Cats and dietary fiber

Written by Allison Wara and Craig Datz

Nutritionists and veterinarians have been interested in dietary fiber as a component of pet foods or as a supplement for many years. Fiber has traditionally been used to modify stool quality and as an aid in weight management, but more recently fiber has been shown to have effects on the gastrointestinal microbiome and may play a role in the management of various disorders.

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Introduction

Definition

Fiber is surprisingly difficult to define. The current human food standard refers to dietary fiber as “…carbohydrate polymers with 10 or more monomeric units, which are not hydrolyzed by the endogenous enzymes in the small intestine…” [1] while the current petfood definition in the U.S. is “any of a large class of plant carbohydrates that resist digestion hydrolysis” [2]. There are many other descriptions of fiber depending on source, composition, methods of analysis, physiological effects, and food labeling regulations.

Dietary fiber is often classified by its properties, such as solubility in water, viscosity, and fermentability in the gastrointestinal tract. Table 1 summarizes the characteristics of common fiber sources used in pet food. It can be difficult to predict the health effects of any one fiber source, and many commercial cat foods include two or more fiber-containing ingredients. For example, fermentable fibers can act as energy substrates for bacteria in the lower intestinal tract which results in the production of short-chain fatty acids [3]. These in turn are absorbed and can modify the structure and function of intestinal cells. Nonfermentable fibers tend to increase fecal weight and volume and may decrease intestinal transit time [3]. Fiber sources with high viscosity often have an increased water-binding capacity that can result in softer, moister feces. It is likely that varying the amounts and types of fiber will affect a cat’s gastrointestinal microbial population, although research into the microbiome is in its early stages [4]. Figure 1 illustrates the solubility and viscosity of different fiber sources.

Table 1. Properties of fiber sources commonly used in pet food.
Source	Solubility	Viscosity	Fermentability
Beet pulp	Low	Low	Moderate
Bran	Low	Low	Moderate
Cellulose	Low	Low	Low
Guar gum	High	High	High
Pectin	High	High	High
Psyllium	Moderate	High	Moderate
Soybean hulls	Low	Low	Low

Figure 1. A demonstration of the solubility and viscosity of different fiber sources where equal amounts are added to 100 mL water. The oat and wheat bran do not absorb water and no changes are seen after 24 hours, whilst the wheat dextrin powder dissolves immediately and stays in solution. Psyllium powder absorbs water and forms a thick gel after 24 hours. Allison Wara - Craig Datz

Fiber and its role in disease

Obesity

In North America, obesity is the most common form of malnutrition in veterinary patients; it is estimated that 35.1% of adult cats are either overweight or obese [5]

(Figure 2). Obesity predisposes cats to a variety of diseases such as diabetes mellitus, hepatic lipidosis, urinary tract disease, orthopedic disease, and dermopathies.

Figure 2. Obesity is the most common form of malnutrition in veterinary patients; it is estimated that 35.1% of adult cats in the USA are either overweight or obese. Shutterstock

Dietary fiber has been used to help manage obesity in both dogs and cats. In particular, slowly fermentable fibers such as cellulose and peanut hulls have been shown to be an effective means of increasing dietary bulk in the gastrointestinal (GI) tract without supplying additional calories. Sources of dietary fiber in commercial pet foods can thus be beneficial, as they are likely to result in the consumption of less food energy. Mixed dietary fibers are also thought to promote the attenuation of glucose absorption from the GI tract, induce gastric distention which stimulates the cholecystokinin-satiation signaling pathway, delay gastric emptying, and stimulate longer ileal transit time [6]. While the effects of fiber on food consumption in cats are not well described in the literature, there is speculation that fiber-enhanced diets might reduce overeating and thus play a protective role against the development of feline obesity [7].

Hunger-driven begging behaviors often compromise client compliance and can result in failure to achieve weight loss in obese-prone individuals. The inclusion of fiber in commercial diets is thought to induce satiety to the extent that it decreases these unwanted behaviors. A study evaluating weight-loss strategies in overweight cats found reduced begging scores (less vocalization and owner-seeking behavior) with a diet containing high-water-binding capacity fiber compared with a diet containing primarily insoluble fiber [8]. Therefore, not only the amount but the type of fiber may have an effect on satiety.

