Catchy title, huh?
Some of my friends have deemed me the “Queen of Poop and Puke”. While not a particularly flattering title, the sentiment is actually rather nice. I’ve worked with six cats with gastro-intestinal issues now – adopted and fostered. Generally, vets lump these cats into the category of “IBD” or Inflammatory Bowel Disease – meaning their intestines are inflamed, reasons unknown.
The thing is the reason generally *isn’t* unknown – at least not to me. The reason is an inappropriate diet – most often DRY KIBBLE. Of the six cats I’ve worked with – not a SINGLE ONE needed to remain on a prescription diet or medications. They were all “cured” by a diet change and nutritional supplements.
It’s that simple. Now, once these poor cats have had their intestines tortured by dry food, they may become more sensitive – some will land up unable to tolerate any commercial dry kibble as well as any canned food – and will ONLY tolerate a grain-free veggie-free fruit-free raw diet, such as:
- Feline’s Pride,
- homemade according to the recipes at catinfo.org or catnutrition.org or blakkatz.com,
- homemade using boneless meat, liver, salmon oil, and TC Instincts powder by Feline Future, or
- pre-ground meat/bone supplemented with Platinum Performance as described by Dr. Elizabeth Hodgkins in her book “Your Cat: Simple New Secrets to a Longer Stronger Life”.
For most cats, however, many canned foods will work just fine. Not kibble. Any kibble. Not grain-free kibble. Not low-carbohydrate kibble. Just do NOT feed kibble. I’ve seen caregivers (and vets) put these poor cats on a high-fiber kibble, gluing the stool together until the poor intestines collapse. I’ve seen them put on some “bland” prescription diet or a diet of meat and rice, and it may work temporarily, then the cat deteriorates. These cats are the MOST likely to land up only tolerating raw.
Anyway, as the proclaimed “Queen of Puke and Poop” I’m often approached by caregivers wanting advice on their cat that vomits, has diarrhea, has bloody diarrhea, etc. Honestly, I am not going to waste time providing ANY ADVICE until the caregiver has eliminated ALL DRY FOOD from the cats’ diet. Having trouble because Kitty is holding out for dry food? At a MINIMUM, get the cat on a freeze-dried raw food. I am NOT talking about one of those heat-processed kibbles that claims to be “almost as good as raw” or the “next best thing to raw” – I am talking FREEZE-DRIED or AIR-DRIED, not heat processed. That’s a decent first step, and many cats with IBD tolerate them (though not all). I do NOT recommend it as a permanent diet because it lacks moisture and cats NEED moisture in their diet for proper urinary tract and kidney health.
Dr. Lisa Pierson has some great tips on transitioning a “kibble addict” to a wet diet here.
So, let’s say you have Kitty on an all-wet (canned or raw) diet and you’re still having trouble. (PLEASE do not even bother reading this if you haven’t changed diet FIRST. You might as well tell me your kitty is spitting up blood while you’re feeding him or her glass shards. Of *course* Kitty is spitting up blood! Don’t bother with endoscopies and ultrasounds and nutritional supplements – Kitty is spitting up blood because you’re feeding him or her glass shards! All the nutritional supplements in the WORLD aren’t going to help until you STOP giving the glass shards.)
So, AFTER CHANGING DIET – if symptoms persist:
- Eliminate grains from the diet – especially corn.
- Consider a non-allergenic diet. I am NOT talking about a prescription diet loaded with grains or a DRY diet. I am talking about eliminating fish, beef, pork, lamb, “meat” of undefined origin, etc. Feed a diet of poultry and/or rabbit only. Start with just ONE flavor of ONE brand and see how Kitty does. Think about what our cats’ ancestors ate – birds and rodents. They did not hunt cows, sheep, pigs, fish…
- Consider B12 injections. I believe vitamin B12 (cobalamin) can speed healing of the gastro-intestinal tract. Supplementing all B vitamins isn’t a bad idea, but injectable B-complex stings – and by using injections we’re able to bypass the inflamed GI tract which may not be able to absorb the vitamin properly.
- Consider folate supplementation orally. I just use an over-the-counter folic acid supplement marketed for human use.
