Some of
you will love the idea of holistic treatments. Others will be extremely sceptical about them.
I'm more of an allopathic (conventional) medicine
person myself, but some of the
methods discussed below worked for Thomas and for many other cats on
Tanya's CKD Support Group
so I think it is important to discuss them.
Even if you try nothing else, I strongly
recommend the herbal remedy, slippery elm bark (SEB) for gastric hyperacidity and
constipation, if appropriate.
Unfortunately holistic medicine is
an area which can attract charlatans and others aiming to make money from the
stressed and the vulnerable. I know you want to help your
cat, but there is no miracle cure for CKD (if there were, I
wouldn't need to run this site), so please don't fall for
the hype (or the testimonials).
Even if you are a devotee of holistic medicine, please be
prepared to use allopathic medicine as well when appropriate. I am not
aware of any holistic treatments that could substitute for phosphorus
binders, for example.
Holistic and Homeopathic Medicine
Holistic medicine aims to treat the whole cat rather
than just symptoms. Holistic medicine consists of a variety of modalities,
including homeopathy, herbal medicine, acupuncture and Traditional Chinese
Medicine (TCM).
The American Holistic Veterinary Medical Association (AHVMA) has a good
overview of holistic medicine and how homeopathic treatment forms a part of
holistic medicine.
If at all possible, please try to visit an holistic vet. The AHVMA has members in the USA
offering a variety of holistic treatments.
East meets west: integrative veterinary medicine
(2007) Silver RJ
Delaware Valley Academy of Veterinary Medicine is a detailed paper about holistic treatments. Not all of
these treatments will be appropriate for CKD cats.
Homeopathy
Homeopathy works on the principle of treating like with like, but unlike
allopathic treatments, homeopathic remedies are extremely diluted (though
in homeopathic terms, this is thought to make them more effective).
There are two types of homeopathy, classical and complex. Classical
homeopathy only uses one treatment at a time. In contrast, complex
homeopathy uses several treatments at a time.
Homeopathic remedies do not work
the way regular medication does - you cannot take a remedy when you feel
sick and expect it to work like an aspirin would. Usually you give a
homeopathic remedy once, then maybe not again for days, weeks or even a
month.
Ideally you should seek advice from a homeopathic vet, though these are
not always easy to find.
If you are using herbal medicine, it is important not to overdose. Herbal
remedies are just like any other drug and may have side effects. Too high
a dose
can actually end up causing the very thing you are trying to treat — for
example if you give too much of a treatment for diarrhoea, it can actually
make the diarrhoea worse. So only give the suggested dose and remember
that, as with all medicines, more is not always better.
Herbal remedies can be very potent, so I would not recommend giving herbs
other than slippery elm bark without input from a qualified professional;
and do ask your vet about slippery elm bark or any other products you plan
to use.
American Botanical Council has links to summaries of research papers, including benefits, harmful
effects and safety testing of herbal medications (primarily relates to
human use).
The natural remedy most commonly
used for CKD cats is slippery elm bark powder (ulmus rubra or
ulmus fulva). Slippery elm
bark is a herbal remedy used for most kinds of digestive or intestinal problems
— it can
be used for nausea, vomiting, diarrhoea or constipation. As a side effect,
it can also improve coat dryness and dandruff.
Slippery elm bark is a demulcent, which means it soothes the stomach lining and
intestinal walls and reduces irritation. This can be particularly useful in
combating the nausea and excess stomach acid which many CKD cats experience. You
will usually see an improvement within a day or two of starting slippery elm
bark.
A potential nutritional prophylactic for the reduction
of feline hairball symptoms (2004) Dann JR, Adler MA, Duffy KL & Giffard CJ The Journal of Nutrition 134(8) pp2124S-2125S found
that it also appears to help with hairballs.
You can use slippery elm bark in addition to
famotidine (Pepcid AC) if necessary (though
with luck the slippery elm bark alone will suffice), but do not give these
treatments at the same time (see
cautions).
The study states that "with PEPPS the concentration of elm USP administered is less than 8%
the slippery elm dose
recommended by holistic veterinarians...Administration of PEPPS was in
accordance to weight. On average dogs or cats weighing less than 25 lbs
received daily doses upwards of 72 mg." The study indicates that the product
was effective but you need a prescription from your vet in order to purchase
it, so buying slippery elm bark over the counter is probably
easier and cheaper.
Drugs mentions that Gastrafate contains
calcium carbonate and calcium sulfate (slippery elm bark also contains
calcium), so it is probably better not to use it if your cat has
hypercalcaemia.
Marshmallow Root
I am occasionally asked about marshmallow root. This shares some similarities
with slippery elm bark and some people use it instead of slippery elm bark,
but slippery elm bark is used most often on the CKD support groups, so I am
more familiar with it.
Ideally, you want organic or wild-crafted slippery elm bark powder from most
good health food shops. See below for sources.
Capsules
If you cannot find loose slippery elm bark, you can usually find capsules in a
350-400mg size. Try to ensure the capsules contain only pure slippery elm
bark, no fillers, because it can be virtually impossible to make the
syrup recipe from
capsules containing anything other than slippery elm bark (it will not
thicken).
Unfortunately it is difficult to find capsules that don't contain magnesium stearate because it
is a glidant used in the manufacturing process (it helps the powder flow when
the capsules are being filled). Magnesium stearate is safe for cats but may
affect the thickening of the syrup, though some people have been able to make
it successfully from such capsules. There is one US supplier below
selling capsules containing slippery elm bark only.
Tinctures
I would avoid tinctures because they often contain other ingredients,
especially alcohol, though some members of my support group in the USA have
managed to find one brand without alcohol.
Slippery Elm Bark Dosage
The usual dosage is:
1/8 to 1/4 (0.125 - 0.25) of a teaspoon of the organic or
wild-crafted slippery elm bark powder once or twice a day; or
one 350-400mg capsule a day. You can give these whole or open them and
sprinkle on the cat's food once or twice a day.
Most cats are given slippery elm bark daily, but some cats do not need it every day, so experiment and see what works best for
your cat.
I open the capsules and sprinkle the slippery elm bark into my cat's food and mix it up, but
slippery elm bark has a
bittersweet flavour which some cats do not like. In that case, try giving
it in a capsule, either the one it came in (though these may well be too big
for the average cat) or, if you are using loose slippery
elm bark, purchase
gelcaps
separately for this purpose.
Some people have found their cat will eat slippery elm bark if it is mixed in
a little
baby food (make sure the baby food does not contain any onion).
Syrup Recipe
You can also
make slippery elm bark into a syrup that is used for digestive problems or
for mouth sores or ulcers. It has the same soothing and healing effects in
the mouth — try dabbing in your cat's mouth ulcers if required. The syrup
is weaker than the straight powder, so you can give a little more of it.
Some people have told me they find it hard to place the syrup on their cat's
mouth ulcers if they are in hard-to-reach areas of the mouth. In such cases,
you may wish to use a syringe to aim the syrup at the ulcers.
If you are using slippery elm bark decanted from capsules, you need pure
slippery elm bark with no fillers, otherwise the syrup will usually not
thicken properly.
Stovetop Method
Take a
stainless steel or heat-proof glass pan (not an aluminium or non-stick
one).
Put one
cup of cold water in the pan.
Sprinkle 1 to 1.5 tsp of
slippery elm bark powder on to the water.
Let it sit until the powder is damp
(this should not take too long), then bring to the boil stirring
constantly.
Reduce the heat and simmer, still stirring constantly, until it
thickens, about 3 minutes or so. It will be the consistency of watery egg
whites.
