGIC CHANGES

A decrease in lean body mass, also called sarcopenia, is a common concern for seniors; studies have shown that an increase in dietary protein of about 50% that of the adult dog (usually not an issue for fresh food feeders) can reduce and/or delay age-related loss of lean body mass. 

Loss of elasticity of the skin, and decline in sebum production can result in dull, brittle fur, scaly skin, and dandruff.

Changes to the digestive system can include a natural decline in enzyme production and a reduction of saliva. While the former is tied more closely in with immunity, the latter means that seniors are more prone to dental calculus buildup, periodontal disease, and tooth loss. Dental diseases do not affect only the mouth; the bacteria can travel through their bloodstream and affect other organs like the heart, liver, and kidneys.

Gradual decline in renal function that may or may not lead to chronic renal disease. Unfortunately, aging is progressive, and our dogs’ organs will begin to show the wear and tear of a life well-lived. The kidneys’ primary roles are to remove waste by filtering the blood, produce urine, and regulate the balance of specific minerals. Generally, 2/3 of the kidneys are dysfunctional before the owner will see symptoms- usually an increase in thirst and subsequent urination-  and at this time the kidney disease can seem to very suddenly appear when previously there were not overt symptoms.

Bone mass will decrease slightly as a dog’s aging bones have reduced mineral content, and cartilage becomes less resilient with a compromised ability to regenerate, which increases the likelihood of osteoarthritis.

Immunity declines with age which increases susceptibility to infection, likelihood of tumors, and, as cumulative antigen exposure in the gut increases, increases the likelihood of developing new intolerances to proteins that they could previously handle. Chronic antigen loads from proteins, infections, environmental allergens, etc. can lead to a chronic inflammatory status. Aging is thought to be associated with an increase in pro-inflammatory cytokines due a loss of cell to cell communication, elevated levels of which may be responsible for age-associated diseases with inflammatory aspects such as osteoarthritis, cancer, canine cognitive dysfunction, sarcopenia, and diabetes.  Senior dogs are known to have reduced CD4 T-cells- the cells meant to trigger a response to infections (so they become more prone to infections), while they can also show an increase is CD8+ T-cells (when can lead to an excessive immune response).  

Gradual decline in cardiac function can lead to heart disease and ultimately heart failure; heart disease is a functional, structural, or electrical abnormality of the heart and is not one specific condition. Rather, it’s an umbrella term, much like liver disease, that refers to a wide variety of conditions such as hypertension, endocardiosis, pericardial disease, degenerative mitral valve disease, and cardiomyopathies.

Sensory decline can involve a senior dog’s vision, hearing, and sense of taste and smell. Lens and retinal changes that may or may not eventually lead to blindness can impact behavior if there is a reduction in a dog’s recognition capabilities; similarly, seemingly innocuous household changes like rearranging furniture can cause anxiety and confusion. Loss or diminishment of hearing may result in your dog being more easily startled, especially while sleeping, and owners should be cognizant of these possible changes! While the loss of taste and smell may seem relatively minor, both of these senses are involved with a dog’s appetite and may result in pickiness and anorexia.

Bruce, a retired racing greyhound, is a very good boy.

NUTRITIONAL CONSIDERATIONS

The main aspect of proactive nutrition for seniors is simply to ensure that the diet is balanced and is providing an adequate intake of essential nutrients. Due to the natural decline in function of the body’s organs, we do not want to further tax their systems by over-supplementing any more than we want to leave them deficient. In general, we look to provide nutrients through whole foods as much as possible. 

Senior dogs can undergo a decrease in their thirst drive at the same time that they may begin having compromised ability to concentrate their urine. This decrease in thirst can be exacerbated by medications and disturbances in their body’s natural functions.  Increase their daily water consumption by making their meals into stews, adding coconut water or bone broth.

Your senior dog’s energy needs can be affected by the presence of any diseases, daily exercise, individual temperaments, spay/neuter status, and any reduced capability to digest and absorb nutrients. In general, seniors tend to need a caloric reduction of about 12%. 

Macronutrients are carbohydrates, fat, and protein- the three things that provide your dog with energy/calories. Some seniors may need less or more fat, or less or more carbs to keep on or lose weight. Certain conditions can necessitate a change in the macronutrient profile such as increasing fats for certain cancers and lowering protein for liver disease. 

Essential fatty acids should be generously provided, especially preformed fatty acids like linoleic acid, an omega-6; EPA, an omega-3; and DHA, an omega-3. Preformed omega-3s tend to come from marine sources, and do not come from plants. 

