Inflammatory Bowel Disease in Cats

A cat with a tummy ache may sit in the "meatloaf" position; squinty eyes are also a sign of pain.

A cat with a tummy ache may sit in the “meatloaf” position; squinty eyes are also a sign of pain.

It seems that more and more cats are being diagnosed with inflammatory bowel disease (IBD). Because this condition is commonly misunderstood, and obtaining an exact diagnosis is difficult, many times the verdict of IBD is reached in a more backward than straightforward fashion.
Warning signs of IBD

With the word “bowel” as part of the name, you might think that the main symptom would be diarrhea. While this is certainly a common sign of IBD, in cats the primary (and often only) symptom is chronic vomiting. IBD can occur at any age, but is most often seen in adult cats between 2 and 10 years of age.

Now, we know that just about every cat vomits at one time or another, and certainly an occasional “urp” is not a cause for panic. So, when should you worry? Vomiting associated with IBD tends to be chronic, intermittent, and recurrent. It often occurs in spurts, where there will be a lot of vomiting for a couple of weeks, then nothing for a month, then another bout. Many cats aren’t particularly bothered by it, and seem completely normal otherwise.

Because of the lulls between episodes, people often do not seek veterinary treatment until the problem has been going on for many months, even years, or until more serious symptoms develop, such as diarrhea, weight loss, depression, or just “ADR” (that’s vet shorthand for the classic symptom, “ain’t doin’ right”). Sometimes, a change in litterbox habits (especially if diarrhea is involved) is the clearest signal that something’s truly amiss.

What is IBD and how is it diagnosed?

What is IBD anyway? IBD refers to a group of chronic conditions affecting the gastrointestinal tract (stomach, intestines, and colon), characterized by an accumulation of inflammatory cells along the membrane lining the tract. The type of IBD varies by what cells are present. The most common type is called “lymphocytic-plasmacytic” gastro/entero/colitis, depending on whether the inflammation is in the stomach (gastritis), the small intestine (enteritis), the colon (colitis), or a combination of these. Lymphocytes and plasma cells (specialized types of white blood cells) produce an immune response through production of antibodies.

Normally, there are patches of immune cells all along the gastrointestinal tract, because of the gut’s need for a good first-line defense against viral and bacterial invaders. But in IBD, so many inflammatory cells can accumulate and cause tissue irritation that the gut lining thickens. This thickening can in turn interfere with absorption of nutrients, leading to weight loss. This thickening can be detected by ultrasound, or it may even be palpable to your veterinarian.

A cat with suspected IBD (or any chronic vomiter) should always be checked by your veterinarian, including a thorough physical exam, complete blood count and blood chemistry panel, a check of the stool for parasites and undigested foods, and perhaps x-rays or ultrasound. There are many other causes of vomiting and diarrhea—parasites, bacterial or viral infection, endocrine disorders, neurological problems, and liver, pancreas, or kidney disease. Your veterinarian needs as much information as possible in order to treat your cat in the most appropriate manner.

IBD can be definitively diagnosed only by biopsy, either surgically or by endoscope. Both require general anesthesia, and both can be very costly. Endoscopy is less invasive, but its range is limited by its length and the curves in the digestive tract. It can take samples from the stomach, colon, and first part of the intestine only. However, if the usual treatments for IBD do not work for your cat, it may be necessary to proceed with a biopsy to rule out more serious conditions.

A less common disease is “eosinophilic IBD.” Eosinophils are white blood cells that are usually associated with parasites or allergic reactions. This type of IBD is poorly responsive to treatment.

Intestinal cancer, especially lymphoma, may also mimic IBD. There is some evidence that IBD may cause or convert to cancer, so prompt diagnosis and effective treatment are essential.

What causes IBD?

Many veterinarians believe that most cases of feline IBD are caused by food allergies or intolerances to proteins in particular. It used to be thought that all nutrients were broken down into their smallest components before being absorbed into the blood stream: proteins into single amino acids, or carbohydrates into simple sugars. Now we know that larger molecules, even whole proteins, can be absorbed intact. When immune cells see the foreign proteins from cat food in the blood, this may provoke the immune system into making antibodies to those proteins. Meat ingredients are, of course, high in protein, but even grains and vegetables, as well as soy, contain proteins that can become allergenic.

