It never ceases to amaze me that people think stomach problems are a fact of life for cats. It is not normal for cats to have constipation or diarrhea or vomiting (other than an occasional hairball during shedding season).
On my list over a thirteen-year period, we have seen this over and over – switching to a fresh raw diet more often than not takes care of any stomach problems, even for cats with lifelong tummy issues.
In cats fed kibble and poor-quality canned diets, continued gut inflammation over time can lead to Inflammatory Bowel Disease (IBD). Common culprits are grains in both canned food and kibble, and even in superior canned foods, ingredients such as carrageenan (a thickener made from seaweed) and guar gum (fiber that is too fermentable for cat guts), can cause problems.
Cats on any diet, even raw, can develop food intolerances, insensitivities, or allergies e.g. chicken & turkey allergies are quite common. This does not necessarily mean they have IBD though it can come to that if the issue is not addressed as white blood cells (eosinophils, lymphocytes, or macrophage) invade the lining of the stomach and intestine.
Diagnosis and Symptoms
A biopsy can show an increase in these inflammatory cells as well as changes in the lining of the stomach, intestines, or colon. However, it is invasive, and at the end of the day, I find that my regimen is no different, so why put a cat through the pain!? Failing a good technician, there is no other definitive way to determine a diagnosis of IBD; several veterinary sites mention challenges with respect to biopsy whether related to collection e.g. specimen itself and size, or with respect to diagnosis. As a result, more often than not an IBD diagnosis is arrived at after eliminating other possibilities e.g. parasites.
Common symptoms of IBD are chronic constipation, diarrhea, flatulence, and vomiting sometimes intermittently and/or in alternation. There can also be straining during defecation as well as pain.
With continued inflammation, the protective mucous lining of the stomach sloughs off, evident in stools either along with or covered in mucous. This increased vulnerability along with continued unaddressed inflammation can then lead to bleeding e.g. in the lower GI tract, which presents as bright (as opposed to dark/black) blood in stool either alone or mixed with mucous.
In addition to colitis, cats can have inflammation in the small intestines (enteritis) and/or stomach (gastritis). So in really severe cases, one sees a constellation of symptoms.
Unfortunately, conventional treatment for IBD consists of antibiotics such as Flagyl, but this only makes matters worse. Not only do these drugs disrupt the normal flora of the colon, long-term use can lead do an overabundance of bad/virulent bacteria such that even cats who did not have colitis before antibiotics, develop it.
The other option - steroids - does nothing to address the core problem. On my list, we have had cats develop diabetes from a single shot of Prednisone:( That's just for starters; please read this article before even considering steroids.
The single biggest thing if a raw diet is not possible, is to eliminate grains from your cats’ diet.
I’ll share what’s worked for my 16 year old cat Pigpen, who came to me with such horrific stomach and intestinal problems that one almost needed to call in a hazardous materials team to dispose of her poop.
Her situation is a bit unusual because usually cats limp along on a poor diet for years, then around middle age, they are diagnosed with IBD. In Piggy’s case, she was only 13 months old, yet from being on Flagyl continuously for 12 of those months, her digestive system was decimated. Of course she had also been vaccinated, de-wormed, and given other drugs up the wazoo, but that’s a rant for another time.
In literally 3 or 4 meals of ground raw (at the time she wouldn’t accept whole prey, but since then she handles it like a champ) without grains, her stool was normal and odor down at least 50-60%.
I then found out about the indiscriminate Flagyl use, and added in probiotics to her food. Continued raw diet plus probiotics soon made the days of eye-watering, chemical-smelling stool a thing of the past.
Her supplements plus a raw diet have kept her symptom-free for 13.5 years now. She did develop a pretty severe intolerance to poultry, but that’s been easy to fix - she eats mostly “novel” proteins/meats..
Some cats with IBD benefit from additional fiber in their diets, but not all do, so this can be a trial-and-error process. In my experience with list/forum and rescue cats, it’s not terribly unusual for cats to be allergic to some types of fiber, so each cat’s case has to be individualized.
Pigpen is allergic to feathers and can only tolerate some types of fur, so I had to find other ways to meet her fiber needs. At first she did well on a combination of canned pumpkin and psyllium. But then she started vomiting and through process of elimination I was able to identify the culprit was psyllium. Eliminating psyllium took care of the vomiting.
I’m now giving her a daily total of 1/8 teaspoon of canned pumpkin along with 1/32 teaspoon of rice bran (EnerG, or Bob's Red Mill brand).
