After 18 years, Ben, my longtime dog, was diagnosed with chronic renal failure three months ago. Failing some other catastrophic illness, his vet of 11 years has said this will be the ‘thing’ that finally takes Ben from this world and my life. Having said that, Ben still clearly has a lot of life and love left in him and so neither of us are throwing in the towel.
When I first received the news of Ben’s condition, I was heartbroken and I grieved … hard. I couldn’t imagine losing him; I couldn’t imagine a life without him. But after a few days immersed in the sadness of the future, I turned my attention back to the present … and, like a participant in some 12-step program, I started to turn my attention to what I could control: Ben’s diet.
I want to make it clear from the outset that I’m not a veterinarian, medical doctor, or anyone with a ton of biologic sciences in my background. I’m lay person with a great propensity for doing research and learning. What I’m presenting is, therefore, a layman’s understanding of things — and my approach has been devised in consultation with Ben’s amazing veterinarian and pharmacists. I’m hoping that in keeping this post simple, however, that my distilled research and understanding will be easy for those of you with similar battles in front of you, now, or in the future. Ultimately, this is a post and recipe written by a man who loves his dog above all else these past 18 years and there is nothing I wouldn’t do for him … and the least I can do is making him remaining months full of quality and love, which starts with his diet.
So, to begin with, I had to learn about renal failure and what is happening in the kidneys which are our bodies’ main filters. Often when we hear about kidney disease, or least when I’ve heard mention of it in the past, it has been related to protein levels in the diet. That’s not to say the protein is the cause, but that once renal failure sets in, protein in the diet becomes a concern. This is why people and animals with chronic kidney disease are often given a protein-restricted diet. Why? Well, what I learned is that the issue isn’t with protein specifically, but what accompanies the protein: protein isn’t the problem and Ben couldn’t live without protein either. The issue is that when the kidneys stop to work at their full function, certain things are not being filtered out and excreted and this creates an imbalance in our blood chemistry. Of particular concern in a mature dog like Ben who has no real pathology but who has simply outlived his kidneys (rare in a dog but more common in cats) is the reduced ability to excrete phosphate and, conversely, retain calcium. This is a double whammy because the body uses calcium to bind with the phosphorus as part of the excretion process. As a result, over time phosphorus levels rise and accumulate in the body’s tissue which causes multiple system issues and in particular, as kidney the disease progresses, cardiovascular complications become more and more likely. In short, there are two outcomes in Ben’s immediate future: heart attack/stroke or multi-system failure which will require the hardest decision I’ve ever had to make ….
This is why this post is about a low “phosphorus” diet, not low protein. You see, phosphorus occurs most abundantly in protein rich foods, but it occurs to some degree in almost all food and ingredients. But before I sing out my solution, there is something else to this story: it is not as simple as omitting or limiting phosphorus. Dogs still need other nutrients and in the end it is about balance — it means, to the best of our ability, equipping the dog (Ben) with what they need while omitting what is going to shorten life. And yet, even at that, there is one more thing you can’t forget — and that this isn’t simply a chemistry experiment: it’s food. That is to say, what I created had to not only be good for Ben, he had to like it enough to eat it. And remember, Ben is a dog that I’ve been feeding and largely cooking for since the beginning: he has discerning palette, to say the least.
The Research and the Goal:
One of the symptoms of renal failure is an acidic tummy and nausea. The result of this is reduced food drive and weight loss which was a telling symptom in Ben. Smaller and more frequent meals have played an important role for him. And while I have chosen to use some supplements in his diet, I’ve largely tried to rely on “functional foods” and variety in his diet to provide him his necessary nutrients. The goal, therefore was to choose:
- Good “fats” rich in calories and other necessary compounds
- Proteins rich in nutrients
- Carbs and veggies high in vitamins and with sufficient soluble fibre — this will ‘bulk up’ the diet as well
- Low phosphorus ingredients throughout (proteins, veggies, grains, fats)
- Combinations that would produce a nevertheless tasty dish
Some other important Do’s and Don’ts in the diet.
