The Truth About Dilated Cardiomyopathy (DCM)
Local Paws.png)
We have had a lot of discussions with customers over the years regarding grain-free diets, mostly concerns after being told to stop feeding grain-free foods without knowing the reason why and leading to a lot of confusion. We feel it is important to address this topic and review the latest research, information, and final FDA report with an open mind by looking at all the information and facts. After all, we all want what's best for our pets!
What Is DCM?
Canine dilated cardiomyopathy (DCM) is a heart disease in dogs that is characterized by weakening of the heart muscle, which leads to a decreased ability of the heart to pump, and if untreated, to cardiac failure.
DCM however is rarer than they lead us to believe. In reality, fewer than 1 in 100,000 dogs are diagnosed with diet-associated DCM and between January 2014 and April 2019 there were 119 reported DCM related pet deaths.
Animal numbers in DCM Reports received between January 1, 2014 and April 30, 2019
| Number of reports | Number of animals affected | Number of deaths | |
|---|---|---|---|
| Dogs | 515 | 560 | 119 |
| Cats* | 9 | 14 | 5 |
*Cats are generally more likely to develop hypertrophic cardiomyopathy (a heart disease)
The FDA Gets Involved
This conversation has been going on since July of 2018, when the FDA announced they would investigate correlations between DCM and grain-free pet foods. These reports were prompted to the FDA by a group of veterinarians.
The first red flag those of us that have been in the pet industry long enough saw, and which led to a lot of confusion and eventually lawsuits, was the veterinarians and FDA targeted brands. Majority of the brands they listed had both grain-inclusive and grain-free options. So why were they listing brands and not specific ingredients?
What we now know is that after a six-month investigation by 100Reporters the three veterinarians at the heart of the DCM investigation all have financial ties to one or more of Hill's Pet Nutrition (Science Diet), Mars Petcare (Royal Canin), and Nestle-Purina Pet Care. Hill's had also recently discontinued their line of grain-free foods with the exception of a few of their "Prescription Diets(TM)" before the initial reports came out, many citing due to low food sales. See "The Consequences" below.
What the FDA also found was that every time they released a public update, there was a spike of DCM reports UNTIL they released their final update after concluding there was no link between DCM and grain-free foods.
†It is typical for FDA to receive a short-term increase in reports after issuing public updates on a pet health issue. In this case, upticks in the number of DCM reports to FDA tend to happen after FDA issues public updates on the DCM issue. Public updates are indicated by the lines in the graph above.
Additionally, they found that certain breeds, like Golden Retrievers, may be genetically predisposed to taurine deficiency, which is well-documented as potentially leading to DCM.
According to the FDA's final report "Dilated cardiomyopathy is recognized as a genetic condition in dogs, typically in large or giant breeds, such as the Doberman Pinscher, Great Dane, or the Irish Wolfhound. It is also seen in Cocker Spaniels associated with taurine deficiency. It is believed to be less common in small and medium breed dogs."
On December 23, 2022 the FDA concluded their investigation. "FDA does not intend to release further public updates until there is meaningful new scientific information to share."
The Latest Research
After the FDA's final report in 2020, researchers wanted to know why now? Grain-free pet foods have been around since before 2011, with a surge in popularity in 2015. But DCM reports remained consistent, so why was there a sudden increase in DCM reports?
https://www.frontiersin.org/journals/animal-science/articles/10.3389/fanim.2022.846227/full
What most veterinarian's skipped over was the dry vs raw debate. The amount of DCM reports to the FDA for kibble was 452, where raw was 9. Why did raw (let's not forget that majority of raw food is "grain-free") have very few reports? The answer, taurine!
What Is Taurine?
Taurine is an essential amino acid found in meat, fish, and in smaller concentrations in dairy products, not grain. It is an essential building block of protein. From what we now know, the debate shouldn’t have been about Grain-Free vs Grain-Based, but what happens when we feed a carbohydrate-based food?
