Low copper diet

[fallmorning]

We have a seven year old cat (Nikon) who started showing signs of liver failure about 8-9 months ago. He's had several biopsies, exploratory surgery, ultrasounds and a feeding tube for about 7 months now. End result being that we don't really know what the problem is, that it isn't going to get better, but as long as he continues to act energetic and happy - we'll let him be. Which he is. The tube doesn't bother him, he plays some but not as much as before, and he's put on weight again.

A couple of things that we did learn. There was some sort of injury caused to his common bile duct, between the liver and gall bladder. It is suspected that he had a gallstone, which he passed, but was large enough to do damage. His gallbladder was rerouted to his small intestine which has helped a lot of the liver problems...(lowered ALTs/Tbil). Another thing that came up was the amount of copper in his liver. When tested (about 1.5mos ago) it was 6-7x the normal amount it should be. The main worry is that with the other problems and the fact that he has lost a lot of liver function already, if it keeps climbing it will destroy his liver.

Long story, short...we need a food with low copper amounts in it. There is currently one food available for this made by Royal Canin (Hepatic Dry food). My problem is that it's full of crap. I have spent the last two hours combing every pet food site I can think of looking for copper values. Most sites simply don't list them. We need something as low as possible, the RC is 7mg/kg. But we also need something that he is willing to eat. He is currently on a mixture of prescription A/D (through feeding tube), Wellness dry/wet, and raw food. In the last week (before we found out about copper levels) he has become obsessed with eating liver...which is now a huge no. I have been trying to get the cats to eat more raw food, which has been a slow process due to having to work around Nikon's various issues. Unfortunately a lot of raw food diets have a lot of liver in them, and due to our kitchen size making it myself really isn't practical right now.

To make things worse, we have three other cats, and for various reasons have been free feeding them. This will more than likely have to change, but ideally we can find something that will work for all of them.

Any suggestions on food is greatly appreciated.

Thanks

 

[catspaw66]

Wow, this one throws me a curveball.  I am looking at different foods, but am coming up with the same thing you are.  I wanted to let you know you are not being ignored, just caught everyone with a new subject.

Welcome to TCS and keep checking back.  Hopefully, we can come up with an answer.

 

[ritz]

I am sorry Nikon is having so much trouble.  Does the vet know why Nikon's copper (iron??) levels are so high?  Was it because of the problems with the gallbladder?

Regarding raw food:  if you feed frankenprey (meat+liver+non-secreting organ like kidney+bone), you can regulate how much liver you feed Nikon.  The recommended percentage is 5%, to give you an idea how much that is for Ritz (female, almost 11 pounds): 0.16 oz a day or around a teaspoon.

The USDA has a free database online of all foods, including meat.  You could go online and look at the copper values of meats and pick the ones with the lowest copper values.

 

[mschauer]

Beef liver is very high in copper. I would avoid any food with it as an ingredient. I would also avoid any food with just "liver" as an ingredient since you don't know what type of liver it is.

 

[fallmorning]

I know it's not the typical problem, especially with cats, so any advice is helpful really. Suppose I just had a vague hope someone reading it might have experienced similar problems.
 

 

[catspaw66]

I know it's not the typical problem, especially with cats, so any advice is helpful really. Suppose I just had a vague hope someone reading it might have experienced similar problems.
 

Non-typical problems like this one take a little while longer to address.  I am still looking and I am sure others are, too.  Keep checking this thread.

 

[fallmorning]

Thanks for looking into it. I think I'm going to try EVO, they publish the most info on their site, which is really nice. It looks like all dry food is way too high in copper, so hopefully we can completely wean him off it. It's going to be a challenge since we have four cats and the vet is prescribing it. First thing...off to buy a scale. Need to monitor overweight cat and make sure Nikon gains it, don't want to change foods on him without it.
 

 

[sugarcatmom]

I found this info regarding hepatic copper accumulation and although it mostly mentions dogs, perhaps there's something there that can be helpful for Nikon: http://www.dcavm.org/09sep.html

Copper Associated Hepatitis.  Abnormal hepatic copper accumulation may be the result of either a primary metabolic defect in copper metabolism or as a secondary event from abnormal hepatic function altering hepatic copper excretion. When we reviewed a number of dogs having chronic hepatitis not associated with genetic copper accumulation we found many dogs had increases in both copper and iron hepatic concentrations. A number of these dogs were also deficient in hepatic zinc. The interrelationship of the heavy metals and liver disease needs further investigation. 