Despite the potential therapeutic properties of fiber on obesity, it should be noted that its inclusion can also result in decreased protein digestibility; weight loss diets must compensate for this by increasing dietary protein concentrations. Moreover, the ratio of slowly to rapidly fermentable fibers is important because research has shown that when rapidly fermentable fibers are included in high concentrations sufficient to promote satiety, GI side effects such as flatulence and diarrhea may be seen [9]. Overall, despite the paucity of information available on fiber in feline patients and conflicting results on its efficacy, its inclusion in commercial diets may prove useful for weight loss in obese-prone patients.

Diabetes mellitus

Previous veterinary literature suggested that dietary fiber improves glycemic control in dogs and cats and aids in the management of diabetes mellitus (DM) [10]. More recent reviews state that the effect of fiber in diabetic cats is unknown and that perhaps low-carbohydrate, low-fiber diets are indicated [11]. Nutritional studies of cats with DM are difficult to interpret because of differences not only in fiber content but also protein, fat, carbohydrate, and actual ingredients in the diets.

In one randomized controlled crossover study [12], 16 diabetic cats were fed a high-fiber (HF) diet containing 12% cellulose (dry matter basis) or a low-fiber (LF) diet (added cornstarch). Pre- and post-prandial blood glucose measurements were lower when the cats ate the HF diet. Insulin doses and glycated hemoglobin concentrations were not significantly different and 4 cats did not show improvement in blood glucose on the HF diet. The authors concluded that the results supported feeding a diet with added cellulose to cats with DM. These data were consistent with an unpublished study conducted by the same authors, in which 9 of 13 diabetic cats had improved glycemic control on a HF diet. However, there were other differences between the two study diets that may have influenced the results; the LF diet was lower in protein and higher in carbohydrates than the HF diet, and caloric intake was reduced on the HF diet. The four cats that did not respond to the HF diet had a lower average body weight (4.7 kg vs. 5.5 kg), so the amount of body fat may be a significant variable [12].

Another randomized study [13] evaluated two wet (canned) diets in cats with DM that were also being treated with insulin. The moderate-carbohydrate, high-fiber (MC-HF) diet contained approximately 11% crude fiber and 26% carbohydrate (on a dry matter basis) while the low-carbohydrate, low-fiber diet (LC-LF) contained approximately 1% crude fiber and 15% carbohydrate. Most, but not all, cats showed improvement in blood glucose and fructosamine in both diet groups. By week 16, insulin was able to be discontinued in 68% of cats on the LC-LF diet and 41% of cats on the MC-HF fiber. The authors concluded that cats were more likely to be well-regulated or revert to a non-insulin-dependent state when fed a LC-LF diet. However, the two diets differed in ingredients (ground corn in MC-HF vs. soybean meal and corn gluten meal in LC-LF) and in fat content (41% in MC-HF vs. 51% in LC-LF, metabolizable energy basis). Therefore it is difficult to determine if the fiber, carbohydrate, or fat content or particular combination of ingredients in the two diets were responsible for the results [13].

Current guidelines for humans with diabetes include medical nutrition therapy [14]. While dietary fiber consumption is associated with lower all-cause mortality in people with DM, there is little evidence that glycemic control is improved with increased intake of fiber or whole grains. Several dietary fiber studies in dogs with DM have yielded mixed results, and decreased caloric intake with high-fiber diets may be responsible for improvement in glycemic control [11]. At present, there is little evidence to support a direct effect of dietary fiber on DM in cats, but weight loss strategies that may include higher fiber can play a role in the management of these cases.

Diarrhea

Various enteropathies in cats can result in chronic diarrhea, a frequent and often frustrating clinical condition which commonly results in presentation to a veterinarian. The finding of diarrhea is often associated with an increase in frequency, volume, and fluidity of stools, which can also contribute to inappropriate elimination. In adult cats, the most common causes of chronic diarrhea are inflammatory (inflammatory bowel disease) or dietary (food sensitivity or intolerance); a less common etiology is neoplasia. Dietary intervention can play a beneficial role in the management of diarrhea and can control its occurrence and severity. Physical characteristics of fiber can both increase or decrease stool passage time; for example, research has shown that beet pulp promotes a shorter intestinal transit time in dogs, while cellulose increases it [15]. There is substantially less information available with respect to the effects of fiber on the rate of stool passage in cats, but the combined knowledge from research in humans, dogs, and the clinical experience of veterinarians suggests that fiber may have the same effects in this species.

