A Mountain, or a Molehill? What Science Really Says About The Incidence of DCM

Episode 33 • 30th October 2024 • Barking Mad • BSM Partners

Jordan Tyler: In: 2018

All of this was spurred by reports from veterinary professionals who felt they were seeing a rise in the number of dogs being diagnosed with DCM, more specifically in breeds of dogs that aren't commonly diagnosed with this type of heart condition. As you can imagine, this caused quite a panic across the pet nutrition landscape, serving to upend entire businesses and cultivating a strong reaction from pet owners, many of whom remain confused today about the safety of grain-free and pulse-inclusive dog foods.

You've heard all about the impact of this announcement across the industry so far in our DCM series. On today's episode though, we're going all the way back to discuss the beginnings of DCM, one of the hottest topics to touch pet nutrition in decades.

Why go all the way back to the beginning? Because just one year after announcing its investigation, the FDA published another announcement stating they believe the potential association between diet and DCM in dogs is a complex scientific issue. Many have used the word multifactorial, which essentially means there are many factors, aside from diet alone, that could contribute to the development of DCM.

This is where our team at BSM Partners started to scratch our heads. Was there actually an increase in the incidence of DCM? And what data were used to come to that conclusion? This back and forth was puzzling, so our team, being the science-minded individuals they are, decided to work with the FDA and veterinary cardiologists to help the industry get to the bottom of this issue.

I'm thrilled to introduce Dr. Justin Thomason, a board-certified veterinary cardiologist and one of the cardiologists who helped provide DCM case data from Kansas State University. Dr. Thomason currently practices veterinary medicine at Blue Pearl Pet Hospital in Overland Park, KS. Also on today’s episode are Dr. Bradley Quest, Principal of Veterinary Services at BSM Partners, and Dr. Stephanie Clark, a Ph.D. and board-certified animal nutritionist and Director of Special Services in our product innovation practice.

Welcome to Barking Mad, a podcast by BSM Partners. I'm your host, Jordan Tyler.

artners published in March of: 2022

Bradley Quest: You're right. It does seem like a long time ago, I guess the reality of it is it wasn't that long ago, but when all of this, the DCM topic or the diet-associated DCM topic, really started coming to the forefront, we felt it was important to visit with the FDA and try to understand.

What kind of information were they basing the public releases on? I mean, even though they were sharing information through public releases, we were more interested in data and researchers who had been sharing that data, and we actually had several meetings—face-to-face meetings—with the FDA in their offices outside of Washington, D.C. And they were super grateful to, to meet with us and share as much information as they could.

During one of those meetings—and again, this was all pre-COVID, mind you—they had shared with us that one of the things that some researchers had shared with them is that DCM was on the increase.

Now, it is not necessarily DCM that would be considered, in these researchers’ minds, diet-associated, but just DCM in general as a condition. And we thought that was really interesting, and we asked them if they could share the data with us that they were basing those statements on, and they said, well, they didn't really have a lot of hard data.

It was more these opinions and what some of these researchers had been seeing in a clinical setting. It was more around what they felt like they were seeing on a day-to-day basis in these research clinics that had been supplying data to the FDA. So, we asked the FDA if they were actually going to research to confirm the DCM as a condition was on the increase. They said that they were not planning on doing that. They did not have the resources to do that.

So, we felt like it was important for the industry, for the pet consumers, as well as the veterinary community, to try and gather as much data as we could to see if, indeed, this was the case. And that's kind of how our, we call it our incident study, if you will, was born.

Jordan Tyler: Thanks for that, Dr. Quest. I am going to throw the same question over to Dr. Stephanie Clark, who is calling in today—what was it like in your experience?

Stephanie Clark: Yeah. I know Dr. Quest said it doesn't seem that long ago. For me, it felt like forever ago. But some key things do stick out. We had met with the FDA quite a few times, discussing this information, and they had shared that they had noted that it was on the rise.

One of the board-certified veterinary cardiologists who we were working with at the time had some preliminary data that actually showed that the cases that she was seeing in the clinic and hospital that she was at were not on the rise. And so that was really interesting preliminary data to bring to the FDA, which only strengthened the need to figure out, is this an anomaly at the hospital that she was working at or is this truly what's going on in the US?

