Author: Dr. Sarah Wilson, BScH, DVM, DACVIM (Nutrition)
What Does the Pancreas Do?
The pancreas is an organ in the abdominal cavity that sits between the stomach and small intestine. It has two main jobs: Exocrine function -this one is for digestion, as the pancreas is the storage place for digestive enzymes to help extract the nutrients found in food when broken down. The second job (endocrine function) is to help regulate blood glucose through the secretion of the hormones: insulin and glucagon.
When we consider pancreatitis, typically it is the job of digestion that is impacted. In a healthy dog, enzymes are stored in an inactive form in the pancreas and when specific cues (such as protein or fat from a meal eaten and arriving in the stomach) signal the pancreas to secrete the inactive form of the digestive enzymes. Once the inactive enzymes reach the intestines, they are activated so that they can start breaking down the food into smaller parts (for example break protein down into amino acids). As the food passes down the small intestines the enzymes break it down into smaller more absorbable nutrient components and various essential nutrients are absorbed throughout the small and large intestines. The pancreas also stores beneficial substances such as intrinsic factor essential for absorbing vitamin B12 (cobalamin), as well as buffering substances such as bicarbonate.
If the digestive enzymes stored in the pancreas were already active, they would start to break down the pancreas – and this is the problem when the pancreas is inflamed. The inappropriately activated digestive enzymes in the pancreas can lead to mild inflammation or to very severe and can impact surrounding organs leading to additional more significant problems.
What is Pancreatitis in Dogs?
Pancreatitis is the inflammation (~itis) of the pancreas. When the pancreas gets inflamed it can be a sudden onset (acute) illness or a long term (chronic) problem, and it can vary in severity from mild to very severe. Due to the pancreas’s location the inflammation can impact surrounding organs such as the liver or intestines, or at times can impact the pancreas itself and may disrupt insulin production and lead to potential diabetes mellitus which can be either temporary or permanent. Most often the inflammation associated with pancreatitis is limited to the pancreas but is still considered painful and should be addressed to help minimize negative impacts and possibly multiple organ damage.
What Causes Pancreatitis in Dogs?
In most situations of pancreatitis, we don’t always find out what the cause of pancreatitis is (which is called idiopathic pancreatitis). However, there are certain events or risk factors that can be associated with pancreatitis.
- Trauma of the pancreas, such as in a car accident (or cats in high-rise trauma).
- Possible poor blood flow to the pancreas or when handled (even appropriately) during surgery.
- Sudden extremely high fat meal, such as when a dog gets extra turkey, skin, and gravy at thanksgiving or sneaking into the garbage!
- Also, dogs with hypertriglyceridemia (high circulating blood triglycerides) can be at risk of developing pancreatitis.
- Certain medications including chemotherapy medications (ex. azathioprine, or L-asparaginase), anti-seizure medications (ex. potassium bromide, phenobarbital), and sulfa- containing antibiotics (ex. trimethoprim sulfa) can predisposed dogs to pancreatitis.
- Metabolic diseases such as concurrent hormonal imbalances can predispose dogs to pancreatitis such as with hyperadrenocorticism (Cushing’s Disease), hypothyroidism, diabetes mellitus, or hypercalcemia. These conditions are associated with altered fat metabolism or increased blood calcium which can activate stored digestive enzymes.
- Obesity has been noted as a risk factor due to the impact of altered fat metabolism.
- Genetic predisposition may also increase risk as some breeds are overrepresented. Miniature Schnauzers are most commonly reported (as they often have altered fat metabolism) but increased prevalence has been noted in Yorkshire Terriers, Dachshunds, Poodles, and English Cocker Spaniels have been proposed to have a distinct form of autoimmune chronic pancreatitis (Coddou et al. 2024).
Acute pancreatitis is inflammation that has a quick onset and resolves with removal of the inciting cause, while chronic pancreatitis is usually associated tissue changes within the pancreas that are irreversible.
Signs
Clinical signs of pancreatitis can be very non-specific and thus make diagnosis of pancreatitis more complex. Milder forms of pancreatitis may show up as some mild abdominal discomfort and vomiting, or just some lethargy and anorexia (being tired and not wanting to eat). Signs can also be acute (sudden onset) and have significant severity or may be more chronic – like a low bubbling simmering stew – of unhappy pancreas. Signs that could indicate your dog has pancreatitis include many different gastrointestinal signs or more general signs.
Gastrointestinal Signs
- Vomiting – either mild or severe, usually after eating
- Diarrhea
- Abdominal discomfort – showing discomfort with touching the stomach/abdomen, moving into prayer position (forepaws and head on ground – hind end elevated), protecting their sides
Behavioral Signs
- Lethargy – general malaise to significant lack of activity/ needing to be encouraged to get up
- Loss of appetite – mild loss, to complete inappetence
- Other atypical behaviors for your dog – acting “off” – is a sign you should investigate your dog’s health needs
What to do???
