I'm going to begin this post with a important point. Unfortunately, due to a lack of research on diet and pancreatitis in cats, there is very little to almost no evidence to support any particular diet recommendations. This is something that both vets and owners struggle with, because even though there's a lack of research, we still need to make recommendations. We need to help our clients decide what to feed their cats, and pet parents still struggle with not knowing what to do.
I myself have a cat that has severe chronic pancreatitis. We don't know when his first episode was, and we don't know the cause/s. His spec FPL is intermittently over 50 mcg/L, and he has a decreased appetite, loses weight, has soft stools, and generally appears unhappy and uncomfortable. As a veterinary nutritionist, I found it really hard not having any research to help guide my diet-related decisions, and so, feeding cats with pancreatitis became a special interest of mine.
Some of the most important nutrition questions asked by owners of cats with pancreatitis include:
Does my cat need a low-fat diet?
Do specific types of fat in the diet need to be avoided?
Should I feed a hydrolyzed or novel protein diet?
My cat is not eating. What should I do? Should I just feed my cat whatever he/she will eat?
So these are some of the questions we will cover in this post. Again, my diet recommendations are derived from different studies including human, cat, dog and rodent studies, as well as anecdotal experience - but there's not a lot of direct evidence in cats yet to support them.
Pancreatitis in cats: a super-quick overview of the basics
In a study of 115 cats undergoing necropsy at the University of California Davis, the overall histopathologic prevalence of pancreatitis was 66.1%.
Acute pancreatitis is characterised by inflammation that is completely reversible; chronic pancreatitis results in irreversible changes. Both can be mild or severe.
Many owners of cats referred to us with pancreatitis describe occasional 'acute episodes' or 'flare-ups' of signs, which can last from 1 week to 3 months or more. In between these episodes, the cat seems well and is able to eat normally. It appears as though these cats may have chronic pancreatitis, with intermittent more acute episodes. This is important, because our nutritional recommendations will vary a bit for acute episodes vs. long-term management.
Pancreatitis in cats has no age, sex, or breed predisposition.
> 95% of cases of pancreatitis in cats are considered to be "idiopathic", and a specific cause cannot be identified.
The most common signs of pancreatitis are lethargy, loss of appetite, vomiting, weight loss and diarrhoea. Pain is not as commonly reported, however this may be because people are not great at recognising signs of pain in cat.
Abdominal ultrasound combined with specific blood tests (such as spec fPL) are the most routine way to diagnose pancreatitis in cats.
Treatment consists of medical management (as needed - fluid therapy, drugs to prevent vomiting and nausea, pain management, appetite stimulants, and nutritional support).
What nutritional support is currently recommended?
For acutely ill cats, the focus is on providing early enteral nutrition using a complete and balanced, high protein, highly digestible diet. Fasting or "resting the gut" is not recommended, and neither is parenteral nutrition, unless there is no other option. Nasogastric or oesophagostomy feeding tubes can be placed in hospitalised cats with a poor appetite, and this has been shown to be well-tolerated.
For cats with chronic pancreatitis, most vets recommend highly digestible, prescription gastrointestinal diets, or hydrolyzed diets. The ACVIM consensus statement on pancreatitis in cats (2021) states: "it is recommended that each cat's diet be assessed and altered if the diet is thought to have contributed to pancreatitis or a comorbidity", however no further information is provided on how to do this, or what to change the diet to.
There is some mention of a difference of opinion between panel members regarding whether dietary fat restriction is helpful or not - most panel members believed not. So that brings us to our next question.
Does my cat with pancreatitis need a low-fat diet?
There is no published evidence to suggest that this is the case. Xenoulis and Fracassi (2022) reported that anecdotally it appears that some cats develop pancreatitis a about three weeks after being switched to a high-fat diet and improve after changing back to a diet with a lower fat content. As mentioned above, some veterinarians also mention individual cases where fat restriction was believed to be beneficial. Again, no research has been done on this yet though.
Given the lack of evidence, there are generally only two situations when I recommend really restricting fat (i.e. a low-fat diet):
1) if your cat has concurrent hypertriglyceridemia (elevated triglycerides). This actually appears quite rare in cats, though.
2) If your cat has such a severe episode of pancreatitis that he/she has transient signs of exocrine pancreatic insufficiency (EPI), such as pale soft voluminous stools. This has been documented in humans, but not yet in cats - however I have seen it occur in my own cat. Keeping fat low in the diet for cats experiencing a very severe episode may help to improve diarrhoea and minimise maldigestion/malabsorption.