- If struggling with diarrhea on a wet diet – you could consider fiber supplementation temporarily. Again, I do not advocate long-term use of high-fiber diets. I believe high-fiber diets stretch the GI tract, causing it to lose elasticity and worst case, causing megacolon. However, if fiber works to “glue together” the stool short-term, giving the cat time to adjust to a change in diet, it could be a stop-gap measure. I use either psyllium (like unflavored Metamucil) or guar gum (like unflavored Benefiber). Add lots of water so it doesn’t clump up and form a choking hazard.
- If struggling with constipation – you can consider additional fat (preferably animal fat, like salmon oil or butter) or if that’s not sufficient, an osmotic laxative (a laxative that draws water into the colon causing stools to be moister, softer, and larger) like MiraLax or Lactulose. Make certain the cat is getting enough water (again, a wet diet – possibly additional water added) so the cat does not get dehydrated. (Update 11/9/2011 – a great link on Constipated Cats by Dr Jean Hofve)
- Pancreatic insufficiency (malabsorption) can sometimes improve with the use of digestive enzmes. I use pancreatin (marketed for human use) – powdered raw porcine pancreas.
- Some cats may also benefit from replenishing the beneficial bacteria in the GI tract (especially after the use of antibiotics). The veterinary version most often used is Purina’s FortiFlora – but other products containing bacteria such as Enterococcus faecium will work well.
- Herbs like slippery elm may reduce intestinal inflammation.
Of course, the best thing to do is not let your cat develop gastro-intestinal issues in the first place by never feeding a dry food. However, if you’ve already got a cat with IBD (or are looking to foster or adopt one) – change the diet. If you’re still struggling, by all means I’m happy to help brainstorm with you. I do believe the absolute BEST thing you can do is go to an all-raw diet as I noted above in the bullets. I’ve had cats go from hopeless chronic diarrhea vet-says-must-euthanize to 100% FINE on a good raw diet.
More info on gastro-intestinal issues in cats at Feline Outreach.
Coblamin/Vitamin B12:
Per Texas A&M Cobalamin Information
THERAPEUTIC DOSING AND ROUTE
As cobalamin deficiency in companion animals is usually secondary to reduced cobalamin absorptive capacity, the use of dietary cobalamin supplementation is at best highly inefficient, and most likely ineffective, in the restoration of bodily cobalamin stores. The route of choice for cobalamin supplementation is by parenteral injection. Generic formulations of cobalamin are readily available and extremely cost effective. The doses we currently recommend for dogs and cats are given in table 1. The dose regime is typically one dose weekly for six weeks, one dose every two weeks for six weeks, then dose monthly. Remeasure serum cobalamin concentrations one month after last administration. Unless the intestinal disease is totally resolved, it is likely that the patient will continue to require regular cobalamin supplementation, the frequency necessary is assessed by regular measurement of serum cobalamin concentration.
Table 1 : Recommended dosages of cobalamin for dogs and cats
400 µg 800 µg Most generic cobalamin preparations are 1mg/ml, i.e. 1000µg/ml. Multi-vitamin and B-complex injectable formulations contain very much lower concentrations of cobalamin, and often cause pain at the injection site, their use is not recommended.
Cobalamin is non-irritant and may be given subcutaneously or intramuscularly, most clinicians deliver it subcutaneously.
Folic acid:
I use one tablet daily. (I buy the smallest tablets I can find, usually 3 to 5 mg – but there are no known side effects of folate overdose, so I don’t worry about using a larger dose if that’s all I have.)
Per May 1999 Antech Diagnostics News:
Changes in serum folate and cobalamin concentrations also may have treatment implications. Many cats with severe cobalamin deficiency as a result of GI disease will not respond to treatment unless supplemented with cobalamin. Cobalamin needs to be administered parenterallyat a dose of 250-1000 ug SQ or IM weekly for 812 weeks. Folate deficiency in cats can cause megaloblastic anemia (macrocytic, non-regenerative), anorexia, lethargy and poor growth. Folate can be administered orally in large doses to overcome the decreased absorption caused by small intestinal disease. The dose administered in one reported case of folate deficiency was 0.5 mg/day for 30 days.
Pancreatin:
I use Pancreatin, 4X 500 mg: 1/2 to 1 capsule with meals. May work more effectively when administered simultaneously with antacids such as famotadine (Pepcid AC).