Senior dogs can be more prone to constipation and thus a source of fiber can be hugely beneficial. Fiber is either soluble or insoluble, and fermentable or nonfermentable. Fiber can be used to manipulate a dog’s stool output, whether he is indeed suffering from constipation or whether he has the opposite problem.

Soluble fiber forms a gel when in contact with water and insoluble fiber does not; rather, it keeps its shape within the body. Fermentable fiber is broken down by microbes through the process of bacterial fermentation, which in turn produces short-chain fatty acids (SCFAs). SCFAs are the primary energy source for the cells in the gastrointestinal tract. Certain fermentable fibers also act as prebiotics, helping to feed the gut bacteria in the gut. 

In the absence of everything but certain diseases, we do not want to decrease dietary protein. Instead, we should provide very bioavailable sources such as eggs, meat, and fish. This will help to mitigate lean muscle loss that is associated with age, and will provide the essential amino acids that are needed for the body’s higher maintenance needs and to combat their higher vulnerability to bodily stress.

In general for seniors we do not seek to bring minerals “well above” the recommended allowance as established by the NRC. 

Phosphorus is the first mineral we would generally look at reducing as many homemade diets are very high in phosphorus (due to raw meaty bones), which puts unnecessary stress on the kidneys. By reducing phosphorus just to the dog’s recommended allowance, and not far above, we can alter the recipe to be renal-protective. For dogs who actually have symptoms of or diagnosed kidney disease, we would adjust the phosphorus down even further. However, in the absence of disease, the calcium to phosphorus ratio shouldn’t be below 1:1. 

We may consider restricting the sodium and chloride, especially if we are looking ahead for a diet to be cardioprotective; in poultry-based diets, these are almost always far above the recommended allowance, simply due to the nutritional makeup of those proteins. 

Zinc is a trace mineral that has a myriad of roles within the body but is especially well-known for its role within the immune system. Zinc affects immunity through many mechanisms. Immune efficiency requires zinc to bind with specific proteins; thus, a low zinc status within the body can lead to a decrease in immune capabilities. Seniors experience chronic, stress-like conditions within the body that can reduce the availability of zinc within the body; additionally, copper tends to increase with aging, and these are two minerals that compete within the body. Zinc should always be provided to the senior dog at least to his recommended allowance, and generally above it; however, it is important to note that zinc can affect certain medications. 

Manganese is a trace mineral that functions mainly in the activation of enzymes and as an antioxidant. The absorption of manganese is very low- around 10%- and while deficiencies on commercial diets are rare, manganese tends to be low in PMR, whole prey, and BARF-style raw feeding. It’s important that we make sure to meet our dogs’ recommended allowance! 

It’s important to be mindful when supplementing, even for the adult dog with his systems in full working order- it becomes even more important for seniors. 

While a diet balanced to nutritional standards should provide sufficient B vitamins, seniors with increased water loss (through urination, etc.) require additional supplementation in order to maintain their body’s daily stores. Dysfunction or dysbiosis in the gut in the form of intestinal malabsorption can reduce the amount of B vitamins available to the dog. B vitamins interact with each other and with other nutrients and amino acids; imbalances can result in or further aggravate deficiencies.

The status of the various B vitamins within the body can be further reduced if the dog is suffering from impaired organ function. Examples include biotin/B7 and certain types of liver disease; folate/B9 and the presence of inflammatory conditions; riboflavin/B2 and hypothyroidism; and thiamin/B1 and heart and/or kidney disease. 

Essential Fatty Acids (EFAs) are polyunsaturated fatty acids that must be provided in food. EFAs have many roles within the body, including those in cell membranes, the immune system, and the circulatory system. 

Omega-6 in particular is required for maintaining a healthy water barrier for the skin. While many owners reach for omega-3 fatty acids when their dogs begin itching and scratching, it’s important to also determine if the diet is providing enough linoleic acid. Diets that are high in fish and red meat and low in poultry can easily be lacking in this vital lipid. Linoleic acid is also responsible for the production of long-chain PUFAs that are then required for cell membranes and, by extension, the inflammatory response. The long-chain PUFA arachodonic acid (AA) is a precursor to eiconsinoids, substances that are released in response to cellular damage. While it can seem counterintuitive to desire an inflammatory response, it’s important to remember that the process is an important part of immune function. 

The omega-3 fatty acids that we focus on for seniors are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These EFAs are essential not only for normal function of the brain and eyes, but also for general homeostasis within the body. In addition for being known for its anti-inflammatory benefits, DHA in particular is required for brain development and can be used for the improvement of cognitive status, thus making it useful in treating canine cognitive disorder. 