Things to monitor and try to bump up and supplement would be:
- Vitamin B (complex)
- Omega 3 fatty acid (a premium salmon oil supplement would be a good suggestion)
- Potassium levels (at least before the onset of advanced kidney disease)
- Calcium levels (over time this will need to increase as a binder to help control the phosphorus even more)
- Q10 coenzyme
- Antacid (e.g. Pepcid AC)
Things to avoid:
- Phosphorus obviously
- Omega 6 fats (because they’re inflammatory)
- Sodium (because with renal failure, blood pressure will increase and the sodium will become a killer)
- Vitamin D (because this is hard for the kidneys to excrete as well)
I did a LOT of reading. I read and read and read, trying to discern what to feed him, what the trade-offs were in nutrients and what ultimately he would still eat. One of the best sources I found was from a Phosphorus Food List (PDF) published by Kaiser-Permanente (a huge, integrated healthcare company in the USA) and from info on that Mayo Clinic’s website on a low-phosphorus diet. I cross referenced this information with dog food diets, labels of dog food ingredients, and numerous other sources. In the end, this is what I determined….
Research Post-Script: There are many comments throughout this blog from people who have been using this recipe for a year or two with success. Many have added their own research and information. Some have different opinions and every dog is different with unique tastes or other underlying conditions, but most people have independently supported this recipe with other research or discussions with other health professionals. One reader, Kerrie E., went to a nutritionist and posted the advice she received here as well. I’ve summarized her information as a PDF attached here.
List of Ingredients to Work With
Protein Sources: Lean Ground Beef; duck; white fish; and egg whites; ground pork (moderate, but tasty)
→ all good choices because of the ratio of fat to phosphorus
Fat: Coconut oil (high in good fat, but low in vitamin D); alternatively, avocado oil
Veggie Sources: Green beans; collards or kale (collards are lower in phosphorus than kale, but kale is richer in almost every other source of vitamin); broccoli (in limited amounts for flavour)
Carbs: Sweet potato; acorn squash; pumpkin (high in potassium); carrots and apples, skin on, in moderation
→ all (except the apples) should be boiled/steamed — water discarded because the water leaches out the phosphorus
Fibre/Carbs: White rice; pearled barley; white bread
→ contrary to what we might think, refined grains are lower in phosphorus so better in these diets than whole grains
Supplements (based on 25lb dog):
- Breakfast: 10mg Pepcid AC antacid tablet
- Breakfast: 25mg Q10 coenzyme
→ You’ll be challenged to find both this dosage and/or Q10 in a non-gel capsule format. However, it does exist. The brand I used is from Douglas Labs which manufactures a “Citrus Q10” tablet which I cut into quarters.
- Dinner: half a B50 complex vitamin (i.e. essentially a B25 complex vitamin)
Finally, while I’m including one recipe here, I’ve included a number of options and substitutions below. Using these options, I’ve ultimately cooked Ben four different recipes so far. Each provides about 6 packages with enough food for about 10-12 days. And I vary the packages every couple of days to make sure he’s getting nutrients from a variety of sources.
My closing tip is, before you package up the dog food, taste it because, if you don’t like it, he/she probably won’t either. Don’t be squeamish — these are 100% human-food ingredients.
Total time: 90 minutes (includes cooling and packaging)
Servings: 10-12 days of food for 25lb dog
How Much to Feed Your Dog:
I’ve added this in as a further postscript because it is the single most frequent question I’ve been getting over the years. The answer is simple but, I know, unsatisfactory: “It depends.” As I say to everyone, each dog trying this diet is different and unique. There are too many variables for me to answer. It depends on size, breed, age, metabolism, stage of disease, and other factors that make each dog special. My advice is simple, however. You know your dog. You know how much he/she would normally have eaten. Trust your instinct. As well, dogs with renal failure or disease are usually in a state of “not eating” and are prone to “wasting.” That is to say, they’re slowly starving to death. As such, let your companion be your guide. They will tell you if they want more or need more. Assuming they’re not overweight or have other diseases, let them eat “until they are full” is my personal recommendation. That’s what I did with Ben … and to make it more successful, I tried when possible, to break his meals up into smaller amounts and feed him more regularly through the day. I hope this helps you all — but if you need more advice, speak to your vet.