So, I thought that was really interesting. It was the first time that the FDA had noted that they had seen any actual data regarding incidents, which definitely opened our eyes to what they had available at their fingertips.

Jordan Tyler: Yeah, being able to work with a board-certified veterinary cardiologist early on must have been really eye-opening.

Speaking of, super excited to have Dr. Justin Thomason with us today, but before we start picking his brain about this DCM incidence question, Dr. Quest, would you like to share with our listeners how you got to know Dr. Thomason?

Bradley Quest: When we decided that we were going to embark on this DCM incidence study, we identified that probably the first folks we needed to contact were, all the accredited colleges of veterinary medicine, including Kansas State University, where Dr. Thomason was the lead cardiologist at the time. We talked about a lot of things, and we started developing a lot of common interests in researching and trying to understand these things. And Dr. Thomason was good enough to help us with that, in supplying data for us.

And then even beyond that, Dr. Thomason helped introduce us to some other folks, other cardiologists at other colleges of veterinary medicine who also were super helpful.

Jordan Tyler: Now, Dr. Thomason, tell us a bit about what you had going on at the time this research was getting started.

nd I'd been there, started in: 2010

One of the things that I did with my service that I thought was useful is we would mark every echo that we did, I could label it as the condition that we were diagnosing, which made it easy for me to retrieve records. I didn't have to go through the medical records themselves. I had every patient coded on my machine with the diagnosis that was there.

So, of course, I was on the listserv, the cardiology listserv with European and American cardiologists, and I knew there were some murmurs of some dilated cardiomyopathy associated with diet, specifically grain-free diets, that was mentioned. I went back and looked at some of the research from previous years and stumbled across grain-free diets and Golden Retrievers, where the Golden Retrievers that were fed grain-free diets tended to have a lower taurine concentration.

So, at that time, what was kind of talked about was maybe this was a taurine deficiency that people were seeing with the diets. Now, I can say at Kansas State University, I was not seeing a lot of dilated cardiomyopathies. I mean, there were certain breeds that we see dilated cardiomyopathy genetic being most common.

So, we did see dilated cardiomyopathy in Dobermans and some of the large breed dogs that would develop what was believed to be genetic DCM because the prevalence was so high in those breeds already. But as far as diet-associated cardiomyopathy in atypical breeds, where we would say, yeah, not a genetic component. At that time, it wasn't something that I recognized at Kansas State University.

And so, when Brad reached out to me, he told me, “Hey, we want to do an incidence study to look at how commonly you were diagnosing DCM pre-grain-free diets because that was the topic was grain-free diets.” But pre-grain-free, how many, what was the incidence of dilated cardiomyopathy at Kansas State University?

-free diets, I believe around: 2009

I thought it was a great idea because I was like, I don't think it's increased for Kansas State University, but let's look back and see what it was pre-grain free diet explosion, and then let's see if that has definitely increased, and we were happy to participate.

Jordan Tyler: Yeah, really trying to connect the dots and get a full picture of the investigation and any issues or discrepancies that may have influenced the FDA to make this announcement. So, the question really is, what's happening here that would make the FDA believe DCM is linked to the consumption of grain-free dog food?

Dr. Quest, you mentioned briefly earlier that some veterinary professionals had come to talk to the FDA about potential concerns they might be seeing. Is there anything else you think is important to know around why the FDA would have thought that this might be a big enough problem to make such an announcement?

Bradley Quest: In our conversations with the FDA, the FDA's job is to obviously look out for the health and well-being of humans as well as companion animals. And, of course, we're working with the CVM, which is the arm of the FDA, the Center for Veterinary Medicine, that specifically focuses on animals.

And when some of these veterinary researchers had brought them concerns, they felt like it was their obligation to investigate further, which we would all wholeheartedly agree with.

To Dr. Thomason's point earlier, at that point in time, first of all, we didn't really know if we had a problem. Secondly, geography epidemiology plays a big role in a lot of disease processes. And when you don't really know, first of all, if you have a problem, and secondly, what the actual cause, or we like to use the term multifactorial, is there something there that's related to a region or geography. I think trying to get information in this case, DCM incidents from as many areas of the country as we could. We felt like we would hopefully help provide more information.

Jordan Tyler: And as you said, this is going to require a lot of input from a bunch of different veterinary cardiologists. And the FDA had already mentioned they didn't have enough people or resources to do this work. So, this is really where BSM Partners stepped up and said, “Hey, we have the time, we have the resources, and we want to help get to the bottom of this.”