Allow to
cool and give ¼ - ½ (0.25 to 0.5) teaspoon up to 4 times a day.
This will
keep at room temperature for a day or in the fridge for up to five days.
Microwave Method
For the non-cooks among us, one of my support group members came up with this
method but it may not work with powdered slippery elm bark.
Take a glass container which holds two cups.
Put one cup of water in the cup.
Add 1 to 1.5 tsp of slippery elm bark powder.
Heat in the microwave on high for about 1.5 minutes.
Remove from the microwave and stir, then put it back in for about another 30
seconds.
Keep an eye on it because you do not want it to boil over.
Remove from the microwave and stir again.
Allow to cool and give
¼ - ½ (0.25 to 0.5) teaspoon up to 4 times a day.
This will keep at room temperature for a day or in the fridge for up to five
days.
Slippery Elm Bark: Where to Buy
USA
San Francisco Herb Cosells loose slippery elm bark powder at the best price I've found, US$22.20
per pound plus exact shipping cost, but their minimum order is for US$30. They
will waive this on request and charge a US$7 small order fee instead;
alternatively you could stock up on other products such as catnip.
Swanson Vitamins
sells its own brand 400mg slippery elm bark capsules for US$3.49 for
60.
UK
Unfortunately, EU regulations for herbal products were introduced in Europe in
2011.
The Human Medicine Regulations 2012
has a list of affected herbs, which includes slippery elm bark as a
restricted ingredient.
Banned or restricted herbal ingredients
on the UK government website states that "Manufacturers,
wholesalers and sellers must ensure any herbal products they place on the
market do not contain banned ingredients. They must also ensure that
restricted ingredients are used legally." It states that as far as
restricted ingredients (such as slippery elm bark) are concerned, the
legislation "Prohibits the sale or supply (including general retail or
following a one-to-one consultation with a practitioner) of herbal
medicines in the UK, if it contains one or more of the listed plants,
except where sold in premises which are registered pharmacies and by or
under the supervision of a pharmacist." This makes me laugh. I wonder
whether the average pharmacist, skilled though s/he may be, has even heard
of slippery elm bark.
I understand that herbal
medicines can still be sold in Europe if they have either a traditional herbal
registration (which slippery elm bark does not) or a product licence.
Obtaining a licence can cost as much as £300,000 per
product, though apparently for herbs it may cost "only" £50,000.
S
ome
manufacturers are arguing that slippery elm bark is a foodstuff, which would
make it exempt from these regulations, and are continuing to sell it. You
can also import it from outside the EU, though in theory it might be
confiscated by customs.
Overall though, my original fears about this new law have not come to pass
and you should still be able to buy slippery elm bark, though it may not
be as easy to find as it was previously.
Neal's Yard sells
50g of slippery elm bark powder for £9.
Holland and Barrett sells 100 370mg capsules
for £10.49. These are the ones I use.
Canada
Amazon Canada sells a 1 lb bag of Starwest
Botanicals organic slippery elm bark powder for CAN$59.99.
Slippery Elm Bark: Cautions
PennState Hershey
states that slippery elm bark can inhibit the absorption of other
medications or supplements. It is therefore best to give it 1-2 hours before or after any other
medications (especially antibiotics), and ideally on an empty stomach,
although it is safe to sprinkle it on food if you wish.
Slippery elm bark also contains calcium, so it is probably safer not to use it
if your cat has
hypercalcaemia.
D-mannose
D-mannose is a simple sugar which is used for cats suffering from urinary tract infections.
Please see
Pyelonephritis and UTIs for more information.
Flower essences or remedies are made by either placing flowers in a
glass bowl filled with spring water which is left in bright sunlight for
three hours, or by boiling flowering twigs in a pan of spring water for
half an hour. The resulting liquid is then mixed with brandy and used as
described below.
The best known
flower essences are
the Bach Flower Remedies. These are thirty-eight individual essences which are designed to
address a specific state of mind or personality trait. These remedies can be
mixed together; in fact, the best known remedy, Rescue Remedy, is a
combination of five different essences.
Flower Essences Research
Many people are sceptical about flower essences, failing to see how they
work or believing that using them simply results in the placebo effect.
Healing with Bach flower essences: testing a
complementary therapy (2007)
Halberstein R, DeSantis L, Sirkin A, Padron-Fajardo V & Ojeda-Vaz M
Complementary Health Practice Review12(1) pp3-14 was a
double blind placebo-controlled study at the University of Miami which
looked at the impact of flower remedies on anxiety in humans, and found that
they appeared to be more effective than the placebo for acute
situational stress for those with high levels of anxiety.
Although I was sceptical, failing to see how they
could work, my own experiences of using
such essences with my cats have been favourable, and since they are
reasonably priced and are unlikely to do any harm, you may wish to give them a
try as appropriate.
These are the remedies which
I think may help a CKD cat, although others may be helpful
too:
Crab apple the cleansing essence
Gorse hopelessness, pessimism
Olive exhaustion
Rock rose
terror, panic (perhaps for vet visits)
Star of
Bethlehem shock
Rescue Remedy for emergencies and crisis
situations
You can of
course also use the essences for yourself.
Flower Essences Dosage
There
are two main ways to give your cat the remedies, and you can give more than one
remedy at a time. However, do not use more than six or
seven remedies in one go or results may be disappointing, because mixing
too many remedies together can make some of the essences ineffective.
Although flower remedies contain alcohol, this is not normally a problem since
they are diluted so much before using. Some remedies are available
alcohol-free and may be labelled as safe for animals, including
Rescue Remedy for Pets, so you may want to look
for these, though I used the remedies containing alcohol with no problems.
There is a pastille form of Rescue Remedy but this should not be used for
pets according to the manufacturer, presumably because it contains xylitol.
Although this is toxic to dogs, there is currently no
evidence that it is toxic to cats. However, some people prefer to avoid
products containing it.
Method
One
Add two to
four drops of each remedy to a 30ml bottle of bottled spring water (do not
use tap water for flower essences). Take four drops at a time from this bottle at least four times a
day, and use a dropper to place the remedies in your cat's mouth. Make
sure you thoroughly rinse the dropper before putting it back into the
bottle.
Method
Two
Alternatively,
place two to eight drops of each remedy in your cat's bowl of drinking
water. As long as your cat drinks four times a day - and most CKD
cats do, of course - he/she will be receiving the correct dose.
Incidentally, it does not matter if you have other cats who share the
water bowl, they will not be affected by the remedies.
I have also heard from one reader who at times of crisis has put a couple of
drops of the remedies on her fingers, and then rubbed the drops into her cat's
ears.
"Bach Flower Remedies for Animals" (2005) Ball S & Howard
J The C W Daniel Company Ltd, is available from
Amazon and from
Amazon UK.
Acupuncture
Acupuncture is
based on the idea that the body has channels along which energy passes.
Imbalances or blockages may arise in these channels, leading to health
problems, but acupuncture can clear the blockages so that the energy can
run smoothly.
To the Western
mind, this can sound strange. However, acupuncture for humans is covered
by many private health care schemes in the UK, because of its proven
benefits. I admit that I myself am a big fan
of acupuncture. It has
worked wonders for me personally, finally getting rid of pain that nothing
else could shift, and had astonishing results on
Harpsie's arthritis.
