Fear and Confusion in Dogland: Our Take on the DCM Controversy

I just got off the phone with another customer. She loves our food. Her dog is healthy and thriving in every way, but suddenly she is afraid. She is afraid because her vet gave her a handout admonishing against “boutique, exotic, or grain-free” foods, suggesting instead a food sold through his practice, and recommending that patients invest in various cardiac diagnostic tests. At first I can barely mask my exasperation as I do my best to allay her fears with facts. We speak for a while. By the end of the conversation, we are laughing together, and she feels more educated and empowered than she had been at the start of the call. Lately I have been through countless iterations of the same discussion over the phone and through email.

This sudden increase in fear-based consumer interaction is due to a series of events: the statistically significant uptick over the past four years in cases of non-hereditary Dilated Cardiomyopathy (DCM); a research study that established a correlation to specific dietary factors; the ensuing FDA investigation; the press it has all generated; and a dissemination of the facts surrounding it that resembles the elementary school game of “telephone.”

After hours spent responding personally to customers and researching the developments and data in the ongoing FDA DCM investigation, we’d like to take a moment to shed light on how the identified DCM factors relate to Evermore and how these DCM cases fit into a larger perspective.

What is DCM?

DCM, also known as enlarged heart, is a fatal cardiac disease that leads to congestive heart failure. Symptoms can include lethargy, shortness of breath, and a loss of appetite, but sometimes sudden death can occur in dogs who appear healthy. Its root causes are unknown, but it is believed to have a genetic component and is common in large, barrel-chested breeds like Dobermans, Great Danes, and Boxers. Since 2001, there has also been evidence of a dietary link revolving around taurine, a beta-amino sulfonic acid (often referred to as an amino acid) that is particularly important in this context for its role in normal heart function and fat digestion. Whole Dog Journal does a much better job of explaining this than we ever could, so we urge you to read this article, as it will help ground our information and opinions.

Why Now?

While a dietary link with DCM is not new information, there has recently been a notable uptick in cases that appear to have a nutritional component. Dogs of breeds that historically have not been known to develop DCM were suddenly developing the condition. Back in 2017, Dr. Josh Stern, a veterinary cardiologist and Golden Retriever enthusiast at UC Davis, began to see a growing trend of Goldens being diagnosed with DCM at the UC Davis hospital. His initial research indicated a correlation between twenty-four Golden Retrievers with DCM and certain popular grain-free diets with high legume and/or potato contents.

Dr. Stern has been collaborating with Dr. Lisa Freeman of Tufts University, Dr. Darcy Adin of the University of Florida, and others to further understand this link, and they are sharing their findings with the FDA, which announced its own investigation into the potential link to diet and DCM in July 2018. There has been a lot of press surrounding this, and a few experts loudly and publicly broadcasting their opinion that anyone feeding a diet that could be categorized as “Boutique, Exotic or Grain-Free” (cleverly acronymed BEG) had better switch to one of five major brands or else they would be putting their pet at risk for developing DCM (one of those brands, Hill’s Science Diet, coincidentally being in the midst of a huge recall for products with vitamin D overages that are alleged to have killed hundreds, possibly thousands, of dogs).

As the press ramped up, we started getting tons of emails and calls. Suddenly vets were saying that grain-free food was inherently dangerous simply because it was grain-free, regardless of what ingredients comprised their recipes in what proportions; that perfectly healthy dogs should change their diets to foods that may be inferior in other regards, but at least they contain grains and are made by the biggest players in the game; that the only way you can safely feed your dog is if other dogs have been bred specifically for the purpose of living their whole lives in a laboratory setting and undergoing nutritional experimentation to prove the merit of a food. However, there is nothing in the data that the FDA has shared that leads to these conclusions in a logically sound fashion.

What the FDA Says

The FDA initially announced its investigation in July 2018; on February 19th of this year, it issued an update that summarizes the current findings on its website. Between January 1, 2014 and November 30, 2018, there were 325 reports of non-hereditary DCM to the FDA. The two charts and excerpted text below are useful (as is the rest of the information they provide in the update), but there are certainly holes in the information being presented to the public.

“Review of the canine reports shows that the majority of reports were for dry dog food formulations, but raw food, semi-moist food, and wet food were also represented.”

