On Monday, February 7, misinformation about animal health came from a surprising source: the American Veterinary Medical Association (AVMA).
“FDA to end updates on dilated cardiomyopathy and grain-free food,” AVMA writer Coco Lederhouse’s headline declared. She explained that, the FDA had decided that the reports “do not supply sufficient data to establish a causal relationship with reported product(s).” In other words, the reports don’t indicate that there’s a problem, so the FDA is no longer going to provide new reports.
Coincidentally, on the same day of the AVMA’s story, preeminent veterinary nutritionist Lisa Freeman at Tufts updated her highly regarded Petfoodology blog with an article that makes the best case possible for the urgent need for these records to be updated consistently and made public.
The AVMA’s press officers declined to provide contact information for Ms. Lederhouse, whose name is in the byline of the AVMA story. TCR contacted president Lori Teller, chief veterinary officer Gail Golab, head of policy Isham Jones, and four different press aides at least twice each over a three day period for comment regarding the erroneous story and did not receive any response.
“Incredibly disappointed in this misleading headline from the AVMA News service on dilated cardiomyopathy,” a veterinarian who identifies herself as “Dr. C” and publishes the blog “Doc of All Trades” posted on Facebook. “Not only does it mischaracterize the position of the FDA in it’s [SIC] subheading, the only research it links on the issue is a heavily flawed survey study funded by an industry group hired by pulse legume lobbyists. This fails to represent the scope of research done on the issue which has continued to implicate certain diet types.”
Yes, the FDA has stated its intention to end updates, as it did prior to the most recent update in December 2022 — the real reason for which was TCR’s original longstanding FOIA). However, only a court can ultimately decide whether it’s lawful for a federal government agency to withhold records. In this case, the records are not only frequently requested, but of urgent public concern. Moreover, the FDA has never claimed that these records are exempt from disclosure.
Top Vet Lisa Freeman Updates Blog Same Day As AVMA Blunder
We’re quoting Dr. Lisa Freeman’s article extensively here, and we’ve added italics in places for emphasis. She published it on the same day of the AVMA’s erroneous story!
Diet-associated dilated cardiomyopathy: The cause is not yet known but it hasn’t gone away
Diet-associated DCM has been devastating both for the affected dogs and their owners. Veterinarians working closely with these patients have been impacted by the distress the diagnosis has caused owners because of the severity of the disease, cost of treatment, and sadness when a beloved dog is sick or dies. But, in addition, most owners I’ve worked with thought they were feeding their dogs the best food possible, only to find out that the diet may have contributed to their dogs’ heart disease. While the number of cases may have decreased, it hasn’t gone away. Cardiologists and other veterinarians dealing directly with these dogs and owners who have lost dogs to this disease know it’s all too real.
The FDA’s latest update
The most recent update from the FDA provided good background information on this ongoing issue, addressing many of the common questions that veterinarians have been getting. Of most interest to those of us actively engaged in researching or following this issue was the update on the number of reports the FDA has received. As of July, 2020, more than 1100 dogs with DCM have been reported to the FDA (and over 20 cats). In the latest update (with numbers as of November 1, 2022), another 255 dogs with DCM had been reported to the FDA, bringing the total number of dogs with DCM reported to the FDA to 1382.
Some may see the lower number of recent reports as an indication that diet-associated DCM is disappearing, which could be happening due to changing diet formulations or the decreasing popularity of grain-free diets. However, I see this as another 255 dogs being reported to the FDA (that’s still about one dog every three days). Not all cases of diet-associated DCM get reported to the FDA. Diagnosing DCM requires an echocardiogram (ultrasound of the heart) which is not always performed. Reporting a case to the FDA is time-consuming. Veterinarians have become busier since the pandemic and may not always report cases (and, while owners can submit reports, they may not be aware of the importance of doing so). So, while the lower rate of reports to the FDA might mean that fewer cases are occurring, it might just reflect fewer veterinarians and pet owners reporting DCM cases.
