AMERICAN CAT FOOD RECALL

Introduction

Diet can be a very useful way of controlling CRF and helping your cat to cope better with the disease. This section contains information on prescription diets, including what to do if your cat refuses to eat the prescription diet which your vet recommends. It also discusses other food options, i.e. non-prescription commercial cat foods and homemade foods. There is also information on certain foods which are not suitable for cats.

Prescription Foods

CRF prescription diets differ from other cat food in that they:

• are relatively low in protein;

• are relatively low in phosphorus;

• have added potasssium. This is usually in the form of potassium citrate because this can help with metabolic acidosis;

• are lower in sodium;

• contain higher levels of B vitamins;

• may contain essential fatty acids.

You can read about all these on the Food Composition and Nutritional Requirements page.

If your cat is prepared to eat a prescription diet, you may find that is the simplest solution to the CRF diet headache. Certainly, if you would like your cat to eat such foods and your cat has been diagnosed at an early stage, it may be better to try to get your cat used to these foods while his/her appetite is still relatively healthy, rather than trying to effect a switch at a time when your cat feels under the weather. However, if your cat is diagnosed following a crisis, and is still under the weather, do not rush to introduce any new food - the cat may associate feeling sick with the food and refuse to eat it, ever; whereas if you had waited until the cat felt a little better, you might have been more successful.

Cornell University College of Veterinary Medicine has a short video with information on prescription diets.

Introducing Prescription Food

These foods can be rather dry (even the tinned/canned food varieties), so it is best not to try to introduce them to your cat's diet in one fell swoop. In fact, it is better for cats not to introduce any food too quickly, firstly because they are creatures of habit when it comes to food - see Diagnostic and Therapeutic Approach to the Anorectic Cat (2001), Stanley Marks, World Small Animal Veterinary Association World Congress 2001) - and secondly because doing so may cause diarrhoea. Mix a little of the new food with your cat's favourite food to start with, and gradually increase the proportion of the new food. It may also help to start with to put a little tuna water (the water in which tuna is packed) on the food to moisten it and make it taste a little better. You could also try warming the food. Some people have found pureeing the tinned food makes it more attractive to their cats. There is no need to rush the introduction of any new food, go at your cat's pace.

When a Cat Refuses Prescription Food

Despite your best efforts, you may fail (as I did with Thomas) to persuade your cat to eat these foods. It can be particularly scary if your vet returns your cat to you after a session on IV and informs you that if you cannot persuade your cat to eat the veterinary diet, you are effectively killing him or her; but remember starvation is far more life-threatening. 

One possible solution is to try a different prescription food - some cats love one brand, but hate the others. There are five brands available in the UK but astonishingly, only Hill's bothers to provide any information about its prescription diets on its website:

• Hills k/d. Hill's also makes a g/d diet, designed for early stage CRF when numbers are hardly elevated;

• Royal Canin Diet Feline Renal Support or Royal Canin Diet Feline Renal Support S/O;

• Purina PVD NF;

• Eukanuba Renal Formula; and

• Specific Kidney Support.  

There are five brands available in the USA:

• Royal Canin Veterinary Diet Feline Renal LP or LP21;

• Hill's k/d. This comes in two formulations, regular, and k/d with chicken - many people find their cats prefer the latter. Hill's also makes a g/d diet, designed for early stage CRF when numbers are hardly elevated;

• Iams (formerly Eukanuba) Multi-Stage Renal Formula;

• Hi-Tor Neo. This food is available without a prescription, and is relatively high in fat content, which might be helpful in a cat who is getting too thin;

• Purina NF Feline Formula.

See Obtaining Supplies Cheaply for online suppliers in UK, USA and Canada at reduced prices.

Prescription Diets provides an overview of the prescription diets available for various conditions.

At Pet Food Direct you can check the composition of many cat foods, both prescription and non-prescription.

