Holistic Nutrition Buy-InWelcome to the wacky world of holistic nutrition, where consumers and bloggers trust each others input more than yours. September 17, 2013 By Narda Robinson, DO, DVM She’s one of your most dedicated clients, yet she steadfastly refuses advice about diets for her dogs and cats. She views Big Pet Food as the ultimate evil-doer, suspecting you were brainwashed during veterinary school to believe that her "little lion” should eat carbohydrate kibble instead of daily raw quail as advised by her "holistic nutritionist.” She is convinced that you missed her dog’s wheat allergy but is thankful that her chiropractor found it. When asked how, she stated that the chiropractor performed "muscle testing" and examined her as a surrogate because her dog could not follow the necessary directions. Her ability to resist the chiropractor’s downward pressure on her outstretched arm weakened when she held a vial of wheat against the dog. He concluded that wheat "broke the energy circuit" between them and this indicated an allergy to the substance. He then prescribed a grain-free diet and performed adjustments on the spine to fix the problem. Welcome to the wacky world of holistic nutrition, where consumers and bloggers trust each other’s input more than yours. You represent the establishment, evidenced by shelves of what they consider "unhealthful" food. You may have found that members of your staff have switched to raw for their own animals and boast in the back about the changes they’ve seen. Just wait until one becomes a "clinical pet nutritionist” or "animal nutrition specialist,” brandishing a freshly downloaded certificate and requesting permission to perform consultations in your clinic. You do some searching online and find that the organization producing these diplomas certifies nearly anyone, even high school dropouts with no science background, after a few hundred hours of online coursework.1 The curriculum includes instruction on the problems with pet food and how to switch to a "better diet," including raw meat and homemade meals. The education extends beyond nutrition and covers chiropractic, homeopathy, herbs, supplements, massage, vaccinations, acupuncture and other natural remedies for health problems. After clicking on related listings, you find site after site questioning veterinarians’ capacity to deliver worthwhile nutritional advice.2 You begin to feel a little sick. Finally, you open your email and discover your alma mater now touts alumni successes in building a company based on dietary pseudoscience. You long to retire. You wonder, what went wrong? Why has such a wide gulf developed between what we offer and what some consumers want? Maybe veterinarians do develop tunnel vision during school, having established comfort with one or two commercial brands and sticking with just those. Or, was our teaching institution too black and white when it came to raw diets? We were taught to recount the dangers of raw food and homemade meals, but are there ways to make them safer? Perhaps absolute abrogation of alternative diets wasn’t the best way forward. Yes, AVMA policy now discourages raw meat feeding for dogs and cats3, but one commercial raw diet has received AAFCO approval.4 And, according to the New York Times, "Sales of commercially prepared raw pet foods reached $100 million" in 2011, not counting dollars spent by caregivers who compiled their own diets at home.5 While this number pales in comparison to the $19 billion conventional pet food market, raw products constitute a rapid growth segment where sales are increasing 15 percent annually. Recalls of conventionally produced, Salmonella-laden kibble, inappropriately manufactured foods with vitamin excesses or deficiencies, and melamine-tainted products undermined consumers’ trust in commercial cooked products. Clearly, veterinary practitioners benefit by keeping current on evidence about raw meat diets, whether pro, con or mixed.6-9 We need to think this through for ourselves. At least raw diets have some science and a bit of supportive evidence. Not so for other holistic dietary approaches, but why should that matter? Why should lack of proven value and safety hinder the promulgation of suspect feeding practices or halt the rise of belief-system-based animal nutrition? Alas, the allure of jumping on the holistic food truck has proven too strong for some veterinarians and even college administrators to resist, as the contagion of folkloric Traditional Chinese Veterinary Medicine (TCVM) practices spreads from Florida to Tennessee, now infiltrating Louisiana as well.10 As evidence of this spreading epidemic, in February the University of Tennessee School of Veterinary Medicine conferred Distinguished Alumni awards to graduates who created a pet food company based on balancing the "energetics" of food.11 Outraged, a leading evidence-based medicine practitioner wrote, "In keeping with this fanciful and completely unscientific approach to nutrition, the company does not produce foods for specific nutritional needs or medical conditions as understood in scientific medicine, but for balancing Yin and Yang and the Five Elements. This allows them to recommend a limited set of diets for any medical conditions regardless of the cause or the specific nutritional composition of the diet based entirely on their assessment of the degree of imbalance in these mystical principles in a TCVM examination…"12 The examination he described relies