Spectrum of disease
DCM represents an advanced stage of heart disease, but it appears that the heart starts to get sick long before obvious DCM has developed. In fact, it’s important to note that the FDA’s numbers refer only to dogs with DCM, and not less severe forms of the disease. In its 2019 update, they stated: “We did not include in these numbers the many general cardiac reports submitted to the FDA that did not have a DCM diagnosis. However, this case information is still valuable, as it may show heart changes that occur before a dog develops symptomatic DCM.” Studies now suggest that dogs with less severe forms of the disease appear to represent the same disease process – just an earlier stage. Dogs with less severe stages of the disease have similar improvements in heart size and function after diet change. In fact, when detected early, dogs with less severe forms appear to have a better response to diet change than dogs with DCM that are having symptoms.
Even in dogs thought to be healthy, researchers have now identified negative effects of non-traditional diets on the heart, including a larger left ventricle (the main pumping chamber of the heart), weaker contraction of the heart, higher levels of a blood marker reflecting damage to the heart muscle, and more dogs with irregular heartbeats. And while studies of DCM suggest worse effects the longer dogs have been eating non-traditional diets, one study showed that in dogs eating a high pea, plant-based diet, the left ventricle increased in size after only three months. Therefore, the number of DCM cases reported to the FDA might be just the “tip of the iceberg,” representing only the most severely affected dogs.
Common toxins and excessive levels of nutrients that can be associated with DCM also have been investigated and have not been identified thus far in the dogs with DCM or in the associated diets. More unique, high-tech approaches to identifying the cause of this problem are beginning to be published (for example, our recent foodomics and metabolomics studies), and additional research is underway by many researchers. Thus far, studies suggest that high levels of peas and lentils in the diet seem to be the strongest predictor for development of diet-associated DCM, and numerous compounds are being investigated to help identify the specific cause and mechanism. While the specific cause has been challenging to identify, our current hypothesis is that compounds in these ingredients may have toxic effects on the heart.
Diet-associated DCM: Where are we now?
- The ingredients most likely at the heart of diet-associated DCM are peas and other pulses, although more research is needed on other ingredients. The presence or absence of pulses cannot be predicted based only on the diet’s name or whether the diet contains grains, so the full ingredient list of the product must be reviewed. If the diet contains pulses (for example, peas, pea protein, lentils, chickpeas, etc) in the top ten ingredients (or multiple pulses anywhere in the ingredient list), it might put some dogs at risk for heart problems.
- When we diagnose dogs and cats with DCM (or earlier changes, such as reduced contraction of the heart, enlarged heart chambers, or irregular heartbeats), we recommend changing their diet to a reduced sodium diet that does not contain pulses or potatoes/sweet potatoes in conjunction with appropriate medical treatment. However, it is important to work with your veterinarian to determine the best medical and nutritional treatment for each individual pet.
- If your dog develops DCM, please report it to the FDA to help the ongoing investigation.
Cardiologists continue to diagnose dogs with diet-associated DCM, especially in regions where non-traditional diets are common. My colleagues and I (and many others) are working hard to solve this challenging and deadly disease affecting dogs which, unfortunately, has not gone away.
AVMA Stays Mum
The AVMA’s leadership, including president Dr. Lori Teller and chief veterinary officer Dr. Gail Golab, declined to comment, as did several individuals in the organization’s press office, when asked if they were concerned about the AVMA’s credibility in light of the mistaken implication in the story that DCM is not a problem worth reporting data about and its mistaken assumption that the FDA could make that decision unilaterally.
The AVMA, which is the main trade group for veterinary professionals, representing approximately 100,000 members, is a deservedly prominent and credible source for information about the veterinary profession and animal health. A significant portion of all data available on veterinary medicine, including economic data, is at the world’s fingertips because the AVMA has undertaken the painstaking work of collecting and reporting the data. The AVMA also publishes the Journal of the American Veterinary Medical Association (or JAVMA) which is one of the most widely read and highly regarded science journals.
Dr. Freeman’s article in full: