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PEER REVIEWED 20 NUTRITION NOTES Dysbiosis of bacterial flora in the intestines can lead to diarrhea and may be present in 50% of dogs with diarrhea. Dysbiosis is often associated with exocrine pancreatic insufficiency (EPI). Laboratory evaluation involves a normal to high trypsin-like immunoassay (TLI) with a low B 12 and high folate. These patients may do best on either a low-residue or fiber-enhanced diet. Additional probiotics, prebiotics, and antimicrobial therapies may also be needed. Pancreatic Disease Pancreatitis is the most common disease of the pancreas and can be acute or chronic in nature. Patients with acute pancreatitis patient will benefit from early enteral nutrition. Unless vomiting is uncontrollable with anti- emetics, small amounts of nutritional support should be given as soon as possible. Typically a nasoesophageal feeding tube is used and a liquid product enteral product is used. For chronic pancreatitis in dogs the main nutrient of concern is fat. A low-fat diet is best and the degree of fat restriction will be dependent on case severity. Protein can also stimulate the pancreas, so high protein diets should be avoided. Cats with acute pancreatitis can be treated similar to dogs with a low-fat, moderate protein diet. Cats with chronic pancreatitis typically do not require diet changes as diet does not appear to be a factor in their disease progression or outcome. The exocrine pancreas secretes numerous enzymes to digest fats, proteins, and carbohydrates. Animals must lose approximately 90% of their functional capacity before exocrine pancreatic insufficiency (EPI) produces clinical signs. EPI characterized by chronic small bowel diarrhea with steatorrhea and voluminous diarrhea. Patients also have ravenous appetite with weight loss. The best treatment for EPI is supplementation with pancreatic enzymes. Diet modification doesn't appear to make much difference in these cases. However, absorption of fat-soluble vitamins (A, D, E, and K) may be impaired and cobalamin may need to be supplemented until clinical signs are well controlled. Large Intestinal Disorders Colitis is a common disorder with many causes. In general, high-fiber diets are helpful with colitis to support the growth of beneficial bacteria and to help with water balance. If a high-fiber diet does not improve large bowel diarrhea, a low-residue diet may be used to minimize nutrients reaching the colon. Finally, if the diarrhea is not responsive to fiber or high digestible diets a low-allergen diet may be used in case there is an immune-mediated component to the disease. Flatulence is an annoyance to pet owners and the dietary goal is to reduce intestinal gas production. Low-residue diets with a fat content lower than their current diet may be helpful. Highly fermentable carbohydrate sources should be avoided (beans, cruciferous vegetables). Alpha- galactosidase (Beano) may also decrease flatulence by improving digestion of carbohydrates. Outdoor exercise may also help expel gases in a less offensive environment. Prebiotics and Probiotics Prebiotics are starches and fibers resistant to digestion. Examples include: Fructooligosaccharides (FOS), Mannanoligosaccharides (MOS), Galactooligosaccharides (GOS), Fermentable fibers. Indications for prebiotics include antibiotic-associated diarrhea, traveler's diarrhea, gastroenteritis, normalizing bowel function, colitis, and irritable bowel problems. According to the food and agricultural organization (FAO) and the world health organization (WHO), probiotics are defined as "Live microorganisms which when administered in adequate amounts confer a health benefit on the host." Ideally probiotics should originate in the species being treated, be nonpathogenic, be resistant to digestion by gastric acid and intestinal enzymes, able to adhere to the intestinal epithelium, and be capable of influencing host immune responses. Probiotics can promote normalized microflora and may have role in allergies. They can also help to inhibit binding of pathogenic bacteria. Many products may not contain the numbers of viable bacteria they claim. References 1. Yunginger JW. Food antigens. In: Metcalfe DD, Sampson HA, Simon RA, eds. Food allergy: adverse reactions to foods and food additives. Boston (MA): Blackwell Scientific; 1991:36–51. 2. Raditic DM, Remillard RL, Tater KC: ELISA testing for common food antigens in four dry dog foods used in dietary elimination trials. J Anim Physiol Anim Nutr 2011, 95. Angela Witzel Dr. Angela Witzel performed her DVM, PhD, and residency training at the University of Tennessee College of Veterinary Medicine. Dr. Witzel is a Diplomate and former President and Chair of the Board for the American College of Veterinary Nutrition. She is also a Clinical Associate Professor of Nutrition at the University of Tennessee Veterinary Medical Center. Her areas of research interest include adipose hormones, body composition, and obesity management.