Washington
State University College of Veterinary Medicine mentions that acupuncture may be of use for
pain management and diseases of the kidneys and the liver, and some people
have had very good results using acupuncture for CKD cats, either by
improving the cat's wellbeing (less vomiting, generally perkier) or
occasionally even through an improvement in bloodwork. It can also help
with appetite. Of course, I have
also heard of a couple of people whose cats did not react particularly
well to acupuncture; but when it is performed by a trained professional
with sterile needles, acupuncture is unlikely to have bad side effects even if
you don't notice an actual improvement, so you may wish to try it and see
how you get on.
Heel is a German company that produces a number of homeopathic remedies.
Members of the German Feline CKD support group,
nierenkranke
Katze, have used these products for many years and speak
highly of them, in many cases finding that BUN and creatinine reduce after
using them.
Normally a combination of three remedies is used:
Solidago compositum
ad us.vet(goldenrod)
Ubichinon compositum (CoQ10)
Coenzyme compositum
ad us.vet(CoQ10)
It is sometimes referred to as SUC, based on the first letter of each
remedy.
Using the remedies in this way is complex homeopathy rather than classical homeopathy, which would
require that a treatment plan be tailored to the individual's needs and
symptoms. However, it can be
hard to find a classically trained homeopathic vet.
The words "ad
us.vet" mean it is a special
veterinary formula but this is only available in German-speaking countries. If you live elsewhere, you will
have to use the human products, which were used by the German support
group before the veterinary products became available.
The Heel Veterinary Guide has information
about these remedies on pages 82 (Coenzyme compositum), 115 (Solidago
compositum) and 121 (Ubichinon compositum).
Luca's
Story tells
(in German) the
story of Luca, who had borderline high kidney values before he was even
one year old. By the time he was three, his creatinine level was 7.4
mg/dl. He was treated with Heel Complex, and his creatinine level fell to
3.3 mg/dl. Luca lived to the age of seven despite having CKD, and died of
cancer, not of CKD.
Research
Ergebnisse zur chronischen Niereninsuffizienz der Katze bei biologischer
Behandlung (Results of treating CKD in cats with biological means) (2006) Eichentopf A, Eichentopf F Biologische Tiermedizin2 pp31-34
discusses the results of a study which used the above remedies plus
another one called Hepar compositum to treat 24 CKD cats aged from 7-17
for eight weeks. On the first two days, the cats were given the basic
three remedies subcutaneously, along with sodium chloride fluids. On days
3-7 the cats were only given the Heel remedies once daily, with dosage
thereafter reducing to once every other day and eventually to once or
twice a week. After the first week the treatments were given orally or
subcutaneously, as preferred by the cat's caregiver. The Hepar compositum
was given once a week between the third and eighth weeks. The study found
that all the cats improved in terms of behaviour (appetite etc.) and most
of the cats had measurably better bloodwork within the first 1-2 weeks,
although results were much less dramatic for those cats in end stage renal
disease. 80% of the caregivers involved in the
study were very satisfied with
the treatment.
Biologische Behandlung bei Katzen mit chronischer
Niereninsuffizienz (CNI) (Biological treatment of cats with
CKD) (2002) Ulf U Wissenschaftliches Veterinär-Symposionder
Firma Heel involved giving the Heel Complex to fifty cats with medium
stage to advanced CKD. Forty cats showed improvement within one week. Ten
cats did not respond so their treatment was discontinued. Five of the
treated cats died but 75% were still alive after 3-6 months, and 50% were
still alive after 7-12 months, often with much improved bloodwork results.
Some of the cats were treated for three years in total.
Dosage
The usual starting dose is 1 ml of each, three times a week (they can be
mixed together in a syringe). After a few weeks, if the cat seems to be
improving, dosage can be reduced to twice or occasionally once a week.
Where to Buy
Heel products are no longer available in the USA or Canada since Heel
pulled out of the North American market on 31 August 2014 because of class
action lawsuits, according to this
press release.
United Remedies in the UK sells Heel
products and will ship worldwide.
Apparently the branch of
Metropolitan Pharmacy located at Frankfurt airport
will ship Heel products internationally. You can e-mail them in English to
ask for current prices. One member of Tanya's Support Group in the USA
ordered sufficient in late 2014 to last her a year, and including shipping it cost her
around US$450.
Bio Pathica
is the UK supplier. It will only supply to fully qualified practitioners
but may be able to put you in touch with such a person in your area.
Rubenal
Chinese rhubarb extract has been used to treat kidney problems in humans for
many years in China. Rhubarb leaves are toxic for cats but the root is
safe. Rubenal is made from Rheum officinale (Chinese rhubarb extract). In TCM
(traditional Chinese medicine), rheum is commonly used in combination with other herbs,
but Rubenal
appears to contain Rheum only.
I first heard about Rubenal in April 2008 from a lady who was participating in
trials of a new CKD treatment made by Vetoquinol (who also make Ipakitine
(Epakitin) and Azodyl) at Kansas State University. Rubenal was launched in Europe in
2008, in the UK in January 2009, and in the USA in July 2009. The trial
results were published in 2011 (see below).
In 2011 Rubenal became the subject of a label review by the FDA in the USA,
which prevents the manufacturer from producing or advertising Rubenal within
the USA, so it appears Vetoquinol have stopped producing it. US suppliers no longer have any stock and it is not
known when or if the FDA will permit it to be sold again (one Canadian
supplier sells it for a high price on the US
Amazon). It is
still available in some other countries.
Rubenal
is
available in two sizes, 300mg and 75mg. The recommended dose is 25mg per kg
(2.2lbs) of body weight twice a day, so a 3kg (6.6lb) cat would need two 75mg
tablets a day.
I have heard from a
number of people in German-speaking countries who have used Rubenal. The
majority of them seem to think it has helped their cats, although one person
said the capsules are too big for a cat to swallow easily.
Rhubarb extract may affect
electrolytes. In particular, it may lower potassium levels, so I would
recommend monitoring your cat's potassium levels and other electrolytes
if you use Rubenal.
Rheum officinale ( a traditional Chinese medicine)
for chronic kidney disease (2012) Wang H, Song H, Yue J, Li J,
Hou YB & Deng JL Cochrane Database of Systematic Reviews11(7)
examined nine trials into the use of Rheum officinale in 682 human
patients. The study concludes "Currently available evidence concerning the
efficacy of Rheum officinale to improve SCr and BUN levels in patients
with CKD is both scant and low quality. Although Rheum officinale does not
appear to be associated with serious adverse events among patients with
CKD, there is no current evidence to support any recommendation for its
use."
The effects of Rheum officinale on the progression
of feline chronic kidney disease (2011) Hanzlicek AS Thesis
submitted to Kansas State University College of Veterinary Medicine
states
"Based on easily measured clinical parameters, this study failed to detect
a
significant difference in cats administered a Chinese rhubarb supplement,
benazepril, or both."
Clinical effects of rheum and captopril on preventing
progression of chronic renal failure (1990) Zhang JH, Li LS, Zhang
M Chinese Medical Journal103(10) pp788-93 investigated the
effects of rhubarb extract and captopril (an ACE inhibitor) on people with CKD.
The three groups tested received either rheum, captopril or both together. The
people who received both together did best but it was concluded that
"long-term low-dose Rheum E taken orally is beneficial to CKD. Its effect is
better than that of Captopril."
Effects of rhubarb tannins on uraemic toxins
(1991) Yokozawa T, Fujioka K, Oura H, Nonaka G & Nishioka I Nephron58(2) pp155-60 found that certain components of rhubarb reduced BUN
and creatinine levels in the rats in the study, though another tannin
found in rhubarb actually increased BUN levels.
Rehmannia 8 (Jin Gui Shen Qi Wan or Ba Wei Di Huang Wan) is a traditional Chinese medicine treatment which is supposed
to strengthen kidney function. Some sites also recommend it for helping
with infection or inflammation.
