How To Lower Belle's Phosphorous Intake

[furmonster mom]

Well guys,  after taking our 17 1/2 year old girl to the vet for a dental, what I though was sure to be an extraction, turned into a conversation about her kidneys, as her BUN was at about 55.

My vet knows that we feed a raw diet, so she did take the creatin number into account, as well as urine concentration. 

Verdict is that we need to lower Belle's phosphorous intake. 

So, looks like I'll be needing to re-balance her meals a bit.

So... I was given some Aluminum Hydroxide (phosphorus binder) to mix in with her food.  Starting dosage is 1/8 tsp per meal.

I'm also aware that I can sub egg whites for the protein side, and eggshell for the calcium side of things...

My two-fold question would be;  how much of each would I sub, and would that affect how much binder I should use?

If it would be better to have this conversation on the side, feel free to PM me.

(hint hint... math makes my head spin!)

PS

No extraction...

Though she had some teeth already well re-sorbed. 

But her remaining 3 teeth are sound! 

 

[carolina]

Well guys, I'm re-visiting this thread after taking our 17 1/2 year old girl to the vet for a dental.
What I though was sure to be an extraction, turned into a conversation about her kidneys, as her BUN was at about 55.
My vet knows that we feed a raw diet, so she did take the creatin number into account, as well as urine concentration. 

Verdict is that we need to lower Belle's phosphorous intake. 
So, looks like I'll be needing to re-balance her meals a bit.

So... I was given some Aluminum Hydroxide (phosphorus binder) to mix in with her food.  Starting dosage is 1/8 tsp per meal.
I'm also aware that I can sub egg whites for the protein side, and eggshell for the calcium side of things...

My two-fold question would be;  how much of each would I sub, and would that affect how much binder I should use?

If it would be better to have this conversation on the side, feel free to PM me.
(hint hint... math makes my head spin!)

PS
No extraction...
Though she had some teeth already well re-sorbed. 
But her remaining 3 teeth are sound! 

I take you feed her bones?
One thing you might want to do, is balance her Meals with eggshells. Not only bones contain phosphorous and eggshells don't, but eggshells is a natural binder.
As for the egg whites, you can substitute 20% 30% of one of her meal a day with egg whites to lower the phosphorus to an even lower level. Remember, because egg whites have no phosphorus, you don't need to balance that with Calcium.
You can achieve pretty much CRF prescription levels like this.
I will tag ldg , she can help you further with the correct meats to feed and such.
Meanwhile, here is where I get eggshells:http://www.knowwhatyoufeed.com/shop_online.html
And here are the mini-spoons I use to measure/balance the meat with it: mini-spoons I use to measure

 

[furmonster mom]

Originally Posted by Carolina  
 

I take you feed her bones?

I had been, yes, but as I mentioned I was trying to figure out how much eggshell to sub for it.

... eggshells is a natural binder.

This is new info to me.  Can you tell me how this works, or point me to some source material?  I'd like to be able to present that to my vet for re-calculating the amount of Aluminum Hydroxide we're using.

As for the egg whites, you can substitute 20% 30% of one of her meal a day with egg whites ...

Ahhhh.  Then I was being conservative with my initial estimate of 15%.

You can achieve pretty much CRF prescription levels like this.

Which brings me to another question:  What is the target level of Phos. for a CRF kitty? 

I posed this question to my vet last week, but haven't heard back from her.

I will tag @LDG, she can help you further with the correct meats to feed and such.
Meanwhile, here is where I get eggshells:http://www.knowwhatyoufeed.com/shop_online.html
And here are the mini-spoons I use to measure/balance the meat with it: mini-spoons I use to measure

Thanks for the links.  I actually have a pretty good source of eggshells (farm fresh), and my mortar & pestle do a nice job of grinding them up. 

 

[carolina]

On balancing the meat:
Note: do not “round up.” With calcium, “more” is not better. The amount of finely ground eggshell powder needed to balance 1 pound of food: 1/2 (one-half) teaspoon of eggshell powder. 1 ounce of food: a slightly scant 1/32 teaspoon of eggshell powder.
The Norpro Mini-Measuring Spoons are not marked in fractions of teaspoons. Their measures are:
TAD = 1/4 tsp (Largest measuring spoon)
DASH = 1/8 tsp
PINCH = 1/16 tsp
SMIDGEN = 1/32 tsp
DROP = 1/64 tsp (Smallest measuring spoon)

Here is some info on the eggshell as a binder: http://dogaware.com/health/kidneymedical.html

Prescription levels are targeted to be below 0.5% phosphorus DMB
Now.... I have been doing some reading and it seems that it's important to add binders ONLY on the late stages of Crf, when the phosphorus levels on the blood are higher than 6mg/dl.
Otherwise you want to control with diet, and not with binders.... Phosphorus is very important in her diet still... And diet is the best way to control it.

