OK, hello everyone. I'm, I'm very pleased to have you join us on this presentation. I'm gonna talk a bit about raw food today.

I wanna start off with a bit of a caveat is that I'm sometimes perceived as being against this. I actually don't have an opinion for or against it at this time. I'm still waiting for more evidence to come out, so I'm going to try to present.

What evidence we do have about this, my other disclosures, I do not work for a pet food company, so I don't have a personal gain in in this one way or the other. I have done lectures that have been sponsored by by pet food companies, but I do not belong to one. I'm not employed by one, I'm not influenced particularly by them.

I'm gonna talk a little bit initially about where owners get their information for foods, some of the beliefs that they may have, and a little bit about what raw foods are, which I guess is kind of, kind of obvious, but, . And then a little bit more about some of their proposed benefits and the evidence or lack of evidence behind those ideas, some of the potential risks of feeding them both to the pet and to the owners and to the clinic staff, and then I'm gonna wind up by trying to address a little bit on how to talk to owners about pet food, which can be a a challenging topic. So why do owners choose raw food diets or why do they choose any any diet?

How do they make their decisions on this? For many, for many owners for many people, nutrition is a very emotional topic, sometimes choices about their own diets is a very emotional topic, . They may decide based on their feelings that it fits kind of how their lifestyle or it just has an emotional appeal rather than looking at the science about this and this cartoon just why do you think this why don't you think this report.

Has any detailed analysis and just a gut feeling, which is how many of us make a lot of our quicker decisions about things. If you have to make a decision very quickly, it may be on your instincts or your feelings because you don't have time to really research it. So where do they get their information about raw food diets?

A lot of it unfortunately comes from the Internet. One study said that 20% of the raw feeders were getting their diets off the Internet. It can come from blogs, it come from from breeders, friends, groomers, pet stores, and there are a few vets who, who propose these as as beneficial diets as well.

So it's always a mystery to me why people believe websites, why do they think the information on those websites is true or substantiated. There is one pet food forum run by a man with a political science degree, there is an author who wrote a book about raw feeding, and his statement about this book from himself, he says, what are my qualifications for writing on the topic? First, I'm not a nutritionist or a veterinary.

Professional, but I am a fanatic when it comes to my dog's health. This really isn't a qualification for nutritional decisions, it's sort of like me saying, well, I love my car, so therefore I'm a mechanic, I do like my car, but I certainly would not try to fix things that go wrong on it myself. So why is the information out there that maybe doesn't have any substantiation?

Why is it easy to believe? Partly because problems diets can be very subtle, they may only show up in a susceptible, susceptible individual or a susceptible breed. That may take years of feeding before they show up, they may only show up when the animal is under another stress, maybe they undergo chemotherapy or that they're ill for another problem, and then, the problems with a bad diet could show up then they may not be identified as being due to diet, they'll say if it's a problem with the immune system.

They do show up earlier in growing pets. We do see a lot of dogs, particularly larger breed dogs that have pretty bad orthopaedic problems due to unbalanced diets. The animals may be infected with pathogens, but the clinical signs may not be clinical.

They may be subclinical or they may have a slightly soft stool, that the owner doesn't really pay any attention to, but they still can be shedding pathogens, and I'll talk more about that later. So evidence-based medicine, evidence-based nutrition are founded on objective evidence-based scientific studies, not opinion. And you've probably all seen some version of the evidence pyramid, this one at the top has systematic reviews or meta-analysis where lots of studies are taken together and a consensus built around the higher quality of those studies, kind of going through this down to the bottom.

Which would be editorials, expert opinions, and I will try to tell you, I don't think I have anything in this talk that is simply my opinion, but if I do say something that is not evidence-based, I will try to let you know this is just my opinion, my, you know, what I've seen in clinics, which is me as an N of one. Which is very similar to an anecdote, which we do get stories about the benefits of things or the detriment of things, that when we get these stories, a plural of these stories, a plural of anecdote is still not data, it's still not research. So what do we have?

Is it evidence-based or anecdotal? So first you need to find out who is making the recommendation, what is their qualification? Where do they get their information and what's it based on?

Is it just anecdotal and maybe two or three anecdotes together? It's a good, that's a good basis for a pilot study, but it's still not evidence, and it's worth knowing the term nutritionist, veterinary nutritionist is not protected. Anyone can use this, anyone can call themselves a nutritionist, unfortunately, in order to claim that they are board certified.

Such as they have a diploma in the American College of Veterinary Internal Medicine in nutrition, or the European College of Comparative Nutrition, or the term board certified veterinary nutritionist and PhD are all protected and this down here in the, in the corner is a cohort of some of my veterinary nutritionist colleagues, all of whom are board certified veterinary nutritionists. That group happens to be at Tufts University. So what is a raw meat diet?

Kind of what you think it is really bones, raw food, some of them do or don't include bones, uncooked meats, poultry fish, occasionally see a raw egg thrown in there, I think fish is a little less common just in the diets that I have seen, not too much of that, . It can include the muscle meat, include internal organs, and include bones, usually it's whole bones, not ground up bones. We do have homemade recipes for this, and there are also several commercial companies who make raw foods.

Last count, I think it was somewhere between 10 and 15 of these were PFMA members, our industry body in the UK. So some of the commercial diets, including all of the ones who are PFMA members, should be complete and balanced for adult pets or all life stages, which would include puppies, and they have to, pardon me, they have to at least be computer balanced to to to make the claim that they are complete on the label. It's not illegal to make an unbalanced diet, but the label itself is regulated.