In terms of long-term diet selection for cats with chronic pancreatitis, is it possible that very high fat diets could be a problem for some cats? Additionally, while a lot of commercial diets for cats do contain 30-45% calories from fat, there is actually an enormous range of options available. From canned chicken breast-based diets containing very little fat, to ultra-high fat diets with 70%+ calories from fat - the question is not only whether feeding these very high fat diets is fine, but also whether chopping and changing between ultra-low and ultra-high fat diets is safe for cats with a history of pancreatitis?
Given the anecdotal reports, we usually err on the side of caution and recommend diets with moderate fat (30-45% calories from fat), and we also recommend consistency where possible. Low fat treats are also a sensible choice.
Until we have more research, it is difficult to suggest anything else. There is currently a study (CATPAD study) being done by the Gastrointestinal Lab at Texas A&M University investigating the association between high dietary fat and pancreatic health in cats; hopefully this will help us to understand more about this topic.
Should specific types of fat be avoided?
There is some speculation online that cooked fats are the cause of pancreatitis in cats (vs. raw or unprocessed fats). There are also theories regarding possible different effects of saturated vs. unsaturated fatty acids, or whether rancid (oxidised) fat could have a detrimental effect on the pancreas.
In humans, there is a study that demonstrated that patients with a high intake of monounsaturated fatty acids experienced more severe disease and more complications. However, the relevance of this to cats is unknown. At this time, there is no reason to suggest that specific fats or diet preparation methods need to be avoided.
Should I feed a hydrolyzed or novel protein diet?
Because pancreatitis is often diagnosed in cats that also have evidence of inflammatory bowel disease (IBD), novel protein, limited protein or hydrolyzed diets are often recommended. There is no published evidence that suggests that cats with pancreatitis will respond to a change in dietary antigens. Could pancreatitis occur as 'an extension' of IBD? Yes, it's possible - we just don't know if this does happen though. If your cat has suspected IBD and pancreatitis - opt for a novel protein diet (if possible, while also keeping fat moderate and carbohydrate low). Otherwise, it's likely not the most important nutritional goal.
Could carbohydrate potentially be a problem for some cats with pancreatitis?
I believe there is enough evidence to suggest that most cats with chronic pancreatitis (especially if moderate to severe, or if there are repeated acute episodes) should be fed a carbohydrate-free, or very low carbohydrate diet. However again, this is speculation on my part, based on the research available. To understand why carbohydrate restriction could be helpful, we need to talk a bit about pancreatitis, insulin, hyperglycaemia, and diabetes mellitus.
We know that inflammation in the pancreas can cause destruction of the cells responsible for producing insulin, a very important hormone for regulating blood glucose. When enough of these cells are destroyed, diabetes mellitus can develop. Not enough insulin is produced (and there may also be some insulin resistance), so hyperglycaemia (or elevated blood glucose) occurs. It turns out that these two things (decreased insulin, and hyperlgycaemia) can both worsen existing pancreatitis and/or increase the likelihood of acute episodes developing.
With respect to insulin, there's quite a few papers that demonstrate a protective effect of insulin on the pancreas. In a study by Bruce et al. (2021), insulin was found to protect pancreatic cells in a rodent model of acute pancreatitis. Similarly, Samad et al. (2014) also found that insulin pre-treament directly protected against pancreatic injury.
Another study in 2022 found that using insulin to control blood glucose allows pancreatic cells to regenerate, whereas hyperglycaemia prevents this regeneration. This is similar to older studies in dogs that show that when the majority of the pancreas is surgically removed, treatment with insulin helps to promote regeneration of the pancreas. So insulin is a definite friend of the pancreas - however that will only really be relevant to you if your cat is also diabetic. If that's the case, good glycaemic control may also help to improve your cat's pancreatitis.
In contrast, hyperglycaemia appears to be a real enemy. An older study in cats by Zini et al. (2010) provides some insight into this; the authors found that experimental hyperglycaemia maintained for 10 days at the typical concentration of untreated diabetes led to a 3-fold increase in the number of neutrophils (a type of inflammatory cell) within the exocrine pancreas.
Hyperglycaemia has been shown in numerous other studies in different species to increase the risk of acute pancreatitis. In an impressively large study, Cho et al. (2023) enrolled 3.91 million people to learn that as glycaemic status worsens (as blood glucose consistently increases) the risk of acute pancreatitis increases. Another large study in people found that as dietary glycaemic load increases, the risk of acute pancreatitis also increases.
We know that in rodents and people, diabetes aggravates acute pancreatitis and suppresses regeneration of pancreatic tissue, and this is due to the hyperglycaemia that occurs. We also know that patients with diabetes are much more likely to develop pancreatitis, and that patients with pancreatitis are more likely to develop diabetes - it's a bidirectional problem. For cats with diabetes and pancreatitis, it's a no-brainer to feed a carbohydrate-free or low carbohydrate diet - this has been shown to increase the likelihood of diabetic remission occurring.
