After 18 years, Ben, my lifelong dog, was diagnosed with chronic kidney failure three months ago. Short of any other catastrophic illness, his 11-year-old veterinarian has said that this will be the “thing” that finally takes Ben out of this world and out of my life. That said, Ben still clearly has a lot of life and love in him, so none of us are throwing in the towel.
When I first received the news of Ben’s condition, it broke my heart and I grieved… hard. I couldn’t imagine losing it; I couldn’t imagine a life without him. But after a few days immersed in the sadness of the future, I turned my attention to the present… and, as a participant in a 12-step program, I began to focus my attention on what I could control: Ben’s diet.
I
want
to make it clear from the outset that I’m not a veterinarian, a doctor, or anyone with a lot of life sciences in my background. I am a lay person with a great propensity to investigate and learn. What I am presenting is therefore a layman’s understanding of things, and my approach has been devised in consultation with Ben’s amazing vet and pharmacist. However, I hope that by keeping this post simple, my research and understanding distilled will be easy for those of you with similar battles in front of you, now or in the future. Ultimately, this is a post and recipe written by a man who loves his dog above all else in the last 18 years and there’s nothing I wouldn’t do for him… And the least I can do is make him spend months full of quality and love, which starts with his diet.
So, to begin with, I had to learn about kidney failure and what’s happening in the kidneys, which are the main filters in our body. Often when we hear about kidney disease, or at least when I’ve heard about it in the past, it’s been linked to dietary protein levels. That’s not to say that protein is the cause, but that once kidney failure sets in, protein in the diet becomes a concern. This is why people and animals with chronic kidney disease often receive a protein-restricted diet. Why? Well, what I learned is that the problem is not specifically with protein, but with what accompanies protein: protein is not the problem and Ben couldn’t live without protein either. The problem is that when the kidneys stop working in their full function, certain things are not filtered and excreted and this creates an imbalance in our blood chemistry. Of particular concern in a mature dog like Ben, who has no real pathology but has simply outlived his kidneys (rare in a dog but more common in cats) is the reduced ability to excrete phosphate and, conversely, retain calcium. This is a double whammy because the body uses calcium to bind with phosphorus as part of the excretion process. As a result, over time phosphorus levels rise and accumulate in the body’s tissue, causing multiple system problems and in particular, as kidney disease progresses, cardiovascular complications become increasingly likely. In short, there are two outcomes in Ben’s immediate future: heart attack/stroke or multisystem failure that will require the hardest decision I’ve ever had to make…
That’s why this post is about a diet low in “phosphorus”, not low in protein. You see, phosphorus is produced most abundantly in protein-rich foods, but it occurs to some extent in almost all foods and ingredients. But before I sing my solution, there’s something else to this story: it’s not as simple as omitting or limiting phosphorus. Dogs still need other nutrients and, in the end, it’s about balance: it means, as best we can, equipping the dog (Ben) with what he needs while omitting what is going to shorten life. And yet, even in that, there’s one more thing you can’t forget, and that this isn’t simply a chemical experiment: it’s food. I mean, what I created didn’t just have to be good for Ben, he had to like it enough to eat it. And remember, Ben is a dog I’ve been feeding and cooking largely since the beginning: he has a picky palette, to say the least.
Research and the
goal:
One of the symptoms of kidney failure is an acidic belly and nausea. The result of this is reduced food drive and weight loss, which was a telltale symptom in Ben. Smaller, more frequent meals have played an important role for him. And while I’ve chosen to use some supplements in your diet, I’ve largely tried to rely on “functional foods” and variety in your diet to provide you with the necessary nutrients. The goal, therefore, was to choose
: Good “fats” rich in calories and other
- necessary compounds
- Nutrient-rich proteins
- in vitamins and with enough soluble fiber: this will also “boost”
- phosphorus ingredients throughout (proteins, vegetables, grains, fats)
- Combinations that would produce a dish however tasty
Carbohydrates and vegetables high
the diet Low
Some other important things Should and should not be done in the diet.
