“Everything Old Is New Again” Ecclesiastes 1:9
“Everything Old Is New Again” Ecclesiastes 1:9
In 2017 Nestlé Purina introduced a diet marketed to aid in the control of epilepsy in dogs and to improve memory loss in elderly canines. (ref) If it lives up to those expectations, I am sure other specialty pet foods companies will follow with brands of their own. However, within the last few years, prescription and non-prescription diet manufacturers have found it lucrative to market a diet for most every dog and cat life stage and disease found in the dictionary. Some of those recipes are confirmed by nutritional science. But many are not. If the companies offer you the results of a study, it was usually paid for by the them. So I would appreciate your offering other readers some independent feedback on the value of NeuroCare™, let me know. I will add it at the bottom of this article.
Although NeuroCare is not a "ketogenic diet" per se, it is perhaps inspired by them. This diet's possible helpfulness in epilepsy rests on the hope that one of the constituents of medium chain triglycerides (decanoic acid), an MCT highest in coconut oil, might decrease the "excitability" of neurons in you dog's brain. (ref1, ref2, ref3) Nerve cell over-excitability (hyper excitability) is thought to trigger epileptic seizures.
Compared to Nestlé Purina's standard One Chicken & Rice™ dog food, their chicken and corn based NeuroCare™ has more protein (29.0% vs 26.0%), a bit less fat (15.0% vs 16.0%), less carbohydrate (40.37 vs ~49%) , the same crude fiber (3.0%), more zinc (285mg/kg vs 150mg/kg), more vitamin A (15,000iu/kg vs 13,000iu/kg), more vitamin E (500iu/kg vs 250iu/kg) and omega 6 fatty acids (2.06% vs 1.6%). NeuroCare™ has 0.63% omega-3 fatty acids. The amount of omega-3 in their standard chicken & rice diet is not given. As such, the NeuroCare™ formula should meet AAFCO dog food standards for any dog of any age. (Revolt in the kitchen? I checked NeuroCare's ingredient percentages on 3/17/16. When I checked them again on 3/22/17 the figures had changed. So go by whatever is written on the bag)
Other than those differences, the primary – and most important - difference in NeuroCare’s formula is that it’s fat/oil content contains a considerable amount of medium-chain triglyceride vegetable oils (MCTs) that replace the animal fat that is usually added to dog foods (often chicken fat). Fish oil replaced the remainder of the lard.
It has been known since the 1920s that a high fat, low carbohydrate diet, as well as fasting (ref), can decreases the frequency of epileptic seizures. However, the use of diet intervention to control seizures went out of popularity with physician when effective anti-seizure pharmaceuticals were discovered.
But the old becomes new again. Today, there is a resurgence in MCT use by physicians - particularly in epileptic children where ketogenic diets seem to be most successful. It might also work later in life; but in adults, compliance in sticking to a diet like this is a major obstacle. (ref1, ref2, ref3)
All creatures need energy to fuel their bodies - to power their metabolism. Those fuels are the carbohydrates and fats (in emergencies or when fed in excess, proteins too) in their diet. It is thought that ketogenic diets are effective in preventing seizures because they shift the body’s metabolism from burning food carbohydrates (presented in the form of glucose) for needed energy into burning fats (in the form of ketone bodies). Since becoming a fashionable way for overweight folks to shed some pounds, lot of non-scientific stuff has been added to ketogenic diets. Like the words “organic” and “holistic” what constitutes a "ketogenic diet" is no longer clear. The tried and true ketogenic diet is defined as having 4 grams of fat to every one gram of protein+carbohydrate. In that proportion, about 90% of the energy comes from fat and 10% from the carbohydrate/protein mix. (ref) I suggest you not try any of those popular online dietary suggestions on your epileptic or forgetful dog. Carried too far, your pet's body pH level can be lowered to dangerously acidic levels and a situation called ketoacidosis can result.