 

[carolina]

Here is a good page re. Phosphorus management, including information on calcium carbonate as as binder (same calcium in the eggshell)
http://www.felinecrf.org/phosphorus.htm

 

[ldg]

mrsgreenjeens has (unfortunately) a lot of experience with CRF. It is discussed extensively in a thread, here: http://www.thecatsite.com/t/266872/home-cooked-for-crf-kitty

Now, the discussion there is for home cooked, not raw, the the principles are the same. When you use fresh bone in raw, if you're feeding the "right" amount of bone for a Ca ratio of give-or-take 1.3:1, because bone comes with both calcium and phosphorus, you wind up with PHOS on a dry matter basis of about 2%. While the prescription diets for late stage target the minimum AAFCO (and some just under it, actually) of 0.5%, by substituting eggshell for bone, you reduce the phos load to just 0.8% on a dry matter basis. Eggshell has only trace amounts of phosphorus, bone has quite a bit.

I've not heard of using 20% or 30% egg white in food, but maybe that's discussed on Tanya's CRF site. mschauer reworked one of Dr. Pitcairn's recipes to be species-appropriate, and brought the PHOS load down to basically 0.4% here: http://www.thecatsite.com/t/266872/home-cooked-for-crf-kitty#post_3430599

I'm not at all familiar with phos binders. I do know I've seen Sally (mrsgreenjeens) discuss them, and that for a number of cats they seem to create more problems than they solve? Hopefully Sally will chime in here.

The bottom line? Just replacing bone with eggshell in whatever raw recipe you already use goes a LOOOOOONG way to reducing the phos load, and many find that this is enough (if kitty is not late stage).

 

[carolina]

ldg , note: 20—30% of one meal a day... Not of all meals... You basically want to substitute a small percentage... I wouldn't substitute that much...
Let's see what Sally has to say

 

[furmonster mom]

On balancing the meat:
Note: do not “round up.” With calcium, “more” is not better. The amount of finely ground eggshell powder needed to balance 1 pound of food: 1/2 (one-half) teaspoon of eggshell powder. 1 ounce of food: a slightly scant 1/32 teaspoon of eggshell powder.

Here is some info on the eggshell as a binder: http://dogaware.com/health/kidneymedical.html

Prescription levels are targeted to be below 0.5% phosphorus DMB

Thanks for the links, good info. 

Funny thing, I found Tanya's site earlier tonight, so nice to know it's a trusted site.

And yes, I do realize that she still needs SOME phos in her diet, and I would much rather control it with diet and not use the Aluminum Hydroxide at all, if possible.

@mrsgreenjeens has (unfortunately) a lot of experience with CRF. It is discussed extensively in a thread, here: http://www.thecatsite.com/t/266872/home-cooked-for-crf-kitty

Now, the discussion there is for home cooked, not raw, the the principles are the same. When you use fresh bone in raw, if you're feeding the "right" amount of bone for a Ca ratio of give-or-take 1.3:1, because bone comes with both calcium and phosphorus, you wind up with PHOS on a dry matter basis of about 2%. While the prescription diets for late stage target the minimum AAFCO (and some just under it, actually) of 0.5%, by substituting eggshell for bone, you reduce the phos load to just 0.8% on a dry matter basis. Eggshell has only trace amounts of phosphorus, bone has quite a bit.

I've not heard of using 20% or 30% egg white in food, but maybe that's discussed on Tanya's CRF site. mschauer reworked one of Dr. Pitcairn's recipes to be species-appropriate, and brought the PHOS load down to basically 0.4% here: http://www.thecatsite.com/t/266872/home-cooked-for-crf-kitty#post_3430599

I'm not at all familiar with phos binders. I do know I've seen Sally (mrsgreenjeens) discuss them, and that for a number of cats they seem to create more problems than they solve? Hopefully Sally will chime in here.

The bottom line? Just replacing bone with eggshell in whatever raw recipe you already use goes a LOOOOOONG way to reducing the phos load, and many find that this is enough (if kitty is not late stage).

Ya know I love ya, hun, but when y'all start talking about the nitty gritty of stuff on a dry matter basis, my head begins spinning.   