Stephanie Clark: That's the benefit of working in industry and being consultants, is you do have that extra time. We're not physically seeing patients. So, we have a little bit more free time in that aspect where we can actually start investigating and shifting our time on reaching out to veterinary hospitals.

And as well, the FDA didn't have time. They didn't have the bandwidth. And so, they really are relying on those who have boots on the ground for this information. Dr. Quest did a ton of legwork on this; he can definitely speak more about how many hours and weeks in a year he spent on this, but it definitely required a lot of time.

And so, being able to work for a company that allowed us to have that time and gave us that time to do these research projects, really put us at that advantage to provide this information to everybody.

hat was published in March of: 2022

Most of those studies have been prospective research studies, meaning data was collected concurrently as the study went on. However, this March 2022, study is retrospective, meaning you gathered information from the past to determine the frequency of DCM diagnosis in dogs over time.

in the United States back in: 2020

Bradley Quest: Yeah, to Dr. Clark's point, when you talk about hours and days and stuff, honestly, I don't even remember. It was a lot.

But I just started with the accredited colleges of veterinary medicine at the time, and I just started contacting everybody. As I mentioned earlier, Dr. Thomason, as well as a lot of the other cardiologists I talked to, obviously have really good personal relationships with their colleagues, and so many folks were good to put me in touch, so I didn't just have to cold call.

And then from there, there's a lot of cardiologists, obviously, in private practice, and some of them in smaller practices, some of them in larger referral private practices, too. So, we started contacting as many of those as we possibly could as well to try to gather as much information as we could.

Jordan Tyler: Right, and as it turned out, only 14 facilities were able to participate and share their data with us. So, I'm curious, Dr. Quest, what do you think were some of the barriers you saw preventing other hospitals from lending their data to the study?

ed was COVID, again, this was: 2020

And then probably secondly, and just as importantly, a lot of veterinary colleges, as well as private referral practices, were actually really interested in helping us by providing data. Unfortunately, in a lot of cases, their medical record systems, they had said, just weren't conducive to searching such as this year on year. In other words, we were trying to gather as many years of DCM incidents from each hospital as possible. And Dr. Thomason had alluded earlier, that he had what sounds like a really good system that he had already in place to be able to find this information and provide it to us, whereas a lot of hospitals I talked to just didn't have that capability, and those probably the two biggest barriers we found.

Jordan Tyler: That's a really good point. And I do want to reiterate your point that most veterinary hospitals, clinics, and colleges don’t have the best record keeping methods. A lot of these institutions are still working with paper records, which run the risk of being accidentally thrown out due to lacking storage systems. And like you said, Dr. Quest, this was a huge limiting factor when it came down to participating in this study. A lot of clinics couldn’t participate because their medical records weren’t robust enough.

What’s more is, I know several hospitals BSM Partners reached out to—including a number of institutions that were really championing the diet-induced DCM message—outright declined to provide data to us for this study. Seems a little counterintuitive, but all that’s to say, even with these challenges, the research team was able to pull together a robust set of data representing every region of the United States, even Hawaii. I think all in all, considering all this adversity, that’s a pretty impressive feat.

So yeah, bringing it back to you Dr. Thomason, you were probably tagging these records before it was cool, and it ended up being really helpful for this research, and just a great best practice for record-keeping overall.

Dr. Quest spoke about the pandemic throwing a bit of a wrench into this whole process. What was it like for you at Kansas State?

Justin Thomason: I think as in most practices you had very limited access to clients. So, a lot of the history taking it was difficult to get because you weren't face-to-face. A lot of times they had a separation from the clients, and we had one contact person that would reach out to the client.

So, gathering history, I would say that we did a horrible job probably across most practices because you didn't have that contact time that you normally would have and that would limit some of the information that you would get from clients.

A lot of times it was, drop the pet off, you would do your physical exam, and do your diagnostics that were required for the, in our case, usually an echocardiogram, but there wasn't a lot of history gathered. And I think looking at nutrition, toxins, environment, I think a lot of that probably was overlooked and, on my part, that was something that I never paid a lot of attention to anyway, and that's kind of a fault of mine limitation is that I don't have that nutrition background.