EPA is also a precursor for eicosinoids, although a different type than those produced by AA. These are less potent, mitigating inflammatory and allergic responses. While EPA has historically been the focus when looking to mitigate inflammatory response, a 2016 study on 154 men and women showed that DHA is actually more effective than EPA in modifying specific inflammatory markers. In this case, those markers were interleukin-18, a pro-inflammatory cytokine that was decreased, and adiponectin, a protein hormone that has anti-inflammatory effects (among a myriad of other effects) that was increased.  For these reasons, EPA and DHA become more important when we want to address an inflammatory condition such as arthritis, IBD, cancer, dermatitis, kidney disease, and so on- all conditions that tend to affect the senior population. 

You may read or hear about an omega-6/omega-3 ratio. This is in response to the eicosinoid production process: both pro-inflammatory eicosinoids (AA-derived) and anti-inflammatory eicosinoids (EPA-derived) are inside cell membranes. When the cell is damaged, the membrane will release its fatty acids and synthesize them into the respective type of eicosinoids. The determination of which eicosinoid, pro- or anti-inflammatory, depends on which omega family “wins” a competition for a metabolic pathway. By increasing the amount of omega-3 fatty acids, we increase the likelihood of an anti-inflammatory eicosinoid being synthesized. 

The ratio of omega-6 to omega-3 fatty acids is often expressed but no definitively “perfect” ratio exists; rather, it depends entirely on the condition and the individual dog. 5:1-8:1 seems to be the average ratio, with therapeutic levels of omega-3s bringing that ratio down to 1:1 or less on occasion. 

Oxidative stress as a result of free radical damage has been associated with the effects of aging and with multiple common canine diseases (such as kidney disease, macular degeneration, canine cognitive disorder, cancer, and cardiac diseases), possibly due to pathologic alterations to the cells (resulting in cell damage). Antioxidants protect the body from oxidative damage by scavenging free radical compounds. 

Antioxidants should, at minimum, be addressed through adequate selenium and vitamin E, the requirements of which will increase in the presence of stress or disease (although a real excess of selenium should be avoided). Antioxidants also become even more important as we begin adding therapeutic doses of omega-3 fatty acids, which are especially vulnerable to oxidation. 

Healthy dogs can endogenously produce their own vitamin C but as with many processes, there is a reduced capability for this for senior dogs. Supplementation of vitamin C can be indicated in some cases. 

Phytonutrients, compounds in plants, can also be added, ideally in the form of fresh, lightly processed fruits and vegetables. Carotenoids like lycopene and beta-carotene and flavonoids like quercetin have proven anti-inflammatory, antioxidant effects and should not be overlooked when addressing antioxidant status.

Coenzyme Q10, also called CoQ10 and ubiquinol, is a lipid antioxidant that is essential for tissue health. While CoQ10 is generally provided in the diet through oily fish and offal, supplementary CoQ10 can be indicated in senior dogs and in the presence of certain conditions (particularly well known for its use in those of the heart). 

L-carnitine, although classified as a non-protein amino acid, has been shown to scavenge free radicals. It is typically supplemented in therapeutic recipes for cardiac conditions, but is worth mentioning here. 

Many senior dogs suffer from gut dysbiosis and/or altered intestinal permeability (“leaky gut”). Years of exposure to environmental toxins (unavoidable to at least some extent these days for the majority of owners), vaccinations, antibiotics, imbalanced or low quality diets, physical or emotional stress, and/or parasitic infections can all contribute to a decline in gut health. 

The gut plays the largest role in the immune system within the dog’s body and repairing and ensuring its health will only benefit your dog. The microflora within are their own ecosystem and, once compromised they can affect the synthesis of B vitamins and vitamin K; the efficiency of the gastrointestinal tract; nutrient digestion and absorption; susceptibility to pathogens; drug metabolism; reduction in short-chain fatty acids; increased intestinal permeability; and stimulation of the body’s inflammatory responses. Keeping the gut healthy is of genuine importance. 

The best way to address gut dysbiosis and/or leaky gut differs differs from dog to dog- like most things with nutrition, it is not a one-size-fits-all approach. 

COMMON CONDITIONS & DISEASES

None of the information provided below is meant to replace medical advice from a qualified veterinarian.

If you suspect your dog has a medical condition, please see a vet. 

WHAT IS CANINE COGNITIVE DYSFUNCTION?

