Finally got last bloodwork back... B12 deficiency

Vet called to say that all the GI blood work was normal except for Gracie's B12 level. NO problems with pancreatic enzymes were found. Vet is suggesting B12 shots for a while to address this deficiency, starting tomorrow.

So, have been researching this condition and it sure seems to pop up as related to enzyme deficiency. Usually these are hand-in-hand or it may be triggered by allergies or a bacterial infection that has impacted absorption. In looking at all of the research I can find, it seems like adding a small amount of digestive enzymes could be helpful, even if we do need the B12 shots to get her back up to speed.

I am not finding much on diet specific to B12 deficiency, but alot of information on diet for dogs with enzyme problems. In those cases, some major diet that surface are:

• Raw food or boiled ground meat mixed with limited ingredient diet is best usually but some do well on limited ingredient quality commercial food, but usually kibble is better than wet
• No grains, but barley MAY be okay
• All ingredients, including any kibble, should be crushed or ground into small pieces. This includes meat or veggies.
• Mix enzyme additive with water and mix into food and let sit about 20 minutes
• Serve food at room temp or close to it
• Smaller meals.... three a day rather than two
• Limited fiber, although some dogs do okay with more fiber
• Lower bone meal content... no more than 15%

For enzymes, some researchers recommend pork-based, even though that seems to be hard to find. A friend who is a breeder has used a high quality egg-based digestive enzyme with very good results with two dogs that had same issue.

So, I would love to know if anyone has deal with B12 deficiency or knows others who have. Did they have to rely on B12 shots or find a more natural way to address this after initial deficiency addressed... would love to not have to give her shots forever! Any tips on diet, enzymes or supplements?? Would enzymes be a bad idea if indeed she does NOT have a deficiency there?

As always.... your thoughts are greatly appreciated.

GraciesMom said:

For enzymes, some researchers recommend pork-based, even though that seems to be hard to find. .

Click to expand...

Not sure if you mean pork-based enzymes, or pork-based diet, but if this is suggesting a pork-based diet, please do not give a dog raw pork; cooked is fine. Raw anything else is okay but not raw pork as it causes problems or dogs don't have something to digest it, or somesuch issue.

I have a friend who gives her child a b vitamin supplement that just gets squirted into the mouth and is absorbed there (as opposed to in the gut). I can ask her what it's called if you're interested.

Raw pork can have the trichina worm parasite which causes a serious condition, trichinosis (killed when pork is cooked). However in practice I recall reading this is extremely rare these days. The USDA says it has all but been eliminated in domestic pork because they are no longer fed raw pork intestines (things you just do not want to know about modern farming... :|). There are less than two dozen cases a year in the entire US. So a dog is unlikely to have any problems any more but a cautious person might wish to avoid feeding raw pork.

Sounds as if vet is diagnosing SIBO - Small Intestinal Bacterial Overgrowth - but I thought you said that they decided this was a large bowel problem and not a small bowel problem. SIBO is treated with B-12 and with Tylan powder - and treatment is for a long term. SIBO may be accompanied by EPI but can also be present without EPI. Sounds as if you have researched EPI - that is the disease that needs the enzymes. They did a cobalamin test? And a TLI test? She was fasted for 12 to 18 hours before test? Get copies of the test results so that you understand exactly what you are treating. Diet alone won't address these problems. Note the statement that this is not caused by a dietary deficiency but caused by a problem absorbing the B vitamins. I intended earlier to ask if you had considered SIBO as this is more common than many vets think. Are the vets saying that she has SIBO but does not have EPI?

http://www.dogaware.com/health/digestive.html#sibo

SIBO and 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 http://www.cvm.tamu.edu/gilab/assays.asp 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.

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2580

Forgot to say - one of the mods in the K9KidneyDiet group is an expert on SIBO. I can ask her for more info. Her dogs did not receive B-12 shots "forever." I can't recall if you can give the injections subq - which means you could give them at home. I do know that B12 stings - I used to mix it into subq fluids for Capers when he had kidney failure and was anemic.

Pat

Thanks all... very helpful information

One correction....the recommendation on pork was ONLY related to digestive enzymes for dogs, not to any plans to feed pork as a food to Gracie. Apparently there are some brands of enzymes that use a pork base. I know nothing at all about that or why it would be better. I plan to use an egg-based one recommended by several friends with Cavs made by Nature's Farmacy. Kinda like I take a pork-based thyroid medication because it works better but I don't eat pork.

Pat... the vet did not mention SIBO or EPI on the phone. Only the low B12 (cobalamin), which was diagnosed with the cobalamin test. I know that TLI was performed and showed normal result. Supposedly all the pancreatic enzymes were normal. Many other GI tests were also done. I am going to get a copy of the results tomorrow. She may well have SIBO too but she does not have alot of those symptoms at all... she does have moderately to soft poop most of the time, but no loud GI noises, amount of poop has actually decreased some, and her appetite has not dwindled during the past few weeks. She has not lost weight since she has been on the bland diet, which may have contributed some to the B12 deficiency as we had trouble finding a meat source to use with that for a while. The boiled lamb is now working and we are increasing it slowly.

Gracie does have alot of the symptoms of B12 deficiency except for low energy. She is sleeping a bit longer at night but rest of the day is the same old playful gal. However, I have noticed a bit of an increased appetite in the past few days, which is somewhat surprising. However, we started adding the digestive enzymes yesterday, even before we knew the B12 results. And today was the BEST poop in a while. So I think the lamb protein and the enzyme are a good path for now till she is stablized.