Since the digestive tract is where these proteins are making their entrance, white blood cells and antibodies gather there. The reaction of antibodies and proteins produces inflammation, which causes the blood vessels in the area to become “leaky,” thus allowing even more and larger proteins to be absorbed. This “leaky gut” syndrome triggers a vicious circle of absorption and inflammation. The bacterial population in the intestines may also shift in response to the altered environment, with overgrowth of some bacteria that may contribute to the cycle.

Dry food is much more often associated with IBD than any other form of food. In some cases, cats may react to a dry food but not to the same brand and flavor of canned food, nor to a homemade diet using fresh ingredients. Dry cat food is at the bottom of many feline health woes, including obesity, urinary tract disease, diabetes, and food allergies. (For more information, see “10 Reasons Why Dry Food is Bad for Cats & Dogs.”)

Food allergies typically develop to ingredients that the cat has been exposed to over a long period of time. Therefore, low-allergen or “hypoallergenic” diets are based on novel protein and carbohydrate ingredients that are not commonly used in commercial pet foods. Ingredients to avoid include chicken, beef, fish, corn, wheat, soy, and dairy products. (Of course, if your cat has been eating a food containing lamb, rice, eggs, or any other proteins, those ingredients must be avoided as well.)

How is IBD treated?

The first and best remedy for a food allergy is a food trial with a “hypoallergenic” or “novel protein” diet. This may be homemade, such as ham baby food with white rice, or commercial cat food, such as duck and potato, or rabbit and green pea. Canned foods usually work better than dry diets. The diet must be strictly followed—no snacks, treats, or other cheating—for several weeks, although a response may be seen as quickly as a few days. Not only can a diet trial support a diagnosis of IBD, but it is also a method of treatment, and many cats will experience a complete remission of symptoms with dietary changes alone.

There are a number of veterinary (by prescription) diets available using “novel ingredients” made by major pet food companies. They are all available only from a veterinarian or with a prescription (although technically a prescription is not legally required). Unfortunately, most of them contain low-quality ingredients, including large amounts of grains, and by-products rather than good quality meat.

While there are better quality commercial foods available over-the-counter that claim to contain limited protein sources, multiple studies have found significant cross-contamination with proteins that are not listed on the label. Chicken is the most common contaminant; unfortunately, it is also the most common allergen. Still, such foods may be worth a try.

Another approach to dietary management of IBD is hydrolyzed proteins, such as in Hill’s z/d, which contains chicken and rice proteins that have been broken down by hydrolysis into smaller particles. Theoretically, the molecules are too small to trigger an immune reaction, and thus the cat should never become allergic to this food. However, in practice, many animals have in fact developed allergies to even these foods, so long-term therapy with such foods is not advisable.

Because of the difficulty, risks, and expense of the primary diagnostic procedures, many cats are simply put on trial therapy. The most commonly used anti-inflammatory drug used in feline IBD is prednisolone, the preferred form of prednisone for cats (there is also an long-lasting injectable form, but this may not work as well as oral medication and carries a much higher risk of adverse effects, including diabetes). This anti-inflammatory steroid can provide a great deal of relief to these kitties. If it works, the presumptive diagnosis is then IBD. Other anti-inflammatory or immuno-suppressive drugs, such as azothiaprine, are also available. Sometimes, a round of antibiotics and acidophilus to adjust an unbalanced gut bacterial population can be helpful.

Prednisolone, of course, carries its own set of side effects. It increases the risk of diabetes and ulcers of the digestive tract, increases susceptibility to infections, and puts long-term stress on the kidneys. A cat on prednisolone will eat and drink more, and may gain a significant amount of weight. You may notice skin and coat changes. Steroids will interfere with diagnostic tests, so if a biopsy is being considered, it should be done first. There are other serious potential long-term side effects of steroids, such as diabetes and kidney disease. On the plus side, the cat will feel much better, and the symptoms will be diminished or eliminated, so the benefits may outweigh the risks, at least for a trial period. However, many veterinarians use steroid treatment long-term; usually for the life of the cat. Unless the dose can be greatly reduced, this could eventually cause significant problems.