So, if you suspect your dog has pancreatitis, what should you do? Diagnosis should be done by an examination with your regular veterinarian (or an emergency clinician if the case arises), and there is not one specific test that will confirm pancreatitis (a biopsy of the pancreas can help confirm but that method is invasive so not typically preferred). Testing of your dog’s complete blood count and biochemical profile can show inflammation that is typically non-specific ( but may suggest injury to the pancreas), a physical examination (putting hands and a stethoscope on your dog) can help find painful areas, and imaging (ultrasound or sometimes x-rays) can further help identify areas that are inflamed and can aid in identifying acute pancreatitis or more severe cases.
Treating pancreatitis has historically been with management of the inciting cause or underlying factor (if possible), and with providing supportive care which often includes maintaining hydration (with fluid therapy if necessary), nutrition support, pain management, gastroprotectants, and possibly anti-emetic (medications to help stop vomiting).
Recently, specifically for treatment of acute pancreatitis, fuzapladib sodium has been conditionally approved for use in dogs by the FDA. This medication is used by your veterinarian and given intravenously (IV) for the first three days of hospitalization and supportive care, and helps minimize the inflammation to hopefully keep clinical signs from getting worse and helping prevent more serious complications such as multi-organ failure. This medication is used for acute pancreatitis only (not tested in dogs with concurrent diseases) and has been conditionally approved for dogs since 2023, treatment use should be discussed with your veterinarian.
Nutritional support is also a mainstay of managing both acute and chronic pancreatitis, but in different ways. With acute pancreatitis, if the inciting cause of pancreatitis is removed (perhaps a medication change, or supportive care after trauma), a long-term change to regular diet may not be necessary, but supportive nutrition during the acute event is extremely important. A lower fat highly digestible diet is often recommended, as increased fat will often stimulate activity from the pancreas – thus lower fat leads to less ‘effort’ on the part of the pancreas. However, once the acute episode is over, many dogs transition back to their regular diet, focus on avoiding the potentially risky medications/or other risk factors, and are not subject to damage leading to chronic disease.
In a chronic pancreatitis case, nutritional recommendations are usually to reduce fat intake, based on individual tolerance. How much is low-fat is not officially defined, as there are minimum requirements for fat and specific essential fatty acids, but the numbers on the label for crude fat are unclear and listed as fed, thus make comparison difficult. So how do you feed less fat and how do you determine what the fat level is in dog food?
Fat Content in Dog Food
Accurately Determining Fat Content
Determining the fat content of a food can be somewhat difficult – as the label usually says Crude fat (minimum) – but what does that mean? Crude fat is a measurement of the fat within a diet, but that number doesn’t account for the moisture content, fiber content, nor energy density of a diet. As discussed in a previous article about protein, the most accurate method of nutrient evaluation is on a metabolizable energy (ME) basis. While nutrient information can be expressed a few different ways, As Fed (what is on the label), on a Dry Matter basis, and on a Metabolizable Energy (ME) basis, the most accurate way is on an ME basis – this way any format of food can be compared: fresh, air-dried, kibble, and canned all can be evaluated and appropriate fat content can be provided to your dog.
As a guideline the chart below shows fat content minimum requirements as compared to guidelines used for management of diseases responsive to fat content (such as pancreatitis) with values on a ME basis.
Chart below: Fat requirements and general guidelines on low, moderate, and high fat diet content on a metabolizable energy (ME) basis (grams fat/1000 kcal)
|
AAFCO |
General Guidelines/Ranges | |||
| Growth Requirements including Large Breed Dogs
(g/1000 kcal) |
Adult Maintenance
(g/1000 kcal) |
Low fat diet
(g/1000 kcal) |
Moderate fat diet
(g/1000 kcal) |
High fat diet
(g/1000 kcal) |
| 21.3 | 13.8 | <20 | 25-45 |
> 50 |
It should be noted that the AAFCO minimum fat requirements for growth of large breed dogs is 21.3 g/100 kcal, which is higher than what would be considered a really low-fat diet (less than 20 g fat per 1000 kcal). Not all dogs with pancreatitis need a low-fat diet, in fact the amount of fat necessary to manage a dog with pancreatitis is based on their previous intake. If they have chronic pancreatitis, and have been eating a high fat diet, moving to a moderate fat diet might be perfectly tolerated and a low fat diet may be unnecessary. However, if a dog has been eating a moderate or lower fat diet, then fat restriction may be needed to manage the pancreatitis.
Fat Content in The Pets Table Recipes
Since our recipes at The Pets Table are formulated to meet the nutrient requirements of growing dogs including large breed dogs, all of our recipes provide more fat than what would be considered a low-fat food for a dog that needs fat restriction. For those cases, prescription low-fat diets are most often the recommendation, and careful monitoring of treat intake is also important. Discuss with your veterinarian the degree of fat control or restriction needed. Most of our recipes fall in the higher fat range (49 – 65 grams of fat /1000 kcal), which provides for energy dense and highly palatable food, and many dogs will happily eat and easily tolerate higher fat diets. Dogs with fat intolerant diseases, such as with pancreatitis, are less able to tolerate higher fat diets (and treats) and should aim for moderate or lower fat foods, thus our current recipes may not be appropriate for that subset of dogs, but we are always looking to create new recipes!