If it says complete on there, it's supposed to be. Of the commercial diets that I know of, none of them have done proper feeding trials. There have been a couple of feeding trials, but when you read how they have done them, it is not what we would consider how to do an actual feeding trial, the length and the selection of the foods and the control of the trial.

Which means the trials are kind of being done on the pets that they're fed to. So I mentioned some of these include organs, that's byproducts and or meat derivatives in another, in another language. The owners may be concerned about these ingredients in a commercial food, but not concerned about them when they're feeding them in a raw diet.

Byproducts that come in a commercial diet, whether it's raw or cooked. In Europe, including the UK, come from animals that are slaughtered for human use under veterinary supervision, so they are essentially what some people would call human grade, they all are, these are the parts of an animal, the healthy parts of an animal which we may choose not to eat or we don't eat enough of it, for the number of animals who are slaughtered, so things like liver. We don't eat enough of that, like things like lung, we usually don't eat at all, so these will go into byproducts, but they're still reasonable ingredients.

Some of these diets may add vitamin mineral premix, some of them add grain, which does need to be cooked, and these may or may not result in a complete diet. If it's a commercial diet labelled as complete, it should, if it's a homemade diet, there's a pretty good chance it won't be. And just touch on raw food, treat some of the things you'll see out there, these can be dried or dehydrated, it does not mean that they're cooked and it doesn't mean they're safe, so rawhide chews and pig's ears, cattle hooves, this one always seems odd to me why owners choose to feed a bull or steer penis.

These are sometimes called bully or pizzle sticks, interesting choice, . We also have a substantial risk of salmonella and other pathogens on these, if you think about. Where the ears and the hooves and the penis end up getting exposed to, they are highly likely to have been exposed to pathogens and faeces.

We also of course have jerky treats which carry a risk of Fanconi syndrome. I do know of several cases in the UK that have been caused by this, so just that's still happening, so just keep that in mind too. So what owners say they wanted a pet food?

One study said the vast majority of owners paid as much attention to their pet's food ingredients as those in the food their family eats. That could mean they don't pay any attention to what their family eats. It didn't really specify which way that went, but we do have a lot of people who are reading labels.

So what owners want from us, it quite varies as we know from clinics, from owners who actively want our advice, they may come in asking questions, which is the most encouraging kind of owner, they may want advice, but they don't ask you, they feel they don't wanna take your time or that you're not interested in that subject, we do have a problem with nutrition with owners perceiving that we don't know anything about it, . So they may not actually actively pursue it from you, even if they would listen to your advice if you were giving it or discussing it. And there is a cohort who are convinced what they're doing is ideal, and they do not really wish to have the conversation with you.

So there is a drive overall toward the concepts of natural foods, organic foods, sustainable foods, I'll talk a little bit about some of these ideas in a bit. I don't have time to go over organic, which has a different definition by each country, sustainable can be a difficult, a difficult choice because it's, there's so much that goes into that word that it almost doesn't mean very much anymore. So some of the things that people who choose to feed raw, may believe in one large study in the US 34% of the owners fed raw, that doesn't mean 34% of owners feed raw, that means 34% of the owners who chose to do a survey fed raw, and there can be selection bias.

In all surveys, you know, you can't put it under your head and force you to to to take a survey, so any survey will tend to focus on the people with more of an interest in that topic. Of the raw feeders, they had a lower trust in vets, only 9% of them consulted the vet about diets, their statement was the nutrition wasn't discussed in the vet consultations, whether that came from them or from the vets, wasn't clear either. They were more likely to say their pet was very healthy, again, you will want to say this about a choice that you have made, so there is a bias in there too.

Interesting, they were less likely to say that their pet was overweight, according to the owner, but any study done on body condition scoring or on obesity where we look at the owner's opinions. It usually varies considerably from the vet's opinion about the dog's body condition, so that's just the owner saying, no, my dog is perfect. Interestingly, although their pet was very healthy, they also were more likely to say it had a food sensitivity.

So a few of the myths that we do here, why dogs and cats can be fed raw food, so maybe you're not eating raw chicken wings yourself, but, but you might want to give them to your dog and cat. There is an idea they have a more acidic. Stomach and this protects them from pathogenic bacteria.

Human stomachs are quite acidic too. It's between pH between 1 and 2, the same as dogs and cats, so there really isn't a different difference in gastric pH. We all have very acid acidic stomach contents.

There's the idea that dogs and cats have a shorter gastrointestinal, tract length, which they do, especially cats. Cats for their body size do have a much shorter, GIT than humans. Dogs are a bit shorter than humans for their size as well, but that's not protective, it's not really like the pathogen rush out of the of the intestine and and don't infect it.

So dogs, cats, humans all have clinical similar signs after eating contaminated food. The severity of the signs is related to the dose of microbes or the dose of toxins and the condition of the host. So some reasons also that are given for either raw diets or just any alternative diets, sometimes a tailor-made or elimination diet is needed and no commercial diet will really suit that individual, I'll just stay on that for a second.

Sometimes they have several different diseases and we don't have a commercial diet that works for them. There's the appeal of whole or organic foods. They look more like the food going on your dinner plate, if you're feeding a a whole food or making a raw diet yourself, the commercial raw diets don't look like what I would eat for dinner, but anyway, some owners just wanna cook for their pets.