- Vitamin B (complex
- Omega 3 fatty acid (a premium salmon oil supplement would be a good suggestion
- at least before the onset of advanced kidney disease) Calcium levels
- time this will need to increase as a binder to help control phosphorus even
- Coenzyme Q10 (helps with heart and kidney health; read more here on Wikipedia for a secular explanation
- Antacid (e.g. Pepcid AC)
)
) Potassium levels (
(over
more)
)
- Phosphorus obviously
- Omega 6 fats (because they are inflammatory
- with kidney failure, blood pressure will increase and sodium will become a killer
- Vitamin D (because this is also difficult for the kidneys to excrete)
) Sodium (because
)
I read a LOT. I read and read and read, trying to discern what to feed him, what the nutrient trade-offs were, and what he would ultimately still eat. One of the best sources I found was a Phosphorus Food List (PDF) published by Kaiser-Permanente (a huge integrated health care company in the U.S.) and information on the Mayo Clinic website about a low-phosphorus diet. I cross-referenced this information with dog food diets, dog food ingredient labels, and many other sources. In the end, this is what I determined…
Research Post-Script: There are many comments throughout this blog from people who have been using this recipe for a year or two successfully. Many have added their own research and information. Some have different opinions and every dog is different with unique tastes or other underlying conditions, but most people have independently supported this recipe with other research or discussions with other health professionals. One reader, Kerrie E., went to a nutritionist and posted the advice she received here as well. I have summarized your information as an attached PDF here.
List of ingredients to work with
protein sources: lean ground beef; duck; white fish; and egg whites; ground pork (moderate, but tasty) → all good choices due to fat to phosphorus ratio
Fat: Coconut oil (high in good fat, but low in vitamin D); alternatively, avocado oil
Plant sources: Green beans; kale or kale (kale is lower in phosphorus than kale, but kale is richer in almost all other sources of vitamins); Broccoli (in limited quantities for taste
)
Carbohydrates: sweet potato; acorn-fed pumpkin; pumpkin (high in potassium); carrots and apples, with skin, in moderation → all (except apples) should be boiled/steamed: water discarded because water leaches
phosphorus
Fiber/carbohydrates: white rice; pearl barley; White bread → contrary to what we might think, refined grains are lower in phosphorus, so they are better in these diets than whole grains
Supplements (based on 25-pound dog):
Breakfast: 10mg Pepcid AC antacid tablet Breakfast: 25mg- Coenzyme → You will be challenged to find this dosage and/or Q10 in a gel-free capsule format. However, it exists. The brand I used is from Douglas Labs, which makes a “Citrus Q10” tablet that I cut into quarters.
- Dinner: half vitamin B50 complex (i.e. essentially a vitamin of the B25 complex)
Q10
Finally, while I’m including a recipe here, I’ve included a number of options and substitutions below. Using these options, I’ve finally cooked Ben four different recipes so far. Each provides about 6 packages with enough food for about 10-12 days. And I vary the packages every other day to make sure I’m getting nutrients from a variety of sources.
My final tip is, before you pack dog food, try it because, if you don’t like it, he/she probably won’t either. Don’t be squeamish: these are 100% human food ingredients.
Total Time: 90 minutes (includes cooling and packing)Servings: 10-12 days of 25-pound dog food
How much to feed your dog:
I’ve
added this as an additional postscript because it’s the most frequent question I’ve been getting over the years. The answer is simple but, I know, unsatisfactory: “It depends.” As I tell everyone, every dog that tries this diet is different and unique. There are too many variables for me to answer. It depends on the size, breed, age, metabolism, stage of the disease and other factors that make each dog special. However, my advice is simple. You know your dog. You know how much you would have eaten normally. Trust your gut. In addition, dogs with kidney failure or disease are usually in a “no eating” state and are prone to “wasting.” That is, they are slowly starving. As such, let your companion be your guide. They will tell you if they want more or need more. Assuming they are not overweight or have other diseases, letting them eat until they are full is my personal recommendation. That’s what I did with Ben… And to make him more successful, I tried, when possible, to divide his meals into smaller amounts and feed him more regularly throughout the day. I hope this helps you all, but if you need more advice, talk to your vet.