But what about cats without diabetes? Could reducing dietary carbohydrate help to decrease the risk of diabetes developing in cats with pancreatitis? Could it help to keep blood glucose lower, perhaps affecting inflammation in the pancreas? While we don't have definitive answers for these questions, we do know that high carbohydrate diets can increase blood glucose in cats (and other species).
We also know that cats with pancreatitis may develop glucose intolerance (this has been shown to occur in people); higher carbohydrate diets may worsen this and exacerbate hyperglycaemia. In cats with diabetes, remission is thought to occur due to reversal of glucotoxicity and low carbohydrate diets facilitate this by lowering and stabilizing postprandial blood glucose.
So, to summarise, pancreatitis can increase the risk of hyperglycaemia, decreased insulin production, and the development of diabetes. Hyperglycaemia can worsen pancreatitis, creating a vicious circle. Feeding a low carbohydrate diet may help to moderate postprandial blood glucose, potentially keeping the pancreas a bit happier.
Our diet recommendations:
For acute episodes or flare-ups:
For cats that are feeling unwell, with a poor appetite, nausea and weight loss, there are a few things to consider:
Have different options handy. Cats that feel nauseous can develop a learned taste aversion to the food they have been eating, meaning that they associate the feeling of nausea with the smell and taste of that food. Therefore, it is useful to have some different diets and foods to offer.
This is not the time to hold back on ultra-palatable foods. Social media routinely advises that cat owners should avoid proteins like canned tuna, or kangaroo, partially because they are too palatable and because cats can become unwilling to eat other things. However, if your cat is sick and not eating - bring out the good stuff. Some things we recommend are: raw or cooked kangaroo fillet, high quality tuna (canned in spring water), plain cooked and peeled shrimp, raw or cooked pork tenderloin, or raw or cooked skinless turkey breast. Most of these are low in fat, to try and limit any maldigestion occuring. You don't need to add vitamin and mineral supplements to feed these foods for a few days, however if it's going well and you want to feed them longer-term, the diet needs to be balanced.
Treats and toppers can be very useful. I prefer plain freeze-dried chicken breast or other freeze-dried treats (e.g. venison fillet, kangaroo fillet, turkey breast, white fish, tuna, or shrimp). Freeze-dried treats can be crumbled over a meal to encourage eating. Try to select high protein, moderate to low fat treats.
Little and often. Small frequent meals may help to promote eating, prevent weight loss, and reduce the risk of reflux. Nausea can be worse when the stomach is empty, so avoid long gaps between meals, if possible.
Keep things consistent and avoid extremes. Try to avoid offering foods with extremely different fat and carbohydrate contents. Because we don't know how well tolerated very high fat or high carbohydrate foods may be, it is safest to avoid them.
Weigh your cat at home, at least weekly. If you have a cat with pancreatitis, it is really important to detect weight loss, and act promptly. I recommend buying a digital baby scale for stress-free at-home monitoring of body weight.
When you have a minute, write a list of all the diets and treats your cat has eaten while he or she has been doing really well. Make it a detailed list that includes brands and flavours. During an acute flare-up, make sure you feed only diets/treats from your "safe" list - don't introduce anything new, and also take note of whether you did change the diet prior to the flare.
Long-term dietary management:
I personally recommend a very high protein, moderate fat and carbohydrate-free (or low carbohydrate) diet.
Some potential choices include:
A homemade balanced raw or cooked diet. For this option, I favour proteins like pork (5-10% fat), kangaroo fillet, venison fillet or wild rabbit - but chicken breast, turkey breast, or duck breast is also ok, unless you are trying to feed a novel protein homemade diet. Make sure the diet is properly formulated and supplemented as needed. Avoid adding carbohydrate sources, and keep fat moderate.
Prescription diabetic canned diets. Examples include Hill's Prescription Diet m/d canned, Royal Canin Diabetic canned, or Purina DM canned. These diets are some of the higher protein commercial options available for cats, and the canned diets are adequately low in carbohydrate. Some of these diets have a lower fat content than others; it's worth checking this if you are worried about fat for your cat.
Low carbohydrate, moderate fat non-prescription canned diets (limited protein or otherwise). There are many different diets that meet this description (for example, some diets made by Weruva, Tiki Cat, Nulo, Farmina, and Rawz). You are looking for fat to be a maximum of about 20-25% dry matter basis, and for carbohydrate less than 10% dry matter basis.
If you want to try a limited protein diet, make sure you check the ingredients list carefully, because many diets sound like they contain limited proteins, however they actually don't. An example of this is Zealandia's "Brushtail possum paté", which contains possum as the first ingredient, but lamb as the 3rd to 7th ingredients.
Thank you for reading! If you would like help with your cat's diet, or have questions, please get in touch: info@vngpets.com
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