Therapeutic Diets and Management of Patients with Neoplasia

• The term therapeutic diet has no legal definition. But, the Food and Drug Administration has guidelines for the labeling and marketing of canine and feline diets intended to diagnose, cure, mitigate, treat, or prevent diseases.
• Veterinary therapeutic diets (VTD) is considered for managing conditions, such as kidney disease or osteoarthritis.
• The quality control of VTD manufacturers is often more stringent than that of over the counter diets (OTC).
• Some VTD may carry the statement reading 'use under supervision of a veterinarian,' and many have AAFCO nutritional adequacy statements for adult, and sometimes growth, life stages. For these reasons, VTD are often recommended for healthy pets to provide better nutrition and to aid in the prevention of common disease states.
• VTD are formulated to assist in managing medical conditions based on known physiologic and nutritional differences between healthy individuals and those with a disease, or to contain nutrients that may have a functional role in managing a particular medical condition.
• VTD used for gastrointestinal disease are moderate in fat, calcium, and phosphorus.
• VTD may also contain anti inflammatory nutrients, as inflammation is a component of many disease states. These ingredients include omega 3 fatty acids, antioxidants, and other special nutrients. They attempt to moderate inflammation in the GI, dermatlogic, orthopedic, and urologic disease states.
• Digestibility of VTD has also been reported to be higher than that of OTC diets.
• According to ELISA testing, VTD are not contaminated with soy or with a protein source not listed on the label.
• When choosing diets to recommend to their patients, practitioners can access the complete nutrient profiles of VTD more easily than for many OTC diets.
• Caloric density in kcals/kg, kcals/cup, and kcal/can is available on websites and product guides. Beginning in 2017, this information is required on all pet food labels.
• VTD are often perceived as expensive compared to OTC diets.
• Compared with human food packaging, pet food bag and can sizes vary greatly. This variability makes it difficult to compare costs on a per bag or can basis.
• A study determined the costs of both VTD and OTC diets on a per 100 kcal basis for comparison because calories consumed per day is the best common measure across all diets. VTD can be competitively priced when compared per 100 kcal.
• Cancer is a highly diverse condition with varying characteristics across different tissues, which emphasizes the need for individualized nutritional approaches.
• Cancer is considered the uncontrolled growth of cells in different tissues throughout the body, which cannot be regulated by normal physiologic functions.
• Due to the diverse nature of neoplastic cells, creating the same therapeutic plan for every patient is difficult.
• Dogs and cats with cancer often experience changes associated with decreased caloric intake and metabolic alterations. They often experience weight loss, decreased appetite, gastrointestinal changes, and loss of lean body mass.
• Cancer cells often rely on glucose as their energy source, a phenomenon referred to as the Warburg effect.
• The Warburg effect occurs when neoplastic cells favor glycolysis over oxidative phosphorylation for energy production.
• Dogs and cats have the ability to synthesize glucose through gluconeogenesis, which means that they can regulate their blood glucose levels irrespective of the carbohydrate content of their diet.
• It is important for cancer patients to get a complete and balanced diet. This provides all the essential nutrients in the appropriate proportions to support physiologic functions, including growth, reproduction and the maintenance of body systems. It also supports the immune system, which is compromised in cancer patients.
• To encourage food intake in all ill pets, clients commonly incorporate treats and toppers into their pet's diet. In the short term, the use of treats and toppers may help maintain caloric intake, continuing them for an extended period can lead to nutritional deficiencies.
• Cancer patients are at a high risk for malnutrition, which may alter the immune system, compromise the ability to respond to treatment, and result in reduced quality of life.
• To encourage food intake in cancer pet, owners can feed in a quiet place, adjust the temperature of the food (warm, cold, frozen), change the feeding location, change the dish or dinner plate, and add palatability enhancers.
• It is important to change the dish of a cancer patient to something preferably nonmetal. Stainless steel can produce undesirable flavor for dogs receiving chemotherapy.
• Palatability enhancers for cancer pets include honey, applesauce (dogs), low fat yogurt, nutritional yeast, and prebiotic supplements.
• Safe treats and toppers for dogs and cats with cancers are chopped carrots, diced watermelon, cauliflower, air popped popcorn, unsweetened applesauce, green beans, broccoli, cantaloupe, apple, kale, sliced banana, baked squash, blueberries, canned pumpkin, and baked sweet potato.
• Protein treats for dogs and cats with cancer are plain low fat yogurt, cooked beef top round with the fat removed, peanut butter with no xylitol, cooked tilapia, cooked ground lamb, cooked chicken breast, and a large egg.
• Important things for cancer patients are fatty acids, antioxidants, protein, and energy density.
• Polyunsaturated fatty acids play a role in several metabolic pathways and help maintain cell wall function. They also serve as an energy source and may help improve appetite and reduce cancer cachexia.
• In cancer patients, oxidative stress can be exacerbated by proliferation of cancer cells, inflammation, and the side effects of chemotherapy and radiation therapy.
• Antioxidants from the diet mitigate oxidative damage and decrease DNA damage, which improves immune function.
• Examples of antioxidants include vitamins C and E, selenium, zinc, glutathione, and various phytochemicals that can be found in fruits and vegetables.
• Proteins, and more specifically amino acids, help maintain and repair body tissues, including muscles.
• Muscle loss and cancer cachexia can lead to weakness and compromised health, making protein a major factor to consider when creating a diet plan.
• Maintaining or increasing caloric intake may be necessary to support increased metabolic demands.
• One way to achieve a diet with higher energy density is to increase the amount of fat in the diet because fat provides more calories per gram than protein or carbohydrates.
• A higher fat diet is one that many dogs and cats find fat to be highly palatable, which may improve diet acceptance.
• No single diet fits the needs of every cancer patient.