If you cannot persuade your cat to eat any of these foods, please do not feel too despondent. As discussed on the Food Composition and Nutritional Requirements page, a low protein diet, whilst desirable, is not always critical; and the other elements of a prescription diet, such as additional B vitamins, can often be handled separately.

In 11 guidelines for conservatively treating chronic kidney disease (2007) Polzin D, Veterinary Medicine December 2007, Dr Polzin makes the shocking observation that "in many or most dogs and cats with chronic kidney disease, death or euthanasia results directly or indirectly from starvation." This is truly shocking not least because it is so unnecessary. I believe that it is far more important that your cat eats SOME food and takes in SOME nourishment, rather than starves; my vet agrees with this approach. Cats eat to live rather than live to eat, and if they do not like what is offered, they may simply refuse point blank to eat. This lack of food intake is more worrying than it might appear, because cats who do not eat may develop a condition called hepatic lipidosis (fatty liver disease) where the liver starts to function abnormally; this can happen after just a day or two of not eating, and can be life-threatening. So you see, it is more important that your cat eats something than that he/she eats the prescription foods. When Thomas was seriously ill after initial diagnosis, we fed him whatever he would eat, and then tried to provide a more suitable diet once he was stable. 

Obviously, if your cat is prepared to eat prescription diets, then by all means feed them. One recent study, Clinical evaluation of dietary modification for treatment of spontaneous chronic kidney disease in cats (2006) Ross SJ, Osborne CA, Kirk CA, Lowry SR, Koehler LA, Polzin DJ Journal of the American Veterinary Medical Association 229(6) pp949-57, did find that cats fed a prescription diet had lower BUN levels and fewer problems with toxins (stomach acid etc.) than cats fed a non-prescription diet. You would expect this, since the food was low protein and low phosphorus. The cats were also less likely to die of kidney-related problems. However, interestingly, there was no difference in parathyroid hormone levels between the two groups of cats. Also, this study did not include the use of phosphorus binders in either group of cats, which might well have made a difference, particularly to the cats eating the non-prescription diet.

So by all mean try to get your cat on a prescription diet, but if you simply cannot persuade your cat to eat these foods, then do not lose too much sleep over it. You have to consider your cat's quality of life: would you want to spend the rest of your life eating a food you detest? Focus instead on offering your cat a food that is relatively low in phosphorus and which contains high quality protein, and remember, keeping weight on and your cat eating regularly is usually more important than eating prescription foods. Many senior foods are relatively low in phosphorus and protein, so they may be a possible alternative.

The US Food and Drug Administration has some information on interpreting cat food labels which may help you to choose a good quality food.

Pet Education explains more about the guidelines of AAFPO (Association of American Feed Control Officials). Note that the amounts given here are minimums.

Feeding Prescription Food to Other Family Cats

It seems that many vets suggest that it is acceptable to feed a CRF prescription diet to other family cats. I do not understand this. If the food is so potent that it is available by prescription only, how would it miraculously have no effect on other, healthy cats? The answer is that it will have an effect: non-CRF cats fed a CRF prescription diet for any lengthy of time run the risk of malnutrition, particularly young cats and kittens, because of the low protein content of such foods.

I know it can be tricky feeding a multiple cat household, so you may have to compromise e.g. perhaps leave out prescription food for all the cats when you are out of the house, but feed the cats separately when you are home. But do always supplement a non-CRF cat with normal, non-CRF prescription cat food. Apart from anything else, this will save you money - prescription foods are expensive.

Other Commercial Foods

If you are unable to persuade your cat to eat the prescription diets, you may have to look into feeding other foods instead. The main options are other commercial cat foods or a homemade diet. Whichever you feed, ideally, as mentioned by Dr Scott Brown in  Management of feline chronic renal failure (1998) Waltham Focus 8 (3), you want your cat to eat food with less than 0.5% but you also need your cat to eat, so if necessary you may have to have a less ambitious goal, at least to start with, of less than 1% phosphorus. But the ultimate aim is to feed your cat a food containing as little phosphorus as possible.

