Chinese herbal medicines and low-fat meat and vegetable diets can prevent pancreatitis in dogs and cats, and resolve acute and chronic stages of the disease.
Pancreatitis is common in dogs and cats. Acute pancreatitis is associated with high mortality, though there is good potential for complete organ recovery if the animal survives. Chronic pancreatitis can cause refractory pain and progressive exocrine and endocrine dysfunction. An integrative approach that focuses on diet and Chinese herbs can prevent and even resolve both forms of this disease in dogs and cats.
The pathophysiology of pancreatitis
There is some confusion surrounding the definitions of acute and chronic pancreatitis. Part of the confusion may stem from the fact that the conditions that incite it vanish once the organ has become inflamed.
Nitric oxide (NO) and its impact on micro-circulation appear to play a pivotal role in the pathogenesis of pancreatitis. The onset of the disease is marked by a lack of NO, yet the acutely inflamed state is marked by an abundance of NO. Preventing and treating pancreatitis thus require almost opposite approaches.
The roles of nitric oxide and endothelial dysfunction
Two types of NO are associated with the pancreatitis:
- Inducible – of importance in the progression of pancreatitis
- Endothelial – of relevance in the initiation of pancreatitis
Inducible NO regulates normal pancreatic exocrine secretion, both by boosting pancreatic microvascular blood flow and directly regulating enzyme secretion. Normally, its presence is key to a properly functioning pancreas. When pancreatitis is in full swing, however, inducible NO levels are high. The pancreas becomes edematous and engorged with blood, enzymes are disgorged, and the organ becomes congested. Meanwhile, the strong free radical activity of NO further heightens inflammation.
These heightened levels of NO and blood flow during pancreatitis are opposed to the reduced micro-circulation and NO levels that trigger pancreatitis to begin with. Before acute pancreatitis develops, pancreatic micro-circulation becomes impaired, blood flow is reduced, and platelet adhesion and clot formation increase. These events are caused by a reduction of endothelial NO in the vasculature of the pancreas; this is known as endothelial dysfunction (ED), which promotes the start of inflammation. Evidence suggests that a lack of endothelial NO, causing associated ED, is what triggers pancreatitis.
To support endothelial NO levels means preventing ED; and to prevent ED means preventing pancreatic inflammation. To resolve chronic pancreatitis, and prevent it in the first place, we need to focus on the cause of ED. For the most part, ED in dogs and cats is caused by diet.
Diabetes, insulin resistance and ED
We’re used to thinking of pancreatitis as a cause of diabetes mellitus (DM). But DM is also a precursor to pancreatitis. Diabetes often precedes pancreatitis because it is linked to ED. In Type 1 diabetes, ED is consistently found in advanced stages of the disease. For Type II diabetes, ED may even precede the disease.
Both types of diabetes are the by-product of insulin resistance. Insulin resistance alters gene expression for a number of pathways known to culminate in ED. Insulin resistance also promotes diabetes. Once diabetes is present, increased intracellular concentrations of glucose metabolites in endothelial cells heighten their dysfunction. In chronic insulin resistance, endothelin levels increase and endothelial NO levels drop.
Sub-clinical pancreatitis can now begin and the dog or cat is more prone to severe acute episodes. Insulin resistance and subsequent ED are important targets for intervention in resolving chronic pancreatic inflammation, and preventing future episodes. While several herbal formulas can be useful, an appropriate diet will help guarantee lasting success.
Preventing pancreatitis with diet
Typically, we limit only fat in the animal’s food, but insulin resistance, obesity and a predisposition to pancreatitis are not caused by high fat alone. Processed, low-end, starch-based canned and kibble diets are arguably the most common cause of insulin resistance. Pancreatitis becomes a rare event when these diets are avoided. Commercial diets are rapidly absorbed and frequently carbohydrate-based, provoking a surge in post-prandial glucose that leads to chronically high insulin levels and eventually insulin resistance with its attendant issues, including a tendency to inflammation in the pancreas and beyond.
In my experience, a minimally processed (raw or homemade) balanced diet of meat and vegetables is most beneficial in preventing pancreatitis in dogs and cats. Pancreatitis seldom occurs in pets fed these diets.
Chinese herbs for pancreatitis
Before using these herbs, you will need to work with a veterinarian who has knowledge and experience in Chinese herbal medicine.