Low-Fat Foods to Consider for Your Dog with Pancreatitis
For dogs with pancreatitis, feeding a complete and balanced diet appropriate for them is most important. Treats are allowed and important too though! They are often a part of how we bond and connect with our beloved furry family, so ensuring the right foods are given as treats can also help you manage their disease. Treats should be low fat and about 10% of their total daily caloric intake – so if they get 200 kcal per day in complete and balanced appropriate fat foods, treats should not exceed ~20 kcal per day so as to not unbalance their overall nutrient intake. So, serving size matters, some treats are appropriately low fat, but may be energy dense, thus only small amounts can be given. Fruits and vegetables make excellent treats as they are low calorie, higher in moisture and fiber, and typically low fat. Remember it is not safe to feed foods that may be harmful to dogs, including anything with xylitol artificial sweetener (also known as birch sugar), chocolate, macadamia nuts, chives, leeks, garlic, onions, grapes, and raisins. You can also go to the animal poison control site for updates on information (https://www.aspca.org/pet-care/aspca-poison-control).
Ingredients to consider
Fruits and vegetables are the best options – such as apples, bananas, blueberries, raspberries, papaya, pears, green beans, broccoli, cauliflower, celery, carrots, sweet potato and many more fruits and vegetables are excellent low-fat ingredients to feed. Be sure not to feed the seeds of fruits, as they can cause problems. When needing to give some food for medications, or encourage intake, consider unsweetened applesauce as low fat, low calorie tasty option (as opposed to a fattier cheese or butter option).
Fatty Foods for Dogs to Avoid
Ingredients to avoid
Many foods have higher fat content and should be avoided in dogs with active pancreatitis, or chronic pancreatitis with risk of adverse event. Obvious foods such as the fat trimmings from meats, gravies, higher fat cheeses, should be avoided, but some foods are also higher fat and may be forgotten. Nuts and nut butters are an example of higher fat foods that should also be avoided.
Other Conditions to Avoid High-Fat Foods for Dogs
There are other conditions that are associated with fat intolerance, similar to pancreatitis, or may have other reasons to avoid high-fat foods.
Lymphangiectasia is a disease of inflammation that impacts the lymph vessels of the intestines and leads to leaking and loss of protein and other nutrients. Treatment is usually ultra-low fat diet (most often veterinary therapeutic low fat diets). Limited treats are also recommended as the possibility of inflammation from protein allergy has been noted in some cases.
Hyperlipidemia is when dogs have increased levels of lipids (fats) in their bloodstream, such as cholesterol or triglycerides. Some diseases may have hyperlipidemia as a consequence of the disease itself or poorly managed disease such as hypothyroidism, diabetes mellitus, pancreatitis, kidney disease, and even some medications can lead to hyperlipidemia. Also, some dog breeds are also prone to hyperlipidemia (ex. Miniature Schnauzers and Beagles). Dogs with hyperlipidemia, should limit high fat food intake, including treats.
Obesity is when body condition (fat that lies overtop of muscle) is excessive. Obesity can contribute to many other health conditions including insulin resistance, heart and lung disease, orthopedic disease, to name a few. While fat intake itself is not problematic, it is much more calorie dense, thus small amounts of fat lead to significantly more calorie intake, which can lead to further weight gain. Some diseases may be concurrent with obesity, which may indicate fat restriction is recommended, but if a dog is obese, higher fat foods can be fed, calorie intake just needs to be carefully evaluated. Feeding a treat of a tablespoon of peanut butter is approximately 90 kcal as compared to a tablespoon of applesauce, which is only 10 kcal. If you are trying to limit excessive calorie intake – feeding applesauce (and other low-calorie, low-fat foods) goes a long way.
Final Thoughts
Pancreatitis is certainly something that needs to be addressed, and some nutritional choices must be made when a dog has experienced pancreatitis. Understanding fat intake, and the level of tolerance your dog has, which is impacted by whether the pancreatitis was acute or chronic, mild or severe – is important. Your veterinarian will be able to recommend appropriate treatment plans, for both short- and long-term management of your dog depending on your dog’s individual case. Being sure to follow recommendations and make healthy nutritional choices for your dog will allow them to live a happy life (with hopefully fewer unhappy pancreatitis episodes).
References & Helpful Links:
Links: (To previous articles referenced within the article)
Helpful websites:
- Pancreatitis in Dogs – Veterinary Partner – VIN
- Pancreatitis and Other Disorders of the Pancreas in Dogs – Merck Veterinary Manual
References:
Coddou MF, Blaclaws B, & Watson PJ. Clinical manifestations of chronic pancreatitis in English cocker spaniels (2024) JVIM