Per: WSAVA 2004 – Exocrine Pancreatic Insufficiency in Dogs and Cats: An Update
Powdered pancreatic extracts (2 teaspoons/20 kg BW/meal for dogs, 0-1 teaspoon/cat/meal for cats) are usually adequate. The powdered form of pancreatic extracts is more suitable compared to the enteric-coated tablets, capsules or raw-chopped pancreas.
Life of the Lintee Bean 
[…] only saw the episodes of bloody diarrhea Afer occasionally experienced cease (likely a symptom of IBD) – but she gained a bit of weight and increased to around 10 pounds. Though not a lot of weight, […]
Thank you for this blog. After months of frustration and hundreds of dollars, I figured out on my own that the dry food was the problem. Why don’t veterinarians see this? They kept prescribing one dry food after another. Anyway, you confirmed my findings, and I appreciate it.
One question: my kitty lost approximately 5 pounds throughout the ordeal, but can’t seem to gain anything back. Suggestions? She’s also hyperthyroid and is taking medication for that.
Hi Nancy!
I’m sorry you and your kitty have had such a difficult time! There’s a few things that could be going on with the lack of weight gain.
1) Are you sure kitty NEEDS to gain 5 pounds? Most of us aren’t used to seeing cats at an ideal weight. They should have a well-defined waist, etc. The average adult cat should weigh between 8 and 10 pounds.
2) Do you think her hyperthyroid medication needs adjusting? I’m guessing your vet is dosing the medication (likely Tapazole/methimazole) based on T4 values. Age and IBD both deflate T4 values, so I personally would want a cat over 10, especially a cat with a history of IBD, in the lower half to lower third of the reference range.
3) Hyperthyroid medications can have side effects, most typically vomiting and diarrhea – but even some more serious ones, so that’s something to think about. Radioactive iodine therapy may be an option, if you’re open to that – or transdermal medications may have fewer side effects. Something to keep in mind.
See my prior blog post on hyperthyroidism:
https://meowmeowmom.wordpress.com/2008/08/06/feline-hyperthyroidism/
Also:
http://www.felineoutreach.org/EducationDetail.asp?cat=HyperT
Best of luck!
Lynette
Good point about the ideal weight! She went from 12 pounds (fat) to her now 8.5 pounds and isn’t budging from that. Maybe it’s because she’s only getting canned food (Natural Balance). Maybe that’s a good thing. Thanks a lot. I love your blogs.
8.5 pounds might be a good weight for her. I’d give it some time. As she’s on a wet diet longer, she might also stay lighter, but start building some muscle.
Since you seem like the smartest person I know right now, here’s another quick question… if you don’t mind.
How long can canned food stay out before it spoils? Is there some trick to going away for a couple of days when the kitties can’t have dry food? Thank you!
Well, my “trick” is hiring cat sitters. Even if I were to leave food out – my cats need their litter boxes scooped and medications.
I have one friend who goes out of town fairly regularly. She has someone come by once a day and feed them and put canned food in a timed feeder set to open 12 hours later. So, they still get two meals a day. Her feed her room for some small ice cubes underneath to keep the food cool.
I’ve seen my cats eat 12-hour old canned food without a problem (and that was without any ice packs/cooling) – I’d be nervous about leaving it out for days… supposedly cats won’t eat spoiled meat, but… eww…
Oh – you could also use a freeze-dried raw product like Steve’s Real Food if it’s just for a couple of days… I’ve thought before about what I’d do in the case of a disaster (like some rare outbreak of a human virus that doesn’t harm cats, but all people are being evacuated from the city… I know, I have a vivid imagination and I do too much daydreaming).. and I think I’d dump a bunch of Steve’s Real Food into bowls or timed feeders and hope for the best.
The freeze-dried stuff sounds like the least stressful option to me. It’s a little expensive, but considering what I’ve already spent trying to keep a “free” pet healthy, it’s not that bad.
Thanks so much.
[…] medicine specialist treating Studley. The specialist has diagnosed Studley with pancreatitis and IBD, based on an ultrasound performed Tuesday. Today he got back the results of Studley’s GI lab, […]
Unfortunately, my vets’ narrow thinking about IBD and prescription dry diets makes me hesitant to trust them on other issues.
