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Please note: We are not veterinarians and this does not constitute medical advice. If you wish to begin use of probiotics, especially if due to a medical condition of your pet, please consult your trusted veterinarian prior to use.
We are learning that the symbiosis between host and bacteria is so deep and interdependent that bacteria affect every aspect of our being: how well our immune systems function, the nutrition we metabolize, obesity, allergies, oral health (& halitosis) – even our moods – all impacted by the make-up of our bacterial communities, our “microbiome.”
An imbalance of “healthy” vs “unhealthy” bacteria is called “gut dysbiosis,” or “gastrointestinal (GIT) dysbiosis.” And gut dysbiosis has been linked to at least inflammatory bowel disease, liver disease, chronic kidney disease, chronic pancreatitis, development of asthma & allergies, and cancer. Every organ in our body, our joints, our cardiovascular system - all can be affected by chronic inflammation. The more research is done, the clearer it becomes that host bacteria is key in managing inflammation, and controlling inflammation is key in prevention or management of many chronic diseases (especially inflammatory bowel disease, becoming ever more prevalent in our cats and dogs).
While the use of probiotics to help prevent or manage inflammatory diseases is in its infancy, recent research has made it clear that we depend on our bacteria for our health and that host bacterial balance is directly related to the health of immune system – not at all surprising as the gut accounts for 70% - 80% of immune system function. (Please see The Problem with Pepcid and Other Antacids).
According to a report published in September of 2015, the microbiome (host bacteria of mammals) is so important, it can be thought of as another vital organ: “It is comparable to the immune system in as much as it is made up of a collection of cells, it contains a 100 times more genes than the host, is host-specific, contains heritable components, can be modified by diet, surgery or antibiotics, and in its absence nearly all aspects of host physiology are affected.”
As it relates to IBD, according to Dysbiosis in the Pathogenesis of Pediatric Inflammatory Bowel Diseases, (Comito and Romano, 2012),
A condition of “dysbiosis”, with alterations of the gut microbial composition, is regarded as the basis of IBD pathogenesis. The human gastrointestinal (GI) microbial population is a complex, dynamic ecosystem and consists of up to one thousand different bacterial species. In healthy individuals, intestinal microbiota have a symbiotic relationship with the host organism and carry out important metabolic, “barrier,” and immune functions. Microbial dysbiosis in IBD with lack of beneficial bacteria, together with genetic predisposition, is the most relevant condition in the pathogenesis of the pediatric IBD."
Since that article was published in 2012, enteric pathogens and gut dysbiosis are now considered a definitive precipitating factor in the development of IBD. There are few studies (though thankfully this body of literature is growing!) of the microbiome in cats and dogs, but the body of work is growing, and the studies examining the microflora of healthy vs IBD cats found significant differences in gut microflora. A study recently published in dogs indicated the ability to diagnose IBD from typing the bacteria of the stool. This indicates a likelihood of the same route of pathogenesis in cats and dogs as in humans. Please see the studies provided in the Further Information section at the end of the article for more information.
Inflammation and impaired gut motility: hairballs and vomiting are not normal. One of the impacts of inflammation in IBD is impaired (reduced) motility (“hypomotility”). Most think of diarrhea when they think of IBD, but it can also mean constipation, vomiting, and in cats, hairballs. In dogs, while megaesophagus is the most common cause of vomiting, in cats, chronic hairballs are a sign of hypomotility. (Chronic hairballs as defined by the study author, Dr. Gary Norsworthy, are vomiting hairballs more than twice a month in any cat, or every two months or more in short-haired cats). This can be an “early warning sign” of IBD. Regular vomiting of hairballs should not be ignored and it should not be considered normal. Probiotics may address the healthy populations of gut bacteria, thus reduce inflammation, and work to restore improved motility. But remember: this took time to develop, and it will take time to resolve – and the cause of the gut dysbiosis (often diet and use of antibiotics being primary culprits among many potential causes) must also be addressed. Probiotics are important, but not a cure-all; they address one specific problem, but not the set of circumstances that created that problem. The most important component of addressing gut health is diet. What our dogs and cats eats influences their gut bacteria. It should come as no surprise that a fresh food, species-appropriate diet fed in its natural (raw) state provides the healthiest microbiome.
Many people and vets, when dealing with pets with chronic vomiting or diarrhea, take a few well-known steps to address the problem: limited ingredient diets, prescription hydrolyzed (easily digestible) diets, antibiotics, and steroids. But these address the symptoms, not the cause. These may enable a cat or dog with impaired intestinal function to resolve the symptoms, but they do not address the underlying cause of the inflammation or motility problem – the balance of healthy vs unhealthy bacteria and how that came to be.