Medium chain triglycerides (MTCs) are fats found in some vegetable oils. They are saturated fats; but they are made up of shorter chains of atoms than most of the constituent fats found in lard (animal fat). MCT are a bit lower in caloric value too, and are eliminated from the body more quickly than longer chain fats. They are though to be non-toxic, at least when they comprise 10 - 15% of a dog’s diet. (ref) But the studies I know of were all short term trials in mature dogs. Purina does not identify the source of the MCTs in their NeuroCare™ diet, other than that it is from vegetable oil, but MCT are highest in coconut and palm kernel oil. MCTs are not only found in vegetable oil. They are also high in cheese, butter, milk and yogurt. Medium chain triglycerides produce more ketone bodies, than common animal fat that is composed mostly of longer chain triglycerides. MCTs are also absorbed more easily than other fats and oils.
1) In some dogs, neither phenobarbital nor a medication plan supplemented with potassium bromide or Keppra adequately controls seizures. That number has been estimated to be as high as 30%. (ref) Another potential medication Pexion, is not currently available in North America thru 2018. In those refractory dogs, this diet - or diets like it - might be helpful. Perhaps it might allow the dose of your dog's current medications to be lowered.
2) I would not begin your dog's anti-seizure program (except in the severest or unique situations) using NeuroCare™ or any other diet based on the MCT/Ketogenic theory. If it appeared to be effective without any standard anti-seizure medications, I would look hard at whether the original diagnosis of idiopathic epilepsy was correct. Many transient problems and some progressive problems can masquerade as idiopathic epilepsy. I would use this diet primarily in an attempt to keep the dose amounts of anti-seizure medications as low as possible during your pet's long-term care. More than half the dogs taking anti-seizure medications experience side effect of one sort or another. So keeping the dosages of those medications as low as possible while still preventing seizures is always the goal. (ref)
In epileptic humans, about 30-40% seem to find some help in ketogenic diets. Because the frequency of seizures vary naturally, and the nature of epilepsy varies from individual to individual, quantifying the improvement in humans or dogs can be difficult. Improvement, when it occurs in humans, is generally seen in 2-6 weeks. Also in humans, the most common side effects are indigestion, diarrhea or constipation. Studies in dogs are not nearly as common and none of them followed the dogs on MCT diets for more than 3 months. There is only one I am aware of. Hill's Pet Foods ran it in 2005. It did not find a ketogenic diet helpful in epileptic dogs. But it was only a few dogs - too few to base sound conclusions upon. (ref) What Purina is marketing is not a true ketogenic diet. Protein is too high and so are carbohydrates. There is no reason I know of why one would expect a pet's brain to shift its metabolism from glucose to ketone bodies on this diet. But, never-the-less the study - paid for by Purina - appeared to find it helpful. (ref)
Please remember that only idiopathic epilepsy – the kind where repeated seizures have no physically identifiable cause – responds to ketogenic diets. Idiopathic epilepsy is the underlying cause of seizures in less than half the dogs that experience a seizure. (ref1, ref2)
Purina also suggests NeuroCare™ as a way to deal with the decreased mental acuity of old age (=CCD). They printed a handout for veterinarians to distribute to pet owners to help them decide if their pet might be suffering from CCD. (ref)
Your pet’s brain can fuel its activity either by burning the glucose in its blood or - during fasting and other low blood glucose situations - it can use the ketone bodies produced from dietary and stored fat as an alternative fuel. In fasting situations the ketone bodies (acetoacetate and β-hydroxybutyrate), produced in the liver, are the fuels that allows its brain to continue to function. (ref)
Neither your doctor nor your veterinarian can tell you with certainty what causes senile dementia (Alzheimer's disease). We do not know if chronic inflammation might be one of the causes. Perhaps it contributes to the problem. Both PUFAs and MCTs are thought by many to decrease chronic inflammation. (ref)
Purina markets NeuroCare™ as being rich in EPA+DHA, Omega-3 fatty acids (PUFAs) as well as MCTs to help support "brain health" and antioxidant Vitamins E & C to "support a healthy immune system". Not all research supports that; but some does. (ref) However, in 2016, the prestigious Cochrane Review reviewed all the studies and found no real evidence that omega-3 PUFAs slowed or prevented mental decline. (ref)
[Cochrane's evaluation of the effectiveness of PUFAs in improving refractory epilepsy in humans was not much better. (ref). As far as PUFA's effects on canine epilepsy, in 2009, one Brazilian vet thought that Omega-3 fatty acids (aka ω-3 or Ω-3 PUFAs) helped his great dane patient (ref); but a UK trial in 15 epileptic dogs found PUFAs ineffective. (ref) ]
Purina also make the "brain health" claim - laced with glowing testimonials - for their Pro Plan Bright Mind Adult 7+ dog food. But alas, gives no scientific evidence or data to back that up either. (ref) Hills did a study adding MCT, fish oil and carnitine - probably in the development of their “Age Defying” Adult 7+ and Adult 11+ dog food line. (ref); but ended up only increasing the carnitine. (Hills markets so many niche formulas that it is hard for me to keep up with all of them and their miraculous claims. Perhaps, they have some other high MCT formulation I am unaware of.)