I feel the same way, Nancy – just had a “disagreement” with an internal medicine specialist that doesn’t “understand” how my cats with IBD can have normal cobalamine/folate levels – when none of the other cats he’s treated (with prescription diets and steroids) do.
https://meowmeowmom.wordpress.com/2008/12/11/vets-and-pet-food/
Interesting. I have a cat that cannot tolerate any dry kibble. She gets diarrhea. I have her on a wet duck and green pea diet. she does fine with that as long as I don’t give her more than a 1/3 of a can at a sitting. She has no ability to self regulate when it comes to food and if allowed, will keep eating. Of course, this leads to diarrhea even with the special diet. How do I get the cat to be self regulating. How do we relieve any inflammation of her bowel which may limit her ability to absorb nutrition?
Hi Karen,
I’m glad the canned duck and pea is working for your kitty. There are a number of duck canned foods you could try – Nature’s Variety Instinct, Evo 95%, etc. You could also try another, less fatty, canned food – like rabbit or turkey. Wellness, Nature’s Variety Instinct, Evo 95%, etc, offer such foods with no grains added. You could also consider a raw diet, which can work wonders – see my “Raw done right” post. Another option is to add a digestive enzyme to her food in the event she has some pancreatic insufficiency. I prefer porcine pancreas, sold under brand names such as Now Foods pancreatin.
I’d also consider folate and/or cobalamin (both forms of vitamin B) supplementation. Folate can be supplemented using the same oral folic acid tablets sold for human use. I’d use one tablet daily, it can be crushed and added to food. However, if choosing one of the other, I’d lean toward cobalamin as my experience shows folate deficiencies more common with vomiting, cobalamin deficiencies more common with diarrhea. Cobalamin (vitamin B12) is best supplemented by sub-q injection – weekly for six weeks, then bi-weekly for six weeks, then monthly.
As for the over-eating, this can be difficult. It may resolve itself once she’s absorbing nutrients properly – she may be instinctively attempting to eat more to make up for her malabsorption issues. However, in some cases, the behavior is too ingrained. You can try feeding on a larger plate, spreading the food to slow her down – but you may always need to watch her portions.
For more information, see the education pages on IBD and Pancreatic conditions at FelineOutreach.org.
Best of luck!
Lynette:
I bought some of the freeze-dried raw food because we’re planning to go out of town for a few days. My cats won’t touch it. Any tricks you could share? Maybe it’s time to find a cat sitter.
Typically I’d recommend transitioning slowly, putting some of the freeze-dried on top of the canned… however, if it’s just for a few days, I don’t know if it’s worth it. Do you have a friend or neighbor that would come in once or twice a day to feed them and check on them? Honestly, even if I didn’t need my cats fed twice daily, I’d prefer someone check on them for my peace of mind.
LOL at “sawdust with fur in it”.
P.S. I don’t blame them. It looks like sawdust with fur in it. yuck.
Right on. I’ll get a cat sitter. They do seem to be warming up to it on their wet food, but I can’t imagine either one of them digging into a bowl of the dry stuff.
And upon closer inspection, it looks more like sawdust with feathers in it.
Ah yes, well the feathers are “byproducts” – for fiber. 😉
How is Studley doing, Lynette?
Studley is home now, thanks for asking. He looks tired, but he’s eating and otherwise seems to be doing well (though he says he needs lots of extra cuddles, which Ralph and I are happy to provide).
I rescheduled his dental for early January, and at that time I’ll have them re-do bloodwork and I also want them to remove a cyst. (Since they shaved his belly/side for the ultrasound the cyst is very obvious.)
Hi again Lynette. I keep coming back to you because you give such practical advice … and my kitty is feeling better because of it! Thank you. My cat, Jordan, is 13 years old and wracked with IBD and arthritis. I’ve finally found a good canned food that seems to agree with her and make her happy, but am not sure what to do about the arthritis. Any ideas? My vet keeps pushing the steroids (to treat both at once).
Hi Nancy!
I’m so glad your kitty is feeling better!!!!