Palatability of homemade diets and of all diets is generally good. Homemade diets obviously are going to be palatable because the owner is choosing the foods that the dog or cat likes, so almost by definition, the palatability has to be good. They may have concerns about additives or some of the ingredients in commercial foods.

I'll touch a little bit on that. I do wanna say that additives are invariably the same or similar to ones that are considered safe in people, so we're not really adding anything particularly strange to to pet foods, . So one of the ingredients, we hear a lot of people want to avoid feeding carbohydrate sources, they want to avoid feeding grain, they want to avoid feeding gluten.

Gluten is very rarely a problem in dogs other than some small breed dogs, including border terriers, some Maltese, Irish set or gluten sensitivity has pretty much been bred out of the breed, and it's almost never a problem in cats. There may be a belief that raw foods are more natural, and I'll touch on that in a bit as well, and there are health claims for raw foods as well that I will touch on. So carbohydrates, carbohydrates sources, or carbohydrates itself are not an essential nutrient in for most dogs and cats, it's not something particularly cats, it's not something they absolutely have to have in their diet such as certain amino acids or fatty acids or minerals or vitamins.

They are easily digested if they're cooked, including by cats. You will get see like in, you know, websites and things that cats can't can't digest carbohydrates, yeah, they, they can, they can digest them quite well if they're cooked and processed. Carbohydrates do have a good nutritional value or their sources do.

They're especially valuable during lactation because it's easier to make milk sugar or lactose from a carbohydrate than it is from a fat or protein source. They are useful after work or exercise for repleting liver glycogen, so if you have working dogs or say some of the racing greyhounds, the owners will often give them a carbohydrate snack or treat after they've worked. Because they find that that gets the dog back up and and going again better.

They also usually include the fibre sources which are beneficial, especially for colonic health and carbohydrate sources aren't just pure carbohydrates or grains or potatoes or lentils, whatever we're using as a carb source also has other nutrients. There's some amino acids, there's vitamins, there's minerals in there too, and they will add those to the diet. So the grain-free diets may not be carbohydrate free, you have other sources of carbohydrates that could go into that.

If you do have a low carbohydrate diet, they have to be fat high in either fat and or protein. You've got a pie made up of three parts, and that pie has to stay around. If you get rid of one of these or decrease the amount of one of these, one of the other two has to change, or both of them.

So when fat is increased, we know this can be problematic for some animals, contraindicated with chronic pancreatitis, contraindicated with hyper triglyceridemia, high fat diets contraindicated in some GI disease such as lymphagicasia, obviously contraindicated for obesity because high fat diets are high high calorie diets. It's really hard to make one. High fat that's low in calories.

So like just a couple of cases that I have seen which were on a raw diet, this was very nice. Goldie, who you can see, I hope you can see, is quite overweight, she was about a 7/9, maybe pushing an 8 out of 9, that's not all coat. The owner thought that he was feeding a low fat food because it said 11% fat on the bag.

It was a free flow tripe-based food. If you look at this on a dry matter basis, and I'll explain that in the next case a little more thoroughly, it was over the diet was over 50% fat, so it was actually an extremely high fat diet, and I have to say this owner was actually mad that he had not been told that by a previous fat. Another example is a puppy who was being fed a diet which was 16.4% fat on the bag.

It was sort of a semi-moist diet with a moisture content of 66.4% and a dry matter basis of about a third of the diet. So if you look at the fat on a dry matter basis, it's the 16/33, it's like.

Just about half of that food is also again made up of fat. So again, risk of obesity, which is serious in puppies, very rapid growth is serious in puppies and can cause degenerative orthopaedic disease, and this particular diet also had on a dry matter basis, a calcium of 3.27 that is in the range which was experimentally used to cause developmental orthopaedic disease in puppies.

So I wanna talk on the natural idea as well, because this has a lot of appeal for owners, it's based on the idea that dogs evolved from wolves and that their natural diet is carcass and bones. Dogs actually are not of all worlds. They have a common ancestor, and they split quite a long time ago, and dogs have been domesticated for 10,000, 15,000 years.

I've even read 40,000 years on this, so they went a different way from wolves many, many centuries ago. And during this time they've been eating a diet more similar to human food as they kind of, you know, gather around the campfire or whatever and over this time, there have been genetic changes so that the dog's genome has evolved to be better able to digest starch and carbohydrates. So fully capable of that.

The other aspect of this is per kilogramme of body weight, dogs can, excuse me, wolves can eat 3 times more calories than a dog, so that means they're also taking in more calcium, more protein, more potassium, more of everything, than the dog per body weight, so they're less likely to be deficient in some of these nutrients which are required per kilo of body weight. So some of the health claims improves the immune system, that it's more digestible, better dental health, on a better coat. I'm gonna talk a little bit about the first three.

The better coat, these are again are often high fat diets, higher fat diets will often make a shinier coat, so like there is that potential benefit, I guess, of it, as long as none of the detrimental effects are happening. So there was a study looking at cats fed raw meat diet for 10 weeks, some were indeed shedding salmonella. In those who were shedding salmonella, they had increased lymphocytes counts and immunoglobulin G, but this to me is not evidence of an improved immune system so much as it is evidence that the kittens were able to respond appropriately to a pathogen.

