Digestive Disorders in Dogs
Also see these articles:
- Addison's Disease: The Great Pretender
- Exocrine Pancreatic Insufficiency
- Pancreatitis in Dogs
- Supplements for Digestive Support
Disclaimer: I am not a veterinarian, nor do I have any formal training in any medical field. The information presented here is not meant to replace your vet's advice or prescribed medications, but only to suggest additional options to explore, based on your dog's condition.
See your vet if your dog has diarrhea accompanied by black, tarry stools or stools with a lot of fresh blood, loss of appetite, frequent vomiting, lethargy, bloating, signs of pain, or if the diarrhea lasts for more than two days. For occasional diarrhea with no other symptoms, try these remedies:
- Feed small, frequent meals, if possible. Keep fat to a minimum. Feed boiled chicken or hamburger (boiling will remove the fat), baby food or cottage cheese, along with white rice (overcooked with extra water) or other bland foods, such as white bread.
- Rice congee is made by boiling one cup of white rice (not minute rice) in four cups of water for 20 to 30 minutes. The liquid is soothing and can help stop both vomiting and diarrhea. Mix in a little chicken baby food or honey for flavor, if needed. Start by feeding the liquid alone, then try mixing the rice as well with cooked chicken breast or boiled ground beef.
- Probiotics (beneficial bacteria) help to keep harmful bacteria in check and restore intestinal balance. They can be added to rice water or other food. There are two strains that have been shown to benefit dogs: Bacillus coagulans (formerly called Lactobacillus sporogenes; available at Amazon), and Enterococcus faecium, a strain that is native to dogs. (Note that despite its proven beneficial effects, E. faecium may be best used short-term due to possible issues with antibiotic resistance, opportunistic infections such as UTIs, and effects if transmitted to humans. Strain SF68 appears to be safer than other E. faecium strains.) Several canine probiotic supplements, such as Jarrow Formula's Pet Dophilus Powder, contain Enterococcus faecium. You can also use products made for people, available from your health food store or department. Continue to add probiotics for two weeks up to six months, to help repopulate the beneficial bacteria in the gut. See my article on Probiotics for more information.
A couple of people have reported success using Primal Defense or Primal Defense Ultra soil-based probiotics from Garden of Life when nothing else worked. Also available at Amazon. I'd be interested in hearing about other people's experience with these products (my contact information is at the bottom of the page).
- Add pumpkin to the food. Pumpkin helps by absorbing the liquid in the system and adds fiber to help firm the stool. Canned pumpkin (not pumpkin pie mix) works fine. Use small amounts only, as too much can actually lead to loose stools. Sweet potatoes are also supposed to help. See below for more info on fiber.
- Applesauce contains pectin, a soluble fiber that can help stop diarrhea. Some diarrhea medications may contain kaolin and pectin (Kaopectate no longer contains either, see below). As with pumpkin, too much can cause problems. See below for more info on fiber.
- Cabbage juice is also recommended for soothing and helping to stop diarrhea.
- Enteric coated peppermint, which you can find in a health store. Peppermint helps with the lower bowels, but must be coated to make sure they reach there intact. This is given 15 minutes before a meal. You can also try peppermint tea. Do not use peppermint in any form if your dog has problems with reflux.
- I've seen several products recommended from people who have used them successfully with their dogs. Note these products are not meant to be used for more than three days at a time:
- Diagel can help treat diarrhea caused by bacteria. Comes in 1-ml (for small dogs), 3-ml (for medium dogs), and 5-ml (for large dogs) syringes. Available at Amazon.
- Diarsanyl for dogs with periodic colitis or occasional acute diarrhea. It contains Montmorillonite clay, which should be safe to use as directed (twice daily for three days). This product is also safe for cats and is available in other countries as well as the US. Also available at Amazon.