And I think after talking with Dr. Quest, I started realizing that an important part of our examination is gathering history from the client, specifically diet and supplements. And that was a weakness of mine, I would say, and definitely during COVID because of just the timing.

But I think that limited a lot of the information that was gathered and we kind of rushed through, if you will. I think we did a good job with the pets. We did our physical and our diagnostic testing, but a lot of that historical background information that we'd normally obtain got overlooked a lot of times.

And I think record keeping, I was trained by Dr. Calvert at Georgia. So, I think being at a university, and I still do it to this day because he really pounded that into me was that every patient that we see is a study and we're united as a profession. I think we all love animals. I think that unites us and we work through clients, but always use the opportunity.

And I remember him saying every time you look at a patient, you're collecting data. It may not be basic research, foundational research in a lab per se. But in the clinic, you're still doing research and that was a different perspective because I think as a profession we think of research and we're thinking in a lab where people are doing molecular research which indeed that's research and that's foundational.

But it was always pounded into me that every time you evaluate something, you're collecting data. And that data may not be useful today, but somebody may come around and say, “Hey, I'm doing a study on DCM, and I want to know, what are you seeing compared to past years and what you're seeing now?” And having that ingrained in me, I always had that coding system that I did. And the interns that would train with me, I told them, “Hey, we're collecting data.”

So, I think his training at the University of Georgia really helped me because it was easy for me to collect that data. Whereas for a lot of people during that time, the medical records, you were short-staffed, so trying to get information from them would be challenging because maybe they're not fully staffed, and they're focused on today's activities.

So having that in my system where I can just reach back and say, “Hey, I can do the search myself and it won't take me five minutes because I can put in DCM, and it's going to show me the patients that were diagnosed with DCM.” And then I can go to medical records with the numbers and say, “Hey, I need case numbers and just have a list.”

And it made it really easy for me and the staff at K-State because I had that information, which was valuable. But for others, it's been a lot of work because we were just short-staffed at that time. Being able to collect that information would be probably challenging.

Jordan Tyler: Absolutely. And to your point, it's crucial to collect information like this so that we can start to really piece this puzzle together. Now, in thinking about medical records and privacy, which is something of a stressful topic in the medical community, even without a pandemic. Some personal information for human patients is protected under federal law by HIPAA.

It just kind of makes me think, Dr. Quest, is there a HIPAA for pets? And how might this have complicated the research process?

Bradley Quest: That's a really good question. As it relates to the data that we collected for this study, it's completely devoid of any personal identifying information.

When Dr. Thomason was at Kansas State or any of the other cardiologists, you know, that provided data from it. They're literally numbers. We received no personal identifying information about the pets themselves or even more importantly, the pet parents’ names or any personal identifying information.

It's literally just data, like how many years and how many cases of DCM were diagnosed in that year, as it relates to the overall cardiology caseload in that particular practice. That's the way we looked at it. When we went to the cardiologist, such as Dr. Thomason at Kansas State, when he was there, we just simply asked if you could share year-on-year, meaning each year, as many years as you can go back, how many new cases of DCM diagnosis did you have in that particular year?

And if you could also share what your overall cardiology caseload was, that way we had something to, you know, compare it to. And what we found When we kind of put everybody's cases together from all the services that were able to provide it. We really didn't see any change, any statistically significant change, year-on-year over all the data that we were able to collect from all the cardiology services.

Jordan Tyler: Gotcha. That's a good way to work around it and still get the data you need. And going back to what Dr. Thomason said about medical records being challenging, he's not wrong. And he is certainly not alone. I've heard a lot of veterinary specialties don't consider things like nutrition and diet history as part of a medical record.

So, when the FDA was conducting its investigation, it was relying on people voluntarily sharing these details with the agency. So, all that considered, I'm curious as to what concerns this might bring up about taking this voluntarily submitted data and extrapolating it to the entire dog population.

Bradley Quest: I think that's a really good point, and the FDA had asked both pet consumers as well as veterinarians to—now they're no longer doing that. They're no longer accepting or asking people to submit cases of DCM to the FDA—but back when this was an ask, I would imagine that a lot of the information they receive is going to have a huge amount of variability to it, meaning some of them may have been submitted by veterinarians that could have a really good medical record associated with it, with a really good diet history.