Are they more digestible? There have been some decent studies looking at this, of some of the nutrients are more digestible compared to that in an extruded dry diet, so it could be more digestible in some cases that might be beneficial. Again, fat overall tends to have good digestibility, so that can affect digestibility studies.

And we do know the processing decreases the digestibility of some nutrients and increases that of others, so it's not necessarily across the board for everything. And similarly, cooking increases the allergenicity of some ingredients and decreases it for others, so we can't even say it's gonna be more or less allergenic because it depends on what is in that diet. So overall, digestibility is pretty good for these diets, is that a good thing?

If you don't need a lot of fibre, and if you're not obese, it could be a good thing, otherwise it may not be such a good thing. Because the higher digestibility means more of the nutrients are staying in the animal and for calories that might not be what you want. And talk a little bit about a microbiome study where they again looked at raw foods compared to a commercial extruded dry diet.

There were firmer faecal scores on the raw food, although it wasn't significant and nobody in either camp had diarrhoea either treatment it did decrease some of the bacteria we consider beneficial, such as Lactobacillus. Increased clotting profringence and E. Coli in a way similar to a chronic neuropathy.

It also increased the dysbiosis index, and that's not a good thing. It decreased the variability of the bacteria, you want more variability, and you do not want an increased dysbiosis index, so overall it didn't perform too well. Now, there was a kind of a problem with the study, as there are with many of these studies, that they did not have the same nutrient profiles, they had differences in the amount of fat and protein and carbohydrates, all of those things will affect the microbiome and digestibility and almost everything else in the diet, so.

A lot of the studies that you see, looking at things like this are apples, what I would call an apple and orange study, they're not really comparing the same nutrients, so you can't say it was due to raw or due to dry because they're different, different ingredients, different nutrients. We hear bones are good for teeth, are bones good for teeth? There's no evidence for less plaque or peritonitis with raw foods and bones, and this has been looked at quite a bit.

They may have less tartar or calculus on the teeth, so the teeth may look nice, but there's been no comparisons with a dental diet, or with actual raw food. A similar composition raw food. So they might look pretty, less tartar, less calculus, but that is mostly cosmetic, it does not cause periodontitis or tooth loss, plaque causes it, so if you're not decreasing plaque, you're not improving the health of the mouth.

Although you might make the owner less likely to want to do a dental, which wouldn't be a good thing. So risks that certainly my my veterinary dental friends have pointed out that they see this fractured teeth as an internist, esophageal foreign bodies, definitely have seen those with bones, gastrointestinal foreign bodies or GI perforation, and you do get the claim the claim that raw bones are safer. Honestly, I don't know.

There hasn't been a study saying. Yes or no on this. I certainly have taken a raw bone that was blocking an oesophagus out of it, .

I've also taken a lot of cooked bones out of esophagu, so I don't know, maybe they are, I don't know, but they're unlikely to contribute to the calcium if it's a whole bone. If it's ground up, it will provide calcium, just chewing on a bone, they're not gonna get enough to do anything. I just wanna mention quickly if a pet is on a homemade diet that is calcium deficiency whether it's cooked or raw, that pet is very likely to develop secondary hyperparathyroidism due to the calcium deficiency and possibly a phosphorous excess, you could also get problems with vitamin D deficiency.

If you try to do a prophylactic dentistry on this mouth, the jaw may fracture, so just be aware if you get in a home fed dog, homemade diet fed dog or cat, into your clinic before you do invasive procedures on the bones or on the mouth, that they may have some problems. So how do we make a complete diet? In Europe, we use the FEDF nutrient requirements.

There's over 37 required nutrients for dogs, depending on their age. There's about 40 for cats, and this is what the tables look like. I don't expect you to be able to read this, but these are freely available online on the FettyF.org website, so the chances of getting all of these in the right amounts by throwing some ingredients together is pretty low.

So some of the recipes that owners use for homemade raw diets, the barf diet's ultimate Vol hard, and as I mentioned before, about 20% of raw feeders use these online diets, and they're mostly based on opinion, even if they're developed by owners or breeders, they're probably based on opinion, including some, vets, or doing these by opinion. Some of the diets very rarely may be balanced by veterinary nutritionists, some nutritionists won't balance a raw diet because they don't believe that they should be fed, some will, the one website that I will recommend, I have no financial stake in this, but they do a good job is the Balance it.com website if you're trying to put a diet together.

And there is a a free version of that that you can use. Almost no border nutritionists recommend raw feeding. There are a couple who will discuss it, now, but most people are not actively recommending it.

So diets on the web. Are largely not complete and balanced. They have similar deficiencies, calcium, as I mentioned, other vitamins, excuse me, vitamins, calcium is not a vitamin, microminerals, linoleic acid occasionally you get ones that are too high in phosphorus and protein, protein probably OK, phosphorus, mm, we need to be careful obviously if we've got any renal problems with that.

There is a theory that if the owner feeds different diets or whatever, several times a week or however often or every day, that the nutrients will balance out, that Monday will, you know, provide the deficiencies that Sunday had. This has actually been studied by Jonathan Stockman, he looked at combining different recipes and computer balanced them and. If both diets are deficient in calcium or zinc or linoleic acid, which are some of the common deficiencies, they are not going to balance out over time.

So again, just some specifically raw diets again, same deficiencies, some of them even deficient in phosphorus, which is kind of hard to do . Some of them, if they were supplemented with human supplements, tended to be very high in vitamin D. Most human supplements have more vitamin D than dogs or cats need, because people are often low in it and, require more, so you do have to be careful using human supplements and know what's in them.