“Based on analysis of the 196 DCM reports to FDA in which dogs were fed only a single, primary diet (i.e., didn’t eat multiple food products, excluding treats), approximately 90 percent of the foods were reported to be labeled “grain-free” (or labeled as zero-grain) and approximately 10 percent ate diets containing grains, some of which were vegan or vegetarian. A large proportion of the reported diets in DCM cases contained peas and/or lentils.”

“Animal protein sources in the reported diets varied widely. Of the 191 reports with a single primary diet that contained animal protein (rather than being vegan/vegetarian), 31 percent contained more than one animal protein source. The majority of diets containing animal protein included fish, eggs, lamb or chicken. No one animal protein source was predominant.”

According to the FDA, these diets “frequently list potatoes or multiple legumes such as peas, lentils, other ‘pulses’ (i.e., edible seeds within a legume, including peas, lentils, beans, and chickpeas), and their protein, starch and fiber derivatives early in the ingredient list, indicating that they are main ingredients.” The FDA does not provide a definition for what constitutes a main ingredient, rather a description that it may appear early on a list before supplements.

I’m sure we’re not alone in wishing the FDA would provide a more quantitative definition in terms of inclusion as an actual percentage of the overall formulation. This might be an accurate way to describe most supplement-heavy, commercial pet foods, which generally have a few recognizable food ingredients and a laundry list of supplements, but it’s not quantitative. According to a recent article in the Journal of Animal Science, reported foods are thought to contain more than 40% pulse ingredients by composition.

There are various theories as to why these diets might be a factor in causing DCM in certain dogs, but the bottom line is, no one knows.

How Does this Relate to Evermore?

We are confident it doesn’t. The operative words here are main ingredient. We’re a little different in our approach — we use a wide array of whole food ingredients and keep supplementation to a minimum. Other than our protein sources, no single non-protein ingredient is particularly prominent in any of our formulas. Of the potentially offending ingredients, Evermore’s grain-inclusive formulas contain nutrient-dense, organic sweet potatoes as 6.6% of the overall formulas. At this inclusion, it should not be considered a “main” ingredient by FDA standards. Sweet potatoes are a common ingredient and have been used in pet food and as standalone treats for decades. If they were somehow a lone culprit in causing DCM, this uptick in occurrences would have begun much longer than four years ago.

In addition, all of our formulas contain 0.7% mineral-rich alfalfa greens. Alfalfa is in the legume family, but the greens are neither “pulses” nor the more commonly used alfalfa meal, which is a feed ingredient that provides a cheap, plant-based protein source. Evermore’s grain-free formulas use no other implicated ingredient in the study, and instead of sweet potatoes, we use 6.9% organic butternut squash. In fact, our grain-free formulas were specifically formulated for pups in need of high-quality, low-carb diets, so the idea of throwing in a bunch of starchy fillers was antithetical to our goal. And frankly, we’ve also always been turned off by the idea of legumes in pet food — who wants a gassy dog?

Further, if being grain-free were the sole cause of DCM, wouldn’t we also have seen this uptick much sooner, and in more dogs being fed raw diets, which are grain-free and have been a major trend for well over a decade now? (In fact, we’re experiencing a bit of whiplash at this overnight shift in sentiment; for years, when we only had our chicken and beef formulas, numerous retailers and consumers refused to even consider Evermore due to the inclusion of modest amounts of organic oats and barley in our recipes.)

What also isn’t being mentioned is that a relatively small number of brands of kibble are linked with a large percentage of DCM occurrences. We are not going to name the companies that were implicated in the initial study or that have been reported since, but this information is out there for dedicated sleuths. None of these are foods that we would suggest to customers when pressed for kibble recommendations. We do, however, take umbrage with the term “boutique.” This connotes a company like ours, while the majority of cases reported come from companies that do between $100-$800 million in annual sales (FYI: we do not).

That all said, we take our responsibility to our customers very much to heart, so we immediately ran our taurine numbers for all four formulas and published them on our website. Please note: there are currently no official guidelines regarding taurine content in food for dogs, as AAFCO does not recognize taurine as an essential nutrient. In addition, we re-tested our methionine-cystine — the amino acid precursors for taurine production in dogs — the AAFCO minimum for this is 0.65% on a dry matter basis, and all of our formulas contain more than double this amount. We also tested L-carnitine, which is often supplemented as part of a treatment plan for DCM and other cardiac conditions. We have discussed these results with the veterinary nutritionist with whom we regularly consult. All of these numbers are available in the expanded nutrient panels on our product page.