Non Prescription Commercial Foods

This is probably the easiest option, since most cats eat commercial non-prescription foods anyway. However, you should not just feed any old food: aim if at all possible to feed a food low in phosphorus and sodium and possibly protein. Many senior foods are relatively low in phosphorus and protein, so they may be an option. Do not introduce any new food suddenly, follow the guidelines for introducing prescription foods.

If you think you have found a food which is low in phosphorus, please be sure that you are looking at it on a dry matter analysis (DMA) basis. The labels on tins usually do not provide information on a DMA basis, so that apparently low level of phosphorus is unfortunately unlikely to be accurate.

I am sometimes asked which commercial foods I recommend. Since cats all have individual needs and preferences, I cannot really answer that question, but I can tell you that I personally aim to feed a food with high grade protein, no or few grains, and an uncomplicated formula, by which I mean no long lists of fruit and vegetables (see below); and if I'm feeding a CRF cat (which is not the case at the moment), I also want a food which is as low in phosphorus as possible.

One food that I feed and which surprises many people is Fancy Feast, you can read more about this below. If you live in the USA, another food that may be suitable for a CRF cat is Petguard. Some of their foods, but not all of them, are unnecessarily complicated in my opinion (see below) and have high levels of phosphorus, but their Turkey & Rice and Chicken & Beef flavours have simple recipes and, based on a call a member of the Feline CRF Information list made to them, both appear to have a phosphorus level of under 0.65% on a dry matter analysis (DMA) basis.

Ultimately, the most important test for me is that I choose a food which my cats will actually eat. You can have the healthiest, most expensive cat food on the planet in your cupboard, but if your cats would rather starve than eat it, it's obviously not a good choice for them. And speaking as someone who likes eating myself, I do like to see my cats not only taking in nutrition, but enjoying doing so if at all possible.

"Natural" and/or "Premium" Foods

People often assume that I feed foods such as Wellness, which many in the holistic community seem to think is a superb food. However, I myself am not a fan of Wellness and similar foods: they contain fruits and vegetables including cranberries, inappropriate for CRF cats, and in my opinion are unnecessarily complicated foods. Many so-called "natural" and/or "premium" foods seem to me to be designed to appeal to the humans buying them, not to the cat. This is not only my opinion: The Association of American Feed Controls Officials itself admits "Because cats and dogs do not select their own foods, and their human owners do, it is not rare at all that labeling and marketing information is designed to appeal to the latest trend in marketing human products."

Cats have very little need for fruits and vegetables - normally they would only eat the small amounts contained in a mouse's stomach - so I do not see the attraction of all those carrots, sweet potatoes and blueberries for my cats. Wellness is also acidified - many commercial foods are, unfortunately, but again this is not suitable for a CRF cat.

If you do decide to feed Wellness, the Turkey & Salmon variety has the lowest phosphorus level at 0.88% on a dry matter analysis (DMA) basis. Chicken & Herring is the next lowest at 0.91%. The new Wellness Core range is very high in meat content, and therefore has high phosphorus levels (over 1.5%) and high protein levels, so I would avoid this range.

Fancy Feast

Fancy Feast seems often to be considered to be "bad" for cats, particularly CRF cats. I'm not American, so I've never quite worked out why this is, but I get the impression Fancy Feast is considered to be akin to "junk food".

Now, apart from having an adorable Chinchilla Persian on the tins like my Indie (who loves Fancy Feast), in actual fact some of the tinned Fancy Feast flavours are not excessively high in phosphorus for a non-prescription diet. The following table is based on information obtained from Purina in 2008 by a Feline CRF Information list member, but formulations may change, so please double check with Purina before relying on these data:

Of course, there is also some bad news. The marinated and grilled flavours above tend to have high sodium levels, so would not be a good choice for cats with high blood pressure. The pâté-style foods (labelled Gourmet, and not included in the above table) tend to have higher levels of phosphorus (1-2%).