Soluble fiber absorbs water from the GI tract to form a viscous gel which can reduce free fecal water and aid in the normalization of stool consistency. The viscous gel also prolongs intestinal transit time and may be useful in treating cases of secretory or osmotic diarrhea as it absorbs luminal toxins. When increased motility is the cause of diarrhea, insoluble fiber can be helpful in decreasing certain types of colonic myoelectrical activity [16].

While randomized, controlled studies are lacking, some veterinarians advocate the use of fiber supplementation for dogs and cats with IBD if diarrhea is a clinical feature. When food hypersensitivities are suspected as the underlying etiology, novel or hydrolyzed protein diets are the typical recommendation. Adjunctive fiber supplementation may be administered to these therapeutic diets to improve intestinal motility and water balance and normalize microflora [6]; psyllium husks and wheat bran have been used effectively in such cases. In other instances, patients with IBD respond best to highly digestible, low fiber diets, therefore fiber supplementation may be contraindicated for some individuals. Assessing each pet on an individual basis is critical in optimizing the clinical outcome.

Constipation

The prevalence of constipation in the feline population is unknown but most veterinary practitioners have treated cats with varying degrees of difficulty in passing feces (Figure 3). Frequent or recurrent episodes of constipation may lead to obstipation, which is refractory to routine treatment. If constipation/obstipation continues to progress, the cat may develop megacolon, an (often idiopathic) end-stage condition characterized by colonic dilation, loss of smooth muscle motor function, and inability to pass feces. Treatment depends on the underlying cause, severity, and chronicity. Early or mild cases of constipation often respond to removal of any impacted feces and laxatives; moderately affected cats may need colonic prokinetic drug therapy, while severe cases of obstipation and megacolon may require surgery in the form of subtotal colectomy.

Figure 3. This cat had chronic constipation as a result of a previous traumatic incident which had damaged his coccygeal vertebrae, making defecation painful. Such cases may benefit from a fiber-modified diet. Dr. Ewan McNeill

Recommendations for nutritional therapy of constipation vary widely. Some authors suggest highly digestible, low-fiber diets, while others prefer high-fiber diets or fiber supplementation [17]. Different types and amounts of dietary fiber have different effects on large intestinal function. Certain poorly fermentable fibers such as cellulose act as bulk-forming laxatives and can help distend the lumen of the colon and increase the rate of fecal passage [17]. However, cellulose has different effects on fecal dry matter and quality in dogs depending on type and fiber length [18]. Other fibers such as psyllium can form a viscous gel (because of its high water-binding capacity) which helps ease the passage of feces. Diets that are low in fiber and highly digestible can reduce the amount of feces produced but do not stimulate motility or fecal passage [17]. As dehydration is one of the underlying causes of constipation, wet (canned) diets are often suggested to increase water intake along with parenteral fluid therapy when necessary. However, wet diets vary in fiber types and amounts and may not be appropriate for all cats with constipation.

Only one study has been published looking at the effects of a commercial diet in constipated cats [19]. In this uncontrolled clinical trial, a moderate-fiber dry commercial diet containing psyllium as the predominant fiber (along with other fiber sources including chicory, fructo-oligosaccharides, mannan-oligosaccharides, rice and corn) was fed to 66 constipated cats. Assessments of fecal consistency and subjective improvement in clinical signs were evaluated by both veterinarians and owners. The results indicated that 56 cats completed the trial and all ate the diet and had improvements in fecal scores. Most cats that were on current medications for constipation were able to decrease or stop the drugs completely. While there was no control group or diet in this study, the positive results support the use of this psyllium-enriched diet as a primary or adjunctive therapy in managing cats with constipation and obstipation [19].