- Bene-Bac Pet Gel beneficial bacteria (probiotics), also available at Petsmart and Amazon
- Dia Bac Diarrhea Control
- Fast Balance-G.I. also called Immediacare G.I. and Quick Relief all made by a company I like and trust. Also available at Amazon: Fast Balance, Immediacare, Quick Relief.
- MediBulk from Thorne Veterinary
- Certain over-the-counter human anti-diarrhetic products can be used for up to three to five days. There are several things to be aware of when using these products:
Dosage for most of these products is given in the links above. For others, adjust the dose according to the size of your dog (large dog would get an adult human dose, medium dog half the dosage for an adult human, small dog one quarter the dosage). None of these should be used long-term, just on occasion as needed. If diarrhea continues for more than a day or two, or if your dog is showing other symptoms such as vomiting, fever, lethargy, etc., see your vet rather than trying to treat at home.
- Pepto-Bismol and now Kaopectate (which was recently reformulated) contain salicylates, which are related to aspirin and may cause gastric problems, although these products are used for dogs. Warning: Do not use any product that contains salicylates if your dog is also getting aspirin or any NSAID drug (Rimadyl, Deramaxx, Metacam, Etogesic, etc.) without your veterinarian's direct advice, and never use them at all with cats. There are other kaolin-pectin products such as Durvet Kaolin-Pectin, Proviable KP, Pro-Pectalin, Pet Pectillin, and Priority Care Kaolin-Pectin that do not contain salicylates and would be a safer choice, or you can use plain Pectin.
- Imodium (loperamide) can be used for severe diarrhea to help reduce fluid loss, but it should be avoided for dogs with the MDR1 mutation that causes multidrug sensitivity in some breeds, including Australian Shepherds (standard and miniature), Border Collies, Collies, English Shepherds, German Shepherds, Longhaired Whippets, McNabs, Old English Sheepdogs, Shetland Sheepdogs, Silken Windhounds, and mixed-breed dogs from any of these breeds (see Dogs with a Drug Problem and Multidrug Sensitivity in Dogs for information about other drugs these breeds may be sensitive to, which include ivermectin, acepromazine, certain chemotherapy drugs, and others).
Imodium is also contraindicated for dogs with intestinal infections, as it slows GI transit time which increases absorption of toxins from bacteria (see Drugs Used in Treatment of Diarrhea). A single dose in that case is probably OK, but if your dog needs more than that, you should see your vet. See Loperamide (Imodium AD) for more info.
Only use after approval from your veterinarian if your dog has respiratory disease, severe kidney disease, hypothyroidism, or Addison's disease (see Dog Cancer Blog).
- One vet recommended Metamucil. Although Metamucil is commonly used as a laxative, apparently the fiber can help absorb water in the colon and thus control diarrhea. It is important that your dog drink lots of water when taking a supplement like this. See below for more info on fiber.
- You can also add fiber with Fiber One Original Cereal. See below for more info on fiber.
- There are several natural remedies that will help soothe and heal the gastrointestinal tract. These include slippery elm bark, l-glutamine (an amino acid supplement), and marshmallow root (herb). Phytomucil (also available in 4 oz size) from Animal's Apawthecary contains two of these. I have also seen a Chinese Herbal remedy recommended called Huang Lian Su that can be used for dogs, but I personally am somewhat leery of using these types of remedies without the specific advice of a holistic vet trained in Traditional Chinese Medicine..
- Carob powder can also be used to treat diarrhea, as well as vomiting and lack of appetite, just add 1/2 to 2 teaspoons to food, honey, water or yogurt three times a day for three days.
