Insulinoma - Diet observations by Bob Church

[Johnny and Demon]

Something I thought you may find interesting:

Date: Wed, 3 Jun 2009 21:52:57 -0700
From: Bob C <[e-mail]>
Subject: Bob C: Q&A: Sugary Treats (Ferret Project & Insulinoma)

Q: "Quick question....once a week I treat myself to a Krispy Kreme
donnut and [my ferret] loves to lick the icing off my fingers. Will
that tiny amount of sugar hurt him? My boyfriend is concerned about
insulinoma."

A: If you are that worried about cleaning your fingers, I can stop by
and lick the icing off for you. I'll do anything to help our ferrets.
Yuck! I am old and gray and crusty ... that image even made me gag a
little. My brain is now bleeeeding!

Sorry, this answer cannot be as quick as you would like; I get quoted
a lot, even when I ask not to be, so I have been forced to carefully
watch what I say and explain things to the final punctuation mark.
But, you can skip to the bottom if you prefer.

I am currently in the process of finishing a group of more than 200
ferret necropsies from North American sources, using the identical
criteria used when I did hundreds of them on feral ferrets in New
Zealand and the scores done in Australia and Europe. While releasing
exact numbers is premature until the work is finished and published,
and without getting into the math, I'll just say that there is an
extremely significant correlation between diet and the presence of
insulinoma, with (so far) a p-value of roughly 0.001 (I am working
towards sample redundancy, so do the math with each added sample). The
shuttle astronauts should have had it so good; that number is better
than expected for rocket science. It means the association between
insulinoma and carbohydrate consumption is valid with only an extremely
tiny chance of error.

If you can, imagine a straight line that represents a continuum of
diet. At one end is a totally raw, whole carcass diet and a diet of
high carbohydrate kibble is at the other end. In between are various
types of diets that have some proportion of carbohydrates, ranging
from zero (the meat end) to perhaps 50% at the "bad kibble" end. What
the Ferret Project study is showing is, the closer the diet is to the
"bad kibble" end, the higher the relative risk of insulinoma.

The key word is risk, which is why I think some people have a hard time
accepting the potential injuries that a long term diet of carbohydrates
can cause to the ferret's pancreas. Risk is a statistical probability,
which means that there is only a chance it will result in disease --
not a certainty. It's like baseball; you know a batter hitting .300
will safely whack the ball 3 times out of 10 -- you just don't know
WHEN those 3 hits will come or what type of hits they will be. While
you can assign risk to a specific activity, it is very difficult to
determine when or where that risk will be manifested.

However, to put things in perspective, the risks of your ferret
developing insulinoma from a carbohydrate diet is significantly greater
than them developing a bacterial disease from a diet of uncooked raw
meat. If you think uncooked meat is dangerous, then you really need to
rethink feeding ferrets carbohydrates. Seriously.

There are several risk factors that contribute to overall disease rates
of insulinoma. Obviously, eating carbohydrates is the major one. I
could not find a single insulinoma in the pancreas of a ferret weaned
on and fed a raw whole carcass diet throughout its lifespan and I've
done enough to know if they are found, then they are very rare. The
data base included New Zealand feral ferrets, Australian ferrets,
European ferrets, and, as mentioned, North American ferrets.
Interestingly, I found insulinomas in New Zealand feral ferrets that
had been captured and fed a kibble diet.

Another risk factor is the length of time eating carbohydrates. The
longer the ferret eats carbohydrates, the higher the relative risk.
Ferrets switched from a carbohydrate diet to an all-meat diet had a
lower risk of disease, although it was obviously higher than the
meat-eating control. It is currently on the edge of being a
statistically significant finding.

A third factor is the carbohydrate load. Foods with higher carbohydrate
loads (amounts of digestible carbohydrates) probably place the ferret
at higher risk for insulinoma. I don't think I can prove or disprove
this under the current Ferret Project study.

Age is a fourth factor; the older the ferret, the higher the risk. This
is probably nothing more than an epiphenomenon and not a real risk. It
is likely that older ferrets have higher rates of insulinoma simply
because they have been exposed to risk factors for longer periods of
time. Older smokers also show more smoking-related disease or the same
reason.

I think physical activity is a fifth factor. I suspect caged ferrets
might have a higher risk compared to ferrets with a higher degree of
physical activity who may better deal with sugars created by
carbohydrate digestion. I have discovered higher insulinoma rates in
shelter ferrets compared to private owners, even though they consumed
similar diets. I need more data on this question; while not well
supported, it could show sick ferrets are more likely surrendered to
shelters. I hope a larger sample will define the difference.

It is possible that some breeding lines have higher rates of the
disease, but if so, then I cannot find a statistical correlation having
any any statistical significance to support it. My observed rates of
insulinoma tend to be statistically similar from different gene pools
from around the world. This suggests insulinoma is most likely an
environmental disease.

It is also possible that specific nutrients consumed at the same time
as the carbohydrates might be a factor. Some nutrients might increase
carbohydrate digestion, dumping more sugars faster into the blood
stream. Others might bind to the carbohydrates, helping transport them
out of the body before they are digested. I think I have figured out
how to do the latter with ferrets, but that is another study, not this
one.