The diagnosis of abnormal Cu accumulation requires a liver biopsy. The measurement of serum copper or ceruloplasm levels to make the diagnosis. Excess Cu within the liver can be demonstrated using histochemical staining for hepatic Cu using rhodanine or rubeanic acid stain. Definitive determination of excess hepatic Cu requires a quantitative analysis of tissue Cu measured on the biopsy sample. Normal canine hepatic Cu concentrations are less than 400 µg/g (ppm) dry weight liver. Hepatic Cu concentrations in dogs with secondary Cu accumulation generally fall in the range less than 1,000 µg/g dry weight while breed associated hepatotoxicities generally have higher concentrations (>750 µg/g). The location of copper secondary to hepatic cholestasis is generally in zone 1 (periportal) location. 

...............
Diet.  Adjusting diet therapy should be considered in all cases however only general guidelines should be given. First, palatability is important to assure adequate energy requirements are met. Next, there is a misconception about diet and liver disease that liver patients should be placed on a protein restricted diet. Protein restriction should only be instituted in the patient that has clinical evidence of protein intolerance (i.e. hepatic encephalopathy). The goal of dietary therapy is to adjust the quantities and types of nutrients to provide nutrient requirements but to avoid the production of excess nitrogen by-products associated with liver disease. As a general recommendation the dietary protein should represent 17 to 22% of digestible Kcal. 

High carbohydrate and moderate fat content is important to supply caloric needs. Mineral supplementation containing high concentrations of both copper and iron should be avoided. 
There is also evidence that fiber may have several beneficial actions in patients having liver disease. First, dietary fiber effectively binds bile acids in the intestinal tract and promotes their removal. Secondly soluble fiber appears to have some benefit in managing hepatic encephalopathy by generation of fermentation products (short chain fatty acids). These act by impairing the intestinal uptake of the surrogate marker of HE, ammonia. Soluble dietary fiber has a similar effect as lactulose and would provide a logical long-term nutritional approach in the management of some animals with hepatic encephalopathy. Psyllium, as a source of soluble fiber given at a dose of 1-3 tsp/day can be used as a dietary supplement. 

Diets low in copper are recommended for the dogs that have copper associated liver disease based on biopsy. The restriction of dietary copper may do little to lower hepatic copper concentrations in diseased dogs having large amounts of hepatic copper. Diet will lessen further absorption of the metal. It is difficult to limit dietary copper because most commercial dog foods contain supplemental copper that meet, or more frequently exceed the minimal dietary requirements. Most formulated "liver diets" have lower copper concentrations and are often supplemented with additional zinc. Homemade diets can also be prepared that do not to contain excess copper. These diets should exclude liver, shellfish, organ meats and cereals that are all high in copper content. Vitamins or mineral supplements should not contain copper or iron. 

.................

Copper Reduction.  If the liver biopsy of a dog with chronic hepatitis indicates significant abnormal hepatic copper accumulation, copper chelators or zinc therapy should be considered. Hepatic copper levels of greater than 1000 µcg/g dry weight liver requires therapy to reduce copper concentrations (zinc or chelator). Animals having greater than 2,000 µcg/g dry weight copper content should all have chelator therapy for at least some period of time. 

Zinc therapy has a number of potential benefits in dogs with chronic hepatitis. Zinc has anti-fibrotic and hepatoprotective properties. Zinc given as the acetate, sulfate, gluconate or other salt has also been proven effective in preventing hepatic copper re-accumulation in Wilson's disease humans that have been decoppered with chelators. When patients were given oral zinc hepatic copper concentrations did not increase. Oral zinc therapy works by causing an induction of the intestinal copper-binding protein metallothionein. Dietary copper binds to the metallothionein with a high affinity that prevents transfer from the intestine into the blood. When the intestinal cell dies and is sloughed, the metallothionein bound copper becomes excreted through the stool. An initial induction dose of 15 mg/kg body weight (or 100 mg BID) of elemental zinc given twice a day is suggested. Following one to 3 months of induction the dose can be reduced in approximately half. The goal is to get serum zinc concentrations greater than 200µg/dl but less than 500. The zinc must be administered on an empty stomach and has the frequent side effect of vomiting. Replacement zinc therapy is administered at a dose of 2-3 mg/kg/day and is given for its antioxidant effects and replacement value in animals having zinc depletion in their liver. 

Chelator treatment has a proven beneficial effect in dogs with abnormal hepatic copper concentrations. Chelators bind with copper either in the blood or the tissues and then promote copper removal through the kidneys. Penicillamine (Cuprimine[emoji]8482[/emoji] -250 mg capsules) is the most frequent copper chelator recommended for use in dogs. The dose is 15 mg/kg bid given on an empty stomach. Side effects include anorexia and vomiting. Therapy using penicillamine is a slow and prolonged process taking months to years to cause a substantial reduction in hepatic copper concentrations however recent studies suggest penicillamine also has a protective effect in the liver beyond chelation therapy. It is believed penicillamine induces a hepatic copper binding protein, metallothionein, thus binding and sequestering copper in a nontoxic form in the liver. A second copper chelator is trientine (Syprine[emoji]8482[/emoji]) that has been produced to use in patients intolerant to penicillamine. This drug is also given at a dose of 15 mg/kg bid and has less gastrointestinal adverse side effects. It is an "orphan drug" and must be special ordered by the pharmacist. In one study of Dobermans with hepatitis and copper penicillamine therapy for 3 months resulted in reduction of copper and the inflammatory damage. 