- Here is Dr. Pitcairn's recipe for using slippery elm bark for diarrhea, from his book, Dr. Pitcairn's New Complete Guide to Natural Health for Dogs & Cats:
Thoroughly mix 1 slightly rounded teaspoon of slippery elm powder with 1 cup of cold water. Bring to a boil while stirring constantly. Then turn the heat down to simmer and continue to stir for another 2 to 3 minutes while the mixture thickens slightly. Remove from the heat, add 1 tablespoon of honey (for dogs only -- cats don't like sweets, so leave it out), and stir well. Cool to room temperature and give 1/2 to 1 teaspoon to cats and small dogs (under 20 lbs), 2 teaspoons to 2 tablespoons for medium dogs (20 - 40 lbs), and 3 to 4 tablespoons for large dogs (over 40lbs). Give this dose 4 times a day, or about every 4 hours. Cover the mixture and store at room temperature. It will keep for a couple of days.Slippery elm capsules are available at health food stores. Urban Carnivore offers a convenient powder form. Powder form is also available at Amazon.
- Digestive enzymes can help dogs who have a problem digesting fat, which often results in a mucousy stool.
- For dogs prone to diarrhea, the following supplements given on an ongoing basis may help
- Nutrigest, Rx Biotic and Rx Zyme from Rx Vitamins for Pets (best prices found at PureFormulas, also available at Amazon).
- Perfect Form, from The Honest Kitchen
- L-glutamine, at the rate of 500 mg per 20-25 pounds of body weight (more is OK)
- Canine Enteric Support (Standard Process)
- Gastriplex (Thorne Veterinary), also available from HolisticPetInfo
- Total Digest also called Acetylator and Digest Discovery
- Vetri-Probiotic BD Digestive Aid, available from HolisticPetInfo
- Enhance Digestive Aid
- Perma-Clear (Thorne Veterinary), also available from Naturamart.
- Berte's Digestion Blend
- Diarrhea can be caused by worms and other parasites. If it continues for more than a couple of days, see your vet to determine the cause and to make sure your dog is not getting dehydrated. Keep in mind that some parasites, including whipworms and coccidia, may be difficult to spot on a fecal exam. Sometimes it makes sense to treat with Panacur to see if it helps, even if the fecal is negative.
- There are many other causes of diarrhea. Too much food can lead to loose stool. Certain supplements, foods or additives can cause a reaction in some dogs. Too much vitamin C (the amount varies by dog) causes loose stools. Too much fat in the diet can lead to loose or mucousy stools. Too much or too little fiber can also be linked to loose stools. See below for more info on fiber.
If diarrhea continues for more than a couple of days, or if it is accompanied by other symptoms, such as vomiting, see your vet for more help. Diarrhea can cause dehydration and may be a symptom of a more serious problem. Your vet also has access to more potent anti-diarrhea medication, if needed. See the following articles for more information:
- 5 Natural Solutions to Your Dog's Diarrhea
- Using Diet to Treat Diarrhea in Dogs
- How to ... Treat Diarrhea at Home
- Diarrhea & Vomiting: When to See Your Veterinarian
- Diarrhea in Dogs and Cats
The suggestions above are meant to help with occasional problems, not severe or chronic diarrhea. For those, see the section on IBD, IBS and Colitis below.
See GI Disorders: Part 3 – Management of Acute Cases for additional information.
IBD (Inflammatory Bowel Disease), IBS (Irritable Bowel Syndrome, which is caused by stress) and Colitis (inflammation of the lower bowel) can cause frequent diarrhea and be quite debilitating, even to the point of being life-threatening. These conditions can be difficult to manage and get under control.
IBD cannot be accurately diagnosed without a biopsy, but there are certain symptoms that will help you determine whether your dog is suffering from large bowel (colitis) or small bowel diarrhea, which can help you decide what the most likely cause may be and what treatments are apt to work. For example, small bowel diarrhea is more likely to be caused by bacterial infection or EPI (see below). See Chronic Diarrhea in Dogs for a description of the differences between the two, and an overview of the possible causes. Also see Colitis FAQ for in-depth information on this topic.