  

I do okay with the basic percentages and such, but this is getting beyond my level.

Hence, why I need help.  lol

Bottom lines are good.

I did see the CRF thread, but since it was labeled for home COOKED, I wasn't sure if it would apply to RAW in the same way. 

I'll take another look at it.

 

[mrsgreenjeens]

Hi guys, sorry I'm not going to be much help.  My little CRF girl is NOT taking phos binders, nor will she eat anything with egg whites in them anymore

.  Pretty much ever since she was diagnosed with CRF she decided "no more raw" or even home cooked, so at the moment I feel lucky if I can just get her to eat at all.  It's the usual loss of appetitte with CRF kitties

, so, really, I don't think I can contribute anything to this conversation

 

[carolina]

Aaaawwww mrsgreenjeens Sally....
I haven't been around in so long.... I had no idea things were declining this much... I am sorry to hear :heart3:

furmonster mom , do you have the test results for you girl? Do you think you can scan and post it here, or post the levels one by one (including the normal ranges)?
I am curious... Did your vet mention CRF, or its just a concern because he BUN is elevated?
How is creatinine? Phosphorus? Did she get a urinalysis?
There is so much more to CRF than just an elevated BUN...
Do you have her last blood test? What was her BUN then?
Dehydration, high protein diets.... All can elevate the BUN levels.... Sure you don't want that high, especially with an older gal... But since she does eat a high protein food... I think the blood test overall needs to be considered.
Is she acting sick? Lethargic, low apetite, losing weight... Have you noticed any of that? .
Here is a bit of help in how to read the levels in a blood test when diagnosing CRF. http://www.felinecrf.com/tests0.htm

 

[furmonster mom]

@mrsgreenjeens ... I am so sorry to hear your girl is not doing well.  A very difficult stage, to be sure. 

 

 

[furmonster mom]

Whenever I take Belle in for a dental, we always do a full blood panel and urinalysis.  It's part of the package for senior kitties.  I don't have the print outs on me, but it is not a problem to get them (beyond making the trip, that is).

As I mentioned, my vet is quite aware of how a high protein raw diet affects the BUN, and her judgement is that 55 is too high, especially after considering some other factors:

the phos level is high

her urine is not concentrating

she is drinking a lot more

she is peeing a lot more

she is off her appetite (we literally have to force feed her half the time)

she has not lost a lot of weight, but is displaying less muscle tone in her hip area

Even though my vet tends to lean toward conventional medicines, I have stuck with her for the last 10 years because she has proven to be open minded about alternatives. 

When Pippen showed extensive scarring on his liver, and I did the research on the meds, she was willing to concede that Sam-e and Milk Thistle would be acceptable alternatives. 

When he ended up with more bruising than expected after his last biopsy, she gave me some Yunnan Baiyao for it.

When Babee was diagnosed with Addison's, she was quick to say she should stay on the raw diet.

When she was talking about Belle's numbers, she said that normally she would put her on a specialized diet, but she knew that I would not be comfortable with that.  When I mentioned ways to bring her phos levels down, she immediately agreed that a diet low in phos was the key (and even mentioned that the old thought of low protein diet has been de-bunked).  She even agreed that egg whites and eggshells would be good alternatives.  HOWEVER, I think she was in the same boat as me as far as not knowing how much of those things would accomplish the goal, so she gave me the binder until we could figure it out.

I very much appreciate the links, the info on calcium as a binder was very helpful.  I had no idea it took so little.

I have an alternating rotation of "meat days" and "bone days". 

Bone days are chicken days: bone-in chicken, heart meat, and liver

Meat days are everything else: meat + other organ (pork & kidney, lamb & brain, beef & melt, etc.,.)

They also get fish oil and Vit E supplements twice a week.

We also have "treat days", where I'll give them some extra raw egg with a bit of raw cream or goat cheese (homemade).

I feed 2 meals of 2 oz.  All the cats are within 2-3 lbs of each other, so they all get the same amount. 

The breakdown per meal is: 1.75 oz meat/bone-in chicken + .25 oz organ/liver  (chicken days get a bonus .25 oz heart meat)

For Belle, I'm currently subbing egg whites for 12% (.25 oz) of the meat portion of her meals.  I'm also adding about 1/8 tsp of eggshell per meal.  I'm thinking less eggshell on chicken/bone days.

Actually... now I know that eggshell can bind the Phosphorus, I'm kind of considering adding a smidge of eggshell to our "meat days" for everyone. 