So how do we ensure a healthy gut flora in our pets – as this is so important to ALL pets, not just pets with IBD? How do we keep their immune systems functioning at their peak? Make sure they have the flora they need to properly metabolize the food they eat and prevent inflammation?
1) Feed a fresh, human grade, biologically appropriate diet to our carnivores, as a proper pH throughout their entire system is the first, most important step to a healthy bacterial balance, and gut dysbiosis can be precipitated by changes in the GI tract pH environment. Diet ingredients, food processing, cooking, species-inappropriate foods (carbohydrates in particular), dry vs wet foods vs raw, the macronutrient content – all of these things impact gut microflora. This means feeding our pets the fresh meat-based diet they are meant to eat. Yes, raw is preferable to cooked, as discussed in our article, "Raw or Cooked? Which Should I Feed and Why?" Our pets do not require their meat be cooked, they are well designed to manage bacterial loads we can't. If you need to cook during your transition or you are not comfortable feeding raw, please either sear the outside of the meat (as this is where any bacteria is located), leaving the inside raw; or cook with low temperatures and moist heat (Yes, EZcomplete premix can be used with raw or cooked boneless meat).
2) Minimize the use of antibiotics (e.g., do not use them prophylactically). Notably, Dr. Martin Blaser of New York University’s Langone Medical Center has warned that antibiotics’ impact on gut bacteria may be permanent — and so serious in its long-term consequences that medicine should consider whether to restrict antibiotic prescribing to pregnant women and young children. “Early evidence from my lab and others hints that, sometimes, our friendly flora never fully recover [from antibiotic use]. These long-term changes to the beneficial bacteria within people’s bodies may even increase our susceptibility to infections and disease. Overuse of antibiotics could be fueling the dramatic increase in conditions such as obesity, type 1 diabetes, inflammatory bowel disease, allergies and asthma, which have more than doubled in many populations.”
But is minimizing use of antibiotics and feeding a fresh, human grade, biologically appropriate diet enough? We don’t know, the research does not yet exist. We have seen cats and dogs weaned to raw develop inflammatory bowel disease, pancreatitis, and chronic kidney disease (in cats) and exocrine pancreatic insufficiency (in dogs) – all diseases we know are related to inflammation and gut dysbiosis. How does that happen? Are we missing something? Apart from antibiotics, dewormers, vaccinations, the quality of our factory-farmed meats, toxins to which our pets are exposed in our homes and outside, and even their drinking water, there is a glaring component missing from the modern diet: healthy bacteria and fungi, and this we can address.
3) Probiotics. Studies of the microbiome and its role in health are exploding. And pet parents FINALLY have a tool to provide our pets with species-appropriate probiotics: the Gut Restoration kit of AnimalBiome. Our next best option is human grade or quality pet probiotics - billions of them, so enough survive your pet's strong stomach acid (with 10x the concentration of hydrochloric acid compared to the digestive juices of a human) to provide the benefits where needed in the intestines. Cats and dogs have very short digestive tract-to-body lengths. As obligate carnivores, cats do not naturally consume anything we think of as fiber, and physiologically, they are not “built” to ferment fiber in the gut.
How, then, do cats and dogs sustain healthy bacterial populations?
1) For cats, interestingly, a study in cheetahs indicates the presence of undigested tissue, such as skin, bone and cartilage, may actually act as a kind of “fiber” in the diet of cats. The study found that whole prey consumption was associated with many changes in the gut associated with fiber fermentation in human guts.
2) I posit that in the wild, cats essentially gets a dose of “probiotics” with every meal by eating the stomach contents and digestive tract of their small prey. The ancestor of dogs, the wolf, may not eat the stomach contents of their prey, but they do consume the rumen (tripe). Unprocessed, green tripe is an extremely rich source of lactic acid bacteria. Thus our hunting wild dogs and feral cats would normally, naturally have a constant supply of fresh bacteria to feed their gastrointestinal tracts, their microbiomes. The diet we feed our cats and dogs, even those feeding fresh food, is often devoid of healthy bacteria - "probiotics" - unless we supplement them. The addition of probiotics to every dog and cat's diet may be an important contributor to their long term health. If one cannot afford to use the Gut Restoration kit of AnimalBiome every year or two, at a minimum, a course of probiotics is recommended during and for at least a month after antibiotic administration (and no, not just E faecium, which most vets provide via a Purina product).