Low-Phosphorus Dog Food
- 2 lbs “lean” ground beef (in Canada ≤ 17% fat)
→ Option 2: or substitute ½ ground beef with ½ ground pork
→ Option 3: or substitute 2 lbs baked trout
- 500 grams (1 pint) liquid egg white ( 12-15 egg whites)
- 1 lb green beans
- 2 cups uncooked rice
→ or substitute pearled barley
- 2 lbs acorn squash, peeled and cubed (♣ see note below)
→ or substitute 1 lb sweet potato and 2 cups puréed pumpkin
- 2-4 tablespoons coconut oil
- ½ cup fresh parsley, finely chopped
- Optional: 1 apple, grated if using the ground pork
- Garlic powder, to taste (optional) **
- Ground pepper, to taste (optional)
** Note (August 28, 2015): A number of readers have raised concern about the garlic powder in this recipe because of research that it is toxic to dogs. To be clear, the quantity I used was very small (a sprinkling = 1/4 teaspoon). Judge me or disagree with me, but Ben ate garlic in food for his whole life because he ate table food/scraps from my plate and rarely was there a meal that didn’t include it as a seasoning. As stated, I’m not vet or doctor so I can’t tell you at what levels it is safe or not safe for a dog of whatever weight. All I know and all I share here is what I did for my dog that lived 18.5 years. In the end, it is listed as optional, but I used it.
♣ Note on Winter Squash: No two veggies are the same in their nutritional profile, even from the same family. While substitutions are possible and even recommended to ‘change it up’ for your pets, always consider your menu as part of an overall “system” of ingredients. Many readers are frustrated at the effort to peel an acorn squash. That is true. But note the nutritional breakdown on the side here with respect to other winter squash and their overall nutritional ratings (beyond phosphorus):
- Cook the rice by following the package instructions (e.g. 2 cups rice; 4 cups water — bring to boil, simmer for 15 minutes; remove from heat, let stand covered for 5 minutes).
Prepare the parsley: wash; remove leaves from stems; and finely chop the parsley.
When the rice is finished cooking, remove lid and stir in the chopped parsley.
- While the rice is cooking, cut the squash in half and remove the seeds. Cut the squash into strips, lengthwise between the “ridges” — using a vegetable peeler, peel the skin from the squash.
Cut sqash into cubes and place it in a medium pot with enough water to fill half the pot.
Bring to boil and simmer, covered, for 20-25 minutes until squash is just barely fork tender. Remove from water and discard water.
- Steam the green beans, whole.
- Place the ground beef in a frying pan and fry for about 8-10 minutes until all the pinkness is cooked out. Season with fresh ground pepper and garlic powder. Do NOT drain off the fat, but let the meat cool.
- Once the ingredients have cooled to “warm,” place them in a food processor or powerful blender (e.g. Vitamix). Combine in 1/2 the squash, 1/3 of the ground beef, and half the beans …
… and puree until smooth.
Add the puree to the rice mixture. Repeat with the remaining squash, another 1/3 of the beef, and the remaining green beans and add them to the rice mixture as well.
Add in the remaining beef, including all the beef fat.
- Using the same pan from the beef, now, melt 1-tablespoon of coconut oil.
When hot, add in half the egg whites and scramble them until thoroughly cooked (about 4 minutes).
Repeat with more coconut oil and remaining egg whites and add them to the other ingredients and stir them in.
→ Note: You can puree all the ingredients, but Ben and I both seem to prefer that there is a bit of some “texture” to the food and having bits of rice and meat that he can spot and smell helps in the attraction.
- Taste for seasoning — try to avoid adding any salt but you may need to add a bit of flavouring. This is why I use the garlic powder. Test some with your “patient” who will be standing by — and make sure he/she likes it too.
- You’re now ready to bag the food in sealable sandwich bags and place four-to-a-bag inside a larger freezer bag.
Hoping your own fido patient love this as much as Ben. Serve in 1/2 cup measures 4-5 times per day. (Note: Ben’s appetite really picks up in the evening which is when he eats about two-thirds of his food).