Again, I mentioned earlier growing animals requirements of calcium and phosphorus and zinc and protein are higher than per kilo of body weight than an adult, so we do see problems with puppies in particular and also kittens on these developing nutritional hyperparathyroidism due to calcium deficiency rickets. If they're not supplemented at all due to a vitamin D deficiency and sometimes both together like this dog who was . He's come from Doctor Ross over, Doctor Ross Allen over in Glasgow, sent me these pictures, and this dog had been brought up on a raw diet, and those hind legs are as crooked as they look like in that picture, and the radiographs were horrific as well.

We have had cases, actually I just had a discuss one of these with me yesterday about owners feeding a raw diet that includes thyroid tissue and the dog's developing hyperthyroidism from from that the neck part of the the carcass being included in the diet. Homemade kitty diets, there's also some studies on this, there was one looking at 117 recipes, both vet and non-vet authored diets. This is not a typo.

The calories varied per recipe from 36 to nearly 7000. Boy, if you're gonna make a recipe with 7000 calories, you'd need to be feeding quite a few cats to to cover that. None of these met all of the National Research Council adultA requirements.

All of these diets, all 117, were deficient. And again, the same common deficiencies, hole is the one I see often in kitty diets, B1, micronutrients, micronutrients, even protein in some of them, which is interesting because generally people want to feed protein to cats, but some of these were protein deficient, and a lot of these diets are specific amino acid deficient. So enough on that, I wanna talk a little bit about pathogen risks, I'm sure you've all seen studies on this, they just seem to come out almost literally every month, more and more studies about the risks of pathogens and raw foods, so, we'll touch on a few of these, I'll try not to drone on too much about it, but we do know.

We do know that there is a risk. Now there was a US study showing that about a third of raw poultry and about 80% of the raw food diets for dogs, the diets themselves were positive for salmonella. This study is about 9 years old now.

Well, salmonella is often brought up as the problem with raw diets, honestly, the UK poultry prevalence of salmonella in the poultry you buy in a grocery store, not necessarily dog diets or cat diets, is between 3 and 8%. It's actually not the most prevalent pathogen. Raw food diet, so we'll talk about some of these a little bit more too, have also tested positive for a lot of other pathogens, including E.

Coli, Eucinia enterocolitis, not estis mind you, not the plague, but the other Eucinia, the GI one, Listeria and Campylobacter, and about half of the UK chicken does have Campylobacter contamination, so not so much salmonella, but definitely campy is out there. And I'll talk a little bit more about a couple of those pathogens. I won't talk more about this, but pigs and pork have also been reported to be contaminated with methicillin resistant Staph aureus.

So salmonella, again, there was a study showing quite a bit of that was contaminated in the US, less so in the UK, although there has been a report of fatal sal salmonellosis in two cats spread raw diets, that was a little while ago now. 19 years ago, there was an outbreak of salmonella in human foods last year due to raw frozen breaded chicken, and just about what I wanted to say, that wouldn't be something we'd feed to a pet. I did see a query coming up saying, is it OK to give this to my cat?

So no. No, don't, the graph on the bottom is the number of, positive lab reports over the last, oh, a little about 10 years. They only go back to 2019.

It, it's hard to get more recent ones. I mean they only go up to 2019. It's hard to get more recent, data from that, but.

You can see it's kind of the lab reports on on humans is kind of sits around 8000 plus or minus, it's not really trending up or down, we're fairly stable on those numbers, and that comes from all sorts of foods, not, not just pet foods or raw chicken. So Campylobacter again, it's the most common cause of human food poisoning is poultry from chicken, and it's often from Campylobactor. Most of it is contaminated, although the highest percentage of contamination, which is considered to be a 1000 colony forming units per gramme or higher is only about 4%.

So yeah, we certainly have, have it out there, although. It's not all at the worst possible level, so the food safety agency, the goal for human foods is to have 7% or less at the highest level, so we are actually meeting this only 4%, but why is it OK to have 7% causing, causing problems? Why isn't this number 0?

Why is our goal. Not zero tolerance for this because it's assuming that you're gonna cook the food, the food safety agency is Food Standards Agency is, is not thinking that you're going to take that chicken home and eat it raw, or feed it raw to your pet. There's a couple that I find quite worrying.

One is the igotoxin producing E. Coli or STEC this is a, this is a nasty toxin, it has been associated with hemolytic uremic syndrome, HUS, which can be fatal. There was a Dutch study by von Bree, sorry if anybody's Dutch and you can correct my pronunciation, and, and colleagues showing that most of the commercial freeze dried raw pet food products, these are pet foods, not human foods, carried E.

Coli, and nearly 1/4 of them carried this STEC type of E. Coli. There was a US study where 10 raw food samples, all of those samples had STEC.

None of the dry or semi-moist foods did. And what is this? I have to remember what year it is.

5 years ago now, there were 4 human STEC cases, 3 of those linked to a raw tripe dog diet, and one of the people in this died. So this is a, this one kind of scares me, almost more than the salmonella does or Campylobacter. Campylobacter is less likely to make you die.

There is also the extended spectrum beta lactammase, E. Coli, ESPL where you might not die immediately, but over time, this is gonna be a, this is gonna be a serious problem for us. So this is the antibiotic resistant bacteria that have transferable resistance, so they can sort of.