How do we provide species-appropriate probiotics to our pets? Interestingly, most articles on probiotics for pets recommend using pet probiotics - as if the strains of bacteria sold in products labeled for pets are different than those in probiotics sold to humans. Yes, there may be an emphasis on different strains, but make no mistake, they are not cultured from dogs or cats. (The only one already widely commercially available in the market is FortiFlora. This strain of E faecium, developed and market by Purina, is cultured from dogs. But it is one strain, not very much of it, and it is not the primary ingredient in the probiotic). But of course every species has a microbiota that is unique. Ideally, we provide bacteria derived from cats to cats and bacteria derived from dogs to dogs for best results. As mentioned, this is an emerging field of science, and currently there is only one commercially available way to do this as previously discussed.
The products for both dog and cats by AnimalBiome are one of the most exciting developments in pet health we have seen in a LONG time. Called the Gut Restoration pill, it is a fecal microbiome transplant pill, "FMT Pill" for short, or "Poop pill" by those involved in the project before the product had a name. This capsule brings the only opportunity for truly species-specific bacteria to be easily administered orally. Freeze dried stool (screened for pathogens) from healthy dogs and cats with a microbiome of proper diversity is encapsulated. We may cringe, but this is simply a form of probiotic. It can also be thought of as a fermented food. (Dogs certainly snack on poop without our purchasing it. The difference, of course, is we know the diversity of bacteria in the FMT pill is healthy for our pets). The results seen by a number of early adopters in our Raw Feeding for IBD Cats facebook group have been, for the most part, quite remarkable.
For those unable to afford the AnimalBiome product, one of the lead researchers in the field of pet microbiomes, Jan Suchodolski D.V.M. of Texas A&M, feels that probiotic selection for use in pets should be based on researched strains [in humans], not whether or not the probiotics are pet-specific, and writes “studies have shown that human or dairy developed probiotic strains are capable of conferring health benefit across species. At this point there is no proven benefit of using a canine or feline specific strain.” If you have tried a pet probiotic and it “didn’t work,” it was likely the wrong strain(s) or not enough colony forming units. Pet probiotics tend to have very little active colony forming units compared to human probiotics, and the (lack of) quality in many pet probiotics (apart from the low, typically ineffective quantities) is one of the main reasons to consider using human grade probiotics. As to doses? This is a very imprecise science at the early stages of research. Too few colony forming units will simply do nothing: too many may cause diarrhea or GI upset. It is best to work with a holistic veterinarian to determine what your pet needs.
A potent source of probiotics for ourselves and our pets is homemade kefir. Kefir is one of the most powerful, natural source of beneficial probiotics available. It is inexpensive and easy to make. Please see our article, Kefir for Pets.
For cats and dogs with IBD (especially when diarrhea is present), in addition to a bacterial probiotic or the FMT pill available only from AnimalBiome, consider the addition of a yeast-based probiotic, Saccharomyces Boulardii. This can be a critically important addition to your pet’s diet. S boulardii stops the replication of pathogens; it stimulates enzyme production by the intestines; and it has direct anti-inflammatory properties among many other benefits. It is not just for the management of diarrhea, it helps the immune system manage inflammation and it aids your pet's healthy bacteria in repopulating the intestines. For the science of S boulardii in IBD and gut health, please see "S boulardii, A Review of the Science."
PLEASE NOTE when S boulardii will NOT work:
- If your pet’s B12 levels are low (common when there is intestinal lymphoma or inflammatory bowel disease), S. boulardii will not resolve the diarrhea. B12 must be supplemented under vet supervision to bring blood serum levels back to normal.
- If your pet has exocrine pancreatic insufficiency (“EPI”), S. boulardii will not resolve the diarrhea. Prescription pancreatic enzymes must be used under vet supervision to treat EPI.
- If your cat (or dog) has diarrhea as a result of hyperthyroidism, S. boulardii will not resolve the diarrhea, the hyperthyroid condition must be treated or managed by your veterinarian.
How to Use Probiotics
Probiotics & Antibiotics: Most probiotics should be given separately from antibiotics, at least 2 hours after antibiotic administration. The exception is the yeast-based probiotic, Saccharomyces boulardii, which can be used as adjunct therapy with antibiotics.
Introducing Probiotics: Remember when working with pets with impaired GI systems (IBD, pancreatitis, EPI, chronic kidney disease, etc.), ANYTHING new should be discussed with your vet, and if you decided to use a probiotic, it should be introduced slowly. Start with an amount lower than the recommended dose and work up to it. The slow-introduction exception is if your cat or dog is in crisis, and you’re adding S. boulardii to stop diarrhea. For emergency use, see instructions below. That said, if the addition of S boulardii makes diarrhea worse, obviously stop, start over, and introduce it slowly.