Low
phosphorus dog food
INGREDIENTS
:
2 lbs of lean ground beef → Option 2: or replace half of the ground
- beef with half of the ground pork → Option 3: or substitute 2
- pounds of baked
- trout 500 grams (1 pint) liquid egg white (12-15 egg whites
- green seeds
-
- barley
- acorn-fed pumpkin, peeled and diced (see note below)
- → or substitute 1 pound sweet potato and 2 cups purled pumpkin
2-4 tablespoons coconut oil 1/2 cup fresh parsley, finely chopped Optional: 1 apple, grated if ground pork is used Garlic powder, to taste (optional) ** Ground pepper, to taste (♣
-
- optional)
) 1 pound
2 cups raw rice → or substitute pearl
2 pounds
**Note (August 28, 2015): Several readers have expressed concern about garlic powder in this recipe due to research that it is toxic to dogs. To be clear, the amount I used was very small (one spray = 1/4 teaspoon). Judge with me or disagree with me, but Ben ate garlic at food all his life because he ate table food/leftovers from my plate and there was rarely a meal that didn’t include it as a condiment. As stated, I am not a veterinarian or doctor, so I can tell you at what levels it is safe or unsafe for a dog of any weight. Everything I know and everything I share here is what I did for my dog who lived 18.5 years. In the end, it appears as optional, but I used it.
♣ Note on winter squash: No two vegetables are the same in their nutritional profile, even from the same family. While substitutions are possible and even recommended to “change” it for your pets, always consider your menu as part of an overall “system” of ingredients. Many readers are frustrated by the effort of peeling an acorn-fed pumpkin. That’s true. But note the nutritional breakdown on the side here regarding other winter pumpkins and their overall nutritional ratings (beyond phosphorus):
DIRECTIONS
:
- Cook rice following package directions (e.g., 2 cups rice; 4 cups water: bring to a boil, simmer for 15 minutes; remove from heat, Let stand covered for 5 minutes).
Prepare parsley: wash; remove leaves from stems; and finely chop the parsley. 
When the rice has finished cooking, remove the lid and add the chopped parsley. 
- While the rice is cooking, cut the pumpkin in half and remove the seeds. Cut the pumpkin into strips, along between the “ridges”; With a vegetable peeler, peel the skin of the pumpkin.
Cut pumpkin into cubes and place it in a medium pot with enough water to fill half.
Bring to a boil and simmer, covered, for 20-25 minutes until the pumpkin is just tender. Remove from the water and discard the water. <img - Steam green beans, whole.
- Place the ground beef in a pan and fry for about 8-10 minutes until all the pink color is cooked. Season with fresh ground pepper and garlic powder. DO NOT drain the fat, but let the meat cool.
- Once the ingredients have cooled to “hot,” place them in a powerful food processor or blender (for example, Vitamix). Combine in 1/2 the pumpkin, 1/3 of the ground beef and half of the beans …
… and puree until smooth. 
Add the puree to the rice mixture. Repeat with the remaining pumpkin, another 1/3 of the remaining meat and green beans and add them to the rice mixture as well. <img - Using the same pan as the meat, now, melt 1 tablespoon of coconut oil.
When hot, add half of the egg whites and stir until cooked (about 4 minutes). 
Repeat with more coconut oil and remaining egg whites and add to the other ingredients and stir in.
→ Note: You can puree all the ingredients, but Ben and I seem to prefer that there is a little “texture” in the food and having pieces of rice and meat that you can detect and smell helps in attraction. - Taste for seasoning: Try to avoid adding salt, but you may need to add some flavor. That’s why I use garlic powder. Try some with your “patient” who will be waiting, and make sure he/she likes it too.
Success! - You are now ready to pack the food in sealable sandwich bags and place four to one bag inside a larger freezer bag.
I hope your own fido patient loves this as much as Ben. Serve in 1/2 cup measured 4-5 times a day. (Note: Ben’s appetite actually increases at night, which is when he eats about two-thirds of his food.)
src=”https://i0.wp.com/eatswritesshoots.com/wp-content/uploads/2014/05/ben_food_low-phosphorus11.jpg” alt=”Boiled pumpkin for low-phosphorus dog food” />
src=”https://i0.wp.com/eatswritesshoots.com/wp-content/uploads/2014/05/ben_food_low-phosphorus15.jpg” alt=”” />Add the remaining beef, including all fat from the meat. 
