Please note: We are not veterinarians and this does not constitute medical advice. If there is a change in your cat's eating habits, it is always wise to seek medical advice and obtain proper diagnostics.
Apart from using medicine (prescription or over-the-counter) there are three basic components of treating GI problems in your cat: food, supplements, and water. Hairballs are also a common cause of nausea and vomiting in cats.
Issues that can cause GI problems:
- What is fed
- How it is fed
- When it is fed
What is Fed
Cats are obligate carnivores (you can read more about this and what it means, here). If cats were in charge of the pet food industry, cat food instructions would likely read, “remove mouse, rabbit or small bird from freezer: thaw and serve.” Anything else is 1) for our convenience, 2) due to our access to feeding resources, or 3) due to the cost of feeding. When our cats get sick, we need to learn how to best balance our time and resources with their needs. So please know that:
- Grains can cause nausea and vomiting.
- Non-grain carbohydrates such as peas or soy-based ingredients can cause nausea and vomiting. This is tricky, because many Limited Ingredient Diets contain peas to raise the protein level and lower the cost. Anecdotally, we’re finding more and more IBD cats reacting to the peas in the food.
- Otherwise high carb foods can cause nausea and vomiting. Many “grain-free” foods simply replace grains with non-grain starches. The problem? Carbohydrate ingestion does not trigger the same gastric secretion as meat-based proteins. A high carb diet can raise stomach pH, leading to improperly digested protein and/or delayed gastric emptying, contributing to nausea and/or vomiting.
- A carb “red flag:” Meat is high in methionine, an amino acid used by many companies as a urine acidifier. If the synthetic version, “DL-methionine” is supplemented, especially if you find it towards the top of the supplement list in commercial food ingredients, alarm bells should go off. The use of DL-methionine in cat food is an indication the food likely does not contain protein primarily from meat or that the food may otherwise be high in carbohydrates. A meat-based diet will be high in naturally-occurring methionine. Those carbs make the entire GI system, not just the stomach, too alkaline, and this can lead to various issues, among them urinary tract health problems and the formation of crystals. Natural methionine is found in meat, one of the reasons a meat-based diet naturally targets the proper pH in cats.
- The many thickeners in most commercial canned foods can cause nausea, vomiting, and GI irritation. Thickeners and gelling agents include carrageenan, xanthan gum, guar gum, locust bean gum, cassia gum, agar agar, tapioca, potato starch, and wheat gluten. This list is not complete, but these are common additives for thickening and gelling. Any or all of them can cause stomach upset and nausea.
- Food/ingredient sensitivities can cause nausea and vomiting.
- Food allergies can cause nausea and vomiting. Grains are a common culprit. A frequently-fed protein can be the cause. This is one reason a variety of proteins in kitty’s diet is so important.
- Kibble is often a culprit. Whether it is problem ingredients, the highly processed nature of kibble, or its impact on stomach pH and motility (including due to being free-fed no matter the quality of ingredients – see Hairballs, below), simply removing kibble from the diet provides relief in many cats.
How Kitty is Fed
- Raise the dishes. Cats normally eat sitting or standing so their throat is at the same height or lower than the stomach. If kitty does have problems with acid reflux, raising the food and water dishes to head-height (while sitting up or standing) can resolve this problem. In Part 1 of the Pepcid series from which this article is adapted, we discussed how acid reflux is not caused by excess acid; it is a problem with muscle tone in the lower esophageal sphincter (the valve that is meant to prevent stomach acid from rising into the throat). By keeping the head elevated and letting gravity work, the raised dishes keep the stomach acid in the tummy. Once there is food in the stomach, the acid is put to work.
- Slow down kitty’s eating. When a cat eats too fast and regurgitates as a result, this is almost always when kitty is fed kibble. Rather than put a rock or ball in the dish to slow down kitty, please just stop feeding kibble. If kitty manages to wolf down food so fast they regurgitate canned, homecooked, or raw food, then portion out smaller amounts and extend meal time to numerous smaller meals over 10 or 15 minutes vs one plop of food in a dish left out for 10 to 15 minutes. (And bless you for having adopted a formerly abused cat or kitty rescued from a hoarding situation, as this is behavior displayed most often by cats in those situations. If your cat is not from one of these backgrounds, if you’ve been writing off vomiting after a meal to kitty eating too fast and you’re feeding raw, home-cooked, or canned cat food, please take kitty to the vet).
When Kitty is Fed
- Feed smaller, more frequent meals. Two meals a day is not ideal for cats. Their systems are geared to eating frequent small meals (in the wild they hunt small prey). Add a meal as late as possible before you go to bed. Reducing the length of time between the last meal of the day and the first meal of the next day often stops overnight “bile pukes” (stomach acid regurgitated from an empty stomach).