Getting Probiotics Into Your Pet: Most pets like or do not mind L. acidophilus-based probiotics just mixed into or sprinkled on their food, but if the product is in an enteric-coated capsule, bear in mind only a small percent of the bacteria may reach the intestines alive if you open the capsule to administer the probiotic. Sometimes meat-only baby food offered as a treat with the probiotics mixed in does the trick. Some may need to purchase empty gel capsules (we recommend size 3). You can transfer the probiotic to the smaller capsules to pill your cat or dog. You can also mix the probiotics with water and syringe them into your pet. Please be careful to syringe the water into the mouth only in order to prevent aspiration into the lungs.
Further Information
Beasley DE, Koltz AM, Lambert JE, Fierer N, Dunn RR (2015). The Evolution of Stomach Acidity and Its Relevance to the Human Microbiome. PLoS ONE 10(7): e0134116. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0134116
Janet Chow, Sarkis K. Mazmanian (2010). A Pathobiont of the Microbiota Balances Host Colonization and Intestinal Inflammation. Cell Host & Microbe, 2010; 7 (4): 265. http://www.sciencedaily.com/releases/2010/04/100426092803.htm
Studies of the feline microbiome:
LE Ritchie 2008. Molecular characterization of intestinal bacteria in healthy cats and a comparison of the fecal bacterial flora between healthy cats and cats with inflammatory bowel disease (IBD), MS Thesis, Texas A&M, Veterinary Medical Sciences. http://oaktrust.library.tamu.edu/bitstream/handle/1969.1/ETD-TAMU-3081/RITCHIE-THESIS.pdf
Janeczko et al. 2008. The relationship of mucosal bacteria to duodenal histopathology, cytokine mRNA, and clinical disease activity in cats with inflammatory bowel disease, Vet Microbiol 128 (2008) 178-193. http://www.vet.cornell.edu/labs/simpson/docs/Janeczko.pdf
Desai et al 2009. Characterization and quantification of feline fecal microbiota using cpn60 sequence-based methods and investigation of animal-to-animal variation in microbial population structure, Vet Microbiol
2009 May 28;137(1-2):120-8. http://www.ncbi.nlm.nih.gov/pubmed/19167842
JF Garcia-Mazcorro and Y Minamoto 2013. Gastrointestinal microorganisms in cats and dogs: a brief review, Arch Med Vet 45, 111-124 (2013). http://www.scielo.cl/pdf/amv/v45n2/art02.pdf
Honnafer, Minamoto, Suchodolski 2014. Microbiota alterations in acute and chronic gastrointestinal inflammation of cats and dogs, World J Gastroenterol. 2014 Nov 28; 20(44): 16489–16497. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248192/
Suchodolski et al. 2015. The Fecal Microbiome in Cats with Diarrhea, PLoS ONE 10(5): e0127378. doi:10.1371/journal.pone.0127378. http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0127378
S. boulardii
Simply explained in the Biocodex FDA submission (last link), S boulardii is not digested and absorbed in the gut and does not exert its effect systemically. Instead, S boulardii acts locally in the lumen of the gut. During its passage through the intestine, S boulardii mimics the physiological effects of the digestive flora, stimulating healthy immune response and reducing inflammation.
Saccharomyces boulardii prevents enteritis from Clostridium difficile infection
http://archives.focus.hms.harvard.edu/2006/091506/research_briefs.shtml
"Saccharomyces boulardii in Gastrointestinal Related Disorders," Point Institute Technical Report (2008) http://www.pointinstitute.org/wp-content/uploads/2012/10/Saccharomyces-Boulardii-in-GI-related-disorders-paper.pdf
Saccharomyces boulardii effects on gastrointestinal diseases, (Zanello et al. 2009) http://www.horizonpress.com/cimb/v/v11/47.pdf
Review article: anti-inflammatory mechanisms of action of Saccharomyces boulardii, (Pothoulakis 2009) http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2009.04102.x/pdf
"Systematic review and meta-analysis of Saccharomyces boulardii in adult patients," (McFarland 2010) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868213/
Anti-inflammatory effects of Saccharomyces boulardii mediated by myeloid dendritic cells from patients with Crohn’s disease and ulcerative colitis, (Thomas et al. 2011) http://ajpgi.physiology.org/content/ajpgi/301/6/G1083.full.pdf
Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders, (Kelesidis & Pothoulakis 2012) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296087/pdf/10.1177_1756283X11428502.pdf
New Dietary Ingredient Notification for S boulardii (FDA submission) by Biocodex (Florastor) (includes summary table and references) http://www.fda.gov/ohrms/dockets/dockets/95s0316/95s-0316-rpt0301-04-vol239.pdf