There is also a version called Rehmannia 6 (Liu Wei
Di Huang Wan),
which as you might guess, contains two fewer ingredients. Chinese members
of Tanya's CKD Support Group tend to prefer Rehmannia 6 because one of the
additional ingredients in Rehmannia 8 is aconite, which can be toxic.
Web MD has some information on aconite.
A few members of
Tanya's CKD Support Group
use Rehmannia and find it helpful, but do check with your vet before
using. Ideally you should consult a vet with TCM training if you do use
it. Give no more than one eighth to one tenth of the human dose, and give
it with food but separately from other medications. Do not use if your cat
is suffering from diarrhoea.
Herbs 2000 mentions that Rehmannia may have a diuretic effect, which is
not good for a CKD cat. It also states that Rehmannia should not be used
in cats with acute infections.
The word "holistic" can be strangely reassuring, but it must not be forgotten
that "natural" does not necessarily mean something is safe. In fact, some
"natural" things can be very dangerous, such as belladonna.
I am pretty open to the idea of holistic treatments such as some of those I mention above.
However, over the years I have become increasingly worried — and not a
little sceptical — to see some of the treatments that are recommended
in the holistic world.
So many of these practitioners do not seem to understand the first thing
about kidney problems in cats! They offer products with diuretic properties (a real strain on sick
kidneys), or offer products which are intended for the lower urinary tract
when in fact the kidneys are the upper urinary tract; many products labelled "for urinary
tract health" are intended to treat feline lower urinary tract disease
(FLUTD), and are often contraindicated for kidney problems. Of course, some of
these sellers get around this problem by not even stating what their product contains!
I would never give such a product to my cats, you need to know what you are
using.
Even if these practitioners understand about kidney problems, they
offer blanket treatments for cats and dogs, clearly not understanding that cats
have unique physiological needs.
A new member of Tanya's CKD Support Group said it perfectly: "we are willing
to try just about anything." So many holistic producers know that and frankly
prey on you. Please, always consider your sources. If they are using scare
tactics, back away. If it's recommended by a friend of a friend's dog's uncle
on social media, back away. If they swear it's safe and they get five star
ratings but no negative ones, back away. If it's available at a "very
reasonable price" (which adds up to US$300 a year), or uses emotional
blackmail ("yes, our product is not cheap, but how can you put a price on your
cat's health?"), back away.
If something sounds too good to be true, it probably is. If that great miracle
cure were such a miracle, we would all be using it, they would be millionaires
(actually, some of them probably are because people fall for the hype) and
this website would be redundant. There is no such miracle cure, so please
don't fall for their marketing tactics.
Remember, I'm not trying to sell you anything here. I
have no axe to grind about any particular CKD treatment.
If it were good, I'd have it on here. I
recommend what I have seen work for my own and other cats (and I have "seen"
thousands over the last twenty years). If I don't rate something, I tell you
why.
Below are some of the products I have seen recommended for CKD
cats, and an explanation as to why they may be inappropriate.
CKD
cats usually benefit from vitamin B supplements, but many other
vitamins,
such as vitamins A and D, can be a problem for CKD cats. Please see
Nutritional Requirements for more information.
Garlic
Garlic
is often promoted as possessing many health benefits. Whilst this appears
to be true for humans, garlic belongs to the same family as onion, and
onion can cause a particular type of anaemia in cats called Heinz body
anaemia. I would therefore not recommend risking garlic supplements,
particularly in CKD cats, who are already sick. The
Which Foods to Feed
page has more information.
Cranberry
You
should avoid giving cranberry or food containing cranberry to CKD cats -
it is too acidic for CKD cats, who tend towards
acidosis anyway.
Cranberries also contain benzoic acid, which cats lack the pathways to metabolise.
Renate is a supplement for CKD cats that contains cranberry and turmeric.
There is more information about it
here.
Nutrient Requirements of Cats, a 1986
publication from the US Board of Agriculture, explains why benzoic acid is not
good for cats.
The International Programme on Chemical Safety
reports on a case from 1971 when 28 cats were fed meat containing 2.39%
benzoic acid. Seventeen of the cats died. Toxicity may develop with quantities
greater than 0.45 g/kg given in single doses or 0.2 g/kg when the item is fed
on an ongoing basis.
The Boston Globe reports on the recent trend
of adding cranberries to cat food, and has a comment from a vet at Tuft's
University School of Veterinary Medicine that there is no evidence that
cranberries have the same benefits for cats as they appear to have for humans.
Noni
Juice
This product has high levels of potassium, which can be dangerous for cats
with advanced CKD. It is not appropriate to use as a potassium
supplement, because it is not possible to tailor an accurate dose.
Noni juice (Morinda citrifola): hidden potential for
hyperkalaemia? (2000) Mueller BA, Scott MK, Sowinski KM & Prag KA
American Journal of Kidney Disease35 pp310-12) reports on a human
male who developed hyperkalaemia (high potassium) after drinking noni juice
several times a day.
I sometimes hear from people who want to give dandelion root or nettles to their
CKD cat
because they have read that it is good for kidney function. However, these are actually diuretics, so
are not usually suitable for CKD cats, who are usually urinating excessively.
There is one study I am aware of,
Urtica semen reduces serum creatinine levels
(2003) Treasure J Journal of the American Herbalists Guild
4(2) pp22-25, where nettle seed extract appeared to
lower creatinine levels in two human patients. However, one of these
two patients had cancer, and the other had lupus and a crisis as a kidney
transplant recipient. Obviously these scenarios do not apply to your typical
CKD cat.
PennState Hershey says that dandelion may
increase levels of stomach acid, and may reduce blood sugar levels.
PennState Hershey
says that stinging nettles may lower blood pressure and blood sugar levels, so
I would be reluctant to use these in a cat with diabetes or a cat on blood
pressure medication.
Dandelion is occasionally used
in CKD cats who are also suffering from heart problems, but this should only
be done with your vet's input. The
Heart Problems page has more information on diuretics as used for heart disease.
Colloidal Silver
Some people use colloidal silver as a type of natural antibiotic. However,
The
National Center for Complementary and Integrative Health
states that side effects "may include neurologic problems (such as
seizures), kidney damage, stomach distress, headaches, fatigue, and skin
irritation." Since CKD cats are prone to many of these problems anyway, I
would not use colloidal silver in a CKD cat.
Essential Oils
It never ceases to amaze me how many feline products contain essential oils.
Cats lack the metabolic pathways to process essential oils, so these oils can
be extremely toxic for them, but unfortunately even some vets are not aware of
this.
Some people claim that it is the quality of the oils that matters, and that
high grade oils are safe to use with cats. This is nonsense. If your body
lacks the pathways to metabolise something, it does not matter what the
quality is. It is like saying a lactose intolerant person would be able to
tolerate organic milk even if they can't tolerate ordinary milk. Both types of
milk contain lactose and will therefore have the same effect on the lactose
intolerant person.
Essentially, essential oils should never be used on
cats, and some sources also question whether hydrosols are
safe.
The Lavender Cat has a detailed brochure
about the risks of using essential oils and hydrosols in cats.
Pot pourri hazards in cats Richardson JA ASPCA/National
Poison Control Center is an article by a veterinary
poison specialist about pot
pourri, which also discusses essential oils (which are commonly used in pot
pourri).