Canine cognitive dysfunction, or CCD, is a neurodegenerative disease that affects the dog similarly to Alzheimer’s in the human patient. It is associated with brain atrophy, neuron loss, and beta-amyloid protein deposits in the brain. It is often underdiagnosed. It cannot be cured, but pharmacologic, environmental, and nutritional steps can be taken to slow its progression.  

WHAT ARE THE SYMPTOMS OF CANINE COGNITIVE DYSFUNCTION?

The symptoms can best be summarized through the acronym DISHA, seen in the chart below: 

Dogs suffering from CDD exhibit a myriad of symptoms, the majority of which are, of course, neurological in nature. The dog may become very confused, disoriented, or vacant, becoming lost around the house and not recognizing friends and family members. A loss of memory, an inability to adapt to change, and an inability to learn new commands or routines can develop. Their personalities may seem to change as they become clingier or more distant with both humans and other animals; they may become more easily irritated or agitated. Pacing around the house, refusing to settle, and walking in circles around the room or home can be associated with cognitive decline. Changes to sleep and bathroom habits are also possible, with sleep/wake patterns happening at inappropriate time (i.e., wide awake at night) and a sudden loss of potty training, including cessation of signals that the dog needs to go outside to go to the bathroom.

WHAT DIAGNOSTICS MIGHT BE RAN BY YOUR VET?

The diagnostics “for” CCD should mainly be to rule out underlying endocrine, metabolic, cardiovascular, and neurological disorders that may manifest as symptoms similar to CCD. 

Your vet will ask questions about changes in behavior or patterns, possibly based directly off of the DISHA chart. 

WHAT ARE THE TREATMENTS FOR CANINE COGNITIVE DYSFUNCTION?

Treatment for CCD should be a multi-prong approach.

Environmental:

  • Keeping the senior dog active and stimulated mentally and physically will help to keep them moving and keep their brain “moving”
  • Keeping rooms lit with natural sunlight whenever possible will help keep them from beginning to nap during the day; taking care to thoroughly “wear them out” during the daytime will promote better sleep at night
  • Using puzzle toys, lick mats, snuffle mats, or other games and similar products during feeding time will help to keep them enriched
  • Drastic changes in schedules and routines and suddenly exposing the dog to strange environments and situations should all be avoided if possible
  • Increase the dog’s likelihood of success with established bathroom habits by increasing the amount of trips outside and making sure the dog’s access is adequate
  • Consider calming pheromone plug-ins like Adaptil

Pharmacologic: 

  • Selegiline
  • Propentofylline
  • Nicergoline
  • Gabapentin
  • Adrafinil
  • N-acetyl-D-mannosamine
  • Buspirone
  • Fluoxetine
  • Tricyclic antidepressants

Dietary & Nutraceuticals:

  • Antioxidant-heavy diet, including lipoic acid, L-carnitine, and CoQ10
  • Provide adequate manganese, selenium, and zinc
  • Addition of MCT oil
  • Increase EPA and DHA
  • Consider the prescription supplement VetPlus Aktivait 
  • Herbal nervines like passionflower or valerian root  (NOTE: Herbal protocols are best conducted under guidance of a canine herbalist) 

WHAT IS OSTEOARTHRITIS?

Osteoarthritis, or OA, is a degenerative joint disease. It is marked by the thinning of cartilage, the buildup of fluid within the joint, and/or the formation of bony growths. Osteoarthritis is extremely common in aging and geriatric dogs, and is often secondary to other orthopedic diseases like cruciate ligament tears, dysplasia, or luxating patellas. Age, obesity, breed predisposition, genetics, and even the age at which the dog was spayed or neutered can all increase a dog’s likelihood of developing arthritis. 

WHAT ARE THE SYMPTOMS OF OSTEOARTHRITIS?

The symptoms can include:

  • Stiffness and lameness
  • Changes in gait, such as hopping or “skipping”
  • Reluctance to get up or exercise
  • Signs of pain, which may manifest to include growling or snapping if the painful area is bothered
  • Other behavioral changes, such as urinating in crates or beds or reluctance to greet owners (since getting up is painful)

WHAT DIAGNOSTICS MIGHT BE RAN BY YOUR VET?

Diagnostics will start out with questions regarding any changes in activity or behavior and a physical exam. Further diagnostics might include x-rays or CT scans.

WHAT ARE THE TREATMENTS FOR OSTEOARTHRITIS?

Treatment for OA should be a multi-prong approach.