These heat-sensitive amino acids are naturally occurring in the high-quality, animal-based protein sources that make up the majority of our recipes — particularly in heart meat, which we include in generous amounts in all of our formulas. Further, we use a low-temperature cook process (up to 170°F) to maintain the nutritional integrity of our food. It is important to point out that the commercial dry foods associated with more than 90% of the reported DCM cases hit temperatures up to three times higher than Evermore.

In early September, we also reached out to Dr. Josh Stern — the cardiologist at UC Davis who first established a potential dietary link — to see if there was any further information that we should be aware of. We emailed the lab and also attempted to connect directly with Dr. Stern via LinkedIn. No one responded to our inquiries.

In the decade that we have been selling food to the public, we have not had a single report of any of our customers developing DCM. In fact, we’ve had quite a few customers come to us over the years because their dogs had various cardiac conditions, and our fresh, low-sodium diets were along the lines of what their vets had recommended. When people inquire about heart-supportive diets, we have always suggested our poultry formulas for their lower fat and sodium and higher taurine contents. We have only had incredibly positive feedback from these customers.

Putting Things into Perspective

Our logo may be a heart, but we like to use our heads. Fear is not rational, and it is well documented that people are more likely to fear less probable outcomes. In human terms, this might mean a fear of flying when one is thousands of times more likely to die in a car accident. Fear is one of the most primal and easy to manipulate of human emotions.

If you want the data, we recommend sticking to the FDA — doing so also helps fit the current DCM scare into a larger perspective. The American Veterinary Association estimates that there are 77 million dogs in the USA. According to the most recent notice, there were 325 reports to the FDA of DCM cases that occurred between January 1, 2014 and November 30, 2018, and 74 of these cases resulted in death — that’s less than one in a million fatality rate. By comparison, there are approximately 6 million new canine cancer cases a year, and 1 in 2 dogs over the age of 10 will be diagnosed with cancer. Since cancer will take the lives of far more dogs than DCM, why are we not hearing more about avoiding known carcinogens found in many pet foods?

For example, aflatoxins — a class of mold, which is something we also test for in routine food safety screening and have never appeared at any detectable level in our products — are firmly established to be carcinogens in humans and animals; in higher concentrations, they can cause acute poisoning and even death. They are common contaminant for corn and wheat and are universally present in some level in feed-grade, grain-inclusive, dry pet foods. Aflatoxins did have their moments in the spotlight in a 2006 Diamond Foods recall when 76 dogs died, and more recently were at the center of a 2015 lawsuit against Purina, specifically relating to Beneful. The case was ultimately dismissed, due to an absence of research on the long-term effects of lower dose exposure of toxins and preservatives. Even so, the public was briefly as fired up about aflatoxins permitted in feed and the preservatives used to keep levels below the FDA-set limits as they are now about DCM.

So, in deliberating whether or not grains and mass market brands are really the best armor a dog has against a rare heart condition, one might want also to consider weighing the probability of DCM against other risks, given all available information. We might want to consider demanding research on the long-term effects of lower-level daily exposure to known carcinogens with the same fervor as further research on the root causes of DCM.

Final Words

We have no doubt that there is a real DCM problem and our hearts go out to all of the families that have been affected. The correlation indicates that more research needs to be done as to why this is happening. However, we have seen no evidence or logically sound argument to indicate that our food should be implicated in this, and an inordinate amount of our time is now spent dispelling the notion that Evermore will somehow cause heart enlargement because we are a small company (generally considered one of our greatest selling points) and two of our formulas happen to be grain-free.

On a more ideological level, the fear that has been stoked, and the way that the information has been presented to the public — wrapped in opinion masquerading as science — is offensive to everything we believe about consumer choice and educated, rational decision-making.

We realize that this is large and dense topic, and this post was long (believe me there’s a lot more we could say as well). If you made it to the end of this article, thank you for your time and mental energy. Want to keep the conversation going or still have questions? We’re happy to chat, you can always drop us a line or give us a call.