Hypercalcemia

Hypercalcemia is a relatively uncommon disorder in cats, with the most common underlying etiologies being idiopathic hypercalcemia, hypercalcemia of malignancy, chronic kidney disease, and primary hyperparathyroidism. Clinical signs are often lacking early in the disease process, which is usually diagnosed as an incidental finding on routine blood work. As the condition progresses, clinical signs become more apparent and can include vomiting, anorexia, weight loss, dysuria, and inappropriate urination. Medical therapy is typically targeted towards the underlying cause.

Dietary interventions are often ineffective because hypercalcemia tends to develop from increased bone resorption and renal tubular reabsorption of calcium. A dietary change to a product low in calcium will only benefit the subset of patients with increased intestinal absorption of calcium such as with hypervitaminosis D. High-fiber diets have been reported to decrease the risk of hypercalcemia and calcium oxalate urolithiasis in humans by increased binding of intestinal calcium, prevention of calcium absorption from the GI tract, and a decrease in GI transit time [20]. There are very few studies in the veterinary literature to support this finding. Fiber-enhanced diets were associated with resolution of hypercalcemia in 5 cats with idiopathic hypercalcemia and calcium oxalate urolithiasis [21] but no effect was observed in another study [22]. Further evaluation of the role of nutritional therapy in cats with hypercalcemia is required before conclusive recommendations can be made.

Hairballs

Hairball vomiting or regurgitation in cats is fairly common but not well-studied (Figure 4). A recent review of the topic [23] classified causes as either excessive hair ingestion or altered upper gastrointestinal motility. Hair ingestion can be seen in cats with pruritic skin disease or that over-groom because of pain or anxiety. Chronic stomach or intestinal problems such as inflammatory bowel disease may alter motility and lead to hair accumulation. When hairballs cannot be eliminated by vomiting, they may cause partial or complete intestinal obstruction, entrapment in the esophagus, or they may enter the nasopharynx.

Figure 4. Hairball vomiting or regurgitation in cats is fairly common. However hairballs can cause various problems including obstruction of the esophagus or intestines.© Royal Canin

Commercial hairball control diets are available that include various types and amounts of fiber. A survey of dry and wet feline diets with hairball claims available in the U.S. found that the fiber sources listed among the ingredients varied widely, and included powdered cellulose, dried beet pulp, soybean hulls, dried chicory root, rice hulls, rice bran, pea bran meal, pea fiber, oat fiber, inulin, and psyllium. Published studies are lacking. A crossover trial comparing a maintenance diet with one with added fiber in 102 cats over 2 months showed an average of 21.5% fewer hairballs and 21.8% reduction in vomiting frequency [24]. Another research study in 16 healthy cats compared the effect of two dry diets, one moderate fiber (6.9% as fed) and one high fiber (14.2%), on fecal hair excretion [25]; after 3 weeks, cats on the high fiber diet excreted an average of twice as much hair as cats on the moderate fiber diet. The results indicated either the amount or the type (psyllium and cellulose) of fibers in the high-fiber diet increased hair passage through the intestinal tract and may reduce the incidence of hairball regurgitation or vomiting.

Conclusion

Both the amount and type of dietary fiber in the diet can impact on intestinal health and function, and have been shown to play a beneficial role in the treatment of various clinical conditions. Further studies are needed to determine the effects of specific diets and fiber supplementation in cats.

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Allison Wara

DVM

United States

Dr. Wara graduated from the Atlantic Veterinary College in Prince Edward Island, Canada in 2010. She then worked for two years in first opinion small animal practice, where she developed a strong interest in small animal nutrition. In 2012 she left to pursue a residency training program in Clinical Nutrition at the University of Missouri College of Veterinary Medicine. Following the completion of her residency in 2014, she joined the MU faculty as a Clinical Instructor in the Department of Veterinary Medicine and Surgery.

Craig Datz

DVM, MS, DABVP, DACVN

United States

A 1987 graduate of the Virginia-Maryland Regional College of Veterinary Medicine, Dr. Datz has worked in both private companion animal practice and at the University of Missouri College of Veterinary Medicine, where he taught primary care and nutrition. He completed a master’s degree and a residency in Clinical Nutrition in 2010 and is dually board-certified in canine/feline and feline practice by the American Board of Veterinary Practitioners. Dr. Datz is currently the nutrition and scientific affairs manager for Royal Canin USA and is also an adjunct associate professor at the University of Missouri.