But also, and we actually know this because the FDA shared some of this information publicly. Some of the cases that were submitted may have very little to no medical history or an actual, what you say, is a diet history. For the record, I am not a veterinary cardiologist, nor am I a veterinary nutritionist, but I do understand the importance of an accurate diet history, really with any medical condition. You can hardly think of anything really and truly that a dog or a cat would come into a veterinary hospital for that a diet history probably wouldn't be relevant. And I would imagine that a lot of these dogs that were brought to the FDA or submitted as cases had inaccurate diet histories, or maybe none at all.

Jordan Tyler: So, coming back to BSM Partners research, the goal of this particular study was not only to collect data about new DCM diagnoses over time but also to track that against the rise of grain-free diets in the market. Which, by the way, is making me just a little dizzy even thinking about how much data this is.

Dr. Clark, how did you go about collecting all that information and piecing it together?

Stephanie Clark: Someone on our team had a connection with Nielsen and Nielsen data, and so they were able to pull that information for us. And it was over the last 12 years or so, by the time we actually published the paper that we had data for, and this is from brick-and-mortar sales, but unfortunately, we weren't able to pull e-commerce, and that's just due to data availability, which only if you think about it, we're not covering that section of where pet owners are purchasing diets from. So even though we didn't have complete sales data, what we did have gave us a really good picture of what grain-free diets were doing over a decade.

Jordan Tyler: And would you mind giving us a super high-level summary about what the incidence rates of DCM actually were over time and in different regions? I know of the 14 hospitals that we worked with, they were, you know, all over the map of the U.S. What were some of the key takeaways here?

Stephanie Clark: Yeah, we were really lucky to be able to represent every region in the U.S. That was one of the critiques that we had is, you know, only having 14 hospitals, but medical records are really hard to get our hands on. I mean, pandemic aside, the veterinary field is always short-staffed. And then the difference between paper records and then switching over to electronic records, trying to just capture all of that.

So, what we were able to capture is really, actually quite impressive for the veterinary field, at least in my opinion, through all the hospitals and clinics that I've worked at, the medical records are definitely not as robust as human medicine. So, that was really nice to at least be able to represent the entire U.S. and different regions.

When looking at the data, it remains relatively flat, which is kind of surprising, right? That's not the story that we have been hearing. We have been told that it's on the rise, and when it came down to the data that we had received, we weren't seeing that. We weren't observing that. It's not what was reported.

Now, that being said, anyone listening, if they've got any medical records that they're willing to share with us, by all means, keep adding to the evidence and the knowledge that we have on the incidents of DCM, but with it not really changing much over the last decade, it kind of raises a couple of questions as a researcher, you start to think are certain hospitals seeing an increase and maybe that's where this whole DCM is on the rise is coming from, or potentially when we are made more aware of something, and it's brought to our attention, we can change focus on that, and it seems like it's rising or we see more cases of that when really we might just be more aware of that disease because it's being talked about, it's in the news, the FDA communication. So, whatever phenomenon was happening, we weren't seeing it in the data. Which, as a researcher, is really interesting.

Jordan Tyler: That's a really interesting point. And shout out to Kait Wright, one of our data experts, who taught me there's actually a term for when we focus more on things simply because they're more apparent to us. It's called the availability heuristic. It's a type of cognitive bias through which we make quick assessments based on the available knowledge, even when considering the bigger picture may prove that initial assessment to be incorrect. The more you know.

So anyway, first you looked at the big picture of DCM diagnoses and dogs. And then once you had a handle on that, you started looking deeper at things like breed and age to help fill in some of the gaps. Dr. Quest, what did you find with this data?

Bradley Quest: Yeah, there were a couple of clinics that were able to provide some, both age and breed data, and what we actually found in those clinics that could provide it was some of the overall diagnosis as time went on, the dogs were getting older, and that could actually be a function of a lot of things and again, it would just be purely speculative, but we all know, or at least we feel like—I guess we shouldn't say we know, but we feel like—veterinary care, quality of care our pets are living longer and that may have something to do with it.

One of the other interesting things we saw in one of the data sets is in this particular hospital, even though their DCM incidents overall year-on-year was increased, there was a little bit of a distribution change between some of the typical breeds like Dr. Thomason had mentioned earlier the typical, Dobermans or Great Danes, Boxers that we think of more as breeds that would be predisposed to DCM.