Targeting insulin resistance – Damp Heat formulas
Three Seeds Combination (San Ren Tang) — Has a clinical reputation for reversing insulin resistance and Type II diabetes mellitus, particularly in cats. Coix markedly increases insulin sensitivity and reduces adipose tissue weight, leptin and insulin levels. The formula is anti-inflammatory, but also reduces predisposition to ED, thus helping to resolve chronic pancreatitis and reduce the risk of future episodes.
An animal needing this formula often has a wet, swollen and lavender tongue, although it can also be a mild red color. The pulse is usually deep and toned.
Four Marvels Combination (Si Miao San) — Used to manage acute pancreatitis. It increases insulin sensitivity and studies have verified its benefits to pancreatitis through its antioxidant effects.
The patient that benefits from Si Miao San has a tendency towards acute inflammation, oxidation and associated insulin resistance, usually manifesting as inflammation at multiple epithelial surfaces (especially the ears, skin, colon, biliary tree and bladder). Signs of Cushing’s can also occur. The tendency to acute inflammation is marked by a superficial and toneless pulse. The tongue is often red or purple-red.
Minor Bupleurum — Interferes with the production of cytokines that promote ED. Most helpful in resolving sub-acute to chronic pancreatitis, especially when due to systemic infection or immune dysregulation. These cases will often have inflammation manifesting in other organs, especially the liver and kidneys (as glomerulonephritis), but also the eyes (glaucoma, uveitis), lungs (pneumonia, pneumonitis), nervous system (disc disease, vestibular disease), and skin.
Animals benefiting from Minor Bupleurum almost invariably have deep, toned strong pulses. One or more vagal symptoms are common, including chronic cough, vomiting, bloating and constipation.
Glehnia and Rehmannia – This combination, known as Yi Guan Jian, contains two plants, Angelica and Rehmannia, that counter ED to restore normal micro-circulation and actively resolve chronic inflammation in a number of tissues. The formula is contraindicated in acute active pancreatitis, since the organ is now severely congested and edematous. It can resolve mild low-grade pancreatitis, and prevent recurrences.
Animals that benefit from this formula have reduced circulation to epithelial surfaces, creating dryness, mild gastric inflammation, and irritable bowel syndrome. Animals often display mild to moderate liver enzyme elevations. Anemia and chronic weight loss may be present, as well as a tendency to timidity or anxiety. The pulse is often thin and the tongue pale, perhaps with a lavender center.
Pancreatitis can be prevented in dogs and cats by using Chinese herbal medicines and low-fat meat and vegetable diets. Once these therapies are instituted, episodes of pancreatitis cease. Herbal formulas may also be used to resolve acute and chronic stages of the disease, and work along with diet to eliminate the inciting factor of recurrent and chronic pancreatitis — reduced endothelial NO. If your dog or cat has been diagnosed with pancreatitis, an integrative veterinarian with experience in nutrition and Chinese herbs can help him get back to health.
Case report — Falco
Falco is a nine-year-old male border collie cross with pancreatitis. The disease seemed to gear up over a long period, with nausea, vomiting and pica, and did not respond to antacids or anti-emetics. An integrative protocol was eventually settled on, consisting of 0.2 mg/kg prednisone, a round of metronidazole and milk thistle. Two herbal formulas, Yi Guan Jian and San Ren Tang, were also initiated.
Falco de-stabilized when herb use became less consistent. Yi Guan Jian alone was resumed, along with metronidazole and continued prednisone use. Although Falco seemed at first to improve again, he had to be hospitalized in November. Clinical signs included lethargy, fever, diarrhea and abdominal pain. ALP was increased to several times the normal value, and an enlarged liver was seen on ultrasound. A snap test showed a strong positive result for CPL and pancreatitis.
Physical examination showed strong-toned mid-depth pulses that responded well to acupuncture. Falco was also given anti-emetics, fluid therapy, hydromorphone and a low-fat bland processed diet. A derivative of Minor Bupleurum was introduced as the new herbal formula.
Falco gradually improved over the next two weeks, but had no appetite for a bland diet, so a low-fat processed kangaroo diet was fed instead. Improvements in laboratory data steadily accrued even as improvements in symptoms were more erratic.
Over the long term, prednisone was discontinued, and the combination of Minor Bupleurum and Three Seeds Combination proved sufficient to eradicate all symptoms. Falco continues taking the herbs, and eats the kangaroo diet.
The author acknowledges the contributions to this case study of Jana Teefy, AHT, RLAT, and Jennifer Marshall, BSc, DVM, both of Edmonton Holistic Veterinary Clinic.