IBD Treatment

Since Inflammatory Bowel Disease (IBD) involves continuous stimulation of the immune system resulting in chronic inflammation, IBD treatment is typically aimed at reducing inflammation by suppressing immune function.

As you can imagine, IBD treatment based on immunosuppressive drugs has the potential to cause serious side effects. This is why it is always preferable to control IBD symptoms with diet and supplements where possible.

Dietary IBD Treatment

The goals of dietary IBD therapy are threefold.

First, we want to remove any substances that may trigger an immune response from the dog's diet. That means feeding a hypoallergenic diet. More on what this entails in a minute.

Second, because dogs with IBD may have difficulties with nutrient absorption, we want to feed a nutrient-rich diet with high digestibility and bioavailability.

And third, an anti-inflammatory diet that promotes solid stool consistency and growth of beneficial bacteria in the intestines is indicated, though the latter will be achieved primarily by means of supplements added to the diet.

Hypoallergenic - This diet should be a simple limited ingredient food consisting of one protein source and one carbohydrate source the dog has never eaten before. Rabbit, venison, duck, whitefish, and potato are ingredients often used in IBD diets, but the ideal ingredient combination will depend on the individual dog's dietary history.

Hydrolyzed dog foods are another option. In a hydrolyzed food, the amino acid chain of the protein has been shortened so it will not stimulate the immune system.

Hypoallergenic dog foods should omit any ingredients that are known to frequently trigger an allergic response. That includes gluten, lactose, coloring agents, synthetic preservatives, and other artificial additives.

High Digestibility and Bioavailability - Dog food ingredients vary tremendously in both digestibility (how much of the food can be broken down and absorbed) and bioavailability (how readily the absorbed food can be utilized by the body).

The kinds of dog foods sold in supermarkets are typically at best 50-60% useable by your dog. They contain a lot of empty fillers that end up as waste and have the potential to exacerbate diarrhea.

Premium dog foods are usually 70-80% digestible, and super premium foods generally have digestibility ratings in the mid to high 80s.

A small number of specialty diets such as the minimally processed, dehydrated single protein venison and lamb diets from Ziwipeak are over 95% digestible.

That means very small stools and high nutrient absorption, and because the foods consist entirely of fresh meat (plus supplements), bioavailability is also excellent.

Other Considerations - Since omega-6 fatty acids are generally pro-inflammatory, while omega-3 fatty acids are anti-inflammatory, dogs with IBD should ideally eat a diet that's higher in omega-3 fatty acids such as DHA and EPA (found predominantly in fatty fish and fish oil) and lower in omega-6 fatty acids (found in many foods, but vegetable oils and poultry fat are especially high in omega-6 EFAs).

The omega-6 to omega-3 ratio should be no more than 4 to 1.

Low-fat diets are often recommended, but not all dogs with IBD have difficulty digesting fats.

Some dogs can't handle highly processed (possibly rancid) fats, but do fine with lightly cooked or raw fats.

If the inflammation is located primarily in the large intestine, fiber, specifically soluble fiber, can be very helpful. Some dogs with IBD improve tremendously when all grains are removed from their diet, and in some cases, starch of all kinds is contraindicated.

Finally, adding probiotics and prebiotics to the diet encourages a healthy microbial balance in the intestines.

See Dog Food For Dog Diarrhea for a more detailed discussion of dietary diarrhea and IBD treatments.

Supplements for IBD Treatment

A number of dietary supplements have proven very helpful in the management of IBD symptoms.

L-Glutamine - This amino acid has been shown to protect and rebuild the mucosal lining of the GI tract in a number of studies. It also has anti-inflammatory properties and can help heal ulcers. L-glutamine is perhaps the most well established IBD supplement with plenty of scientific evidence (mostly from human studies, though) to back up its efficacy. For most dogs with IBD, a dose of 500 mg per 10 kilos of body weight will result in a reduction of symptoms within a few weeks.

N-Acetyl Glucosamine (NAG) - NAG is an amino sugar and the basic building block of substances known as glycosaminoglycans or simply GAGs (formerly called mucopolysaccharides) that have the ability to repair the intestinal lining. A number of clinical trials with human IBD patients have shown significant improvements following treatment with NAG.

Fish Oil - High in the anti-inflammatory omega-3 fatty acids DHA and EPA, fish oil supplements have proven very helpful in reducing inflammation in human IBD cases (doubling the remission rate in one Italian study), and there's plenty of anecdotal evidence that they can help dogs as well. However, they must be introduced very slowly in dogs who have difficulty digesting fats.