 

 

[ldg]

Hun, the eggshell should not be added on top of bone. Eggshell should be used instead of bone. Eggshell provides calcium and trace minerals without phosphorus. Bone has a lot of phosphorus.

Adding eggshell will cause the diet to have too much calcium, and will be constipating.

The homecooked diet can be created just the same, just don't cook the meat, or meat and liver.

Or just make the food you do, simply substitute eggshell at the rate of 1/2 teaspoon per pound of meat and organ instead of bone.

Without removing the bone, you don't reduce the phosphorus load.

 

[furmonster mom]

Okay... I can see what you're saying there. 

I was thinking that the extra calcium would help bind the extra phosphorus in the bone.  But I can see how adding calcium on top of the bone would be like giving too much bone in the balance of things.  Gotcha. 

See, sometimes I just need a new way of thinking about it in general terms... then it clicks. 

For instance, the reason I'm thinking of adding eggshell to everyone's meals on meat days is because obviously they are high phosphorus days without any calcium to balance it.  Instead of thinking about it as "balance over time", I need to consider that the phosphorous is still going through the system.  It's not like it's going to wait around 'til the next day for its partner to show up!  

   All this time, I was thinking I was doing okay with the every other day rotation... now I'm not so sure. 

 

[ldg]

Okay... I can see what you're saying there. 

I was thinking that the extra calcium would help bind the extra phosphorus in the bone.  But I can see how adding calcium on top of the bone would be like giving too much bone in the balance of things.  Gotcha. 

It is giving too much calcium, and puts the diet out-of-balance.

See, sometimes I just need a new way of thinking about it in general terms... then it clicks. 

For instance, the reason I'm thinking of adding eggshell to everyone's meals on meat days is because obviously they are high phosphorus days without any calcium to balance it.  Instead of thinking about it as "balance over time", I need to consider that the phosphorous is still going through the system.  It's not like it's going to wait around 'til the next day for its partner to show up!   :doh3:    All this time, I was thinking I was doing okay with the every other day rotation... now I'm not so sure. 

In order to incorporate eggshell into the diet, the only appropriate way to do it is by replacing bone with whatever portion eggshell you want to use.

If you feed ground, make different batches: some with bone, some with eggshell. Then you can safely alternate.

If you feed PMR, feed fewer bone-in meals, and balance some meals with eggshell. I feed one, sometimes two, bone-in meals weekly. When I feed a bone-in meal, I skip using the eggshell (which I add at mealtime) for the next 2 or 3 meals, depending how much bone was eaten.

 

[ldg]

Here is the link to Tanya's felinecrf information on phosphorus binders: http://www.felinecrf.org/phosphorus.htm#binder_types

Specifically, calcium binders: http://www.felinecrf.org/phosphorus.htm#calcium_binders

Note it says

"Calcium-Based Binders

Calcium Acetate
Calcium Carbonate
Ipakitine/Epakitin
Renal

Sometimes your vet will recommend using a calcium-based antacid such as Tums or PhosLo as a phosphorus binder. These are not an ideal choice because:

these binders are not as effective as binders containing aluminium hydroxide;

they may make your cat's calcium levels rise too high (hypercalcaemia).

Hypercalcaemia in cats (2001), a paper by Dr Chew presented to the World Small Animal Veterinary Association World Congress 2001 mentions that using calcium-based binders may cause hypercalcaemia. Thus, if you are using a calcium-based binder, frequent monitoring of blood calcium levels is essential. You should not use a calcium-based binder if your cat is taking calcitriol.

Effects of phosphorus binders in moderate CKD (2012) Block GA, Wheeler DC, Persky MS, Kestenbaum B, Ketteler M, Spiegel DM, Allison MA, Asplin J, Smits G, Hoofnagle AN, Kooienga L, Thadhani R, Mannstadt M, Wolf M & Chertow GM Journal of the American Society of Nephrology 23(8) pp1407-15 found that binders containing calcium acetate, lanthanum carbonate or sevelamer carbonate did reduce phosphorus levels but also caused calcium build up in blood vessels, which can lead to heart problems."


Basically, with a homemade diet there is no need to use eggshell (calcium carbonate) as a binder. As it is an effective bone replacement, there is no need to risk hypercalcaemia by using it in addition to the bone in the diet, when you eliminate the potential for hypercalcaemia by using it to replace the bone in the diet.

 

[furmonster mom]

Actually, Hypercalcaemia did occur to me as well when you mentioned too much calcium before.  It did click... just not real quick.  lol.

Thanks for the extra info.  

 

[ldg]

:bigthumb: