iPet’s Ally Weekly Q&A Round-up 08-31-20: Is Bile Salts a possible hidden resolution for acid reflux?

iPets Ally Ultimate Q&A Round-up 08-31-20

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Hello! I’m Dr. Ruth Roberts, your pet’s ally. Wow! We have a lot of questions very insightful questions which I think it’s going to help elucidate a lot of things for many of the group members. So, let’s start.

The Dog Digestive System: Things you need to know
Almost every veterinarian when asked, will tell you that a healthy digestive system is a marker for a healthy dog.
So, the thing that happens first is that your dog sees food and what that does, is create saliva in the mouth and then the dog or cat hopefully chews the food. Now, what happens with kibble digestion is they tend to just sort of scarf the whole thing down without chewing it and so the first step of physically breaking down the food never happens and it doesn’t get mixed in with the saliva. The next step is it hits the stomach and when the brain sees the food and the saliva starts to be produced, hydrochloric acid should be produced in the stomach as well so that by the time the food gets there, it can be digested properly and the bugs that may have traveled along with the food is killed and the breakdown process certainly starts.
When your dog has seen the food and is chewing it, that cues in the pancreas to start producing digestive enzymes and cues the gallbladder to start releasing bile into the small intestine so that by the time the food comes out of the stomach into the duodenum, which is where the bile duct and the pancreatic duct are, the food hits these other digestive enzymes as it travels into the small intestine as a slurry, it can be better digested and the nutrients can be well assimilated. So, from there, the food travels through the small intestine and all of the nutrients are absorbed then it goes next into the large intestine.
Now, in the large intestine, the vast majority of what’s happening are two things; One, this is where the probiotic organism that are either given through capsules or fermented foods, things of that nature, live. They start to digest the insoluble fibers that we and our pets cannot eat. The other thing that happens in the large intestine is water is absorbed from that ingesta and then that’s how you go from eating a slurry of food to having a relatively solid stool come out.
With aging, there’s a lot of things that can go on and one of those is that the gut health starts to decay and the villi – the little fingers in the small intestine that absorb the nutrients and then further process the food molecules, tend to get blunted with leaky guts syndrome. If your pet had parvo or hookworms or round worms or something like that, that’s going to really mess up those villi that’s where things like L – Glutathione starts to come in handy. With the colon as well as the small intestine, when we age, we can also have neurologic issues with them which is more of a problem in cats but this is part of what may happen with constipation, we retain the stool in the colon too long, too much water is absorbed and it becomes difficult to pass.

Is Bile Salts a possible hidden resolution for acid reflux? And what does Gallbladder sludging means?
So, what do bile salts do and what does gallbladder sludge mean? Gallbladder sludge is seen on an ultrasound. Looking at the gallbladder in the liver, you’ll see literally a white line of goo down underneath and then a black color which indicates a clear fluid, what that means is that the biliary system in the liver is inflamed and it is producing mucus and dropping that mucus down into the gallbladder so that’s what we call sludge.
This is not a biliary deficiency but instead, the biliary system within the liver itself is irritated and so adding in a digestive enzyme may or may not be helpful. In many cases, I’ve seen digestive enzymes actually worsen GI symptoms so I would not go with a super heavy-duty digestive enzyme supplement because it can actually end up creating more stomach distress and things of that nature. Interestingly, the drug that we end up using to treat biliary sludging is ursodiol which is made from a synthetic version of a polar bear bile salt. So, if you’re seeing biliary sludging, that would be the appropriate medication. If your veterinarian saw bile salt sludging then I would ask them about whether ursodiol wouldn’t be appropriate.