Concentrated tea tree oil toxicosis in dogs and cats: 443 cases (2002-2012)
(2014) Khan SA, McLean MK & Slater MR Journal of the American Veterinary
Medical Association244(1) pp95-9 concludes "Intentional or
accidental use of 100% TTO in dogs or cats caused serious signs of CNS
depression, paresis, ataxia, or tremors within hours after exposure and
lasting up to 3 days. Younger cats and those with lighter body weight were at
greater risk of developing major illness."
Essential fatty acids (EFAs) are polyunsaturated fats (sometimes
abbreviated as PUFA). They are essential in the sense that the cat's body
cannot synthesise them in sufficient amounts, so they have to be obtained
through food.
The two main types of EFAs are omega 3 and omega 6.
Commercial diets tend to contain far more omega 6, partly because omega 6
EFAs are cheaper and more stable, but excessive amounts of omega 6 fatty
acids may create a potentially
harmful imbalance. The correct balance is not yet known, though some
believe it is probably around 5:1 (omega 6:omega 3).
There are two omega 6 essential fatty acids for cats, linoleic and
arachidonic. Even if you give your cat linoleic acid, cats do not have the
pathways to convert linoleic acid into arachidonic acid, so another source of
arachidonic acid is necessary. Cats can only obtain arachidonic acid from
animal products.
Skin and coat in cats (1999) is an article from the
Waltham Course
on Dog and Cat Nutrition which states that "cats require a dietary source of
both linoleic and arachidonic acids."
Unfortunately, excessive amounts of omega 6 fatty
acids may cause inflammation of the kidneys and therefore may not be a good
thing for CKD cats, so if you want to give your cat an essential fatty acids
oil, consider a fish-based oil instead. See
Nutritional
Requirements for more information on essential fatty acids for CKD cats.
Information about Astro's Oil can be found
here.
Flax Seed Oil
(Linseed Oil)
Flax seed oil is commonly used in cat foods, and may also be recommended as an
essential fatty acid supplement. I don't object to flaxseed oil per se, I use it myself.
There have been recent reports that flaxseed may contain cyanide.
Ground flaxseed — how safe is it for companion animals
and for us (2019) Lindiger M
Veterinary Science Research1(1) pp35-40 reports on safe levels for
humans but states that the safe level for cats is unknown.
Since flax seed oil is of limited value to cats anyway, because their bodies cannot metabolise it properly
(flax seed oil contains around 13% linoleic acid but no arachidonic acid), so
I would not bother with it.
Coconut
Oil
There is a real trend for using coconut oil in humans, and I use it myself,
but it is also not the best choice for cats. It contains only around 2%
linoleic acid, even worse than flax seed oil.
Adding medium chain triglycerides to a cat's diet
(2017) Fascetti A Winn Feline Foundation blog advises against
using coconut oil in cats, saying that it contains triglycerides, which can
reduce palatability for cats, not a good idea for most CKD cats.
Coconut oil and cats (2015) Hofve J also advises
against coconut oil for cats. She mentions that it contains triglycerides,
which can reduce palatability for cats, not a good idea for most CKD cats.
diferuloylmethane)
is one of the components of the spice, turmeric. It is thought to have an
antioxidant and
anti-inflammatory effect and may have cancer-fighting properties in
humans.
Therapeutic roles of curcumin: lessons learned from
clinical trials (2013) Gupta SC, Patchva S & Aggarwal BB American Association of
Pharmaceutical Sciences Journal15(1) pp195-218 has an
overview of the use of curcumin in humans.
In 2010, the Morris Animal Foundation reported on
research at Colorado State University into the use of a derivative of
curcumin called FLL32 for the treatment of a form of cancer called
osteosarcoma in dogs.
Renoprotective effect of the antioxidant curcumin:
recent findings (2013)
Trujillo J, Chirino YI, Molina-Jijón E, Andérica-Romero AC, Tapia
E & Pedraza-Chaverrí J Redox Biology1(1) pp448-456
states that curcumin is a "promising renoprotective molecule against renal
injury." However, the findings referred to are largely experimental
studies performed on rats to induce acute kidney injury.
Curcumin is not approved for use in humans and I am not aware of
any studies in cats.
Role of curcumin in systemic and oral health: an
overview (2013) Nagpal M & Sood S Journal of Natural
Science, Biology & Medicine4(1) pp3-7 says that curcumin "may
cause gastric irritation, stomach upset, nausea, diarrhoea, allergic skin
reaction, and antithrombosis activity interfering with blood-clot
formation." It may also increase the risk of calcium oxalate
kidney
stones, which are difficult to treat. It may interact with medications
such as
famotidine.
Ground turmeric as a source of lead exposure in the
United States (2017) Cowell W,
Ireland T, Vorhees D & Heiger-Bernays W Public Health Reports
132(3) pp289–293 reports on "a growing body of evidence indicating
that turmeric containing excessive concentrations of lead is available for
purchase in US grocery stores and that childhood lead-poisoning cases
attributable to consumption of contaminated turmeric have occurred in the
United States. We hypothesize that turmeric is being intentionally
adulterated with lead to enhance its weight, color, or both."
Although there are now some forms of curcumin designed for cats, which
some people use for arthritic cats, I would not use it in a CKD cat.
Renate is a supplement for CKD cats that contains cranberry and turmeric. There is more
information about it
here.
Judging by the number of people who join Tanya's CKD Support Group who are
already using this product, its manufacturer is very good at marketing,
particularly on social media, though it is not particularly popular with
longer-serving group members.
Kidney Support Gold
contains astragalus root, cordyceps sinesis, rehmannia and Dong Quai root:
astragalus root is thought to be an
antioxidant. It seems relatively
safe though apparently it should only be used short term in
cats.
cordyceps is a fungus which appears to help boost the immune system. It
has been used in human kidney transplant patients and appears to help reduce
the risks of complications in these patients when used in conjunction with
cyclosporine, an anti-rejection medication commonly used following kidney
transplants. Cordyceps is a natural blood thinner. It may increase the effectiveness
of
corticosteroids, so I would not use it in a cat who is on steroids.
dong quai (Angelica sinesis) is a herb which appears to help manage female
hormonal imbalances, e.g. around the time of the menopause. Some Chinese
studies indicate that using dong quai and astragalus may help kidney function
in rats with surgically induced kidney disease. It may slow blood clotting.
The US National Library of Medicine says that
taking dong quai in large amounts for a long period of time may be unsafe
because it contains carcinogens (chemicals thought to cause cancer).
Some people do like Kidney Support Gold, but it is not cheap and not proven,
so personally I wouldn't use it when more proven
treatments are available. I would not use it without talking to your vet first, and
ideally to an holistic vet.
Tripsy
I used to receive regular enquiries about a product called Tripsy. Tripsy is
apparently still going, though I never get asked about it any more.
Tripsy is designed for "kidney, renal and urinary disorders" (love the
tautology). I think they are being rather modest.
Tripsy seems to be a panacea for whatever ails your cat. It can simultaneously
help treat Feline Lower Urinary Tract Disease, kidney stones and kidney
disease. As a bonus, it also helps the liver and pancreas.
Of course, none of this would be necessary if you hadn't made the mistakes you
did. Apparently you caused your cat's problems by your choice of food
for your cat. If only it were that simple, we would all feed the "correct"
food and CKD would disappear and I could have a life.
Unfortunately one of Tripsy's primary goals seems to be to increase urinary
flow so it contain a lot of diuretics, which is not a good idea for CKD cats,
who tend to urinate a lot and become easily dehydrated anyway. One person told
me they contacted the manufacturer about this and were told that the other
herbs in the product "help balance the diuretic effect." I find this rather
confusing. Why give a diuretic but combine it with something that stops it
being a diuretic?