They actually did see more diagnoses of DCM in some other breeds, including mixed breeds, in this data set. This goes back to a lot of the things we've talked about in this and some of the other podcasts that at least I think a lot of us feel like DCM is definitely multifactorial in that it could actually be genetic, but not genetic how we traditionally think about like genetic being in that breeds that I just mentioned, the breeds that are in the literature, there may be other factors such as genetics we've talked before about subclinical myocarditis and, other things, latent viral infections, things that could also play a role in addition to the diet.

We can't say that we could completely rule that out because we also know there are times and conditions where diet definitely plays a role in cardiac conditions such as this. So, it's really hard to say, but we did see some differences in some of those data.

Jordan Tyler: Dr. Thomason, what are your thoughts on all this, especially the piece about dogs potentially being diagnosed at later ages?

Justin Thomason: I think it's important to establish the diagnosis of DCM with an echocardiogram, and it's best to be diagnosed by a cardiologist because, as was mentioned, when the FDA started reaching out and discussing the grain-free dilated cardiomyopathy, I think the tendency for practitioners that maybe aren't trained in cardiology specific is they'll get a pet that has a murmur and then they determine, and it's a small breed dog and it has degenerative valve disease is what it really has, but they hear the murmur and then they question the client and say, what diet are you feeding?

And then it's grain-free. I think I've noticed a lot of people from my area specifically, but others as well, that I was talking to other cardiologists that they would assign a diagnosis of DCM because of the heart murmur and the diet without getting an echo per se. And so, I think that's one of the important things is that reaching out to cardiologists, not that other people can't do cardiology—I mean, I train veterinarians to do cardiology—but I think that diagnosis can be tricky, and I think a lot of people latched on to heart disease and grain-free diet. So, then any heart disease equaled grain-free. And I'm like, no, no, no, no, no, no, that's actually valve disease that that pet has. It's not related at all to the diet that we know of valve disease being genetic in small breed dogs.

Jordan Tyler: Oh no. I see how that would cause a lot of confusion and potentially lead vets and pet owners down the wrong treatment path.

And then we also have other rollouts. As Dr. Quest said, there are other differentials or causes of dilated cardiomyopathy. So genetic being one, nutritional, myocarditis, there's different toxins, volume overload. So, you could have a pet that has valve disease that goes undiagnosed, but then over time, these large breed dogs develop systolic dysfunction due to that volume overload that started as a valve disease. That's a form of DCM, but it's related to the valve and hypervolemia rather than diet. So, there's a lot of factors in there that I think that's important that we had that data from cardiologists to kind of evaluate that more thoroughly and establish a diagnosis.

But there are those cases where I would say, yeah, there's one or two that I could show you where I'm like, okay, here's a pet that had dilated cardiomyopathy phenotype, and here's the differentials, and we looked for everything, and the only thing that we found was one of these diets that's been associated and we changed the diet and lo and behold, it got better now. Was it the diet? Was it a transient cardiomyopathy that may be viral? That could be a possibility. Sure. I think those are possibilities as well, but that being so rare, it makes it hard to determine what's causing it.

And that's one of the pleasures of working with Brad and his team that I really respect is that he's taken that initiative to say, “Hey, we want to figure this out because we don't want to harm. We want, we're trying to do the best for pets.” And I applaud him and his team for doing what they're doing, but it is a challenge because I've been involved with the studies and I'm like, man, it's just so rare that it's hard to get enough animals to really tickle out what the “it” is, if it is nutritional and what is it about the nutrition that's related to this DCM? Is there a genetic component? It just makes it a challenge to really figure that out.

But I applaud Brad and his team for doing what they're doing. Cause I know he's pounded his head a couple of times and reached out to me and expressed his frustration and his eagerness to try to solve this problem, and I hope that we figure this out. I think we will at some point in time.

Bradley Quest: Really, this study couldn't have happened without all our BSM Research team, Dr. Clark, Dr. McCauley, Dr. Streeter, as well as all the cardiologists that provided the data. Thank you. Honestly, all the work we did would be nothing because we don't have clinical practices. We don't have direct access to that data, but we just hope it helps folks.

And it's like we always say, all good research leads to more research, and it's definitely not done. And we definitely are committed to that because it's just like Dr. Thomason said, nobody gets into veterinary medicine, nobody gets into the pet food industry, because they don't love pets, and we're right in that boat, too.

