Nutrition Related Heart Disease in Dogs

beagle eating dog food

A broken heart: risk of heart disease in boutique or grain-free diets and exotic ingredients

By Lisa M. Freeman, DVM, Ph.D., DACVN, veterinary nutritionist and professor at Cummings School of Veterinary Medicine at Tufts University Posted: JUNE 04, 2018 – Read the entire blog

Earlier this year, Peanut, a 4-year-old male Beagle/Lab mix was diagnosed with life-threatening heart disease at our hospital.  Peanut had been lethargic, not eating well, and occasionally coughing.  The veterinary cardiologist seeing him asked what he was eating and found that his owner, in a desire to do the best thing for Peanut, was feeding a boutique, grain-free diet containing kangaroo and chickpeas.  Peanut required several medications to treat his heart failure but the owner also changed his diet….



dilated cardiomyopathy

Dilated cardiomyopathy, or DCM, is a serious disease of the heart muscle which causes the heart to beat more weakly and to enlarge. DCM can result in abnormal heart rhythms, congestive heart failure (a build-up of fluid in the lungs or abdomen), or sudden death.

In dogs, it typically occurs in large- and giant-breeds, such as Doberman pinschers, Boxers, Irish Wolfhounds, and Great Danes, where it has been thought be caused by two categories: genetics or a primary deficiency of an amino acid called Taurine.

Recently, some veterinary cardiologists have been reporting increased rates of DCM in dogs – in both the typical breeds and in breeds not usually associated with DCM, such as Miniature Schnauzers or French Bulldogs.

There is the suspicion that the disease is associated with eating boutique or grain-free diets, with some of the dogs improving when their diets are changed. The US Food and Drug Administration (FDA) Center for Veterinary Medicine and veterinary cardiologists are currently investigating this issue. This has led to the addition of a third category of DCM: diet-related with normal taurine levels.



“BEG” diets have been implicated: Boutique, Exotic Ingredient, Grain-Free.


The number of cases of DCM reported to the FDA has skyrocketed since 2018:

DCM reports to fda


For a brand to be included on this list there needed to be at least 10 cases reported. This list is ranked most reported to least reported.


DCA cases reported - FDA



To date, the following major pet food companies have not received any reports of nutritional related DCM. Pet owners should vigilant in choosing any pet food and follow the guidelines listed above.

This list is in no particular order: Science Diet/Hills, Royal Canin, Eukanuba, Iams, and Purina.




The mechanism for why these diets are causing DCM is unclear. What is clear is that there is a strong relationship between eating these diets and developing DCM. It is also important to note that there have been grain-containing diets also implicated in this correlation, which means simply adding grains back into the diet is not likely to decrease the potential of developing DCM.


Proposed potential mechanisms for causing DCM:

  • Inadequate nutritional expertise and quality control in smaller, boutique, companies
  • Legumes have the potential to bind methionine and cystine (which alters taurine synthesis/metabolism)
  • Unknown interactions between exotic ingredients in the diet: Kangaroo, lentils, duck, pea, fava bean, buffalo, tapioca, venison, salmon, lamb, barley and chickpeas have been implicated
  • Toxicity of ingredients (cardiotoxic)




Do not fall victim to commercials that portray exotic ingredients as more natural or healthier than typical ingredients; there is no truth to this or evidence to their claims.  This is just good marketing that preys on our desire to do the best for our pets.


Is Grain-free better?

Many pet owners have, unfortunately, also bought into the grain-free myth.  The fact is that food allergies are very uncommon, so there’s no benefit of feeding pet foods containing exotic ingredients.  And while grains have been accused of causing nearly every disease known to dogs, grains do not contribute to any health problems and are used in pet food as a nutritious source of protein, vitamins, and minerals.




Exotic ingredients include kangaroo, lentils, duck, pea, fava bean, buffalo, tapioca, venison, salmon, lamb, barley and chickpeas, among others.

Not only are the more exotic ingredients unnecessary, but they also require the manufacturer to have more expertise to remain nutritious and healthy after processing. Exotic ingredients have different nutritional profiles and different digestibility than typical ingredients, and also have the potential to affect the metabolism of other nutrients.  For example, the bioavailability and metabolism of taurine is different in a lamb-based diet compared to a chicken-based diet or can be affected by the amount and types of fiber in the diet.




Be Aware of Catchphrases:

  • Holistic – There is no legal definition for this term under laws devoted to pet foods.
  • Human grade – There is no legal definition for this term. It is a catchphrase that is false and misleading.
  • Natural – This is a regulated term. The food must contain natural ingredients without chemical alterations.
  • Organic – This is a regulated term. Must follow USDA rules and have the USDA seal on the bag.


Ask Questions:

According to the World Small Animal Veterinary Association (WSAVA), three important questions to answer when choosing pet food are:

  • Do they employ a full-time qualified nutritionist? Appropriate qualifications are either a Ph.D. in animal nutrition or board certification by the American College of Veterinary Nutrition (ACVN)
  • Is the diet tested using AAFCO feeding trails? Feeding trails are expensive and time-consuming. A lot of smaller pet food companies typically forego expensive feeding trails.
  • Where is the food produced and manufactured? Does the company own their manufacturing plant or do they rent time from other manufacturing plants? Choose a brand that owns its own manufacturing equipment. This allows for higher environmental quality controls and no cross-contamination.


Pay Close Attention to Labels:

  • AAFCO & Nutritional Adequacy Statement – The most important thing you can do when choosing a dog food is to look for the AAFCO Statement. The Association of American Feed Control Officials (AAFCO) is a voluntary membership association of local, state and federal agencies charged by law to regulate the sale and distribution of animal feeds and animal drug remedies. Your dog food should have passed AAFCO feeding guidelines and should be labeled for a specific stage of life.

We do not recommend a specific brand of food. We recommend any brand that has an AAFCO statement and has undergone a feeding trial.
The AAFCO statement should include two things:

    1. Look for the words “Animal feeding tests” or “feeding trial.” Usually it reads something like: “Animal feeding tests using AAFCO procedures substantiate that….”
    2. It should be labeled for a specific life stage (i.e. Puppy, Adult, etc.) not All Life Stages

Read carefully because brands can have an AAFCO statement through formulation only – those brands have not undergone a feeding trial. The feeding trial is what establishes the nutritional adequacy. A statement for formulation only will read something like: “this brand is formulated to meet the nutritional levels established by the AAFCO dog food nutrition profiles for…”

  • Beware of “All Life Stages” – Foods labeled “All Life Stages” are required to meet the nutritional needs for the most demanding time of life and are thus essentially made for puppies or kittens. Be careful of these foods since they can be nutritionally imbalanced for certain life stages.


Back to Blog