It started with a late-night cough. Verai Ramsammy was worried about her miniature schnauzer, Louie. She was a meticulous dog person, the kind who bought special food for her pets. She made a veterinary appointment just to be safe.
Within months, Ramsammy's second dog, Mico, fell ill with the same problem. This made Ramsammy's veterinarians sit up. The two dogs were unrelated. Their only connection was their home.
Their cases helped link a serious, sometimes fatal, heart condition with the latest dog food fad. As more cases were reported from around the country this year, veterinarians and the Food and Drug Administration began investigating a potential link between boutique, grain-free diets and a heart disease called canine dilated cardiomyopathy (DCM), which had been known primarily as a genetic disorder.
This summer, the FDA issued a caution against grain-free diets. Since then, many more reports poured in.
Three weeks after Louie's cough and a bronchitis misdiagnosis, Ramsammy said, the 19-pound "typical barky schnauzer" with a rough black coat stopped eating and had trouble breathing.
"It was bad. It just progressed so quickly," said Ramsammy, an ICU physician familiar with emergencies. She took him 1 1/2 hours away to the North Carolina State College Veterinary Hospital in Raleigh for advanced care.
After a sleepless night at the hospital with Louie, Ramsammy saw Mico collapse outside the hospital. "He had this spastic movement and then he scrambled to his feet," she said. She assumed that stress was affecting the dog as it was to her. Inside the hospital, Louie's heart was enlarged and fluid was filling his lungs. Ramsammy held him as he died, one month after symptoms began.
Three months later, Mico, a soft-haired, salt-and-pepper-colored schnauzer, was collapsing more frequently. Darcy Adin and her veterinary team at North Carolina State found he also struggling had an enlarged heart. The veterinarians put Mico on heart medication immediately. The dog was "on the verge of going into heart failure the way Louie did, and it's just lucky they caught it in time," Ramsammy said.
Canine DCM weakens the dog's heart, Adin said, so it enlarges to try to compensate. After a certain point, fluid backs up from the heart to the lungs, causing congestion and coughing, include difficulty breathing, weakness and lethargy. It can "lead to congestive heart failure signs and, in some cases, sudden death," Adin said.
At the University of California at Davis, veterinary cardiologist Joshua Stern started to see surprising signs of heart disease in golden retrievers. Multiple veterinary groups, working independently at first, started noticing this trend. The world of veterinary cardiology is small, with around 200 specialists in the United States, Stern said. They alerted the FDA. Together, they began compiling cases and investigating environmental conditions that might affect unrelated dogs in one household. The vets found many of the sick dogs had been on grain-free diets, high in legumes, prior to their illnesses.
"There was a lot of guilt that it was something I'd done, but I had no idea what it was," Ramsammy said.
On July 12, 2018, the FDA put out a cautionary statement. Canine DCM typically was caused by a genetic predisposition in large breed dogs. The recent cases "indicate that the impacted dogs consistently ate foods containing peas, lentils other legume seeds or potatoes as main ingredients," the report said. The dogs ate the diet for months to years.
The FDA had received 30 reports of dogs affected with DCM linked to grain-free diet, and the veterinary cardiologists had collected about 150 cases. Martine Hartogensis, the FDA Deputy Director of the Center for Veterinary Medicine, said that since the statement, the FDA has an additional 120 reports of DCM, most involving grain-free diet. At least 24 dogs have died of the condition.
The FDA is still investigating the link to grain-free pet food. An FDA press officer said in an email that it "has not determined that the pet food is causally associated with” the illnesses and deaths. No dog food has been recalled.
"If dozens of babies were getting deathly ill eating a formula, that formula would have been pulled from the shelf a long time ago," Stern said.
The condition is linked to a taurine deficiency. Taurine is an essential amino acid that most animals, including humans, create their own. Dogs get a lot of it from their diet. Chicken and beef are high in taurine, while rabbit, lamb, legumes, pea-protein and other ingredients found in some grain-free foods have little or no taurine. If items naturally low in taurine are placed in food formulas, they must be supplemented with taurine, Stern said.
Big brands of dog food have the resources to test their dog food extensively in the lab and in feeding trials, Stern said. The FDA and federal law have mandated that pet food be safe and properly labeled. But in a statement to The Washington Post, the agency said it "does not have premarket approval authority" for pet food formulas.
There are important things to look for on dog food labels. For example, the phrase "complete and balanced" means the food has met the minimum requirements set forth by the Association of American Feed Controls, AAFCO monitors the sale and distribution of pet food as well as recommending nutrient profiles for cats and dogs.
Dog food trends follow pet owner tendencies. "As the push for raw ingredients and organic growing grew in the human market, it similarly grew in the pet market," he Stern said.
Stern said dogs do not need just the "chicken cutlet," as some pet food advertises, even if this sounds more appealing. Byproducts on pet food labels are defined as organ meat, lungs, liver, etc. These are all great for dogs to eat, Stern said.
Some dog owners may think their dogs have allergies, but Stern and Adin said the most common allergies for dogs are to not grains, but meat. Chicken is a common allergen for dogs. While a dog can be allergic to corn or wheat, it would be very rare to find a dog allergic to all grains.
Dogs, unlike wolves, are omnivores and can consume up to 50 percent of their diet as carbohydrates.
Verai Ramsammy had fed a grain-free diet to her dogs based on a friend's suggestion. She thought, "It's probably like carbohydrates for humans — too much really isn't healthy for them."
But, Stern says: “The truth is from a genetic perspective, dogs really aren't that much like wolves anymore. Dogs evolved and so have their digestive tracts."
The pet food industry response to the canine DCM increases has been varied. Mars Petcare, the manufacturer of brands like Pedigree and Whiskas, said: "We take any pet concern seriously. Along with the broader pet food industry, we are working with the FDA to better understand any potential link between ingredients and DCM."
Verai Ramsammy fed her two mini-schnauzers California Naturals dog food before they got ill. The company’s website says it is out of business as of summer 2018.
With dogs genetically predisposed to DCM, the condition is irreversible. But in these new cases, adding taurine to the dogs' diet and taking them off legumes can reverse the disorder if caught early enough, Stern and Adin say.
Mico is one such case. He has been on heart medications since May 2017 and is doing well, Ramsammy said. A typical monthly bill for Mico is $110 in medications.
"I told him he's going to have to get a job," Ramsammy said.