Some flavours of Fancy Feast contain a preservative called sodium nitrate (or nitrite). Nitrite poisoning in cats and dogs fed a commercial pet food (1997) Worth AJ, Ainsworth SJ, Brocklehurst PJ & Collett MG New Zealand Veterinary Journal 45(5) pp193-195 reports on the effects of this preservative on some cats (note: there is no evidence that the food used in this study was Fancy Feast).

The nearest UK version of Fancy Feast, judging by the tins, seems to be Purina Gourmet Gold. Unfortunately it does not appear to have the same "kitty crack" appeal of Fancy Feast, plus it seems to have much higher levels of phosphorus. However, it may be useful to try this in times of crisis. 

So basically, most cats do seem to love Fancy Feast, and even those who are not feeling too good may eat Fancy Feast. Some cats on the CRF list have eaten nothing but Fancy Feast for years, and have done well on it, with the addition of phosphorus binders when needed.

The pâté-style foods (labelled Gourmet), whilst too high in phosphorus to use as a regular diet in most cases, are often easier for cats with poor teeth to eat than the other types (grilled, marinated etc.), and can also be mixed with water until smooth and used for syringe feeding or as a base for mixing medications.

Therefore if you live in the USA, I would recommend keeping a few tins in the cupboard in case of need. It was the only thing Indie would eat when she was sick once. Incidentally, Fancy Feast was not affected by the 2007 petfood recalls.

Foods for Urinary Tract Health

You should be wary of foods which say that they are designed to "support urinary tract health", or "magnesium-controlled", or words to that effect. You should also avoid foods that contain cranberries or additional Vitamin C. This type of food is acidified because it is actually designed to treat a different kind of problem to CRF called Feline Lower Urinary Tract Disease or FLUTD (see Links and Resources) and may have the effect of increasing the amounts of potassium lost in the urine, which is bad for most CRF cats. It is therefore best not to feed these acidified foods to CRF cats, who tend to have quite high acid levels anyway. 

Foods for Cats with Other Conditions (Diabetes, Food Allergies or IBD)

For cats with diabetes and CRF, please see the Related Diseases page regarding diet for both conditions. If your cat has IBD or food allergies and has been on a limited ingredient diet, you may be able to continue with this diet because some of these foods are pretty low in phosphorus. For example, my cat with IBD and food allergies ate IVD Limited Ingredient Lamb & Pea tinned food, which all my cats loved but which has a phosphorus level of only 0.67% on a dry matter analysis basis. Unfortunately IVD was taken over by Royal Canin so this food is harder to find now, and does not seem to be available at all in Europe. Royal Canin Green Peas & Lamb has a phosphorus level of 0.94% on a dry matter analysis basis, which is far higher, though might still be acceptable for a cat with both IBD and CRF. Hill's z/d is probably a better alternative, with only 0.67% phosphorus on a dry matter analysis basis.
 

Choosing a Food

In order to make it easier for you to choose an appropriate food, I have compiled data on the phosphorus, protein, sodium and fat levels in many cat foods available in the UK, including the prescription diets, so you can make comparisons (many of these foods are available in other parts of Europe). I'm not currently in the UK so I cannot check out any foods personally, and some of these foods may be designed for maintaining urinary tract health, so please be careful.

For similar information on US foods, click here.

UK Food Information

• Dry Food Data

• Tinned Food Data

• Manufacturer Contact Details 

If you have any information on any UK food not shown on the lists, please contact me and I will add it to my lists. 

Janet & Binky's site has information on the percentage of calories provided by protein, fat and carbohydrate in a number of non-US cat foods. 

US Food Information

The sites above are for foods available in the UK. 

Ohio State University Nutrition Support Service compares the various prescription diets available in the USA. Click on Search, choose Cat as the species and Reduced Phosphorus/Protein as the food type.