One of the herbs in Tripsy is hydrangea, which is apparently "A pain reliever
that increases the flow of urine and eliminates swelling and fluid
retention." Unfortunately hydrangea is toxic for cats, according to the
ASPCA, and can cause vomiting,
lethargy and diarrhoea.
Some people do like Tripsy according to the reviews on their website, but it is not cheap and not proven,
so personally I wouldn't use it when more proven
treatments are available, which do not erroneously blame you for causing your
cat's illness. I would not use it without talking to your vet first, and
ideally to an holistic vet.
Hemp-Based Products
and Cannabidiol (CBD)
There is increasing interest in using cannabis-based products for a variety of
ailments in humans, and some people are also interested in using these
products in their cats.
Mammals have an endocannabinoid system in their bodies. This system consists
of a number of receptors in the brain and throughout the body. Humans have CB1
and CB2 receptors. Cats definitely have CB1 receptors, but it is not known if
they have CB2 receptors.
CB receptors regulate many physiological processes, including pain and
appetite. It is thought that cannabis-based products may affect the
endocannabinoid system in a positive manner, helping, amongst other benefits,
to control pain and improve appetite.
Difference Between Marijuana (THC) and
Cannabidiol (CBD)
The cannabis plant contains more than eighty biologically active compounds
known as cannabinoids. The two usually of primary concern when discussing
cannabis are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).
Marijuana and industrial hemp are both derived from the cannabis plant and
therefore both contain a number of cannabinoids but — and this is key — in
different ratios. Marijuana, when processed, contains very high levels of THC (which is
what gives the high) and low levels of CBD (cannabidiol, which affects the
nervous system but does not give a high). Hemp, when processed, contains very
low levels of THC (0.3% on a dry matter basis) and high levels of CBD.
Despite the name, some (but not all) forms of medical marijuana are based on
hemp.
Marijuana (THC) and Cannabidiol (CBD) Regulation
USA
Marijuana is a Schedule 1 drug in the USA. Some US states permit marijuana
(THC) to be used in humans for medical reasons, and in 2012 two states
(Washington and Colorado) also legalised marijuana for recreational use.
Nevertheless, under federal law the DEA still considered a product derived
from the cannabis plant to be a controlled substance.
However, in 2018 the Agriculture Improvement Act of 2018 removed hemp (defined
as cannabis or derivatives of cannabis with a THC content below 0.3% on a dry
matter analysis basis) from the Controlled Substance Act's definition of
marijuana. Therefore hemp is no longer a controlled substance under federal
law.
In 2019 the US Food and Drug Administration held a public hearing into the
legal status of certain cannabis-based products and has set up a working group
to look into the matter further.
Medicinal cannabis was legalised for humans in the UK in late 2018, but it is
only very rarely prescribed, and only for very specific conditions such
as rare seizure disorders, nausea and vomiting caused by chemotherapy, or
muscle spasms and stiffness caused by multiple sclerosis. It can only be
prescribed by hospital consultants, not by GPs.
Canada
Cannabis was legalised in Canada for humans in 2018. According to the
Canadian Veterinary Medical Association, vets
in Canada are not legally allowed to prescribe cannabis products to companion
animals, though the law is due for review in 2021, so this may change.
CBD-Based Products for Cats
There is increasing interest in using these products for pain such as arthritic pain, anxiety and
occasionally for inappetence. A number of companies in the USA have developed
hemp-based products for animals. These products are not illegal in the USA and
may be imported into Europe (indeed, it is legal to grow industrial hemp in
the EU) but not into Australasia (although Australia has recently legalised
medical marijuana for humans). However, see
below.
Veterinary Marijuana? (2013) Nolen RS
JAVMA News discusses the use of marijuana in pets.
I have not had much feedback about CBD-based products yet, but several members
of my support group have tried one of these products on their cats. After
about a week, most of them did see an increase in appetite.
Personally, I would want veterinary input, and ideally more research, before
using CBD-based products in my cat.
CBD-Based Products: Research
Colorado State University College of Veterinary Medicine is looking into the
use of CBD for epilepsy and arthritis in dogs, and Cornell University College
of Veterinary Medicine is also investigating the use of CBD in dogs.
Pharmacokinetics, safety, and clinical efficacy of
cannabidiol treatment in osteoarthritic dogs
(2018) Gamble L-J, Boesch JM, Frye CW, Schwark WS, Mann S, Wolfe L,
Brown H, Berthelsen ES & Wakshlag JJ Frontiers in Veterinary Science
epub found that CBD may be helpful for dogs with osteoarthritis
Consumers' perceptions on hemp products for animals
(2016) Kogan LR, Hellyer PW & Robinson NG American Holistic
Veterinary Medical Association Journal42 Spring pp40-48 reports on
a survey of people who had given hemp-based products to their pets. Of the
just under 12% of people surveyed who were using these products in their cats,
the majority seemed to think they were most effective for pain, inflammation
and to help sleep. The main side effect seen was sedation but the second most
common was an increased appetite.
Single-dose phamacokinetics and preliminary safety
assessment with use of CBD-rich hemp nutraceutical in healthy dogs and cats
(2019) Deabold KA, Schwark WS, Wolf L & Wakshlag JJ Animals (Basel)
9(10) p832 gave CBD oil to healthy dogs and cats. The study states
"Based on these and other recent data, CBD-rich hemp nutraceuticals appear to
be safe in healthy adult dogs, while more work in cats is needed to fully
understand utility and absorption." The study adds that liver enzymes should
be monitored in cats receiving CBD.
In 2019 the
American Veterinary Medical Association
submitted comments to the FDA regarding the use of CBD in companion
animals which state "Although we are encouraged by some of the information
obtained from therapeutic investigations into the use of cannabis for
treatment of epilepsy and osteoarthritis, few well-controlled studies have
been published and results thus far are inconsistent...much of what we know
regarding the use of these products in veterinary patients is anecdotal. It is
not our intent to suggest that benefits may not exist. To the contrary, there
appears to be real potential for cannabis-derived products in the veterinary
medical space. However, the path to market must support pursuit of the
research necessary to produce safe and efficacious products with valid label
claims."
As far as CBD for CKD goes,
A review of cannabis in chronic kidney disease symptom
management (2019) Ho C, Martinusen F &
Lo C Canadian Journal of Kidney Health and Disease6 pp1-14
looked at the use of marijuana (including both CBD and THC) in human CKD
patients. The study states "Until further studies are conducted, the role of
nonsynthetic cannabinoids for symptom management in patients with CKD should
be limited to the treatment of chronic neuropathic pain."
Safety and tolerability of escalating cannabinoid doses in healthy cats
(2021) Kulpa JE, Paulionis LJ, Eglit GML & Vaughn DM Journal of Feline
Medicine and Surgery23(12) pp1162-1175 gave cats increasing doses
of CBD, THC and a mixture of both. Adverse events were more common in cats
given either THC or THC and CBD together, but cats given increasing
doses of CBD did experience some adverse events, including drooling and
wobbliness.The study concludes "Our findings support continuing research on
the potential therapeutic uses of orally delivered CBD in cats, and for its
consideration as a safe treatment optionin veterinary medicine." All the study
authors are current or former employees of the supplier of the product used in
the study.
CBD-Based Products:
Issues
Some brands make bold marketing claims. In 2015 the
FDA issued a warning letter to Canna-Pet stating that the claims on
its website meant that its products were unapproved new drugs. Canna-Pet
subsequently changed its advertising. Canna Companion received
a similar letter.
One major problem with many hemp-based products is that they may not contain
much, or even any, CBD.
