Low purine diets, does it get any more confusing?
Purines are natural substances found in plant and animal cells that are vital to the chemical structure of genes. Purines can be found in any food group (i.e. meat, vegetables, fruit etc.), but are higher in meat and fish, than other food groups.
Having spoken to many owners of dogs with Leishmaniasis, I can certainly understand their confusion. How can you put together a LOW PURINE diet that is natural and healthy for your dog, when meat is high in purines and dogs need meat?
To answer this question we need to look at why your dog is being recommended a low purine diet, and then what is actually a low purine diet for a dog?
There is ONE reason for a dog owner wanting to put their dog on a low purine diet.
Risk of Bladder/ Kidney Stones
Leishmaniasis and low purine diets for dogs
Acquired xanthinuria (bladder/ kidney stones) is a common complication in dogs that are being treated with the drug allopurinol for urate urinary tract stones or leishmaniasis.
The only reason a dog with Leishmaniasis is being recommended a low purine diet is because of the allopurinol. However it’s worth noting that allopurinol is not always necessary then nor is a low purine diet.
A dog who is in remission from Leishmaniasis should be on a management dose of allopurinol, which is taking it for ONE WEEK PER MONTH. Studies have shown that administration of allopurinol is an effective way of maintaining clinical remission in dogs with leishmaniasis. (1)
Allopurinol can be discontinued when:
- The presence of complete physical and clinicopathological recovery evaluated by a thorough physical examination, CBC, full biochemistry panel and urinalysis.
- A marked decrease of antibody levels (to negative or borderline by a quantitative serological assay).
- If it is not possible to control or decrease the xanthinuria with low purine diets or by reducing the drug’s dosage, to avoid the risk of urolithiasis, if massive xanthine crystalluria is present.
How to reach a point where allopurinol can be discontinued
It has long been established that a dog’s nutritional intake is intrinsically connected to the immune response and, therefore, the progression of Leishmaniasis (2,3).
Unfortunately, the majority of tinned dog foods provide sub-optimal dietary benefits due to the fact that protein levels are lessened due to intensive food processing, denaturing proteins, reduced nutrient availability, and low-quality food sources.
As well as a low-quality, low-protein diet, obesity can also contribute to the advance of Leishmaniasis.
Weak Immune System
Having a weakened immune system plays a crucial role in the clinical manifestations of canine Leishmaniasis and is a fundamental aspect in the development and progression of the disease (4). Both Cutaneous and Visceral Leishmaniasis protection relies on cell-mediated immunity.
As inflammation is related to progressive diseases, reducing inflammation decreases the likelihood for both the emergence and resurgence of the disease (5,6,7,8). Inflammation is reduced by the specific fresh food diet plan detailed below, as well as a reduction in stress, exercise, and increased oxytocin (more time gazing lovingly at your dog) (9).
Inflammation is caused by:
- An incorrect or incomplete diet, leading to high blood sugar levels, high glycaemic carbohydrate levels, gluten sensitivity, and deficiencies in Magnesium, Zinc, and Vitamin D.
- Oxidative stress
- Lack of exercise
- Lack of sleep
Dangers of long term allopurinol use
Allopurinol is associated with clinical relapse and its side effects include urinary conditions, with one study finding that 45% of dogs taking allopurinol develop urinary issues
There are also several side effects in the case of long-term usage of allopurinol, such as xanthinuria, renal mineralisation, and urolithiasis. (10,11).
How to make a low purine diet for a dog with Leishmaniasis using allopurinol?
The recommended methods of minimising the risk of urinary stone formation are:
- A complete fresh food diet obligatory, processed dog foods are higher purine forming compounds. Avoid all HIGH purine ingredients, see here.
- Use MEAT or FISH from beef, cod chicken, duck, pork, lamb, rabbit, turkey, vension
- Dogs with a history of stones must only consume low fat meats; lean beef, cod, venison and rabbit.
- Organ meat should be liver or heart from beef, chicken or lamb. Organ meat should only make up 5% of the diet for sensitive dogs and 10% for healthy dogs (Ideally chicken liver or lamb liver or heart)
- If your dog has had issues with crystals/ stones, a low fat diet should be implemented. Using appropriate, not excessive, amounts of carbohydrates (10 – 15%) and increasing meals per day if your dog is losing weight.
- Using small amount (10-15%) of grated low purine vegetables is generally great for all breeds with a purine metabolism problem. (Avoid higher purine veggie, check here)
- Adequate hydration (some evidence suggests that bottled, distilled or filtered water can be beneficial. Techniques such using bone broth to the water to encourage more drinking can be used.
- Encourage the animal to perform frequent urination (just take them out a bit more often than normal)
- A. F. Koutinas and C. K. Koutinas, “Pathologic mechanisms underlying the clinical findings in canine Leishmaniosis due to Leishmania infantum/chagasi,” Veterinary Pathology, vol. 51, no. 2, pp. 527–538, 2014.View at: Publisher Site | Google Scholar
- Malafaia, G., 2009. Protein‐energy malnutrition as a risk factor for visceral leishmaniasis: a review. Parasite immunology, 31(10), pp.587-596.
- Nweze, J.A., Nweze, E.I. and Onoja, U.S., 2020. Nutrition, malnutrition, and leishmaniasis. Nutrition, 73, p.110712.
- J. Alvar, C. Cañavate, R. Molina, J. Moreno, and J. Nieto, “Canine leishmaniasis,” Advances in Parasitology, vol. 57, pp. 1–88, 2004.View at: Publisher Site | Google Scholar
- P. M. Kaye and T. Aebischer, “Visceral leishmaniasis: Immunology and prospects for a vaccine,” Clinical Microbiology and Infection, vol. 17, no. 10, pp. 1462–1470, 2011.View at: Publisher Site | Google Scholar
- F. Y. Liew and C. A. O’Donnell, “Immunology of leishmaniasis,” Advances in Parasitology, vol. 32, pp. 161–259, 1993.View at: Publisher Site | Google Scholar
- S. Hosein, D. P. Blake, and L. Solano-Gallego, “Insights on adaptive and innate immunity in canine leishmaniosis,” Parasitology, vol. 144, no. 1, pp. 95–115, 2017.View at: Publisher Site | Google Scholar
- C. L. Barbiéri, “Immunology of canine leishmaniasis,” Parasite Immunology, vol. 28, no. 7, pp. 329–337, 2006.View at: Publisher Site | Google Scholar
- L. Manna, R. Corso, G. Galiero, A. Cerrone, P. Muzj, and A. E. Gravino, “Long-term follow-up of dogs with leishmaniosis treated with meglumine antimoniate plus allopurinol versus
- Torres, M., Pastor, J., Roura, X., Tabar, M.D., Espada, Y., Font, A., Balasch, J. and Planellas, M., 2016. Adverse urinary effects of allopurinol in dogs with leishmaniasis. Journal of Small Animal Practice, 57(6), pp.299-304.