The Kat Karma site has information on the percentages of phosphorus, protein, fat and sodium in a wide variety of foods available in the USA:

• US Dry Food

• US Canned Food

• US Cat Food Manufacturers

Janet & Binkie's site has information on the percentage of calories provided by protein, fat and carbohydrate in a number of US cat foods:

• US Dry Food

• US Canned Food

Homemade Foods

Some people feed their cat a homemade diet, either raw or cooked. Since cats have very complex nutritional needs, this is not something which should be undertaken lightly, you need to do a lot of research in order to ensure that you are providing correct levels of essential nutrients. Pet Diets claims that "one survey found that 90% of the homemade diets prescribed by over 100 US veterinarians were not nutritionally adequate for adult dogs or cats". They also state that few recipes in books or on the internet have been properly tested to ensure they are nutritionally complete. It is particularly important to get the ratio of phosphorus to calcium correct, and to ensure that you are providing enough taurine - taurine deficiency can cause blindness and heart failure. Baton Rouge Abyssinians has some information about taurine requirements in cats.

You also need to be particularly careful with raw diets since these may increase the risk of salmonella poisoning. If you want to look into the option of a homemade diet further, here are some sites with information on homemade diets, though please note, I would be very careful about using a diet with a high amount of carbohydrates as some of these sites recommend (always check with your vet about such diets) since cats have no nutritional requirement for large amounts of carbohydrates: 

USDA National Nutrient Database is a database where you can search for any food ingredient and get a nutritional breakdown, including phosphorus and protein levels.

Hill's Homemade Food - this is based on a recipe provided by Hill's in USA for cats who refuse to eat their prescription diets.

Feline Future - an introduction to the cat's nutritional needs and how to prepare a homemade diet; it includes a diet for CRF cats.

Kat Karma - the bottom of this page has links to homemade food sites.

Petdiets - in the USA has veterinary nutritionists who  can design a personalised diet for your cat if required.

University of California Davis - in the USA can devise a diet to suit your cat if your vet contacts them and provides current bloodwork. The personalised diet costs around US$65 (2002).

Balance IT is a site run by veterinary nutritionists who can provide you with customised recipes for you to make homemade (cooked) food for your cat, although they do not appear to offer recipes specifically for CRF cats. Supplements are also available.

Food Cautions

Raw Food

You need to think carefully about feeding a raw food diet to a CRF cat, because CRF cats are immune compromised, and according to a recent study (Septicemic Salmonellosis in Two Cats Fed a Raw-Meat Diet (2003) Stiver SL, Frazier KS, Mauel MJ & Styer EL Journal of the American Animal Hospital Association 39 pp538-542), raw foods may carry a greater risk of salmonella poisoning, although it must be noted that the incidence of salmonella in cats generally is very low. But there are other risks: Raw meat diets spark concern (2005) is a news report by the Journal of the American Veterinary Medical Association which found that 99% of raw meat samples intended for dogs were contaminated with a variety of bacteria.

Onion and Garlic

Please do NOT feed anything containing onions to your cat, EVER: onions contain an alkaloid disulfide compound which causes a cat to form something called Heinz antibodies - these antibodies trigger a serious form of anaemia which can kill. Particularly susceptible cats may only need to eat a tiny amount of onion for this to happen. Some people believe the same caution applies to garlic, which is a member of the onion family.

Pet Education has information on both onion and garlic.

ASPCA has detailed information on onion and also mentions garlic.

Allium species poisoning in dogs and cats (2005) Cope RB Veterinary Medicine 100 (8) pp562-566 is a recent paper which mentions that onions, garlic, leeks and chives are potentially toxic to dogs and cats, and that problems may occur after consumption of a single large quantity or repeated consumption of small amounts, even of dietary supplements rather than garlic or onion themselves.

Pet Diets is a site owned by Dr Rebecca Remillard, a veterinary nutritionist, which states "the possibility of developing a Heinz body hemolytic anemia appears to be variable between pets, and it is not possible to predict which animals may or may not have such a reaction to onion or garlic."  