All kibble is produced with a heavy amount of carbohydrates. Making kibble is like baking – you have to have a flour source, whether that is grain, potatoes, or legumes. All companies add a synthetic vitamin and mineral pack to their kibble diets in order to compensate for the lack of fresh ingredients, especially meat, in order to meet minimum nutritional requirements.
Since the FDA investigation most companies have since added synthetic taurine into their foods, including the big brands. Because kibble is so heavily processed and cooked at high temperatures, there could be other factors affecting the levels of taurine found in the food and how it is absorbed in the body.
What About Legumes?
In a more recent 2023 study, which appears in The Journal of Nutrition, lentils, beans and peas (also known as pulses) are safe and healthy for dogs.
According to Kate Shoveller, Ph.D., a professor in the Department of Animal Biosciences in the Ontario Agricultural College, Champion Petfoods Chair in Canine and Feline Nutrition, Physiology and Metabolism, and lead author of the study, previous clinical studies in DCM have failed to examine whether pulse ingredients play a role in the disease, specifically with dogs that are not genetically predisposed.
"We found that regardless of the amount of pulses consumed, none of the dogs showed changes to indicate the development of DCM or body composition changes.”
“Our data suggests the inclusion of pulse ingredients in dog food is not a causative factor and emphasizes the importance of understanding the nutrient composition of each ingredient and ensuring that foods exceed minimum nutrient requirements,” Shoveller said. “Ultimately, pulses are a dependable protein alternative in the food industry and this study emphasizes their safety even when incorporated at high concentrations.” You can read more about the study here.
And although on December 23, 2022, the FDA concluded there was no causality with specific types of pet foods, the truth is dogs eating highly processed starch-based pet food or unformulated or poorly formulated meat-based diets can and do acquire DCM from ongoing nutritional deficiencies.
So what caused the spike in DCM?
The Consequences (Lawsuits)
As of February 2024, a new lawsuit filed against Hill’s Pet Nutrition Inc. and other defendants alleges that they “carried out a coordinated scheme to persuade American pet-owners that the grain-free dog food products sold by many Hill’s competitors all increase the risk and severity of a deadly canine heart disease called dilated cardiomyopathy,” according to a news release.
In addition to Hill’s, which is a subsidiary of Colgate-Palmolive Co., defendants include “a group of academic veterinarians and organizations with financial ties to the company,” according to the release from Wolf Haldenstein. Named in the suit are Hill’s, the Morris Animal Foundation, the Mark Morris Institute and five veterinarians."
The lawsuit included this image below of an email from Dr. Freeman (one of the original five veterinarians) to the FDA regarding her “protocol” to submit DCM cases to FDA (note the second bullet point under item 2):
The protocols given to veterinarians also states “In other words, under the protocol that Dr. Freeman established, an FDA report should only be submitted if a DCM-positive dog was not eating one of the core products made by either Hill’s or one of the other two largest and best-established manufacturers in the country." Wait, what? So she's saying if you are feeding Hill's, Purina, or Royal Canin, and a dog is DCM-positive don't report it to the FDA?
Freeman’s own protocol establishes that she cherry-picked her sample in a way that would create the impression of a connection between smaller brands’ products and DCM, whether grain-free or not.”
You can read more about the Hill's DCM Class Action Lawsuit here.
See another new Class Action Lawsuit with Hill's misleading consumers about their line of "Prescription Diet(TM)" here.
Conclusion
This conspiracy theory has been disproven. Just like the garlic debate, even though it's been disproven since 2008 and found in almost every bag of pet food (including Hill's and Purina), we always have it pop up every year. We have days where we start to sound like a broken record, trying to give our neighbors the latest facts and let them know what the experts say is the best way to protect their pet's heart. Dilated cardiomyopathy (DCM) in dogs is largely an inherited disease and not the result of a grain-free or legume-rich diet.
