Guidelines to Treating IBD

By Lisa Provost

Because this disease is so exhausting and the learning curve is so large, we’ve put together some guidelines for you to help make things a little easier.

KNOWLEDGE – Arm yourself with knowledge and education as much as possible. Believe it or not some vets are still not well versed in IBD and may not know the current treatments and diagnostics. Getting your pet properly diagnosed can alleviate a lot of questions and going back and forth. Research the medications, side effects of those meds, what tests need to be done, what your options are and yes even bring information with you. If your regular vet is not interested in working WITH you or doesn’t have the education on IBD, look elsewhere. It’s your right as the pet parent to seek a 2nd or even 3rd opinion. We do it for people, why not for our furry sons and daughers. Have a plan when you go to the vet. Ask about steroids for inflammation (most of the time it’s needed to get the inflammation down enough for the body to start healing itself), anti-emetics and anti nausea medications (9 out of 10 cats with IBD are nauseous even if they don’t vomit. If your cat is walking away from their food consistently, this may be why). Appetite stimulants (don’t risk fatty liver, it can take less than 48 hours to set it with cats).

Records – Ask your vet for a copy of all of your cat’s records. This will help you know exactly what tests were done, when they were done last and what the results were. It also helps to have these if you’re in a support group so you can relay information correctly. So each time you bring your cat in for a checkup or more blood work, ask them for a copy of what was done and the results when you go to pay your bill.

Keep a Journal – Keeping records of your own of your cat’s progress, setbacks, good days, bad days, etc. will give you some perspective. Often times it will seem like it’s been one bad thing after another. If you’ve got the evidence in front of you, it can give you hope that maybe the last month wasn’t as bad as you thought, and ease your anxiety. Also keeping a medication record can be extremely helpful! If you get to a point where you’re giving them several things a day, you work for a living, can’t remember when the last time kitty got their pill, this will be invaluable. Make a weekly checklist.

DIET – Feeding them a species appropriate diet can do wonders for not only any sick kitty, but a healthy one as well. Cats are obligate carnivores, plain and simple. Contrary to what some believe, domestication has not changed their genetics, nor can it. MEAT is their primary source of sustenance. They don’t need, nor should they have, gluten of any kind, wheat, barley, corn, soy, spinach and other vegetables high in oxalates (in fact limit the veggies, they don’t need them), sorbitol and other sweeteners, carrageenan and other gums and thickeners (carrageenan is the worst one, scientifically proven to instigate and cause IBD).

No one wants to hear this; you do what you can, as this disease is terrible and they are so nauseous most of the time it’s difficult to switch foods. But no matter what any vet tells you, dry food was never, ever part of their natural diet. It’s over processed, sprayed with junk in order to entice them to eat it, does absolutely nothing to help their teeth (it only shatters and stays in their gums), dries out their organs (they need MOISTURE just like us), and causes kidney disease among other things. It’s also extremely irritating to the GI tract of a kitty with IBD. This would be like my doctor telling me it’s better to eat potato chips every meal, every day. Can you imagine? http://www.ibdkitties.net/feline-nutrition/

Try feeding a novel protein like rabbit, lamb, duck, kangaroo or venison; something that your cat isn’t usually exposed to in their diet. Sometimes it’s a specific allergy they have to chicken, beef, egg, seafood, etc. It’s a process of elimination. Stick with low carbohydrates and healthy fats as these are converted into energy and the unused portion stored away for future use. This will give the liver and the GI tract a chance to rest. But if the cat’s GI tract is already compromised, the rest of the organs are working harder to break these down, including the liver. http://www.ibdkitties.net/switching-foods/. If too many carbohydrates get stored in the liver, things can quickly escalate to hepatic lipidosis, (fatty liver disease) and even pancreatitis. Even healthy cats should only be allowed to ingest 3-5% of carbohydrates per meal, because cats don’t have the natural biological enzymes and enzyme pathways to process carbohydrates.

If you’re having a hard time finding a food that doesn’t contain certain ingredients and/or they are not doing well on any commercial diet, there is always home cooking. A lot of times that works out better as you have control over the ingredients and where you obtain them from. Just be sure to follow instructions and supplement correctly. For more on home cooking see homecooked: http://www.ibdkitties.net/homecooked/. There is also a recipe for a nutritious bone broth which can help your kitty if they’re losing weight and suffering from malabsorption. http://www.ibdkitties.net/bone-broth/.

Raw is no doubt the best diet for an obligate carnivore. Commercial raw diets can still contain undesirable ingredients but are worth a try if you are afraid to prepare it yourself. In the fight against IBD, MANY, MANY kitties have eventually been able to come off of their medications or at the very least, reduce them when fed a proper raw food diet.
http://www.ibdkitties.net/about-raw/
http://www.ibdkitties.net/raw-feeding-instructions/

Your vet will probably recommend a prescription diet, and unfortunately they contain the very ingredients that can aggravate the inflammation. But sometimes prescription food does indeed help and if that’s all the cat will eat then it’s very important to give it to them for the time being. The goal is always to try and feed them a more species appropriate diet. Treats are just as capable of making your cat vomit or have diarrhea, it really doesn’t take much at all. Healthy treats should consist of MEAT; that’s it. Pet food companies have come a long way in making great treats and there’s no reason to feed the ones with a million ingredients in them. Freeze dried treats are the best thing. They can also be used as food toppers, just crumble them up on the food to entice them to eat. You can even buy a food dehydrator and make your own.