Would Chiropractic Adjustments be helpful in treating regurgitation or esophageal reflux? And why does reflux get worse at night?
For concerns related to the regurgitation and esophageal reflux, one might wonder if chiropractic adjustments can be helpful? It may well be. I know some folks that have had been adjusted themselves or have had their pet adjusted and then the GERD issues go away.
What chiropractic aims to do is adjust the vertebrae and the other bones that are impinging on nerve roots and so the idea is that there’s a nerve root impingement that’s creating the GERD issues. Now, how does that differentiate between acupuncture? Acupuncture would be treating more of a pattern of disharmony and so that’s going to approach it more from an internal kind of root structure. I hope that’s helpful.
Now, the theory on why reflux get worse at night is that the stomach is empty. Acid reflux tends to happen physiologically and because in that sequence of digestion the right steps didn’t happen, the stomach acid didn’t get produced and the signal should’ve been chewing and coming down into the stomach but because many dogs bolt their food, the stomach never gets the stomach acid turned on and so what happens at night is the food is moved into the small intestine and the acid production finally gets turned on while the stomach is empty.
There are a couple of things you can do to lessen the reflux symptoms; One is feeding more frequently because it helps reduce the acid reflux symptoms because the goal is to actually put food into the stomach when the acid production is actually happening. The other thing is that if you have given things like acid reducers, it does take a long time to get the stomach acid production back on track. A lot of people will use betaine for themselves but it gets a little tricky with dogs because they can’t tell us when they have heartburn.

Is lean meat good for dogs?
Chicken, Turkey, lean ground beef, and chuck steak or roast are animal – based proteins, which help dogs grow strong.
Now among all the meats mentioned, chuck roast frankly, is the least expensive cut but what’s important is that the leaner you go, the better. So, round roast is also awesome and then as I was saying, the leaner you go with conventional meats, the less pro – inflammatory it is so the leanest you can find is definitely the best.

What are the best pain medicines for Kidney disease?
There’s a couple of things you can think about; one is galliprant, it actually is a non – steroidal anti – inflammatory. However, it is not supposed to be as tough on the kidneys so that’s one. If your pets are really having a bad day, that’s something you can ask your veterinarian about. The other ones are CBD oil, tramadol, and gabapentin and if it’s just not working then I wouldn’t use it.
Now, you’re going to be kind of feeling your way through with any of these prescription medicine. So, some she reacted so badly to tramadol so it’s one of those deals for many pets, it will help provide pain relief but it definitely is sedating. You can also try meloxicam; the beauty of that drug is that you can really titrate it to what’s effective. The other thing you can try is the Assisi loop that’s something we are yet to try but a client of mine said that it has been a miracle for all three of her dogs. I hope that helps.

Which among the grape seed extract and grape juice is toxic?
So, it’s thought that the skin of the grapes has the toxic part. A grape juice product may be a little dicey and in addition, the grape seed extract is generally considered to be sort of an antibiotic.
I think that using an antibiotic on a regular basis is not going to do much for gut health but if you use it topically and then go for a walk that should be okay. Personally, I would avoid the grape juice supplement because it is concentrated and has the potential to create issues. The other interesting things about grape toxicity is that initially, the reports were dogs eating huge quantities something like 2 kilos of grapes for a 40 pound dog and indeed, we can get grape toxicity if we eat something like 10 pounds of grapes at one go but I met a woman that said that she felt that it was the fluoride anti – fungal medicine that they put on the grape that was actually creating the symptoms.

What’s the difference between reduced glutathione and liposomal glutathione?
Now, here’s the deal about glutathione, this is not very effective, this reduced glutathione, it is very difficult to get enough glutathione into the system and so a liposomal glutathione is really a much better bet. It is not cheap but it does work. So, for pets with liver issues, I will often recommend this because it’s sort of the master antioxidant for the liver, this tends to be very helpful. It has been very helpful as far as reducing liver enzyme issues and then often you can make a maintenance of milk thistle and maybe a couple of other things but that may be helpful.