You know, shift their little plasmids around and make other bacteria resistant to extended spectrum cephalosporins. Sweden, a study found, all of the commercial frozen raw dew folks they had, oh sorry, E. Coli was found in all of them, the SBL ESBL one, the, the.

Antibiotic resistant one was found in nearly 1/4 of them. Again, the Van Bree study, they found that the SPL, I can't say these initials, the SPL producing E. Coli was an 80% of free dyed freeze dried cat and dog foods, raw foods.

Another study found it again in nearly 80% of commercial frozen raw cat food, and it's been found in the majority of the faeces of cats fed raw food, . So we do seem to be spreading this antibiotic resistance by feeding raw foods, so as we now are being asked to be kind of antibiotic monitors and helping keep these drugs available for veterinarian and human use, this to me is a serious concern. I do wanna mention Listeria, it's not one we think about very much, partly because sometimes it doesn't cause anything, you know, we can get it and not know that we have it.

It can cause abortion, has been reported in dogs to cause abortion as well as people. People can just think they have the flu and not know they have Listeria. It can also cause a fatal meningitis in people.

It hasn't been reported in pets, but but certainly in people who are immunosuppressed, and a friend of mine nearly died from this. She is on chemotherapy, so this is a little bit near and dear to me that how serious Listeria can actually be, again, it was. Found in about half of the freeze dried raw pet foods in the Dutch study, in a US study, a lower number, about 16% for monocytogenes, but none of the processed foods, the cooked foods were positive.

So we often hear this, oh well, there's, you know, bacterial contamination of raw foods as well, and I said just mentioned in the several of those studies, it's either much, much lower or non-existent. And this is again a US study looking at raw foods, semi-moist foods, and dry foods, dog and cat foods, and they tested between 120 and 196 of each of these type of foods. In this one, they did find a considerable amount of salmonella, 15 of the raw pet foods, one dry cat food out of however many of those others add up to, I don't know about 3 or 400.

They did find quite a bit of Listeria in this study. Again, 32 of these were positive for Listeria. None of the processed foods were positive for Listeria.

So, yeah, there is a little bit in dry foods and canned foods, but much, much less. One other one I want to mention is tuberculosis, where we have had mycobacterium bophus from commercial freeze dried cat food, which killed quite a few cats in the UK. I don't know the total number of cats most recently.

Because TB can be a latent infection and infect the cats a couple of years later, we're still seeing cases of this, or Professor Gunmore who usually is the one these come to is still seeing cases of it, so this is still going on. I know it was over 40 cats were killed. I don't know what the last number is.

Remembering, freezing doesn't kill most bacteria, it doesn't kill Mbovis. It lives very happily in a -70 freezer. This is how bacteriologists often store their microbiological samples is in freezing because when you thaw them, they wake up and multiply quite happily.

Freeze drying also doesn't kill them. Just mention parasites, just briefly, some of the ones that we normally think about Sarcocyta, Neosporin, Toxicarra, you kind of occus, that's the nasty tapeworm, so those can all be found in, raw food. The kind of caucus is the one that forms cysts and can kill you.

Excuse me, raw meats also can carry toxoplasmosis, and this is a little kitty that's, you can see his, the eye on the left side, his right eye as you face him is quite cloudy. This is a picture from Professor Gunmore, so thank you to her for that of a cat with the ocular form of toxoplasmosis. These can be killed by freezing, so as long as the food is frozen, has been frozen for an appropriate length of time, at least a day or two, these, these become much less likely.

So can we just prevent contamination by cleaning the food bowls and being really careful in cleaning our counters, if only. There was a study done in Guelph, in Canada, and they intentionally contaminated some food bowls with salmonella and then tried to get rid of it. So they had metal bowls and plastic bowls.

They did just the warm waters rinse and scrub. It removed none of the salmonella from the metal bowl. It was 100% of it was left, removed 8% of it from the plastic bowl.

So then they scrubbed it with soap, which did a little better. They got rid of 17% and 25% in metal and plastic, so still, you know, over 3/4 of it left. Then they soaked it in bleach, which you would think would kill everything, which doesn't, 10% bleach is a little stronger than what you get in the grocery store too, removed about a third of it in the middle and 1/4 of it in plastic, so no better than the soap in plastic.

And then they put it in the dishwasher, which is what we often do in clinics, isn't it? We just, you know, rinse them off and throw them in the dishwasher and it steams and we think everything is good. That removed about 1/3 of it, so 2/3 of it still left of the salmonella, they did a scrub bleat and soap.

This got a little better. It actually removed 3/4, over 3/4 of it from the metal bowls, about half of it from the plastic, so this stuff sticks around. Again, M.

Bovis, in order to kill M bovis, so if you're gonna just wipe off your counter, you need to wipe off your counter with something that's over 70 °C for 15 minutes, we're just not gonna do that, so these, these guys are kind of persistent. So health risks to owner in the public again, raw meat that they're handling is often contaminated, so it does involve cooking what you eat. Washing your hands, you know, it's as, as good as you can with the hygiene, if you are going to have this around, don't wash your chickens because that just spreads the contamination all over the place.