2015 warning letter and test results states
that the FDA tested various products, including those made by Canna Companion
and Canna-Pet, and "in some of them, did not detect any CBD. It is important
to note that these products are not approved by FDA for the diagnosis, cure,
mitigation, treatment, or prevention of any disease, and often they do not
even contain the ingredients found on the label. Consumers should beware
purchasing and using any such products."
Five years later, this continues to be a problem.
Cannabinoid, terpene and heavy metal analysis of 29 over
the counter commercial veterinary hemp supplements
(2020) Wakshlag JJ, Cital S, Eaton SJ, Prussin R & Hudalla C
Veterinary Medicine Research and Reports11 pp45-55 examined 29
products and found that they all contained less than 0.3% CBD, though some
contained none. The study concludes "The products analyzed had highly variable
concentrations of CBD or total cannabinoids with only 18 of 29 being
appropriately labeled according to current FDA non-medication, non-dietary
supplement or non-food guidelines. Owners and veterinarians wanting to utilize
CBD-rich Cannabis sativa products should be aware of
low-concentration products and should obtain a COA enabling them to fully
discuss the implications of use and calculated dosing before administering to
pets."
It is also possible for products stating that they contain
CBD to contain some THC, which could be dangerous for cats.
Cannabis-based products contain terpenes, which are the
compounds that give plants their colour, smell and taste. Different cannabis
plants have different terpenes. Some, for example, may contain lemon- or
pine-scented terpenes, which many cats dislike the smell of. You need to see
the Certificate of Analysis from an independent laboratory which will state
which type of terpenes are in the product.
Deciding how much CBD to give your cats is also
problematic, because the correct dose is not known.
CBD-Based Products: Choices
A product called Epidiolex is approved for use in humans with rare seizure
disorders, and according to the
American Veterinary Medical Association,
"is Schedule V and is available to veterinarians for extralabel use in animals
under the Animal Medicinal Drug Use Clarification Act (AMDUCA)."
Some people buy OTC products for their cats (and in some countries you may not
have any alternative) but there is no guarantee they contain what you think
you are buying (see Issues).
CBD-Based Products: Side-Effects and
Interactions
CBD may increase the effects of
amlodipine (for hypertension).
Drugs has more
information.
It may also interact with
painkillers such as
buprenorphine, tramadol or
fentanyl.
Aloe
Vera
Aloe vera is a plant with antioxidant and anti-inflammatory properties which
historically has been used in humans for skin conditions and for constipation. Human
studies have indicated that it may have cancer fighting effects, however long
term use may cause cancer according to one study in rats and mice.
The outer part of the plant is toxic to cats but the inner part is safe.
Aloe juice made from the inner leaf contains anthraquinone, a stimulant
laxative. In 2002 the US Food
and Drug Administration issued a final ruling stating that "the stimulant laxative ingredients
aloe (including aloe extract and aloe flower extract)...in over-the- counter
(OTC) drug products are not generally recognized as safe and effective or are
misbranded."
I consider there are much better, gentler and, bearing in mind the need to
source a product that is definitely not toxic to cats, safer treatments for
constipation and would not give aloe vera juice to my cat.
The reasoning
behind these products is that giving kidney glandulars (extracted from
cows' kidneys) is supposed to strengthen the cat's own kidneys. Renatrophin is pure
kidney extract, while the other two products contain other ingredients.
The process by which these extracts (known as protomorphogen or PMG
extracts) are obtained is patented by Standard Process.
I am concerned to note
that the products contain some or all of phosphorus, calcium and vitamin
A, which can be a problem for CKD cats. They also contain
flax seed oil, and alfalfa,
which is toxic to cats.
A small percentage of
Tanya's CKD Support Groupmembers
do like these products. Personally,
though, I'd save my money. If you do decide
to use them, Renatrophin contains magnesium citrate, so should be
given apart from phosphorus binders containing aluminium.
Amino Acids: Protein Supplements
Amino acids are the components of protein. There are 23 amino acids which
cats need, and they can manufacture twelve of these themselves, but the
other eleven must be obtained from food.
Taurine
is one example of an amino acid which cats must obtain from food.
Virginia-Maryland Regional College of Veterinary
Medicine explains more about cats and
amino acids.
One study,
Plasma amino acid profiles in cats with naturally
acquired chronic renal failure (1999)
Goldstein RE, Marks SL, Cowgill LD, Kass PH & Rogers QR American Journal of
Veterinary Research60(1) pp109-13, found that CKD cats in all
stages of CKD had lower levels of amino acids than healthy cats.
However, they concluded "the magnitude of these changes is mild and of little
clinical relevance." This is an older study, and it might eventually be shown
that supplementary amino acids are in fact helpful to CKD cats, but currently
there is no evidence that this is the case.
Nevertheless, there are a few amino acid supplements marketed for
CKD cats as follows.
The maker of
Astro's Oil also offers Astro's Oil Renal
Care Protein (previously called Astro's CRF
Protein Powder).
It was apparently tested on 24 cats and 11 dogs but this study has not
been published.
The supplement
is 96% amino acids made from wild Pacific deep sea white fish which is
enzymatically pre-digested (fish protein hydrolysate), so the amino acids
supposedly are very low molecular weight and therefore need little
processing by the digestive tract. In other words, the product supposedly
creates very little nitrogenous waste. However, since it is made from
amino acids, by definition it will produce some nitrogenous waste.
Astro's Protein Powder is intended to counteract some of the possible side
effects of reduced protein diets in CKD patients (muscle and weight loss and
malnutrition). It can be used in conjunction with Astro's CRF Oil, or
added to food to supplement protein and calorie intake. The manufacturer
states it does this
without placing extra strain upon the kidneys, in a similar manner to
egg whites.
The powder is odourless and water soluble. It is usually given about twenty minutes before food - it can be mixed with
water and syringed into the mouth or offered as is in a bowl (apparently some cats
like the taste and will eat it like this). The recommended dose is a
quarter of a tsp per 10lb (4.5kg) of cat 1-2 times a day.
The product costs US$35.95 plus shipping costs of US$7.95 for a 60g jar
which would last 1-2 months for most cats. The shipping cost is
usually the same for up to three items (around US$7 for the USA). The
product is shipped from Canada and tends to take a couple of weeks to
arrive in other countries, though it may take up to five weeks. The seller
does not used tracked
shipping, so it is hard to know if it is on its way, and it is sometimes
intercepted by Customs (probably because it is so poorly labelled, though
that may have improved with the new packaging) so it
does not arrive.
I am not aware of any studies into the use of fish
protein hydrolysate in CKD patients but it appears to be helpful with
other conditions.
Reparative properties of a commercial
fish protein hydrolysate preparation (2005) Fitzgerald AJ, Rai PS, Marchbank T, Taylor
GW, Ghosh S, Ritz BW, Playford RJ Gut54 pp775-781 found that fish protein
hydrolysate significantly reduced gastric injury in rats and concluded
"Fish protein hydrolysate possesses biological activity when analysed in a
variety of models of injury and repair and could provide a novel
inexpensive approach for the prevention and treatment of the injurious
effects of non-steroidal anti-inflammatory drugs and other ulcerative
conditions of the bowel." Another study,
Fish protein hydrolysate reduces plasma total
cholesterol, increases the proportion of HDL cholesterol, and lowers
Acyl-CoA:cholesterol in liver of Zucker rats
(2004) Wergedahl H,
Liaset B, Gudbrandsen OA, Lied E, Espe M, Muna Z, Mørk S and Berge RK
Journal of Nutrition134 pp1320-7, concluded that fish protein hydrolysate
"may have a role as a cardioprotective nutrient."