Can IBD be treated holistically?

Holistic treatment options also start with diet, usually a homemade one. However, raw meat diets are risky in IBD cats, because the inflamed gut lining impairs the body’s defenses against the foreign bacteria that we know are in virtually all meat. Two ways around this:

(1) Lightly cook the meat when first introducing a homemade diet. As the gut heals, cook the meat less and less until you can feed it raw, if desired.

(2) Do a VERY gradual introduction, starting with mixing a tiny amount of raw meat in with the cat’s regular food. Ratchet up slowly until the cat is fully converted (if that’s your preferred endpoint.)

Feeding in timed meals, rather than leaving food out all the time, also allows the gut to rest and heal between meals. It is not natural for a cat to eat constantly, as many dry-food munchers do.

Eliminating dry food from the diet is sometimes the only necessary step in milder cases of IBD.

The most comprehensive holistic modalities for treatment of IBD are homeopathy, homotoxicology, acupuncture, NAET, and herbal medicine; although other therapies may be beneficial in any particular case. To find a practitioner near you, see the directory by state at www.holisticvetlist.com.

Adding digestive supplements will help the cat digest the food, and repopulate some of the “good” natural bacteria.

Probiotics (beneficial or “friendly” bacteria) are gaining acceptance for the prevention and treatment of IBD in humans, and research suggests similar uses in animals. They are thought to work by out-competing pathogenic bacteria, helping heal the gut lining, and modulating the immune system’s activity. They also have anti-inflammatory properties. Choose a probiotic supplement with several strains of bacteria, as different strain has different effects.

Digestive enzymes can also be very helpful for IBD. An insufficiency of natural digestive enzymes, which are produced in the pancreas, can both cause and mimic IBD. Animals studies suggest that digestive enzymes can help reduce colon inflammation. Since food allergies are usually involved in IBD, assisting the gut in breaking down potentially allergenic proteins may also have a positive effect. In addition, becaue IBD is often accompanied by liver and/or pancreas inflammation, providing digestive enzymes reduces the “workload” on the pancreas and helps relieve symptoms. Proteolytic enzymes from fruits such as pineapple and papaya are especially important. A good plant- or yeast-based combination of protease, lipase, amylase, and cellulase is ideal.

Prebiotics, such as inulin, are special types of soluble/fermentable fiber that maintain a healthy gut environment and nourish intestinal lining cells.

For temporary relief, the herbs slippery elm and marshmallow root, which are very safe and non-toxic, can help soothe the gut lining and reduce discomfort and diarrhea. About ⅛ to ¼ tsp. of powdered herb, mixed with a little cool water, can be added to each meal.

Can IBD be prevented?

Clearly, it would best to prevent this disease from ever getting a foothold. A diet of fresh, whole, unprocessed foods is the least likely to result in food allergies and other digestive issues.

Changing diets (using a variety of brands, flavors, and forms, such as canned, commercial raw, or homemade) at least every 3-4 months, to a food with different protein and carbohydrate sources, may prevent your cat from becoming allergic or intolerant to a single food in the first place. If you’re feeding canned food, once your cat gets used to it you can change flavors with every meal if you like. My cats never get the same meal twice in a row!

Always make any diet switch, including the introduction of supplements, gradually, to avoid rejection or tummy upset.

In addition, holistic veterinarians have long believed that vaccines cam make the immune system abnormally sensitive or over-reactive, increasing the likelihood of developing IBD of other immune-mediated diseases. There is increasing evidence from scientific studies that this is so. Not every cat needs every vaccine — be sure to discuss your cat’s disease risk and optimal vaccine program with your veterinarian. Vaccines are intended for use in healthy animals only; if your cat already has IBD or other chronic illness, talk to your veterinarian about submitting an exemption from legally required vaccinations.

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