It's a good idea to treat presumptively for parasites to rule them out as a cause, as some can be very difficult to detect on a fecal exam (whipworms in particular are hard to find). Panacur (Fenbendazole) is a very safe drug to use that is effective against most intestinal worms, including whipworms, as well as giardia. It will not work for coccidia, unfortunately, but the drugs needed to treat that are stronger and I wouldn't encourage using them without a definite diagnosis. I know of people who have spent months trying different diets and supplements to try to help their dogs with chronic diarrhea, only to find out that the cause is parasites and treatment with either Panacur or Albon (for coccidia) clears the problem up quickly.
Although there are many causes of chronic diarrhea, one factor that I've seen come up over and over again is an intolerance for grains in the diet. Many dogs that are switched to a grain-free raw diet do very well, often better than they have in their entire lives. In general, you want to stay away from all grains and other starchy foods that take a long time to digest, such as potatoes and corn, limit the amount of fiber (from vegetables), and avoid dairy, to see if that helps. See below for more info on fiber.
Carrageenan, an ingredient used as a thickening agent in many canned foods, has been associated with intestinal ulceration, inflammatory bowel disease (IBD), and acid reflux. While most studies have been done on carrageenan, it's possible that other thickening agents, such as carboxymethyl cellulose, polysorbate 60 and 80, guar gum, xanthan gum, and agar agar, may also contribute to digestive problems in sensitive dogs. Look for stews and other more liquid (not formed into a pâte or loaf) canned foods to avoid these ingredients. See the following for more infomation:
- Carrageenan Just Don't Do It
- What’s this ingredient in my pet’s food? Carrageenan?
- Review of Harmful Gastrointestinal Effects of Carrageenan in Animal Experiments
- Common ingredient in packaged food may trigger inflammatory disease
Problems with grains may be related to food allergies, or to difficulty digesting carbohydrates, or to gluten intolerance. Sources of gluten include wheat (including Kamut and spelt), barley, rye, and triticale; oats are considered questionable (oats are gluten-free but processed oats can be contaminated with gluten), while buckwheat, corn/maize, and rice are gluten-free. Dogs with gluten intolerance may also react to dairy products and to soy. Grains can contain molds or storage mites that can cause an allergic reaction as well.
Chronic pancreatitis may be a cause of diarrhea, particularly if vomiting, anorexia (loss of appetite), or abdominal pain is also present, but symptoms may be as subtle as not wanting to play or skipping meals occasionally. There's a blood test your vet can do to find out whether pancreatitis is contributing to your dog's problems called the Spec cPL.
Many dogs with IBD, chronic pancreatitis, or other gastrointestinal problems have difficulty digesting fat and may need a low-fat diet. See my article, Healthy Low-Fat Diets for Dogs, for more information.
For IBD, colitis, and other forms of gastric irritation, here are some supplements that may help:
- N-Acetyl Glucosamine (NAG) is a form of glucosamine that helps to repair the intestinal lining. It may be especially helpful for dogs with IBD. It is found in many digestive supplements, or can be purchased separately at a health food store. Products that contain NAG include:
- L-glutamine and Slippery Elm Bark can also help soothe the digestive tract and relieve inflammation. L-glutamine in particular helps to repair the mucosal lining of the digestive tract. L-glutamine is a single amino acid that should not provoke an allergic reaction, even in dogs with severe food allergies.
- Phytomucil is an herbal supplement that can help with IBD and other digestive problems. It contains slippery elm along with marshmallow root, licorice root; and plantain leaf, which are herbs that are beneficial for the digestive tract.
- Seacure is hydrolyzed fish protein shown to help with leaky gut syndrome and malnutrition. Because it is hydrolyzed, it should not provoke an allergic reaction even in dogs with severe food allergies. It is at least 40% l-glutamine, so I don't know whether it's more effective than plain l-glutamine (which is much less expensive) or not.