I wrote down my thoughts on arthritis here:
https://meowmeowmom.wordpress.com/2008/08/02/arthritis/
Also there’s a Feline Outreach page on the subject:
http://www.felineoutreach.org/EducationDetail.asp?cat=Arthritis
Best of luck!
Lynette
Hi again Lynette! I’ve started dabbling in a raw diet for my two cats. Quick question: Is the Platinum supplement all they need with ground meat products?
Hi Nancy!
Platinum Performance needs to be added to ground meat AND BONE to make a complete meal for cats. If you are using ground raw meat (no bone) I’d suggest something like Feline Instincts powder by Feline Future (felinefuture.com). If using cooked meat, I’d suggest something like Call of the Wild supplement by Wysong.
See my “Raw Done Right” post for more information.
https://meowmeowmom.wordpress.com/2008/12/04/raw-done-right/
I have a multi cat household who was on c/d hills due to a frequent uti cat(since passed) . My katrina rescue had began to vomit up this food out of nowhere and also have blood stool stinkiness. My vet suggested to switch to w/d bc of higher fiber and to stop vomiting. Well, his vomiting stopped immediately but hes been having blood in his stool. So reading this i feel awful about feeding dry but with a MULTI household its more affordable and less stinky. Its expensive doing the hill thing. The w/d is even more expensive bc you get less pounds. They are eating me out of my wallet. I also feed buffet style bc of my hours. Do you think i should feed them all on a timed schedule and separate him with his special diet(per your recommendations on what food) and then i wont have to worry about them eating the others food. Or can you make this special diet in bulk affordable? I have a small farm which i love and dont mind spending the money on, but within reason.
Hi Mary!
Consider something like 9-Lives ground dinners (canned) – I can get it for 25 cents per 5.5 oz can – MUCH cheaper than the prescription foods. Meal feeding, and feeding WET food will benefit your cats immensely. (Honestly, would have helped your cat with FLUTD more than dry c/d – if you read my posts on FLUTD, the ONLY proven effective treatment for some forms of FLUTD is feeding an all-wet diet.) If they need additional fiber TEMPORARILY, you can add psyllium (like unflavored Metamucil) or guar gum (like Benefiber) – add water as well or it can clump up and form a choking hazard.
I’d feed them twice a day – whether by timed feeder or not. I just feed mine in the morning and evening – since I almost always spend the night in my own bed, it’s not difficult.
Consider reading my post “vets and pet food”
[…] pancreatitis (inflammation of the pancreas), cholongiohepatitis (inflammation of the liver), and inflammatory bowel disease or IBD (inflammation of the […]
I have a 10 year old cat who had a subtotal colectomy when he was about 2 years old. Since then, he has always had a problem with loose bowel movements and a problem with passing his feces. The vet put him on Cisapride, but this causes him to have very watery stools and it drops everywhere, so I stopped giving it to him. About 5 years ago, he started pooping on the living room carpet and now he does it almost everywhere. The vet has now put him on FortiFlora for his diarrhea, but it hasn’t helped much. About a year ago, he started urinating and pooping on our couch and in a certain spot on the kitchen floor. I am at my wits end as to what to do now. We love him dearly, he is a sweet, gentle and loving cat who my husband and I just can’t bear to put to sleep, but I cannot stand to go on like this, he runs our life. We can’t go anywhere overnight because we get up to this mess every morning and even though my daughter lives upstairs, I cannot leave her with such a situation. The food he is on is Hill’s W/D with chicken and also Science Diet Adult hairball control, savory chicken entree. Do you have any other suggestions at all??
My suggestion would be to STOP ALL DRY FOOD, and stop ALL science diet/Hills products!
Get him on an all-wet (canned or raw) diet…. poultry or rabbit – no grains, NOW. You can add a little fiber (unflavored Metamucil or benefiber) temporarily if needed – but long-term all that fiber (e.g., high-fiber w/d and hairball control) is going to continue stretching his intestines until they have no elasticity at all!
Thanks, Lynette; isn’t metamucil a laxative? He sure doesn’t need that with his diarrhea. What is wrong with Science Diet/Hills products? Can you recommend any brand of cat food that you feel is better?