Jordan Tyler: Now, coming back to the diet history piece and grain-free food in particular, this data shows a relatively flat line for DCM diagnoses amid significant spikes in grain-free pet food sales. So, when you put these two data points together, it sort of undermines the argument that grain-free causes DCM, and it really enforces the idea that there's something more going on here.

So, Dr. Quest, I know you've been in the pet food industry for a long time. What do you think made grain-free diets so popular?

Bradley Quest: Yeah, there's a lot of theories on that, and everybody kind of has their take. I mean, I think part of my take is a lot of it has to do with whether it's actual or perceived about pets with allergies, whether it's food allergies, environmental allergies, and for all I know, this could be something that we being pet parents have created with our pets in some ways. But I think there's a lot of folks or a lot of humans who have developed food allergies or intolerances to things. And a lot of times that gets equated over to our pets, whether they're actual or perceived. So, I think that's one aspect of it that makes alternative ingredient diets popular.

But then, on the other hand, there's actually an agriculture commercial factor to this as well. When you look at a lot of the ingredients that are used, we'll call them grain-free pet foods. A lot of those are pretty much exclusively used there. Now, not to say that we don't use different legumes and stuff in human foods, but a lot of the ones that are specifically used in pet foods, that's pretty much all they're used for.

ood sales really dropped from: 2018

So, I think there are really two components there. There's ingredient availability and usage for pets as it relates to human food ingredients, and then there's also what the pet parent either knows their pet needs or thinks their pet needs, you know, based on, you know, what other kind of medical conditions they have going on.

Jordan Tyler: You bring up a really good point there in terms of the ingredients used in grain-free diets and how this FDA announcement impacted people who grow those types of ingredients as well.

Pulse farmers were really benefiting from a drastic rise in the use of these ingredients, not only in pet food but also for human consumption, especially when it comes to people making more health-conscious and environmentally friendly food choices. When DCM hit, the pet food side of this equation really suffered, and the impact here was most felt by small family pulse farmers.

We actually interviewed Tim McGreevey of the American Pulse Association about just this topic, and he was an absolute wealth of information. Really great storyteller. For those listening who haven't heard the episode, we'll link it for you in the show notes. It's a really, really great episode. Don't forget to bookmark it.

Now, sort of bringing this episode home, this study definitely highlighted that there wasn't a great correlation between grain-free dog food and DCM incidences. I guess my question, probably a lot of other people's question would be, how do we do better about this in the future? I mean, DCM was a huge example and its repercussions continue today, but that wasn't the first time the industry faced an issue like this.

back to the melamine issue in: 2007

I mean, the veterinarians really thought they saw something, and of course, it makes sense to bring it to the FDA. Are there are maybe other routes or better ways to address these warning signs from the veterinary community and consumers with our regulatory agencies?

Bradley Quest: Yeah, I think that's a really good point. When Dr. Solomon, who was directing CVM at the time, said that he thought it was imperative that industry, academia, and the federal agencies, including the FDA, work very collaboratively together; I think he's absolutely right about working in transparency, and that includes information sharing, what we've tried to do is both do retrospective research like this, where we're leaning heavily on institutions like Dr. Thomason at Kansas State or any of the other cardiology services that we did.

I would also like to give shout-outs to some of the ones who provided, Dr. Leach at the University of Missouri, Dr. Baumwart at Washington State, as well as all the others. If it wasn't for the collaboration and the free sharing of information that they gave to us, we wouldn't know this stuff, and it goes back to all along when we're doing our research and others, and I know we've talked about the prospective feeding studies that we've done, we were very open and transparent with the FDA. We solicited the FDA's feedback on our research protocols because we wanted their opinions. We wanted their takes on the research that we wanted to do as well. And folks like Dr. Thomason as well, and even other veterinary nutritionists to folks outside of our BSM Research group collaboration is super important.

Jordan Tyler: Very well said. Collaboration only makes science better because it allows us to share information that will benefit everybody and solve problems in a more holistic way. Plus, we're learning new things about pet health and nutrition all the time. So, applying all that knowledge is key to getting to the bottom of complex issues like this one.