What are the different types of collagen? And how do each type works?
Here’s the really interesting thing about collagen, there’s something like 16 or more different types of it and what we tend to have access to most frequently, is Type 1 and Type 3 and those are the most common because of the vanity effect mentioned.
Type 1 collagen is important in bone, skin, and connective tissues and it is also an interstitial matrix collagen organized in fibrils. Interstitial tissues are actually what allows your lymph to flow through and what connects tissues to each other and kind of holds things in place.
Fibrils are bundles of fibers running in particular directions so for those of you that eat meat and that you’ve trimmed a tenderloin let’s say, that big white tissue is the connective tissue and you can see some of the bundles run in different ways and what that does is create an incredibly strong matrix to hold that muscle together. A tenderloin is essentially your backstrap muscle and so it’s doing a lot of work keeping the spine erect, moving, flexing, and all of those things.
Type 2 collagen is the main component of cartilage so for those of us that are concerned about joints, intervertebral disc, things of that nature, this is the one that’s super important. Now, Type 3 collagen is another interstitial type collagen. It’s hard to find a product that actually has all three of those together. So, there’s collagen and the tissues there but to get all five types of collagen, you have to have all these different types of protein sources essentially. Now, theoretically, the collagen is down below a particular dalton size so that it will not be detected by the immune system.
We’ve also got Type 1, Type 2, Type 3, Type 5, and Type 10. So, what are Type 5 and what are Type 10 collagen? Type 5 collagen is a fibular collagen and it’s essential for allowing Type 1 and Type 3 to do its work so that also contributes to the bone matrix, the cornea, so for anybody who’s had a dog with eye problems, this is probably a good thing to add in and then the interstitial matrix of the muscle, liver, lungs, and placenta. So, placenta not so much but what this does is help the collagen that we want to repair tissues and keep it happy. This allows it to form in normal rows right. Now, Type 10 collagen is considered to be a network forming collagen and it is often expressed in the chondrocytes the cells that produce cartilage in the hypertrophic zone of the growth plate which doesn’t apply unless you’re sort of a growing dog and then in the calcified zone of articular cartilage of long bones. So, if we think about the knee, we’ve got this cartilage covering over the top of the tibia, a cartilage blends into an osseous or bony type tissue so Type 10 collagen is going to help that cartilage continue to sit tightly on the bone and the new cartilage to form in place so as that joint heals, things look better. I hope that makes some sense.
The product we’ve got up on the store is a Type 1 and Type 3 collagen supplement and while that’s going to be helpful for skin and bone, and things of that nature, and to some degree to the joints, it’s not as complete as it should be so we’re going to be looking for some other stuff.

What is the upside of feeding your dogs a high – fat diet?
The upside of high – fat diet, for aging pets, is that it helps them feel full that’s when their little brains know they’re full so if you’re feeding a low – fat diet, this is when they tend to be chow hounds and they’re absolutely after you constantly.
Now, there’s a lot of information coming out that fat’s been vilified. For instance, in cardiovascular disease, high – fat diets lead to hypercholesterolemia well, it turns out that’s absolutely not true. What happens is this chronic inflammation can increase your cholesterol level but the thing that they’re discovering is that it’s not so much that the diet is too high in fat and that’s what’s creating the heart disease. It’s the chronic inflammation so there’s a great deal of evidence that as we age, our brains need more fat to maintain the myelin, the wrapping insulation so I think the idea of restricting fat and protein in older pets really is a very poor one so I hope that makes sense.

What are the possible treatments for pre – surgery anxiety in dogs?
Assuming that your pup needs a biopsy of a lump and but he’s really sensitive about needles so you might be wondering if lidocaine is a good option. Typically, there’s not a lot of topical lidocaine used in veterinary medicine because it simply doesn’t seem to work very well.
Now, what can help kind of reduce the anxiety a bit? Putting an ice pack on top of the lump for say 3 to 5 minutes immediately prior to sticking it is going to numb it up a little bit. The other thing you can do is if he or she really gets anxious about seeing the needle come towards him or her, then you can do shield the eyes, use adaptil, things of that nature, or lavender oil to just kind of calm things down. Personally, I would try the ice trick first, and if your vet doesn’t have one, just bring a little ice pack with you and stick it on the lump for a few minutes’ prior. I hope that helps.
I think I have all of the questions covered and you all did an excellent job this week of getting all these questions out there. Again, I’ll be talking with you on Tuesday instead of Monday as we’ll be travelling on Monday so we’ll see you Tuesday at 11 o’clock. Do watch for the Labor Day sales coming up, we’ve got a new storefront coming up as well which I think is going to make life a boatload easier for you to find what you’re looking for. As always, take good care and remember your pet’s best health starts in the bowl. Thanks so much!