- Probiotics can help replenish the friendly bacteria and eliminate the pathogenic bacteria in the intestines. There are two strains that may be particularly good for dogs: Bacillus coagulans (formerly called Lactobacillus sporogenes; available at Amazon) and Enterococcus faecium, a strain that is native to dogs. Bifidobacterium animalis (found in Probiotic Miracle from Nusentia, available at Amazon) has also been shown to reduce recovery time for acute diarrhea. Several canine probiotic supplements, such as Jarrow Formula's Pet Dophilus Powder and Fortiflora from Purina (best price at EntirelyPets), contain Enterococcus faecium. (Note that despite its proven beneficial effects, E. faecium may be best used short-term due to possible issues with antibiotic resistance, opportunistic infections such as UTIs, and effects if transmitted to humans. Strain SF68 appears to be safer than other E. faecium strains.) You can also use products made for people, available from your health food store or department. More info in my article on Probiotics.
- Prebiotics help support the beneficial bacteria in the intestines, which may help with digestive disorders. Larch arabinogalactan is a form of soluble fiber that is frequently used as a prebiotic, found in supplements such as Arabinogalactan Powder from Vetri-Science/Food Science and Arabinogalactan. Fructooligosaccharides (FOS) are another form of soluble fiber used as a prebiotic that is often included in probiotic supplements. Chicory is a third type of prebiotics, used in Animals' Apawthecary Pre-Biotic Plus (available at Only Natural Pet Store, see my Shopping web page for coupons). More info in my article on Prebiotics.
- Fish Oil (such as salmon oil or EPA oil, not cod liver oil), which contains the vital omega-3 polyunsaturated fatty acid EPA, can help break the inflammatory cycle in colitis as it does in rheumatoid arthritis and psoriasis. Some studies have been done that indicate supplementing with omega-3 fatty acids can help with intestinal inflammation. Fish oil is the best source of these and has been found beneficial in human patients with IBD. Give a maximum of 1 gram (1,000 mg, which generally includes a combined total of 300 mg EPA and DHA fatty acids -- you can use fewer gelcaps if the fish oil has more EPA and DHA) per 10 pounds of bodyweight. Be sure to also give vitamin E whenever you supplement oils, no more than 1-2 IUs per pound of body weight daily, or you can give more less often. Evening Primrose Oil or Borage Oil may also be helpful, due to a high content of gamma-linolenic acid (GLA). Be sure to also give vitamin E whenever you supplement oils. Note that fish oil may be contra-indicated in dogs with fat intolerance. More info in my articles on Oils.
- Coconut Oil contains medium-chain triglycerides (MCTs) that are a form of fat that does not require the same type of digestion as other types of fat, and so can be used for dogs with pancreas problems or fat intolerances. Be sure to use only virgin (unrefined) oil in glass jars. Maximum dosage is 1 teaspoon per 10 lbs of body weight daily, but start with less and build up. Keep in mind that coconut oil is pure fat and adds 40 calories per teaspoon.
- Enteric coated peppermint, which you can find in a health store, can be helpful for dogs with colitis. Peppermint helps with the lower bowels, but must be coated to make sure they reach there intact. This is given 15 minutes before a meal. Do not use peppermint in any form if your dog has problems with reflux.
- Other herbs that may help with colitis and gastrointestinal inflammation include yucca herbal tincture or glycerite (such as Yucca Intensive), quercetin (bioflavonoid, available at Amazon), bromelain (an enzyme that may work synergistically with quercetin, available at Amazon), boswellia (herb, available at Amazon) and curcumin (a spice, also called turmeric).
- Digestive enzymes are helpful to some dogs. Most dogs with colitis need help with digestion of the nutrients for best assimilation, but occasionally enzymes may make diarrhea worse, so discontinue or try a different brand or type (plant-based, animal-based/pancreatin, or soil-based) if you don't see improvement.
- There is also anecdotal evidence of Bovine Colostrum being helpful, available at Amazon.
- Ellagitannins (extracts from raspberries and blackberries) may help with gastritis (stomach inflammation) and ulceration. Read more in Monica Segal's newsletter.