Now, Dr. Quest, I know you mentioned this earlier, but I just wanted to revisit it. One group in which you saw a statistically significant increase in DCM diagnosis over this period was the mixed-breed dog population.

Now again, DCM is multifactorial, and there's a lot of mixed breed dogs out there. So, I was just wondering, what would you tell pet owners about this statistic in particular? What does it mean, if anything?

Bradley Quest: Yeah, I think whether it's for a condition like DCM or anything else, or just general overall health, I think the thing to remember is, even though we know a lot about nutrition, we know a lot about, for instance, cardiology, it's an ongoing learning process, really, for anything.

Dr. Thomason had talked about one of his mentors at Georgia, and we've all had mentors, and one of my mentors used to tell me, you know, don't go looking for zebras when you're surrounded by horses. But having said that, sometimes you’ve got to pay attention to the zebras too, meaning the things that don't show up as common as some of the other things, and then investigate it further to try to determine.

As Dr. Thomason said earlier, you're always going to find this case that doesn't really fit the textbook and try to figure out if there's any commonality between that one and the last case you saw that didn't fit the textbook and then try to collaborate with your colleagues to see what they're seeing and really, when you get down to it, that that's kind of how this all started.

It felt like there should have been maybe a broader collaboration, you know, across services, across areas of the country, across more, more people before we really tried to dive into drawing a conclusion.

Jordan Tyler: I’m glad you made that analogy, Dr. Quest—if you spend your time looking for zebras, you’re bound to find things that look like zebras. This has really played out, in my opinion, with Lisa Freeman’s research. She’s spent a lot of time attempting to link various factors to the development of DCM, but when you approach research with preconceived notions like this, looking for specific things, you’re more likely to misrecognize. Like, those notions could lead you down a path that validates your viewpoint, but isn’t actually based in science, and this is dangerous and misleading for pet owners—who might not be as familiar with how to properly assess research credibility—and veterinarians who serve as trusted advisors to those pet owners.

And I also want to reiterate your point about the importance of keeping good records. With any given case, veterinarians are collecting data that could potentially be useful for other pets and pet parents down the road, or play a key role in enabling a larger, more collaborative effort to come together and really provide the best chance for interpreting medical data and coming up with solutions that address health issues.

That would be my key takeaway from this episode. But Dr. Quest, what would you like people to walk away from this episode and this study knowing?

Bradley Quest: I think probably the most important thing that people can take away is do your own research, meaning that we're not expecting, you know, pet parents to actually be researchers. But, you know, there's always different angles, different sides to every story. Do your own research. And most importantly, if you're not sure about something, consult with somebody who you respect their opinion on it. And in most cases, that's going to be their veterinarian. And if their veterinarian may or may not be up to speed or well-versed on a specific topic, in this case dilated cardiomyopathy, then seek someone who is.

There's so much information out there and us as researchers, it's really hard, even as a researcher, sometimes to disseminate what you think is credible from what's not credible, and that's for nutrition, that's for really anything, but try to seek out credible sources, and if you're not sure, try to keep seeking out credible sources.

Jordan Tyler: It takes a village, and collaboration on a larger scale between veterinary nutritionists, and cardiologists, nutritionists, and food scientists, industry members and consumers alike is the way toward a more comprehensive understanding of DCM and so many other pet health and nutrition topics that are relevant today.

We always say here that it's great having so many different types of experts at BSM Partners, but all those areas of expertise operating in a silo won't get us anywhere. It's so important. Only when we come together in the spirit of consilience and really leverage each other's expertise, and strengths can we overcome great obstacles like this.

As we close out today's episode, here's one last friendly reminder to check out the show notes from today to get up to speed on all the research and investigation BSM Partners has conducted into DCM over the last several years. And we're not done yet. So be sure to stay tuned for future coverage and insights surrounding the DCM issue.

Thank you for tuning in to Barking Mad, a podcast by BSM Partners. If you'd like to learn more about us, please visit our website at www.bsmpartners.net. Be the first to know about new episodes by subscribing to the podcast and share it with a friend.

We'd like to thank our dedicated writing team. Ada-Miette Thomas, Neeley Bowden, Paige Lanier, Kait Wright, and Dr. Katy Miller. A special thanks to Lee Ann Hagerty and Michael Johnson.

Share Episode

Shownotes

Transcripts

Follow

Links

Chapters

Video

More from YouTube