They did tell us at the vet school that they believed this to be a large bowel issue... but who knows??? I know the ultrasounds showed that food was not processing as fast as it should in the tummy and large bowel, but seemed to be okay in small intestine. But have no other data on that other than what they vet and radiologist reported.

I do think that there is likely some enzyme issue or at least a protein digestive issue at play... but maybe not enough or consistently showing up. I don't know.

I will report back on the tests, but right now we are working on the assumption that we are only dealing with low B12 but that either EPI or SIBO could still be an issue, even if not showing up in tests at this time.

Thanks all for your help... keep your ideas coming.

Was just reflecting on the vicious cycle...

Gracie needed more B12 to get better, but we had problems identifying a meat source for her to eat for the past 3 weeks while she was on bland diet. Which extended her problem... since she was not getting enough B12. So.... finally on the road I hope to her getting better since lamb apparently works for her.. at least for now! But looks like B12 shots coming up for at least the near future.

Right - but GI symptoms PLUS low value on cobalamin AND normal TLI test equals SIBO without concurrent EPI. This isn't just a situation of overall low B-12 from diet deficiency which would expect to show as low energy, tiredness, etc; this is a failure of the intestine to absorb dietary B-12 (with resultant bacterial overgrowth or SIBO). So change in diet alone wouldn't be effective treatment. And enzymes only help if there is concurrent EPI. And, yes, Viokase is supposed to be superior for EPI, and it is a pork product.

http://vetmed.tamu.edu/gilab/research/cobalamin-information

Pat

Thanks Pat

I am going to ask the vet about SIBO.... and if some Tylan might be called for. I had already flagged SIBO as well as EPI. I am told that folate and TLI tests were normal, but have not picked up results yet. I do think that there is an enzyme issue here possibly related to digesting certain meat proteins....or maybe there food allergies keeps her from digesting those proteins. Without a doubt, beef made her worse and dairy did not get her better. The cottage cheese is now gone. I do know that now that she is on some enyzmes and we have ramped up the lamb in her food she is doing notably better, so this may be useful data. We do have her on probiotics too.

Gracie's appetite definitely better....

Just not sure if that is because she is feeling better because we have added enzymes to her food and added more meat.... or if it is sign of EPI..... even though the TLI test was normal. Wish this stuff was easier to decipher!!!

Debra-

My Lance was diagnosed with EPI and B12 deficiency (thanks to Pat of course) almost a year ago so I am well versed in all things related to both and am happy to answer questions or provide a sounding board if you ever want to PM me. Lance is 11, so much older than sweet Gracie but since the diagnosis and beginning treatment, he is totally fine and healthy as a horse-my vet actually marvels at how well he is doing.

We use the pancreatic powder you mentioned and I tried several brands before finding one that I really liked. It is made by Virbac. It's slightly more expensive than the others but it is white in color so doesn't stain around the mouth (we tried one that was brown in color and poor guy looked like he had poop on his face all the time!). For the B12 we did shots weekly for 12 weeks then rechecked and his levels were normal so we took a break then started back up again, we are another break right now. Our specialist said he often sees the levels level out after a series of shots. Do ask for a written prescription for the B12 though if you need to do shots, it was much less expensive at my people pharmacy than getting it from the vet.

As far as his diet, we did have to switch to more frequent feedings but I only feed half at the mid-day meal and that has seemed to work. He is older and slower and walks are not his favorite so I don't want him to fatten up, but do want his tummy full all day. We switched to a limited ingredient diet recommend by the specialist (also listed on one of the sites Pat sent me) it is Nature's Balance Fish and Sweet Potato.

Lance is so much better now and trust me the diagnosis is scary but it was so easily fixed once we figured out what the problem was. As my specialist said, "I don't love disease but I love diseases like these that are easy to treat." Hope this helps!

Catharine

Thinking of you and gracie.

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Actual test results are a bit surprising.. see IBD or food intolerance issues

Gracie's B12 is low but not dangerously. The cobalamin showed 270 and normal is 284 to 836.

Folate levels were within normal range. 8.1 test result and 4.8-18 is normal range.

However, her TLI was really really close to being high, not low. She was at 33.3 and their normal range is 5.0-35.0.

If high, indicates either acute panceatitis, malnutrition or renal dysfunction instead of a digestive enzyme production problem. The PLI was at 37 which indicates that we can rule out pancreatitis, because that would have to be at 201 or higher to indicate that problem.

So I think we are looking at IBD and/or food protein tolerance issues that have led to overall nutrient absorption issues over the past few weeks. It has not helped that we had her on a bland diet that was not really balanced for a few weeks. She has not shown any signs of renal problems. No changes in urination that we can detect.

Pat or others.... do you think I am reading this right?

Given this, I think we are going to proceed with getting her on a balanced diet. She seems to tolerate the lamb/rice in home-cooked and kibble form so far. We are increasing the kibble slowly.

What I have seen is that her appetite has been increasing alot in the past few days as we have had her on food that she seems to tolerate. She is like a Hoover vacuum cleaner! We no longer have to try to force her to eat... she WANTS it.

Long-term diet is still in question but staying the course for now since we have her stabilized and her poop is almost normal. Just a tad soft. No question that removing beef and dairy have helped. She can't eat them.... period. Am thinking about combining a raw diet with a limited ingredient kibble down the road.