Smaller and more often – The old school thinking of feeding a pet twice daily is gone. That’s too long a space in between meals and cats are grazers. Feed three to four (even five or six if your kitty is sick) smaller meals throughout the day if possible. This is the best way to ensure that your cat doesn’t gorge itself in one sitting and then vomit partially digested food shortly to several hours afterwards. This gives your cat time to digest each small meal and hopefully not regurgitate it. Each time an IBD kitty vomits it irritates the GI tract and esophagus with acid reflux usually occurring as well. Vomit sometimes contains white foam or bile that’s backing up from liver and pancreas excretions. A person with a bleeding ulcer can tell you how much that hurts. So now you know why your kitty stops eating. Because when they get nauseous and vomit, it hurts. If you’re not home to do that, invest in a timed-feeder. Make sure to feed your kitty as late as possible if they have IBD and its associated conditions. The later at night, the more acidic their stomach becomes and this may cause vomiting. An anti-emetic or slippery elm bark may be given an hour or so before the last evening feed to settle them for the night.

Frequency – expect frequent food changes. Keep a good stock of at least three to four different kinds of foods around at all times. A lot of people think at first, as did I, that when your cat eats something one day and then refuses it the next, that it’s just being finicky. Feline IBD creates a lot of nausea and think of it this way: When you’re sick with the flu or a cold and you vomit something you just ate, do you want to eat that very thing soon after? No, you can’t stand the sight, smell or taste of it. It’s the same thing with your cat. Just move on to another one of the foods for a couple of days to a week and then maybe after your cat has had a chance to forget the experience, go back to the other food again. Nausea is a very big problem in IBD cats and one that affects their ability to stabilize the disease. Your cat may need to be on an anti-nausea and/or anti-emetic medication in order to eat without vomiting.

Rotation – it’s best to rotate their food choices often. This will discourage their bodies from getting used to one set of ingredients and proteins, and developing allergies to them. Would you want to eat the same thing for the rest of your life? I highly doubt it, and they shouldn’t either. The old school way of thinking its okay to force the same food day after day on your cat is gone. This is a sure fire way to cause food allergies and intolerance. Please see the switching foods page for information on how to slowly and safely introduce new foods into their rotation: http://www.ibdkitties.net/switching-foods/

Elevation – Elevate your cat’s dishes. When a cat eats as quickly as they tend to do with their heads facing in a downward direction, they don’t usually pick their heads up to swallow, they just inhale. Keeping their heads slightly elevated or even with their neck while eating, helps to ensure the food goes in one direction, down.

Ingredients – Read ingredients on EVERYTHING, not just food labels. All kinds of pet products are laced with dangerous and unsafe chemicals, oils and ingredients. When reading ingredients on any product, such as supplements, avoid fillers and chemicals. You want the least toxic product (and again, natural doesn’t always mean safe). No sweeteners like sorbitol (that can cause major diarrhea in pets), no silicon dioxide, magnesium sterate etc. When buying supplements, try to get something in powder form or in a veggie cap. Please refer to the toxic/dangerous page on both the foods and supplements pages.
http://www.ibdkitties.net/supplements/toxicunsafe-natural/
http://www.ibdkitties.net/toxicunsafe-foods/

WATER – I have a filter hooked up to my kitchen sink and only give filtered water to my cats, no tap water at all. I feel it’s best for my own health as well and this way none of us get the chemicals, contaminants and/or unhealthy bacteria that are in city water. Water is full of carcinogens, medications, bacteria, etc. City water systems don’t have the capabilities of filtering everything out. If you can’t do a water filter, at least give only bottle water, preferably something from a health food store that’s free of BPAs, arsenic, etc. There are several brands out there. Read more about water here: http://www.ibdkitties.net/clean-water/

FECAL TRANSPLANT– Consider doing a fecal transplant as it’d had great success for IBd, diarrhea, vomiting, or digestive disorders, etc. AnimalBiome uses a microbiome assessment kits to allow pet owners to view their pet’s bacterial diversity, and they are developing solutions in the form of fecal microbiota transplant (FMT) pills and cat- and dog-specific probiotic mixtures. Their FMT pills are currently being tested in a pilot study through veterinarians and the results to date are very promising. Research is also being done by universities and institutions like the Winn Feline Foundation on fecal transplant and mibrobiome.
https://www.animalbiome.com/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248192/

SUPPLEMENTS & NATURAL – When giving supplements and anything natural, make sure not to overdo it. Your cat has to filter EVERYTHING in the liver, not just medication. Over stimulation of the liver can cause problems and EVERYTHING has side effects, everything. Doesn’t matter if it’s natural or not. I have seen plenty of cases where diarrhea was made worse due to too many treatments at once.