on subjective diagnostic techniques that lack rigor and reliability, even for the species (human) for which they were designed. Basing diets on dubious diagnostic techniques does not constitute safe and ethical practice. As the author of this response, now president of the Evidence Based Veterinary Medicine Association, continued, "This lends a thoroughly undeserved aura of legitimacy to ideas that belong on the rubbish heap of medical history along with the treatment of infection by bloodletting and of epilepsy by application of leeches.” Why would a college13 known for its excellence in veterinary nutrition coddle pseudoscience? Could tens of thousands of dollars in donations from a TCVM proponent, i.e., the American Holistic Veterinary Medical Foundation,14 have paved the way for a softening of attitudes to myth-based medicine? Is this a predetermined strategy on the part of Quasi-Big Pseudoscience?15 Ignorance Is Not Bliss This "elephant in the living room," i.e., unproven approaches in holistic animal nutrition, is impossible to overlook. Avoiding critical examination is unwise. Veterinary students and practitioners need a science-based method of determining which pose dangers and which offer promise. Veterinary school administrators should be apprised of the fallacies of TCVM pseudoscience and other untested methods before more fall victim to their influence, despite attractive financial incentives.16 Or is the direction of higher education moving toward a "pay to play" system, as in Texas, where faculty who garner the largest financial gains get to keep their job?17 If so, TCVM food therapists may be teaching the next generation of students, recommending rhubarb for horses18 or coffee and tobacco for the depressed dog.19 A pay-to-play approach to holistic nutrition? Dr. Robinson, Dipl. ABMA, FAAMA, oversees complementary veterinary education at Colorado State University. These are the footnotes for Dr. Robinson's July 2013 Evidence Based Medicine column, Holistic Nutrition Buy-In. FOOTNOTES 1 Academy of Natural Health Sciences website. Pet Nutrition. Online (Home-study) programs. Accessed at http:/fanhs-school.com/pet-nutrition.html on 05-06-13. 2 Myths about Raw Feeding Website. Myth: Vets are thoroughly qualified to dispense nutritional advice. Accessed at http://rawfed.com/myths/vets.html on 05-07-13. 3 AVMA website. Raw or undercooked animal-source protein in cat and dog diets. Accessed at https://www.avma.org/Policies/Raw-or-Undercooked-Animal-Source-Protein-in-Cat-and-Dog-Diets.aspx on 05-06-13. 4 Nature’s Variety website. AAFCO Feeding Trials. Accessed at http://www.naturesvariety.com/vet/aafco on 05-07-13. 5 O’Connor A. The raw food diet for pets. The New York Times’ Well Pets. May 23, 2012. Accessed at http://well.blogs.nytimes.com/the-raw-food-diet-for-pets on 05-07-13. 6 Kerr KR, Beloshapka AN, Morris CL, et al. Evaluation of four raw meat diets using domestic cats, captive exotic felids, and cecectomized roosters. J Anim Sci. 2013;91(1):225-237. 7 Singleton C, Wack R, and Larsen RS. Bacteriologic and nutritional evaluation of a commercial raw meat diet as part of a raw meat safety program. Zoo Biol. 2012;31(5):574-585. 8 Dijcker JC, Hagen-Plantinga EA, Everts H, et al. Dietary and animal-related factors associated with the rate of urinary oxalate and calcium excretion in dogs and cats. Vet Rec. 2012;171(2):46. 9 Kerr KR, Vester Boler BM, Morris CL, et al. Apparent total tract energy and macronutrient digestibility and fecal fermentative end-product concentrations of domestic cats fed extruded, raw beef-based, and cooked beef-based diets. J Anim Sci. 2012;90(2):515-522. 10 Coffey M. Leading the way. Integrative Veterinary Care Journal. 2012; Winter Issue. Accessed at http://www1.vetmed.lsu.edu/Events/item46774.pdf on 05-08-13. 11 Pet-Tao website. Accessed at http://pettao.com on 05-08-13. 12 Skeptvet Blog. University of Tennessee Veterinary school recognizes "excellence” in alternative medicine. Accessed at http://skeptvet.com/Blog/univ-of-tennessee-veterinary-school-recognizes-excellence-in-alternative-medicine/ on 05-08-13. 13 University of Tennessee Veterinary Medical Center website. https://vetmed.tennessee.edu/vmc/Pages/default.aspx Accessed at 05-08-13. 14 American Holistic Veterinary Medical Foundation website. Foundation news: moving forward to improve medical outcomes. Accessed at http://foundation.ahvma.org/index.php/ahvma-foundation-blog/86-foundnewssep2012 on 05-08-13. 15 Skeptvet Blog. American Holistic Veterinary Medical Foundation gives $10,000 to University of Tennessee veterinary school to promote alternative medicine. Accessed at http://skeptvet.com/Blog/american-holistic-veterinary-medical-foundation-gives-10000-to-university-of-tennessee-veterinary-school-to-promote-alternative-medicine on 05-08-13. 16 Jing Tang. "Headline News: Chi Institute has donated $30,000 to University of Florida resident program…”. TCVM News. Issue 13, 2010. Accessed at http://www.tcvm.com/News2010DecR.pdf on 05-08-13. 17 Greene D and Goodwyn W. Perry’s vision for University of Texas criticized. NPR News. Accessed at http://www.npr.org/perrys-vision-for-university-of-texas-criticized on 05-08-13. 18 Cantwell, S. Large Animal Proceedings. North American Veterinary Conference, Orlando, Florida, USA, 14-18 January 2012. Volume 26; Gainesville:The North American Veterinary Conference,2012,unpaginated(Conference paper). 19 Clemmons RM. Feeding according to TCM. Accessed at http://www.google.com.