I no longer add anything but above-mentioned fiber to Piggy’s meals. Once in a while though, and especially in the initial stages, she used to get at each meal:
- Whole Psyllium husk (Frontier brand): fiber source, must add at least 1 Tbsp water -- 1/16 tsp
- L-Glutamine (Source Naturals brand powder): an amino acid shown to help slow down catabolism (break down of musle) and repair the abdominal wall and mucous lining -- 1/16 tsp
- Saccharomyces Boulardii: increases gut immunoglobulin, Secretory IgA (SigA) in duodenal fluids & anti-inflammatory cytokine, Interleukin 10 (IL-10). Thorne's is a good option, but for cats with constipation, Jarrow is better because it also has MOS. Reseach summary on S. Boulardii here. -- in children's studies, 250 - 750mg doses have been used, and in adult studies 1,000 - 3,000mg. For a cat with acute symptoms, one would use more but for a chronic situation with pudding poop (as opposed to really loose stools:), 50mg can be enough. Cut back on dose as symptoms e.g. firmness of stool, improves.
- Digestive enzymes (Prozyme, Petguard, or Dr. Goodpet): cellulase, lipase, protease, and lipas, not to be confused with proteolytic or pancreatic enzymes -- follow brand guidelines.
- Fructooligosaccharides or FOS, a prebiotic: Note - some cats can get gas and bloating from this, so be watchful. I would avoid this for cats prone to loose stools. Also if feeding canned food, many of them add inulin/chicory as FOS, so do not add extra if this is the case. Piggy was (still is, and will always be) on a raw diet, so she didn't get FOS from her meat diet. -- a little goes a long way on this one, amount will vary by brand.
- Probiotics (Jarrow Pet-Dophilus powder or non-dairy UAS Labs DDS capsules which also contains FOS) -- look for as many strains of beneficial bacteria as possible and a minimum of 1 billion CFU per kitty serving.
Primal Defense is a good brand that contains enzymes and probiotics, and just 1/32 tsp a day can help a cat. Get one of these dash, pinch, and smidgen spoons that measure out 1/8, 1/16, and 1/32 of a tsp; they come in extremely handy with kitty cats as they require such teeny dosages.
The first 4-5 days of each month, I would give her 5cc (1 tsp) of slippery elm bark (SEB) gruel once a day. I make SEB like any tea infusion – add 1/4 tsp of the bulk powder to 2Tbsp of boiled water. It'll thicken as it sits. Powder from capsules isn’t as strong, so if you are using that, add ½ tsp to 2 Tbsp of water.
Note: like other things high in mucilaginous fiber, SEB might inhibit absorption of other stuff given long with it, so give at least 30 – 60 minutes away from food to be on the safe side. Some cats actually like the taste of SEB slurry, and will lick it up when mixed with some treat e.g. yogurt or even alone. If at all possible, use Marshmallow Root (MR) in place of SEB since they are similar in action and because SEB is endangered from over harvesting and Dutch Elm disease. Some cats do just as well on MR and for others nothing but SEB does the trick. Since there are so few safe options for cats, and SEB is one of those precious few, each of us has to decide where this all fits in.
Many cats with IBD only need L-Glutamine short-term, and long-term maintain with a raw diet alone or with Primal Defense added plus whatever fiber source they can tolerate. Please do thorough research for contraindications (related to liver and kidney disease) before giving L-Glutamine for any extended period of time especially if you have a teenage or older kitty.
Currently, Pigpen gets 1/8 teaspoon of canned pumpkin daily along with 1/32 teaspoon of rice bran and a 250mcg B12 shot once a month. If you cannot get B12 injections (they are by prescription in the US but available in Singapore, UK, and Canada OTC), another choice is sublingual methycobalamin, which if you have a co-operative kitty, you can place in her/his mouth and hold the jaw closed for at least 30 seconds or till it dissolves. The only kitty-safe brand containing sublingual methycobalamin and no icky flavors, colorings, etc. is Natural Factors.
Once your cat is all better, it’s possible s/he’ll be able to absorb crushed-up methycobalamin tablets added to food. If neither injection nor sublingual is doable, then giving as much as one 500mcg per day should be okay. Reason being the estimate for oral B12 availability in humans ranges from 1 - 15% absorption, so if a cat absorbs 1% of a 500mcg pill, it would meet 2x their daily requirement. B12 is water-soluble so any extra is excreted via urine.
According to National Research Council (NRC) 2006 guidelines, a 10 lb cat needs 2.5mcg of B12 daily. However, these studies have found low cobalamin (and folate) levels in cats with IBD due to impaired absorption. In my experience, more than one condition can cause low B12 levels in cats. So I’d rather err on the side of giving B12 than not.
As with everything I’ve written here and on the site, YMMV of course. Wishing all kitties good health. If you'd like help with a health, diet, or behavioral issue, click here for a consult.