First, do one thing at a time. You’re never going to know what’s working or causing problems. Give that one thing a week or two before adding something else on. Second, understand that not everything natural is safe. There are too many claims by companies and even some vets now touting fads like coconut oil when the fact remains that cats cannot process medium clain triglycerides. It may not harm your pet at first or in small amounts but continued use and long term, we just don’t know. Their livers are not the same as ours and build up of toxins is possible. That goes for many natural things including essential oils, etc. Personally I’m not willing to risk my pet’s safety on a slight chance something might work and there could be a danger to their health involved. http://www.ibdkitties.net/supplements/toxicunsafe-natural/. Also make sure to research everything you’re giving, don’t just take the words of any old website that claims to have a magic cure. There isn’t one. As of right now there is NO CURE for IBD and anyone stating so is wrong. Strides are being made for better treatments but no cure as of yet. It can go into remission like anything else but no cure right now unfortunately.

DIGESTIVE ENZYMES & PROBIOTICS – Digestive enzymes should be given on a regular basis to all cats. They break down any food and hair trapped in the intestines. Proteins are broken down by protease enzymes, lipase digests fats, and amylase digests starches. If your cat’s enzyme production is impaired, food will not be properly digested or absorbed. But if your cat has ulcers or bleeding ulcers, digestive enzymes should not be used because there is no protective mucilage normally present, and the digestive enzymes will go to work on the exposed muscle. Human grade probiotics have proven much more effective than most pet versions (although Animal Essentials is a very, very good one). The flora in their systems is taking a beating as it is. Pet probiotics don’t have nearly enough CFU or the right kind of flora to treat this effectively. If your cat has pancreatitis please check with your vet first before giving any kind of enzymes. See Probiotics: http://www.ibdkitties.net/supplements/probiotics/

MEDICATIONS – On the premise of switching things around, the same may have to be done with medications, supplements, etc. As with anything else there comes a point when the body gets too used to it and it may not work that well anymore. If you notice this happening with their medication, don’t get discouraged. Talk with your vet about other things you can try and the same goes for any natural treatments. It comes with the territory and having forewarning that this will in all likelihood happen several times, can help you be prepared for it. http://www.ibdkitties.net/introduction-to-steroids-4/

Anti-emetics – If you ever see vomit with a pinkish/reddish tinge to it, that’s blood. That means the GI tract is very irritated and painful. If their vomit looks like coffee grounds, this can indicate bleeding ulcers. Speak to your vet about possible treatments for acid reflux and nausea; Cerenia (prescription only) and Zofran are the go to meds now. Pepcid A/C, Zantac, Prilosec may be used but it’s best not to use antacids long term: http://www.ibdkitties.net/pepcid-and-other-antacids/. Reglan (metaclopramide) for motility, Sucralfate (for ulcers). Zantac is said to have motility attributes also and may be worth trying before going onto prescription Reglan. Everything has side effects and many medications cannot be used together. So always speak to your vet before putting your pet on any medication! Pepcid and Zantac need to be given two hours apart from any medications or it can absorb the meds. http://www.drsfostersmith.com/product/prod_display.cfm?pcatid=9700

Slippery elm bark powder is an herbal anti-inflammatory and also works well for stomach irritation and diarrhea. It works very well and doesn’t have any known side effects. In fact more vets are recommending it. Using the aforementioned medications long term can cause a lot of other serious health issues so adding SEB to the mix can help greatly. See Tips & Tricks page for instructions on how to prepare and where to get it: http://www.ibdkitties.net/tips-tricks/

Appetite Stimulants – If your cat stops eating, please call the vet immediately. It takes less than 48 hours for a cat to develop hepatic lipidosis (fatty liver disease). Once that happens they need to be hospitalized as it can be fatal. If your cat has stopped eating completely and nothing is working to entice them, (like baby food without onions or garlic, tuna, boiled chicken, etc), call your vet and request an appetite stimulant. There are only two for cats at the moment, mirtazapine and cyproheptadine. I personally recommend cypro as it does not have the same risk and side effects of mirtazapine. The bonus of using mirtazapine is it only has to be given every three days. But mirtazapine is a human based anti-depressant and has the potential to cause seratonin syndrome. This is not as uncommon as it was once thought but it still does not happen to all cats. Cyproheptadine is an antihistamine and works differently. You do have to give it daily and sometimes twice a day. It can make them sleepy so I suggest starting out with a smaller dose. Some are using Zyrtec now as an appetite stimulant and while it does work well, like everything else it can have side effects. It’s been reported in only a few human cases but it can elevate liver enzymes, and cause severe itching as withdrawal symptoms when given daily for months or years. Like any antihistamine it can dry them out. Just be aware.

B12 injections – should also be considered for malabsorption which is often present when there is diarrhea and/or pancreatitis. Diarrhea will not resolve until the B12 levels are back to normal. See the importance of B12: http://www.ibdkitties.net/the-importance-of-b12/

THE CAREGIVER – This can be a very discouraging and exhausting disease. Please remember to take time for yourself because you are a caregiver: http://www.ibdkitties.net/caregiver-stress/

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