I have 2 other cats, which also causes a problem when it comes to dedicating myself to one cat’s problems. They all eat each other’s food; would the diet for the problem cat be all right for the others? Plus, they all love the dry food inbetween their wet food.
Metamucil is FIBER – it’s used just like w/d or hairball control – to temporarily bulk up stool, make it less runny – but long term is bad for digestive tract.
Hills uses cheap ingredients and CORN and CELLULOSE (sawdust) which is inappropriate for a true carnivore (which cats are).
NO DRY FOOD. Read my post on the subject. It causes problems like IBD/diarrhea.
ALL cats should eat an all-wet grain-free diet. They will all benefit from this change.
https://meowmeowmom.wordpress.com/2008/01/11/six-reasons-not-to-feed-dry-cat-food/
Canned food recommendations:
https://meowmeowmom.wordpress.com/2008/12/10/canned-cat-food-which-one/
How to feed raw (if you want to go that route)
https://meowmeowmom.wordpress.com/2008/12/04/raw-done-right/
There’s lots of posts in the feline nutrition/health category…
Janis,
Make sure to check out catinfo.org and catnutrition.org. You’ll find them very helpful.
Lynette
Hi Lynette – I’ve had my male siberian on a raw diet now for 2 years. It’s somewhat controled the diarreah but not really. Now it’s mostly soft serve with ocassional bouts of watery poo.
You say the first step in to get on a “proper” raw diet like the ones you listed. I’ve been making mine with chicken, calcium (he won’t eat bone), Kitty Bloom for vitamins and minerals and Digest-Aid for probiotics.
Do you have any thoughts on the Kitty Bloom products? The cat really likes the taste but could it be causing the continued diarreah?
Originally I bought the TC Instincts but it made my cat thow up.
I’m getting him tested for B12 and the pancreatic function next month.
Thank you for any thoughts,
Stephanie
Hi Stephanie,
I’m not familiar with the KittyBloom products. A quick glance – I’d worry about it containing all the minerals your cat needs. Consider consulting Dr Pierson (catinfo.org) for her boneless recipe. Also it mentions a derivative of cheese – a problem if your cat is lactose intolerant, I’d think.
I’d consider changing from chicken to rabbit, if that’s an option. I’ve seen amazing results using a raw rabbit diet.
Best of luck,
Lynette
Thanks, Lynette. I remember consulting her site when I was first researching and went with the Kitty Bloom because it was a little easier “all-in-one” solution like the TC Instincts. But I’ve wondered about the possibility of the cheese being a problem.
Also, that’s great advice on the rabbit. I’ve been keeping it in reserve as a new unique protein and it might be time to switch.
I really appreciate all the information on your site!
Stephanie
I am soooo frustrated with begging for help from every vet I come in contact with and getting nothing. I hate that most veterinarians are now 5 or 6 vets in one office and you get who you get, and none of them know, really know your pets as they are not the only person that take care of them! I have a cat that is diabetic, I switched him to an all can diet and he went into remission. WHY VETS DO NOT TELL EVERYONE TO DO THIS IS JUST HORRIFIC! They know this is a preferred diet, but keep us in the dark. My cat was also diagnosed with hyperthyroidism, we took him to a facility that would make his thyroid “normal” again and he would never have to take pills again. WRONG! They overfried his thyroid and now he is severely hypothyroid and has to take a pill every day! He is chronically having problems with constipation and I have begged for some kind of solution……It’s constipation, not rocket science you would think, but I get no remedy. Can you suggest anything for him. He already has enough health issues to deal with, I would like constipation to not be added onto that. He has had normal poops more often than not, but the last month or so I’m having this constipation problem. Thank you for any suggestions. Also, I have 4 cats and they all eat can only.
First, Kim – congratulations for getting your cats on an all-wet diet!
As for constipation, my suggestion would be a little Miralax powder mixed in food. (Or you can mix with water and syringe it orally, but it’s relatively tasteless, most cats will consume it in food.) My girls are both older (around 16 years) and get constipated sometimes. I put a little Miralax in their food. I’d suggest starting with 1/8 tsp to 1/4 tsp per day… increasing to twice daily if needed.
This is not a solution if they are already severely constipated, but it’s a great daily remedy/preventive. It draws moisture/water into the colon, softening the stool.
Best of luck!