Environmental:

  • Provide an orthopedic or memory foam bed
  • Keep the dog warm and dry; do not keep dogs suffering from osteoarthritis outdoors
  • Utilizing ramps and stairs around the house and car as needed
  • Investing in slip-free flooring, such as non-skid carpet runners or rugs; yoga mats; or padded flooring
  • Using boots or non-slip socks for the accepting dog
  • Keep nails trimmed to appropriate lengths
  • Exercise modification to not further exacerbate condition 

Pharmacologic/Medical: 

  • NSAIDs for pain relief and anti-inflammatory properties
  • Steroids for anti-inflammatory properties
  • Adequan injections
  • Surgery (many factors play into this)
  • Laser therapy
  • Hydrotherapy
  • Massage/TTouch

Dietary & Nutraceuticals:

  • Weight reduction where necessary, including possible reduction in energy intake for maintenance diets
  • Therapeutic doses of the omega-3 fatty acids EPA and DHA
  • Manipulation of ratios between omega-6 and omega-3 fatty acids
  • Increase antioxidants with increase in omega-3 fatty acids
  • Chondroitin sulfate and glucosamine
  • Green-lipped mussel powder
  • Avocado soybean unsaponifiables (ASUs)
  • Enzyme therapy
  • Herbal therapy like boswellia, devil’s claw, comfrey, licorice, and/or turmeric (NOTE: Herbal protocols are best conducted under guidance of a canine herbalist) 

WHAT IS CHRONIC KIDNEY DISEASE?

Simply, CKD is the inability of the kidneys to efficiently filter waste products from the body. Chronic kidney disease is associated with aging and dogs, and can be a sign that the body’s organs are wearing out. CKD cannot be cured, but an early diagnosis followed by kidney-protective treatment can slow the progression, resulting in more time with your dog and a high quality of life. 

WHAT ARE THE SYMPTOMS OF CHRONIC KIDNEY DISEASE?

Generally, the symptoms during the earlier stages of CKD are increased water consumption and increased urine output. Once about 2/3 of the kidney tissue is destroyed, there will be a significant increase in waste products in the body and symptoms will begin to manifest quickly. These more advanced symptoms can include:

  • Loss of appetite
  • Lethargy/depression, which is directly related to an increase of waste products in the blood
  • Vomiting 
  • Diarrhea
  • Very bad breath that smells like ammonia
  • Weight loss or muscle wasting
  • Weakness caused by low blood potassium
  • Mouth ulcers 

WHAT DIAGNOSTICS MIGHT BE RAN BY YOUR VET?

  • Serum chemistry profile, looking for abnormal concentrations of urea, creatinine, and other non-protein, nitrogenous compounds in the blood, plasma, or serum
  • Complete blood count (CBC)
  • Urinalysis 
  • Blood pressure
  • IDEXX SDMA
  • Ultrasound
  • Kidney biopsy 

WHAT ARE THE TREATMENTS FOR CHRONIC KIDNEY DISEASE?

Often, this is dependent on the primary cause (if one can be found). However, treatments can include:

  • Dietary management
  • Phosphorus-binding agents
  • Calcitriol dose replacement to regulate the parathyroid and calcium 
  • Medications to reduce vomiting and nausea
  • Medication to decrease gastric acid secretions 
  • High-dose fluid “flush”, called diuresis 
  • At-home fluid therapy 
  • Medications to reduce blood pressure 

DIETARY MANAGEMENT

Nutrition plays a major role in disease progression and is a mainstay of CKD treatment. The goals of dietary management are to alter disease progression through the manipulation of specific nutrients; utilize nutrition to control uremic symptoms; and maintain or improve the dog’s quality of life.

Generally, we use the following approaches during dietary/nutritional management:

  • Increase water intake
  • Maintain or increase energy intake as needed
  • Provide high-quality, highly digestible protein; we do not restrict protein in the earlier stages of CKD
  • Restrict phosphorus- for most raw fed dogs, this involves removing bones entirely as well as reducing the amount of meat proteins, especially those that are high in ammonia 
  • Reduce, but not restrict, sodium 
  • Provide sufficient amounts of potassium
  • Increase the omega-3 fatty acids EPA and DHA
  • Remove plant-based fatty acids from the diet
  • Increase fiber, especially fermentable fiber
  • Increase antioxidants, including vitamins E (tocopherols & tocotrienols if possible) and C; carotenoids; flavanols; and lutein
  • Increase the amino acids taurine and arginine 
  • Herbal therapy can be beneficial but should be conducted under the guidance of a canine herbalist