See my post on Inflammatory Bowel Disease that discusses a recent veterinary conference Update on Inflammatory Bowel Disease, which talks about diagnosis and treatment for some additional information, including mention of using Budesonide (Entocort® EC) in place of prednisone when immunosuppressive drugs are needed, as it has fewer side effects and may be more effective.
Here are links to more information on IBD, IBS and Colitis, as well as some other causes of chronic diarrhea:
- GI Disorders: Part 4 – Management of Chronic Case Great overview with information on conventional, alternative, and experimental treatments, including fecal transplants.
- Colitis in the Dog and Cat good list of possible causes, plus how to differentiate between small- and large-bowel diarrhea
- Colitis in Dogs and Diarrhea and Loose stool from VetInfo, always a good source
- Diarrhea information from WSU College of Veterinary Medicine
- Inflammatory Bowel Disease information from Veterinary Partner, another good source
- Inflammatory Bowel Disease in Dogs and Cats information from PetEducation, another good source
- Canine Colitis
- Dietary Management of Chronic Diarrhoea good information on diagnosis as well from SpeedyVet
- Treating Acute Diarrhea And Chronic Diarrhea in Dogs commercial site, but one I trust, written by a vet
- Natural Aids For Treating IBD Talks about the use of herbs and supplements
- Beja anecdotal information from one dog owner who has been thru this
- Inflammatory Bowel Disease Update (human oriented)
- Inflammatory Bowel Disease from Holisticat (cat oriented)
- All Fiber is Not the Same
- The Fiber Factor from my article on Canine Diabetes
- Dietary Considerations from my article on Diets for Dogs with Diabetes
- Dietary Fibre and Gastrointestinal Disease more from SpeedyVet
- Food trials and tribulations for allergic pets
- Allergy testing for pets: Beyond the food trials and tribulations and onto the big guns
- Diet and Large Intestinal Disease in Dogs and Cats
- Update on Inflammatory Bowel Disease
- Management of Inflammatory Bowel Disease in Dogs (scroll about two thirds of the way down the page)
- Laboratory assessment of gastrointestinal function
- Nutritional management of the most common digestive diseases in dogs and cats
- Clinical and Nutritional Aspects of Managing Gastrointestinal Health, Diabetes, and Obesity
- Intestinal Disorders in Dogs and Cats
- Diagnosis and Management of Refractory Diarrhea
- Histiocytic Colitis in Boxers and other Large Bowel Diseases
- Remission of histiocytic ulcerative colitis in Boxer dogs correlates with eradication of invasive intramucosal Escherichia coli
- Advances in Dietary Management of Gastrointestinal Disease
See Exocrine Pancreatic Insufficiency for more information on EPI.
Diarrhea and other stool problems can also be caused by diseases such as SIBO (Small Intestine Bacterial Overgrowth) and EPI (Exocrine Pancreatic Insufficiency). SIBO can be related to IBD.
Symptoms of SIBO include loud stomach noises, lots of gas, increase in stools, often mushy, and many times, DECREASED appetite and loss of weight. SIBO may be linked to a Vitamin B12 (Cobalamin) deficiency, which occurs due to problems absorbing this vitamin, not due to dietary deficiency. It is treated with B12 injections, and usually with Tylan (tylosin), an antibiotic powder, or Oxytetracycline. Antibiotics must be given for 4 to 6 weeks to be effective. Tylan is very bitter, so is best given in capsule form. It is expensive, but you can find it cheaper in bulk and just put it into capsules yourself using an inexpensive capsule maker (apparently the 00 size capsule holds 1/4 teaspoon). Additional treatment should include probiotics, and may involve feeding a low fat diet and/or a novel protein diet, if food sensitivities are suspected. L-glutamine might also be helpful in repairing the intestinal mucosa (give 500 mg per 25 lbs of body weight). In German Shepherd Dogs, SIBO may be a primary condition, but in other breeds, it is considered secondary to other gastrointestinal conditions, such as IBD, EPI, delayed intestinal transit due to partial obstruction or other causes, food sensitivities, etc., so it is important to find and treat the primary condition, and not just the SIBO. The most common test for SIBO is a blood test sent to the GI Lab at Texas A&M. It is a Cobalamin (B12) & Folate test (dogs with SIBO usually, though not always, have low Cobalamin and/or high Folate). If you run these tests, it makes sense to also run a TLI (for EPI) because if the results of the B12 or folate are off they are going to tell you to first rule out EPI (see below for more info on EPI). Go to Texas A&M University (TAMU) GI Lab to read about these tests (they are the first two listed). Dogs are required to be fasted 12 to 18 hours before the test. Note that B12 injections are colored red and may cause the urine to be a reddish color. See Bacterial Overgrowth in Dogs-More Common Than You Think for more info.