 

[catspaw66]

Thank you for the article.  Very interesting.  I wonder how many pets out there have high copper levels.

 

[white shadow]

Welcome to TCS, fallmorning!

I have spent the last two hours combing every pet food site I can think of looking for copper values. Most sites simply don't list them

Well, just because the websites don't list certain ingredient values doesn't mean that they're not available.........

From time to time, people get together online to create catfood databases which show various dietary values for individual products, and this always requires speaking with food company reps by phone. In my experience there has been relatively no difficulty in obtaining this kind of information. One example of such compilations is that put together by a group of people caring for cats with reduced kidney function. Here is how the coordinator describes the results http://felinecrf.org/food_data_tables.htm#data_sources There's a comprehensive US manufacturer's list here http://felinecrf.org/catfood_manufacturers_usa.htm

If you're looking for wet foods, you'll need to come up with a maximum acceptable value for copper content....it (obviously) will not be calculated by kg and, you may need to understand the concept of measuring on a dry matter basis...more info on that here http://felinecrf.org/food_data_tables.htm#dry_matter_analysis (the foundation for this is the fact that the moisture/- water/content of foods varies)

 

[fallmorning]

Thanks for the links. I've sent out emails to a couple of the ones I was looking at, with mixed results. But I hadn't thought to try calling them. felinecrf.org looks like an amazing site. Will have to spend some time looking over all of it.

 

[jessica jimenez]

What did you end up doing? Can you post an update? My cat also has liver issues and I've spent hours upon hours trying to research solutions. I don't like giving her Royal Canin either.

 

[fallmorning]

The RC food was pretty much ground corn, which bothered me a lot and the cat wasn't a big fan of. We decided that there was nothing else we could do for him other than make him happy. So I blended the food, strained to get the grainy bits of corn out (wasn't going through tube otherwise) then mixed it with a liquid milk diet. (like catSure and CliniCare)

He died mid-april. It was pretty obvious that it was time.  He had started throwing up more the previous 24 hours, and I woke up around 2am to check on him and he was miserable. We had him put down and a necropsy performed. It turned out that he had a birth defect where the biliary tubes in his liver hadn't fully formed that finally got to him. The specialist we had been going to said it was amazing that he had lived to be seven. It wasn't something that they had actually considered because most things like that turn up while they're still kittens.

I know it's a horrible answer...but the best I have is talk to the vet. Mention to them that you don't like the RC and ask for alternatives. Are you doing it because of the low copper content? I found one research thing online (here) that recommended a dairy/tofu diet. Interesting read anyway.

Good luck.
 

 

[denice]

What did you end up doing? Can you post an update? My cat also has liver issues and I've spent hours upon hours trying to research solutions. I don't like giving her Royal Canin either.

You didn't mention what is going on with your cat's liver.  If it's general decline in function and high enzymes there are supplements containing SamE and Milk Thistle that can help.

 

[jessica jimenez]

Thanks Denice. They aren't really sure what's wrong with it exactly but she's on denemarin and that crappy liver diet but her numbers are still creeping up. The only thing that brings them down is antibiotics but I don't want to keep doing that to her. They want to give her a course of antibiotics every few months to keep her numbers down but I was hoping for a better solution. I was wondering if I could give her a better diet or if I could also give her milk thistle in addition to denemarin but there isn't very much info available online about this that I can find and the vet seems to be satisfied with selling me all of his remedies rather than helping her over the long term. 

 

[denice]

The Denemarin has silybin which is an extract of the active ingredient that is in milk thistle.  A supplement like denemarin helped my cats enzyme levels come down after having fatty liver disease.  I don't know anything else to suggest.

 

[DTODD]

My 5 year old Siamese has a liver that is storing copper like dogs do. We had a biopsy two years ago and she has been on five meds a day (Denamarin, Predisolone, Ursodol (that dogs take for the same liver disease cut to 1/4 dose) and Penicilliamine twice a day once before each meal to remove the copper from her liver. I feed her limited ingredient Applaws wet cat food and supplement with a limited ingredient- grain free, potato-free dry food. She does get the junk food once in a while as I haver her sister that is fine. I had the University of Tennessee (one of two Universities in the US) that develop special recipes for pet diet needs. Spent a lot on vitamins, etc. to add and she won't touch the food. Tried 4 different recipes - no way she would eat it and it was very time-consuming. She is doing ok, but still has jaundice. Vet didn't want to do blood work last month and said just cross your fingers on how long she will live. She doesn't play but seems content and has not been throwing up. I give her distilled water (no copper) and keep looking for a better diet.