MCTs helpfulness in Alzheimer’s - human or canine - remains quite hypothetical. (ref) As for the added Omega-3 fatty acids in NeuroCare™, some human results are positive (ref1, ref2, ref3) and some are negative (ref1, ref2) In 2010, Purina published a study they had commissioned that concluded that old beagles fed a high MCT diet did better on some mental abilities tests. (ref) The authors implied that the improvement might have been due to a decrease in an old dog's brain ability to utilize blood glucose and that the ability of MTCs to provide a substitute brain energy source (ie ketone bodies) might have resulted in a clearer mind. But they did not design the study to test that theory and make no such claim now for their NeuroCare™ product (at least none I'm aware of).
If your dog's decline in mental abilities were related to certain liver problems, (eg cholestasis) it is conceivable that MCTs might be beneficial since they are absorbed even in the absence of the bile salts normally produced by your dog's liver. Without their normal ability to absorb fats, those pets can also be deficient in the fat-soluble vitamins A,D,E, & K. So any dog food with moderately elevated levels of those vitamins might be helpful. All speculation.
I cannot tell you if NeuroCare™ or a similar recipe might benefit your forgetful pet. Nobody can. Try it for a few months if you are inclined to and see.
Then let me know.
Your Feed Back Is Appreciated
The value of feeding NeuroCare™ to your dog is still up in the air. As with all new products and therapies, information accumulates over time. Was NeuroCare™ helpful for your epileptic or forgetful dog? Did he/she enjoy eating it? Did your dog's weight go up or down? Were its seizures less frequent or less severe? Was diet the only change you made to your dog's current therapy? Were you able to lower its dose of phenobarbital, potassium bromide, Keppra, Pexion, etc? If so, by how much? Did the pet’s blood work results change? What other changes have you noticed in your pet on this new diet?
How about you elderly pet’s mental abilities, forgetfulness and alertness? Do you feel it slowed the advances of Father Time? Did its number of potty accidents decrease? Did it sleep less? Did it pace less? Was it more active?
Ultimately, it is pet owners like you – not company infomercials and promotionals - that give the thumbs up or thumbs down on a product. So let me and other readers know and I will post your emails here. Over time, this article will change accordingly.
Some have suggested adding a human-grade coconut oil or an MCT concentrate to your dog’s current, low-carbohydrate, dog food in a similar amount as mentioned in one of my references (rptref). That could be a commercial dog food or a home cooked product. But if your dog is truly epileptic, its medical and nutritional management need to be in the hands of a qualified veterinarian that you visit - not based on articles like this one that you read somewhere on the internet. Seizures, managed improperly, can be quite violent - even fatal - and some signal other deep and very serious health issues. So find a reputable, non-corporate veterinary practice that your friends speak highly of. One that does not intensely market products. Discuss the issue with them. You can point them to this article if you wish. I believe that it has the most thorough list of references available on the web.
In an exchange of emails, a leading research physician in dietary methods of epilepsy control in people also noted to me that the carbohydrate content of NeuroCare™ was quite high if one was attempting to shift brain metabolism from carbohydrates to fats. But he thought the diet perhaps might be useful based on its MCT content alone. I explained to him that it is the carbohydrate that provides the necessary "glue" to bind pet food kibble together during the baking process. And that perhaps that was the reason the diet had so much of it. In "grain-free" pet kibble, manufacturers simply substitute the carbohydrates from peas, potatoes, soy or tapioca to hold their products together during baking. The fat is sprayed on after baking in an amount limited by the porosity of the kibble. (ref) That physician also experiments with ketogenic diets in epileptic rats. He remarked that the high-fat diet they must use is very messy - the animals get grease all over their fur. He thought that a diet that high in fat probably would not be acceptable to a companion animal owner.