High prevalence of contamination of treats, I won't even, I actually took this picture in a pet store and I won't touch this stuff, I think it's quite scary. Pet faecal shedding of organisms is a major health risk, and this I do worry about, it might be OK for the, you know, middle aged adult male female that owns that pet, but if the dog is pooping in the park and there's, you know, toddlers playing there, then we are potentially into some problems. There was a very recent study, last month, a couple of months ago, whatever month this is, anyway, this year, 2022.

On the prevalence of antibiotic resistant, multi-drug resistant, and 3rd generation cephalosporin resistant E. Coli, and it was present in half, 1/4 and 1/3 respectively of the faeces of 114 raw fed dogs, so between 25% to 50% of these dogs are shedding antibiotic resistant E. Coli.

So again, TB, there were a couple of people who were exposed during the CAT study. We don't know how they're doing yet. We don't know they were, they were not actually, I'll go back a second, they were not exposed from handling the food, they were exposed from handling abscesses on the cats.

Toxoplasmosis, gone again is, I think we've all known for vet school is a risk for pregnant women and infants in particular. There is more risk from handling or ingesting raw meat than from handling cat faeces. I know a lot of the medics say, oh, you know, women should have the, the husband change the cat later, which is not a bad idea anyway, but they're more at risk from raw meat than they are from cat faeces because cat faeces only become dangerous after 24 hours, as you probably remember that the, the mycoplasma has to spoil it.

So increased risk for those who are immunocompromised on chemotherapy, on prednisolone, one of my cops is on prednisolone, so technically she would fall into this category for pregnant women, for very young children, for elderly people as well. This is actually a baby with Toxone. So if the owners are gonna feed raw, it should be an informed decision, they should know a little bit about these and my take on this is if we're not telling owners about it, we're kind of being negligent if something goes wrong, if their child gets sick and, and you didn't have the discussion about the animal's diet.

Are you liable for this? I don't know. I'm not a lawyer.

I don't know if we are or not, but to me that would be a little bit worrying if I had not had that discussion with the owner and informed them of the risk of their diet choices. Also in your hospital, if you're hospitalising raw raw food fed pets, which I wouldn't have put that that way, that's hard to say, just be aware there is a risk to other pets in your hospital, if you have dogs on chemo, if you have dogs with diarrhoea, if you have a cat with diabetes, if you have really almost everybody else in your clinic probably if they're there. For a, for a disorder, is potentially immunocompromised, so just be aware that.

Keep these, keep the cleaning of these pets, keep these pets away from the other pets in your clinic because you don't want to be the one, you know, where he comes in for a nasal discharge and goes home with diarrhoea. Risk to staff, should you consider reverse barrier nursing for these animals, especially if you have staff who come under any of these, these qualifications as well. So what's the evidence?

Basically, there's a summary on this part of it, we do know if they're homemade diets, they're probably gonna be nutritionally incomplete and unbalanced, if they are not a PFMA member, they still may be a commercial diet may be incomplete as well, depending on who's formulating the diet. Very few, if any, out on potential benefits. Little better digestibility of shiny or coat.

Kind of about it for me, and again, some of these studies are apple and orange studies, they're not really comparing similar diets and a a lot of the a lot of the studies that you see on these, if you really look at the nutritional part of the study rather than just the concluding sentence for it, you'll see they're, they're not comparing processing, they're comparing nutrients. Lots of studies on potential infectious disease rats on the pathogens, enough that I find it kind of scarier, the monitoring should be better on commercial diets, although there are studies on commercial diets on pathogens as well. Technically, the monitoring has to be better on commercial diets cause nobody's monitoring what you do in your home.

So how do we talk about this? I'll try to finish up there with just a, a few ideas on this, to be honest, I don't have the magic bullet for this. I'm not always successful either, none of us are, none of us can can persuade everybody, .

And as I mentioned at the beginning, pet food choice can be quite emotional. People are quite invested, some of them, not all of them, in, in what they're feeding, and we all have a belief system that we work within. And if the diet choice fits that owner's belief system, or that their dog needs to be natural or however that works or different from this talk, but perhaps they're vegetarians and and they feel that their pet should also fit that that belief system that they have.

So in order for us to be comfortable, the information that we hear needs to fit with our identity. And our brains like to kind of take shortcuts. It's how the brain works.

You could your brain really actually wouldn't be able to work if it didn't take some shortcuts, it would be overwhelmed. So for a lot of things we like the quick heuristic simplistic answer, . Rather than going in more deeply to the decision making process, and one of the classics on this Ockham's Razor, which people still tout out as being, you know, the how to make, how to make a good decision about science or about whatever.

The simplest explanation is most likely the right one. It's actually not true. And it's also a pretty old idea.

It's a vegetable remnant. Of mediaeval science, not really science, from oops, sorry, I got an extra number in there. I made up a new year here that hasn't happened yet, but from the 1200s to the 1300s to redundant 4 in there sorry.

So, and Occam actually, and I think I have a picture of him here, there he is, he actually brought this up for the support of divine miracles. And I'll let you to think about that later, but science is complicated. The, the simplest explanation is not necessarily the right one, and it might be easier for an owner to say, my dog is from a wolf, he should be fed a natural diet like his wolf-like ancestors, rather than trying to understand genetics and nutrition and physiology and metabolism and everything else that really goes into the science of nutrition.