End Part ONE -- Part TWO follows [combined into one post. BIG]

PART TWO

So, what does all this mean? Remember, this is preliminary work with at
least another year to go for confirming studies. Data is still being
entered. I reserve the right to change Ferret Project findings and
conclusions without notice or apology.

1. I am extremely confident in saying that the longer a ferret consumes
carbohydrates, the greater the chance that it will develop insulinoma.
Physical activity seems to independently increase those risks. Based on
what I have learned, the ferrets with the highest risk of developing
insulinoma are those that live in cages and consume a high carbohydrate
diet, such as kibble (highest insulinoma rates were found in ferrets
in a long-term shelter situation). Those with the least risk are those
that eat a whole carcass diet and live in an environment which allows
strenuous physical activity, such as climbing, digging, leaping,
wrestling, and running. Everything else is somewhere in the middle.

2. I can do a single test on a ferret older than 2 years of age and
reliably predict their diet (meat vs kibble). The older the ferret, the
more reliable the test. THAT is how significant diet is on the ferret.
If I combine that test with a dental inspection, I am rarely wrong.
People all over the world can confirm this claim.

3. There is a striking difference in the number of insulinomas found
during necropsies and those reported by owners or vets, suggesting
insulinoma is under-reported in North America (and worse world-wide).
This makes sense to me because I feel insulinoma is a "threshold
disease." That is, up to a specific threshold, the ferret can tolerate
the problem. They may slow down a bit, which can be attributed to all
sorts of other things, including age, caging, other illness, or even
seasonal physiological changes, so it is not noticed. Also, I suspect
a significant number of insulinomas remain undiagnosed because the
symptoms are masked by other problems, such as cardiomyopathy or
arthritis. If blood sugar tests are not done regularly, the disease is
masked by another problem, or the ferret never crosses their specific
tolerance threshold, it is unlikely an insulinoma will ever be
diagnosed. Many long term FMLers can testify that what appears to be
a healthy ferret will suddenly get ill and have a blood sugar crash
diagnostic of insulinoma. Well, those pancreatic beasties didn't grow
overnight. The ferrets probably had it for some time, but the recent
illness dropped their tolerance threshold and they crashed. The lesson
is, if a necropsy is not done and the vet has not inspected the
pancreas, it is very likely that a good percentage of insulinomas will
be missed. I am currently trying to get a handle on that percentage of
misses.

5. At this time, I do not feel the genetics of a specific breeding
line has a lot to do with the disease, based on my observation that
insulinoma rates are statistically uniform across worldwide gene pools
when sorted by diet. If Marshall Farms ferrets have a higher rate of
the disease (which I still need to determine), it is probably due to
those ferrets being most likely to live in cages and consume kibble,
placing them at higher relative risk. I *DO* think there is a genetic
link, but I think it is essentially species wide and effects all
ferrets more or less equally.

So, what do I recommend?

1. Feed your ferret a diet with the least amount of digestible
carbohydrates possible. The closer that number is to zero, the lower
the risk of your ferret developing insulinoma. Note that a low
carbohydrate diet may reduce risk, BUT, some ferrets will still develop
the disease, so don't assume "low carbohydrate" means "no disease".

2. House your ferret in an environment that encourages frequent
physical exercise, especially running, climbing, digging, wrestling,
and leaping. An alternative could be an exercise program that could
accomplish the same physical result outside the housing area. I think
the final numbers will show this to be an important factor.

3. Always ask your vet if they would do a necropsy of your dead ferret.
While some vets will demand payment, many will do it for free simply to
learn and better their practice. I know a lot of people hate the idea
of a necropsy being done on a beloved companion, but it really does
help your vet learn. That translates as better care for other ferrets,
perhaps one you might never meet.

4. I honestly doubt if the occasional carbohydrate treat has *ANY*
impact on the development of insulinoma. It is likely that insulinoma
is caused by the long-term (chronic) impact of elevated sugar levels
on the pancreas (a similar mechanism seen in some types of diabetes),
so short term moderate sugar spikes would have relatively little
impact. So, the occasional sugary treat will probably not statistically
increase risk if your ferret is on a carbohydrate diet, nor should it
increase risk for a ferret on a meat diet. Pay attention to the word,
"occasional;" if done more than a few times per week, "occasional"
morphs to "part of diet" and then it *IS* a problem.

So, to FINALLY answer the question, I don't think the occasional lick
of icing from a donut will cause any longer term problem beyond that
which exists for the risk category for the primary diet. It is always
better to feed your ferret the best diet possible and there is no
dietary or nutritional reason to feed sugar or ANY carbohydrate.
Still, the benefits of bonding and shared affection, not to mention
the reduction of stress, more than likely far outweighs the risks of
disease cause by the occasional sugar fix (providing those treats
meet the above caveats).