Symptoms of EPI include INCREASED appetite; huge fluffy, smelly, gray or yellowish stools (often described as "cow patty stools"); frequent defecation; weight loss; gas; and loud stomach noises (called borborygmus). The dog's pancreas doesn't produce enough digestive enzymes to break the food down and therefore no matter how much they eat, they can't digest their food and therefore they are literally starving. Loss of weight can be rapid. EPI is most common in German Shepherd Dogs, but occurs in other breeds as well. Dogs with chronic pancreatitis have an increased risk of developing EPI. A blood test called TLI (trypsin-like immunoreactivity) is used in combination with tests for Folate and Cobalamin to confirm a diagnosis of EPI.
This condition is treated with prescription powder enzymes, such as Viokase. Viokase is hundreds of times more potent than the standard digestive enzymes you would find in a health food store. Viokase is very expensive, but there are generic equivalents such as Bio Case that are a little cheaper (see below). Once your dog is stabilized, you can also try reducing the dose to see if the improvement can be maintained with less, as dosage needs often decrease over time.
Alternatively, raw cow or pig pancreas can be used to supply digestive enzymes; see this article on Exocrine Pancreatic Insufficiency for more information. See the sections on Frozen Raw Food Products and Raw Food Co-ops and Local Groups for help finding a supplier in your area (companies that supply parts may be able to get you pancreas even if it is not in their product list). You can also talk to butchers, ranchers and livestock processors in your area to see if they can supply you with raw pancreas.
See Gastrointestinal Function Tests in Dogs and Cats for more info on interpreting the results of TLI, folate and cobalamin tests. See Chapter 1, Exocrine Pancreatic Insufficiency, for detailed, technical information on EPI diagnosis and treatment.
Note that Medium Chain Triglycerides (MCTs) may be easier for a dog with EPI to digest. Studies show that digestions of MCT fats in dogs with EPI is reduced only by about 25%, while digestion of long chain triglycerides (LCTs) is reduced by about 95%. MCTs are found in milk fat and in coconut oil. See Use of Medium Chain Triglycerides in Clinical Nutrition for more information on this topic. Note that when supplementing with coconut oil, you should use virgin (unrefined) oil in glass jars. You can give as much as 1 teaspoon per 10 lbs of body weight daily, but start with less and build up.
Low-fat diets are traditionally recommended for dogs with EPI, but surprisingly diets with 43% calories from fat have been shown to promote better protein, fat and carbohydrate digestibility compared to diets containing 18% and 27% calories from fat in dogs with experimental EPI. Another study failed to show any significant benefit of severe fat restriction (13% of calories). These observations suggest that feeding a higher fat and thus more energy dense diet could promote a rapid restoration of optimal body weight without recourse to medium chain triglyceride oil. However, I would exercise caution when increasing the amount of fat in the diet, as dogs with EPI may also have fat intolerance, so increased levels of fat may lead to diarrhea in some dogs.