Feline Advisory Bureau reports on sixteen cases of allium poisoning in cats dealt with by The Veterinary Poisons Information Service (VPIS) in the UK, which is part of the Medical Toxicology Unit at Guy's and St Thomas' Hospital in London. Follow up details were only available for four of these cats. One died, two recovered. As for the fourth, "anaemia and jaundice were ongoing problems at the time of follow up after a cat had eaten garlic cloves."
San Francisco Chronicle has an article by a vet which mentions both onion and garlic.

Heinz body anaemia in cats is a paper by J Tarigo-Martinie and P Krimer of the University of Georgia College of Veterinary Medicine.

Haematologic changes associated with the appearance of eccentrocytes after intragastric administration of garlic abstract to dogs (2000) Lee KW, Yamato O, Tajima M, Kuraoka M, Omae S, Maede Y American Journal of Veterinary Research 61(11) pp1446-50 found that HCT levels reduced in dogs fed garlic extract, and Heinz bodies were detected. The conclusion was that "foods containing garlic should not be fed to dogs". Cats are even more sensitive to Heinz body anaemia than dogs, so this advice applies even more so to cats.

Petfood Industry reports that the US Food & Drug Administration is funding a study into the safety of feeding garlic to cats and dogs.

Tuna

Tuna is not an ideal food for cats for various reasons:

1. Firstly, it can be a very addictive food for some cats, to the extent that they will refuse to eat anything else. 

2. The US Food and Drug Administration has guidelines on the amount of tuna that pregnant women can safely eat. However, the US Environmental Working Group, which worked on the studies with the FDA, believes that that human-grade tuna has unusually high levels of the toxic metal methylmercury. They recommend that pregnant women should not eat tuna at all, and that children should eat tuna no more often than once a week. Human-grade tuna tends to consist of the white "meat", while animal-grade tuna tends to consist of the lower grade red "meat", so, at least in theory, animal-grade tuna could contain more pollutants. A 2003 study in The Lancet indicates that eating tuna may not be a problem for pregnant women and children after all (Web MD has a report on this), but I think it might be wiser to err on the side of caution with a sick CRF cat.

3. You might decide to feed human grade tuna instead, but that does not avoid another problem associated with tuna, namely vitamin B1 (thiamine) deficiency. Cats who eat tuna regularly can develop this problem - symptoms are often neurological and include dilation of the pupils, loss of balance, seizures and death if left untreated. Healthy Pet has information on this. Provet UK has information on this and on the dangers of feeding fish to cats generally.

4. If you feed a cat any fish diet exclusively, the cat can develop a condition called steatitis (yellow fat disease), which is caused by a Vitamin E deficiency resulting from the imbalanced diet. Firstly the cat becomes very nervous, and then becomes hypersensitive in all the nerve endings of its skin, so it is very painful for the cat to be touched. The treatment is massive doses of vitamin E under a vet's supervision, and discontinuing any food containing vegetable oil or mineral oil because this will deplete the body's stores of vitamin E even more. Armed Forces Institute of Pathology discusses a case of steatitis in a cat (click on Case Study III) - this cat was put to sleep.

5. Tuna lacks taurine, an amino acid which cats need to obtain from their food: a lack of taurine in a cat's diet can cause heart and eye problems. Baton Rouge Abyssinians has some information about taurine requirements in cats.

6. One study, Evaluation of dietary and environmental risk factors for hyperthyroidism in cats (2000) Martin KM, Rossing MA, Ryland LM, DiGiacomo RF, Freitag WA Journal of the American Veterinary Medical Association 217(6) pp853-856, found that "cats that preferred fish or liver and giblets flavors of canned cat food had an increased risk" of developing hyperthyroidism.

As you can see, feeding tuna regularly has some serious health implications for cats. A little tuna occasionally is unlikely to be cause for concern, but I would not recommend feeding it for any length of time or too often. One possible compromise is to add the water in which tuna is packed to your cat's prescription or other diet in order to make it more palatable. See tuna water for more information.

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