According to Dr. Karen Becker, "adding rice or grains back in to your dog's diet (which is what veterinarians are recommending) is the worst thing you can do." When it comes to kibble, by offsetting meat with high amounts of carbohydrates, pets become amino acid deficient, starving the heart of critical resources which ultimately results in degenerative organ disease. Protein deficiency is likely the biggest contributor which can be caused by excessive levels of carbohydrates and/or fats, processing methods, poor-quality raw ingredients and/or synthetic add-ins.
Interested to know how much carbohydrates (and sugar!) are in your pet's kibble? The amount may shock you!
Turn your bag around and find the Guaranteed Analysis.
Add the Protein % + Fat % + Moisture % + Ash % (if not listed the most common is 6%). Then subtract 100. This will give you the carbohydrate percentage that's in your dog's food.
Ex. Science Diet Large Breed Adult
23.9% + 14.7% + 10% + 6% = 54.6% - 100 = 45.4% carbohydrates. That's almost half of that bag of kibble is carbs and sugar.
Even "fresh" and "farm" diets can have up to 50% carbohydrates. If your food does not list all the needed analysis for the calculation, contact the company to find out. If they won't disclose it to you, it's time to move on.
What Should I Take Away From All This?
We feel there are valid reasons to question the nutritional completeness of all kibble formulas; not just grain-free diets. It has always been our motto to incorporate as much fresh, less-processed food into your animals’ diets as possible.
We need to broaden our considerations when it comes to the food we traditionally feed our animals. For example, asking, “What happens when we feed our dogs one diet for most of their lives?” “Can any one brand, protein, or flavor meet the nutritional needs of every animal on an individual basis?” “If humans cannot thrive on a fortified cereal for our entire lives, why do we expect our animals to be able to?”
Long story short, we recommend:
Adding fresh, unprocessed meat into the diet. Taurine is an essential amino acid derived from meat (not grain!), so if the concern is that these animals are developing DCM from a taurine deficiency then we conclude that adding meat is the solution.
Rotating proteins! Each protein contains different amino acids. If we are only eating chicken, we're missing out on so many key amino acids and a diverse amino acid profile.
Check your ingredients! Look for ingredient splitting (corn, corn gluten, corn meal) and a specific meat should always be first (ex. cod, lamb, chicken). Stay away from "mystery meats" like meat meal, meat by-products, animal fat, and animal digest. The first five ingredients make up primarily what is in that bag. If you have chicken followed by 3-4 carbohydrates, you're feeding primarily carbs with little meat.
Use kibble for additional calories and a budget buffer and consider fresh food as your animal’s nutritional foundation. Check out our handy blog here to help find the best kibble for your pet.
Local Paws has a variety of the highest quality (with grain or without grain) pet foods on the market, as well as the best toppers to protect that heart. If you are ready for an upgrade for your family member's health, Local Paws can help you find the perfect food for your pet.
To Research Further - Check Out These Sources:
A broken heart: Risk of heart disease in boutique or grain-free diets and exotic ingredients by Lisa M. Freeman, DVM, PhD, DACVN in Tufts Vet Nutrition (original article that created the discussion)
It’s Not Just Grain-Free: An Update on Diet-Associated Dilated Cardiomyopathy by Lisa M. Freeman, DVM, PhD, DACVN in Tufts Vet Nutrition (follow up article by the same author)
FDA Investigation into Potential Link between Certain Diets and Canine Dilated Cardiomyopathy – FDA.gov (most recent FDA statement)
Grain-Free Diet Not Linked to DCM in Dogs, Research Review Finds - Veterinary Practice News
Taurine Deficiency in Cats from National Animal Supplement Council (NASC)
Lawsuit Claims Hills Pet Food and Veterinarians Fabricated Grain-Free Diet Scare - Susan Thixton
How Canine Heart Disease Was Tied to Grain-Free Dog Food - The Associated Press
Foods That Invite This Epidemic of Nutrition-Related Disease - Dr. Karen Becker