Some members of Tanya's CKD Support Group are happy with this
product, saying it has increased their cats'
appetites. Other people have told me it didn't seem to harm their cats in
any way, but nor did it help them. The best way for cats to take in the correct balance of amino
acids is normally from eating a complete food designed for cats, but if
you do want to try this product, run it by your vet first.
RenAvast and
AminAvast
RenAvast was
launched in the USA in summer 2011 and contains something called Avastamine
(AB070597). Avastamine is said to consist of "naturally occurring
biomolecules", which apparently means it is a proprietary mix of six specific
amino acids and one peptide. I suspected one of them would be
l-arginine, but they did not state which ones until August 2013, when it
was announced that RenAvast contained a "Proprietary blend of amino acids and
peptides 300mg: L-Aspartic, L-Carnosine, L-Glutamic Acid, L-Glutamine,
Glycine, L-Arginine, L-Histadine [sic]." Apparently each 300mg dose contains
25 mg L-arginine, 50 mg glycine, 50 mg L-glutamine, 25 mg
L-histidine, 50 mg L-aspartic acid, 50 mg L-glutamic acid, and 50 mg
L-carnosine.
Amino acids are the components of protein. Peptides are the molecules formed
when two or more amino acids are joined together.
RenAvast was originally marketed as a dietary supplement. Dietary supplements do not need
US Food and Drug Administration approval but the manufacturers made the bold
claims that RenAvast "can halt the progression of chronic renal failure in
cats" and that "unlike other products and drugs, RenAvast does not treat the
symptoms of renal failure, it treats the cause."
The
FDA states that
"a product sold as a dietary supplement and promoted on its label or in
labeling as a treatment, prevention or cure for a specific disease or
condition would be considered an unapproved — and thus illegal — drug."
On 1 August 2012, the
FDA issued a warning letter to the
manufacturer of RenAvast about their claims for RenAvast. The
manufacturer took no notice, so in July 2015 the
FDA issued an
injunction banning the manufacturer from marketing RenAvast "unless and until
it obtains an approved new animal drug application or meets the requirements
for an investigational new animal drug exemption."
This is obviously unlikely to happen, but according to
JAVMA News, the manufacturer may continue to
market RenAvast abroad and the same product can also be made and sold in the
USA, but only if it is under a different name and with different marketing
which does not make the same medicinal claims. Enter AminAvast.
RenAvast was widely promoted online and the same applies to AminAvast. The
marketing literature for RenAvast focused heavily on a study published online
by the manufacturers (rather than in a veterinary journal), AB070597 and its
effect on declining renal function in felines (2007) Archer J, published
online. This reports on 19 cats who were given RenAvast over a two year
period. Cats joined and left the study during this period so it is not known
over how long a period the results for individual cats were measured. No cats
in the trial were on sub-Q fluids or a therapeutic kidney diet, but it is not known if they were receiving other treatments
such as phosphorus binders or Azodyl. Many of the cats were in early stage CKD
(Stage 2 of IRIS), and it is not uncommon for cats in this stage to survive
for years.
Effect of AB070597 on blood-serum creatinine
concentration in cats with chronic kidney disease (2015) Archer JD
Research Journal for Veterinary Practitioners3(3) pp58-68
appears to be an update of the above study. It reports on 27 cats who were
given RenAvast. Control cats were added retrospectively — I'm not at all sure
how that works. The study found that RenAvast appeared to have positive
effects on the creatinine levels of the cats in the study, though again, it is
not known what other treatments the cats were receiving, and they did not have
any concomitant diseases such as hyperthyroidism.
The manufacturer claims over two million doses of RenAvast/AminAvast have been
given without problems. I wonder how they know? Some members of my support group have tried RenAvast/AminAvast and like it,
whereas others think it has either not helped or has
made their cats worse, but they did not report this to the manufacturer.
What do I think? My feeling is that RenAvast/AminAvast is unlikely to be the miracle cure that its
manufacturer's aggressive marketing claim it to be, and it is certainly not
cheap at over US$30 a month. It also sticks in my craw that the manufacturer
plays on people's vulnerabilities, doesn't play by the rules, and markets the
product really aggressively. If the product is so good, why is that necessary?
To sell two million doses, I guess.
The best way for cats to take in the correct balance of amino acids is
normally from eating a complete food designed for cats, but if you do want to
try this product, run it by your vet first. Personally, I would save my money
and put it towards more proven treatments.
Beaphar NutriSupport
Kidney
Beaphar NutriSupport Kidney contains taurine,
L-carnitine and yeast. It is unlikely to cause any problems, but I can't see
that it brings much to the table either.
Shirley's Wellness
Cafe
I sometimes receive distressed e-mails from people who have read about
the "seven mistakes in treating pets with chronic renal failure" discussed on
Shirley's website. Having read the article myself, I'm not surprised people are
upset. Basically, you caused your cat's CKD; but on no account are you to
treat it. In particular, you are not to use the following:
aluminium-, calcium- or lanthanum-based
phosphorus binders.
I notice she does not give alternatives though. Presumably you should just
leave your cat feeling lousy and allow the CKD to progress faster rather than
use those nasty products.
antibiotics, even if your cat has a urinary tract infection. I
discuss D-mannose above, and I'm not a person who believes in the use of
antibiotics willy nilly, but if your cat has a UTI, s/he needs an antibiotic.
erythropoiesis stimulating agents
(ESAs) for severe anaemia. Apparently using these products is pointless:
"The remedy begins to work within a day; but most studies have shown that pets
return to normal blood cell levels after four weeks of consistent therapy."
This is completely untrue but hey, better to let your cat die of treatable
anaemia than use another nasty product.
There are many more gems such as these.
The problem with holistic sites like this is that they have an agenda. I
don't. Well, I do, but my agenda is to find what works for CKD cats, not to
push the holistic approach at the expense of everything else. I try to give a
balanced view, of course I do have my own prejudices, we all do, but I try to
be as impartial as I can. I don't care if something is holistic or not. All I
care about is that it works and is safe (i.e. the benefits outweigh risks,
e.g. with ESAs when used appropriately). And I don't sell anything on my site,
so I have no axe to grind, I simply look at every treatment and give my
opinion supported by research where at all possible.
I really do not recommend visiting this website. If you have had the
misfortune to do so before coming here, here is your new mantra: I did
not cause my cat's CKD.
TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE
EXTREMELY DANGEROUS.
I have
tried very hard to ensure that the information provided in this website is
accurate, but I am NOT a vet, just an ordinary person who has lived
through CKD with three cats. This website is for educational purposes
only, and is not intended to be used to diagnose or treat any cat. Before
trying any of the treatments described herein, you MUST consult a
qualified veterinarian and obtain professional advice on the correct
regimen for your cat and his or her particular requirements; and you
should only use any treatments described here with the full knowledge and
approval of your vet. No responsibility can be accepted.
If your cat
appears to be in pain or distress, do not waste time on the internet,
contact your vet immediately.
This site was
created using Microsoft software, and therefore it is best viewed in
Internet Explorer. I know it doesn't always display too well in other
browsers, but I'm not an IT expert so I'm afraid I don't know how to
change that. I would love it to display perfectly everywhere, but my focus
is on making the information available. When I get time, I'll try to
improve how it displays in other browsers.
This site is a labour of love, from which I do not make
a penny. Please do not steal from me by taking credit for my work.
If you wish to
link to this site, please feel free to do so. Please make it clear that
this is a link and not your own work. I would appreciate being informed of
your link.