- Feed a freeze dried meat treat to kitty when you get up, and/or prior to bed, and/or in the middle of the night, and/or prior to meals. The anticipation of food gets the gastric juices flowing. Giving kitty a protein-based meat treat that puts those gastric juices to work can stop the morning (or overnight) pukes, and can stop the regurgitation of the morning meal. In some cases, a middle of the night treat will resolve pre-breakfast vomiting better than any medicine. For those making a trip to the bathroom in the middle of the night, taking the time to give kitty a treat can improve your cat’s morning – and yours as well. If bile pukes happen during the day, or meal regurgitation is a frequent occurrence, feed kitty a few small bites of freeze-dried meat treats as needed, when you get home from work, or about 10 to 15 minutes before each meal to see if that resolves the problem. Pure Bites, Whole Life, and Grandma Lucy’s are popular brands of single-ingredient meat treats made in the USA.
- Stop free-feeding and move to timed meals. (Better yet, stop the kibble). In cats, indigestible solids (such as hair) are the last items to leave the stomach. They are forced out of the stomach only by the strong peristaltic waves created by hunger pangs. If kitty is never hungry, motility is impaired and waste material does not move through kitty’s system properly. Obviously this can cause nausea. Also, a belly full of hair or improperly digested food can cause a loss of appetite as kitty feels full. (For transition tips and how to help kitty understand the concept of meal time, please see Transitioning Your Cat to Timed Meals.)
- For more on the timing of meals for kitty, please see How often should you feed your cat?
Hairballs are by far the most common cause of nausea, inappetence and vomiting in cats. And yet hairballs are NOT normal. I know, it’s news to many. But a healthy cat does not normally have anything other than an occasional hairball, and tossing a hairball more than twice a month in long-haired cats and more than once every two months in short-haired cats can be indicative of GI disease. A study published in 2014 found that 99 of 100 cats examined for chronic vomiting – including tossing hairballs – had GI disease. Of those 99 cats, 50 had some form of cancer, and 49 had some form of inflammatory bowel disease. Many may still joke about hairballs, but hairballs are NOT a joke.
A primary symptom of hairballs is regurgitating undigested food hours after eating. Prior to this point, kitty feeling full and seeming “picky” about eating can be a subtle sign of hairballs:
- Cats with hairballs often seem “picky” but otherwise fine: they don’t necessarily display any signs of nausea other than wanting to eat but not eating;
- Kitty regurgitating the meal undigested hours after eating is often hungry immediately, and displays no other behavioral signs of illness.
To address hairballs in our cats, it is best to:
- Stop free feeding and feed timed meals (addressed above)
- Stop feeding kibble (feed canned, homecooked, or raw food – food with moisture)
- Feed species-appropriate food (low carbohydrate, no grain foods, with animal-based proteins only, addressed above)
- Forget the petromalt or petroleum-based hairball products. It is best to address hairballs by treating the underlying problem: GI motility. If a species-appropriate, moist food fed in timed meals does not resolve the problem, please see Hairballs: How Best to Treat Them.
As with people, in cats food itself is frequently the root cause of nausea and vomiting (and for those with it, their diarrhea). Medicine is not the best answer when food is the problem. Medication is an important tool, and has its proper time and use. But altering what, how, and/or when we feed is often all that is needed to make kitty feel better. Feeding fresh food where we control the ingredients is sometimes needed (and EZcomplete fur Cats is the perfect option!), and in our opinion, always preferable. Our cats are obligate carnivores. Their physiology is designed to have a low stomach pH and to eat animal-based nutrition. Our cats are descended from desert animals and while some may drink water, cats do best when fed a moist diet, better yet, a fresh food diet. In many instances, identifying a problem ingredient can be difficult, and it is easiest to help our kitties feel better by simply getting off the commercial food merry-go-round. Transitioning is not always easy, but there are many tricks, tips, guides and resources to help. Persistence ALWAYS pays off. The road to good health is not a race, it is a journey.
Funaba et al 2003. Effects of a high-protein diet versus dietary supplementation with ammonium chloride on struvite crystal formation in urine of clinically normal cats, Am J Vet Res, Aug; 64(8):1059-64 (2003).
Funaba et al 2004. Evaluation of dietary carbohydrate on formation of struvite crystals in urine and macromineral balance in clinically normal cats, Am J Vet Res Feb::65(2):138-42 (2004).
Norsworthy et al 2013. Diagnosis of chronic small bowel disease in cats: 100 cases (2008-2012), J Am Vet Med Assoc, Nov 15;243(10):1455-61 (2013).
Plain English summary, by Gary Norsworthy, DVM for Veterinary Practice News, January 2014: Chronic Vomiting in Cats isn’t Normal After All.