So the other problem we have, one, it needs to fit with us, one we like simple answers, we all like simple answers, and once you have an idea planted, it's very hard to remove, so the initial statement, whatever you hear on something, that's kind of your baseline that you major everything else against. And if you have to reject that idea, it's actually what I'm not a psychologist and I'm well out of my, my knowledge zone here, but from what I've read on this, it's resource demanding of your brain, so you, it actually requires a cognitive effort to kind of come away from the simple, especially if it's a simple, my dog's a wolf, whatever your your initial version of that is. To think about that idea more requires actually quite a bit of work.

So once something is accepted as true, that thought persists. So we have, this is how the brain works. We're receiving information that conflicts with the core belief system and the brain goes at that, get rid of that.

We're not, we're not listening to that idea. So how do we overcome this? How do we talk to owners about pet food?

So we have the owners who actively seek our advice, we love those, we have the ones who will listen to us when we talk to them, and we have the ones who might be a little bit harder to have the discussion with. Why don't they change their minds when we talk to them when we are faced with facts contrary to our beliefs, owners' beliefs, our own beliefs. Or their desires, people actually become more determined, so this becomes a very difficult thing to approach.

If your self-confidence is rattled by facts intruding on beliefs, so that you wanna believe, I wanna believe dark chocolate is really good for me because I love dark chocolate. So if somebody tried to come along and tell me that it was bad for me, I would find all of this, all of the things I could, that, that, that go against that and defend that. That's sort of the same idea.

I'm not a smoker, so I can't use that example. So doubt actually turns people into stronger advocates, and we see this politically as well when things start getting a little shaky with whatever political beliefs or party you support, a lot of people then defend it even more adamantly. And this sort of discomfort and conflict is called cognitive dissonance.

You kind of have two different things sort of of sort of working on your brain at the same time, but. So what do we do with this, ? Difficult, difficult, especially, especially if people are quite entranced, so we need to sort of have some empathy with the owners, we need to sort of discuss their ideas openly.

We need to. Have them be aware that we have something in common to to get them relaxed, to have our consulting room be a safe place that we both want what is best for their pet, and one of the ways I have started this conversation with some owners is actually asking permission to have the conversation, I might get this in the slide, I can't remember, just, you know, can we talk about. You know, what is your diet choice?

Can we talk about that? So we need to ask them maybe why they've chosen the diet they've chosen, and then ask permission to discuss that. So we need to listen to their ideas, we need to respect their feeding decisions even when we disagree with them, regardless of.

What they are and what we disagree with and then try to discuss potential changes with them. And as I said, consider asking if the conversation is acceptable, and I've been surprised how frequently I get a yes on this when I did not expect a yes. So people are more liable to change if they discover the facts themselves, but in a consulting situation that can be difficult, I find sometimes just having handouts on it, I'll mention that in a second, can be helpful there too, just giving them something to take home and small changes are more likely to occur.

You may not change completely what they're doing, but maybe you can get rid of the jerky treats, for instance, or get rid of something that you feel. It's kind of the first line of what you want to change. So try to use succinct information.

You're gonna laugh at this one state a core idea and so sort of maybe you shouldn't let your raw fed dog lick your baby's face. Use printed material, we don't retain much from oral information. Usually they say, and you probably remember this from vet lectures, if you didn't have the stuff printed, you only retain about 15%.

So discuss it if they're willing to use handouts, use handouts with graphics. Plain bold font is apparently more effective from what I've read. Positive message, no more than 3 messages, and I laughed when I typed this because obviously I have more than 3 messages on this slide.

Pictures and diagrams, so communication summary, listen to the client first, present your key message, provide supporting facts where you can possibly in paper, if you do need to state a misperception or a myth. State first before you say it that it's a myth. The more you hear something, even if you know it's not true, the more part of your brain starts to wonder if it could be true.

If I spent the next 10 minutes telling you the earth was flat, even though you know it's not, I hope, part of your brain will start to wonder. So, fill the gap with of the myth with new information you supporting visuals, and you can't change everyone's mind. I think it is worth always stating it, it's worth always having the discussion.

Both because we need to have informed clients and you need to protect yourself too, mostly because we need to have informed clients. So just try to have the discussion where you can. I have had clients who just come in and say I feed on, I don't want to talk about it, so that makes it harder.

And it's I think I already touched on all of these things, so I won't repeat them if they wanna feed. Oh, this one I didn't touch on if they do wanna feed raw, try to choose a. I shouldn't say either try to choose a complete balanced commercial food, go to PFMA and look at the website for people who belong to that because they should have a complete commercial food or oh that's the either or use a nutritionist to balance the diet.

Use care with these patients in the clinic that they don't contaminate your other pets or your staff. And this is to me a reliable source of nutrition information, I mentioned PFMA. They are a member of FettyF, which is the European kind of larger industry group, .

Wassava has a nutrition tool kit which includes a handout on raw feeding that has some graphics and pretty pictures and things on it, and you are welcome to download those and have them in your clinic, hand them out. BSAVA now has fact sheets available. The Purina Institute, which, although it has the Purina name on it, is functions independently of the pet food company.

Has some very good information and some various webinars. Oops, that wasn't meant to happen. Out to, as does the Mark Morris Institute has some good information on their website.

The Tufts Pet Foodology is nutrition blog by the board certified nutritionist who I showed a picture of, it's a little bit US but it's fairly, fairly generalised too, and Pet Nutrition Alliance also has some useful tools on it. If you wanna take a screenshot of that, that is fine. And that is the end.

I don't think I'm too much over time. Thank you very much for listening to this, for watching it, and I hope all of you are doing very well.