Dogs with EPI will benefit from a low-fiber diet, regardless of the amount of fat in the diet. See below for more info on fiber.
Also note that there are studies, including one in the publication above on MCTs, showing the bacterial lipase works better for dogs with EPI than pancreatic lipase, and is supposed to be less expensive. Unfortunately, all I can find on this are studies, not products. If anyone knows of any bacterial lipase products, I would appreciate it if you would let me know.
Links to more info on EPI, SIBO, and their treatment:
- Exocrine Pancreatic Insufficiency
- EPI * Exocrine Pancreatic Insufficiency
- Laboratory Diagnosis of Intestinal Disease in Dogs and Cats
- Viokase-V (this site also carries Bio Case V and Pancreved)
- Viokase-V (this site also carries Pancrezyme and generic alternative Epizyme)
- Bio Case V from Thomas Labs
- Exocrine pancreatic insufficiency
- Pancreatic Insufficiency
- Exocrine Pancreatic Insufficiency (EPI) (search for EPI)
- What is exocrine pancreatic insufficiency?
- Pancreatic Insufficiency (Maldigestion Disorder)
There is a new forum and an email group for people with dogs that have EPI:
See Addison's Disease: The Great Pretender, the article I wrote with CJ Puotinen, for more information.
Non-specific gastrointestinal signs are a common indication of Addison's Disease, even if electrolytes (sodium and potassium) are normal. These signs may include vomiting, diarrhea, inappetence, dark tarry stools (melena -- approximately 15-20% of dogs with Addison's will have this symptom) or blood in the vomit, especially if symptoms improve when the dog is given fluids and corticosteroids such as prednisone, then later worsen again. Five percent of dogs with Addison's may have acute gastroenteritis resembling Parvo or HGE (Hemorrhagic Gastroenteritis).
Dogs that appear to be in acute renal failure (high creatinine and BUN, with low urine specific gravity) may also have Addison's Disease. Low cholesterol, low protein (globulin and albumin), and elevated liver enzymes may point to Addison's Disease.
Hypoglycemia (low blood glucose), or hypercalcemia (high blood calcium) may also be signs of Addison's; in fact, one person who knows a lot about Addison's, says, "I have yet to see an Addisonian (Primary/Typical, Primary/Atypical or even Secondary) who did not have a very low glucose reading prior to being medicated."
A sick dog with a normal or elevated lymphocyte count may have Addison's. Signs of weakness and even collapse that come and go point strongly toward Addison's disease.
Low sodium and high potassium resulting in a sodium:potassium ratio of less than 27 is a classic sign of Addison's disease, though they cannot give a definite diagnosis, and normal values do not rule it out. The definitive test for Addison's Disease is called an ACTH Stimulation test, where blood cortisol levels are measured before and one hour after receiving an injection of synthetic ACTH hormone. Low initial cortisol and little or no reaction to the ACTH indicate Addison's disease.
One of the medications used to treat Addison's Disease is called Florinef. It is expensive when purchased from your vet, but you can get it for much less from compounding pharmacies. Compounding pharmacies can also provide a liquid version which may be easier to get the proper dosage, especially for small dogs. Here are some compounding pharmacies that offer Florinef:
Tiffany Natural Pharmacy (recommended by people on the K9Addisons list)
Florinef for less lists a number of pharmacies that offer compounding for Florinef
Percorten-V (desoxycorticosterone pivalate or DOCP) is an injectable medication given approximately every 25 days. It is the preferred treatment, as it is easier to get dogs stabilized and keep electrolytes normalized than with Flornef. Once the appropriate dosage has been identified, you can save money by learning to give the injections at home. Percorten-V can be purchased from 1-800-PetMeds, who will match any lower price you find.
Please see the following sites for more information on Addison's Disease in dogs:
You can contact me if you have any comments, but I regret to say that I can no longer respond to questions about individual dogs. See my Contact page for more information. My name is Mary Straus and you can email me at either or