Probiotics - Supplementing your dog's diet with viable "friendly" microorganisms (probiotics) can help restore a healthy microbial balance in the intestines. This, in turn, can help protect against the overgrowth of pathogenic bacteria, yeasts, and protozoa. Two probiotics that appear to be particularly helpful in cases of IBD are the bacterium Lactobacillus sporogenes and the yeast Saccharomyces boulardi.

Prebiotics - Prebiotics selectively promote the growth and activity of beneficial bacteria in the intestines, while reducing the numbers of hostile bacteria. Mannan-oligosaccharides (MOS) go a step further by also preventing several types of pathogenic bacteria from attaching to the intestinal lining.

Digestive Enzymes - Digestive enzyme supplements containing lipase, protease, amylase, etc. may be able to help some dogs with difficulty absorbing adequate nutrients from their food.

Entero-Chronic - This is a new IBD treatment from Spain I've begun using in my clinic. The primary ingredient is a resistant starch that is converted to the anti-inflammatory, anti-carcinogenic short-chain fatty acid butyrate in the large intestine. Other ingredients include GAGs, MOS, and beta-glucans. Read more about Entero-Chronic Here.

IBD Drug Treatment

Unfortunately not all cases of IBD in dogs can be controlled entirely with diet and supplements. Many dogs with IBD will require treatment with immunosuppressive drugs, at least initially.

Once in remission, it is often possible to slowly phase out the drugs and maintain the dog on a diet- and supplement-based IBD treatment.

Various drugs are used to treat IBD in dogs, and due to the nature of the disease, most of them have an immunosuppressive component:

Corticosteroids - Steroidal medications such as prednisone are the primary drug treatment prescribed for dogs with IBD.

Corticosteroids very effectively reduce inflammation in the GI tract by suppressing the immune system cells responsible for the inflammation. Unfortunately, the effect is not limited to these specific cells or even the GI tract; corticosteroids have the potential to suppress overall immune function, thereby increasing susceptibility to infection, if given at high doses or for long periods of time.

Side effects such as increased thirst, increased appetite, and weight gain are common. Long-term use or high doses can result in gastrointestinal ulcers, muscle degeneration, skin and coat problems, diabetes, inflammation of the pancreas, liver and kidney changes, behavioral changes, and other serious side effects.

Therefore corticosteroids should be used in the lowest dose possible, and attempts should be made to gradually wean dogs off the drug once they are in remission.

Antibiotics - Metronidazole is the most commonly used antibiotic IBD treatment in dogs. In addition to killing several types of pathogenic bacteria in the digestive tract, metronidazole kills protozoa and inhibits the immune system, reducing inflammation.

Tylosin is another antibiotic that is frequently used, particularly in cases of IBD where the inflammation is located primarily in the large intestine. Metronidazole, tylosin, and other antibiotics may be prescribed in addition to or instead of corticosteroids.

Sulfa Drugs - Sulfa antibiotics such as sulfasalazine may be prescribed for their anti-bacterial and anti-inflammatory effects on the large intestine. While also immunosuppressive, sulfasalazine generally has fewer side effects (being dry eyes as the main one) than corticosteroids, so if your dog's IBD is concentrated in the lower GI tract, your vet may try this drug before resorting to prednisone treatment.

Immunosuppressive Agents - In severe cases that do not respond to corticosteroids or other IBD treatments, immunosuppressive drugs such as cyclosporine and azathioprine may be prescribed as a last resort. These drugs are commonly used to prevent organ rejection in individuals receiving transplants, and they can have serious side effects. They are typically considered only after all other options have been exhausted.

Other Drugs - Anti-parasitic drugs, anti-diarrheal drugs, anti-spasmodic drugs, and antacids are just a few examples of other drugs that can be helpful in treating some cases of IBD. Sometimes a "drug cocktail" consisting of two or more medications is necessary to control a dog's IBD symptoms.

Different dogs will require different IBD treatments. In many cases, the combination of a hypoallergenic diet and anti-inflammatory drugs successfully controls symptoms. But since IBD is a chronic disease and long-term treatment with immunosuppressants increases the potential for adverse side effects, the ultimate goal should be to maintain dogs without the use of prednisone or other immunosuppressive drugs wherever possible.

This may require extensive trial-and-error to find the right dietary solution and supplement blend, and it won't always be successful, but when it is, the results are well worth it.