Put simply, if your ferret is at great risk for insulinoma, the
occasional sugar treat will probably not raise those risks with any
statistical significance. If your ferret is at low risk, the same is
also likely to be true. However, if your ferret has been diagnosed
with insulinoma, by all means DO NOT give them sugary treats (unless
medically warranted for low blood sugar). Consult your vet and have a
ferret physical prior any significant changes in your ferret's diet.

Great alternative treats that ferrets like as much (or more) include
licks of dairy butter, small meaty treats, bits of chicken gizzards,
hearts and livers, and even my ferret's personal favorite: Jell-o
made with pureed chicken or beef liver.

That last one makes me gag a bit, but it is all for the ferrets.

Bob C
[e-mail]

[Tressie]

Hi Annik,

Thank you for sharing Bob Church's article!

I hope people reading it will get the message, which is carbohydrates are not great for ferrets! However, I don't want people to confuse a raw meat diet with a whole prey diet and think raw is necessarily better.

Whole prey is the ideal food because it is nutritionally balanced. Raw meat only diet is NOT nutritionally balanced, plus there are numerous risks!

The position statement by the Canadian Veterinary Medical Association bears reading over:

Raw Food Diets for Pets - Canadian Veterinary Medical Association and Public Health Agency of Canada Joint Position Statement

Position:

The Canadian Veterinary Medical Association (CVMA) and the Public Health Agency of Canada (PHAC) believe that there is evidence of potential health risks for pets fed raw meat based diets, and for humans in contact with such pets. Currently there is little scientific evidence supporting the efficacy of these diets. However, the documented scientific evidence of potential animal and public health risks in feeding raw meats outweigh any perceived benefits of this feeding practice. If veterinarians do recommend raw meat diets for pets under their care they should be aware of potential liability concerns should a pet or in-contact human become ill due to pathogens originating in the diet.

Veterinarians recommending raw food diets must inform pet owners of potential risks, and should educate the owners on how to mitigate risks of pathogen exposure in both handling the food and in managing pets consuming raw meat diets. It is also important for veterinarians to emphasize that there is a higher risk of human infections if pets on these diets are being used to visit human hospitals for therapeutic reasons, or if pets are fed in households with people who have compromised immune function, or where there are very young children that could come into direct contact with the food or with the feces of pets consuming raw foods.

Background:

Feeding pets raw meat based diets is a recent trend. Multiple benefits of feeding these diets are touted, but all are supported only by anecdotal reports.

To date, no scientific evidence to support the efficacy or safety of these diets have been published. There are now multiple peer-reviewed studies documenting potential risks from bacterial pathogens present in raw meats for both pets fed these diets, and for in-contact humans. Studies have also proven that pets fed raw meats can shed potential bacterial pathogens in their stool thereby acting as a source of potentially significant zoonotic infections to in-contact humans. The public health risks of feeding raw food are magnified with evidence that bacterial pathogens in raw foods, and in the stool of pets fed raw foods have enhanced patterns of antimicrobial resistance.

Soooo bottom line conclusion is that if you are considering feeding raw- go for the whole prey! Otherwise - stick to a high quality kibble as the primary diet, and throw out those Bandit, etc. treats! ;D

Tressie

[Johnny and Demon]

Thanks for the ad on Tressie
I'm still trying and trying to give them chicken (raw and cooked) .. but I'm glad to know that high quality kibbles are good choice as main diet. Just too bad that most people think its ok to feed your pets what they like because most of time, they like the no-nos

[mindy]

if a raw diet is done right with raw meat, bone, and organ then it really is the best option. the problem is most people don't know how to do it right. i would LOVE to switch my ferrets to a raw diet but i don't have access to whole mice and whole chicks. i could give them chicken wings with added organs and heart meat but i don't feel that is enough variety. you need at least 3 different protein sources to make a successful raw diet.

i feed my dogs raw and am currently growing (? is that the right word?) a raw diet (white worms and baby brine shrimp) for my fish. i would feed my cats and ferrets raw too if i could find the sources.

i just wonder about fred. i got him at 2 1/2 years old. i wonder what he was being fed by his previous owners (i think the diet he was on last was poor quality kitten food from the grocery store) and i know he was in his cage most of the time before he came to live with me. my poor, happy, handsome boy could have had a longer life (maybe) if he was fed a better diet and given more exercise.

i never give my ferrets any kind of treats and i feed only grain free kibbles. even then i don't feel it is good enough.

about contacting an infection from a raw fed pet: i don't really know how likely that really is if you follow common sense about cleaning etc. handle the meat the same way you handle meat to feed to your family, clean the counters, utensils, cutting boards, etc and you won't have a problem. if raw meat is that dangerous you wouldn't be able to get it! my boys (dogs) eat their food in their crates and the crate floors get washed down with vinegar. and about catching something from the stool? seriously, who touches the poops?? i pick them up with a biodegradable bag and toss them in the trash, then i wash my hands! just the same as if you were picking up any poops. only thing is they are MUCH smaller. i have been feeding my dogs raw for over 2 years now and so far so good.

there are also studies showing how much bacteria in kibble fed dog poop as well. there has been studies proving that there is bacteria on kibble too. and, not to mention the amount of bacteria in a kibble fed dog's mouth! yuck!