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September 11, 2013

一個獸醫對處方飼料的看法


作者:Lisa Pierson

學歷:University of California, Davis 加州大學戴維斯分校獸醫系

譯者:an eccentric wino
 
This piece of translation work is dedicated to my Hana.



'Prescription/Therapeutic' Diets
處方/療效食物

Let's move on to the veterinarian 'prescribed' diets which are also known as "therapeutic" or "prescription" diets. 

我們來談談獸醫“處方”食物,也就是所謂的“有療效的”或是“醫生處方”的食物.

"Prescription/therapeutic diet" is another label that is certainly not indicative of a high quality diet or one that is necessary. 

“處方食物”是一種標籤,不代表是高品質,或高品質是必要條件.

These diets represent an area of the commercial cat food industry that is very misleading.

這種食物在貓食業界中是一個非常誤導人的區域.

Many of these very expensive products contain corn, wheat, and soy which have no logical place in your cat's diet.  These diets are often very high in carbohydrates and, of course, all of the dry versions are water-depleted.  Many of them also contain by-products as the main - and often only - source of protein. 

許多這些非常昻貴的產品成份含有玉米,小麥和黃豆,這些食材在貓的飲食中沒有邏輯可言.這些食物的碳水化合物很高,而且所有的乾料都是剥奪水份的.很多處方乾料中還含有副產品為其主要 - 而且常常是唯一的 - 蛋白質來源.

While by-products can be very nutritious (and this really is the least of my concerns regarding these diets), they are cheaper than muscle meat so one would think that as much as these diets cost, the companies could use a more consistent source of high quality protein.  (See by-products on the Commercial Food page for more details.)

副產品可以是非常營養的(但在處方食物中,這部份我的關切是最低的),其價格比肉便宜,所以你會覺得如果把處方食的售價納入考量,製造商可以用能反應售價的優質蛋白質做為食材.

Study the ingredient list for Hill's dry i/d while keeping in mind that cats are obligate carnivores.

研究一下希耳司的i/d處方食,同時別忘了貓是絕對的肉食動物.

This dry food is 29% carbohydrates on a dry matter basis and is, of course, water-depleted.  The ingredients are as follows:

這份乾料的碳水化合物乾物比是29%,而且當然是剥奪水份的.其食材如下:

Chicken By-Product Meal, Brewers Rice, Corn Gluten Meal, Whole Grain Corn, Pork Fat (preserved with mixed tocopherols and citric acid), Powdered Cellulose, Dried Chicken, Chicken Liver Flavor

雞副產品肉餐(註1),釀酒用碎米(註2),玉米麩(註3),玉米粒,豬油(用生育酚和檸檬酸-一種天然防腐劑-的混合物保存),纖維素粉末(註4),乾燥雞肉,雞肝調味料

The base ingredients and composition mirror those of many dry foods found in pet stores and supermarkets.  Also, this is a very good example of the 'ingredient splitting' rule.  This rule states that ingredients have to be listed very specifically which works in the pet food manufacturers' favor.  It allows the grain fractions to be broken up into smaller components which places them lower on the list since ingredients are listed by weight.  However, when all of the grain fractions are added up, their contribution to the diet (including the protein content) often greatly outweighs the first ingredient.

這些基本的食材和組合也出現在許多寵物商店和超市販售的乾料中.再者,這是一個非常好的“食材分割”規則的例子.這條規則的內容是:食材以有利於製造商的特定方式標在包裝上.這條規則允許穀物被分割成較小的部份,因此得已被列在較後面的位置,因為食材的條列次序是根據重量而定.然而,當你把所有穀物被分割的小部份全部加在一起(包含蛋白質成份),其總重量常常是高於第一個列出來的食材.

I have asked many times on VIN (Veterinary Information Network - the 'who's who' of veterinary specialists from all over the world) just what makes this diet worthy of being called a "Prescription Diet for Feline Gastrointestinal Health" or, for that matter, what makes it an optimal diet to feed to any cat? I have never received an answer and the VIN threads have had Hill's representatives participating.  My questions about the quality and composition of their prescription diets are always met with dead silence.

我多次詢問獸醫資訊網VIN (Veterinary Information Network – 當中有許多來自全球的所謂名人獸醫專家的機構),想知道為什麼處方食物可以被冠上“貓科腸胃道健康的處方食物”的字樣,為什麼處方食物是任何貓的最理想食物.我從來沒有收到任何回覆,而且在VIN的留言串中有希耳司的人出現.對於他們的處方食物我所提出的有關品質和成份問題,我得到的都是沈默以對的回應.

It is important to note that most of these diets do not have robust clinical feeding studies supporting their safety for long-term feeding or even for use in treating the various diseases they target.

大部份的寵物處方糧 – 那些只能夠向獸醫購買的處方糧 – 缺乏有力的臨床餵食研究,以證明長期餵食的安全性,甚至缺乏可以使用來治療他們所宣稱的諸多不同疾病的證明.

On the contrary, we have plenty of evidence to show that feeding water-depleted, high carbohydrate, plant-based diets to carnivores does not honor their carnivorous make-up but, instead, promotes disease in this species.

相反的,我們有許多證據顯示給肉食動物吃這種剥奪水份,高碳水化合物,以植物為基礎的食物,並不符合他們身體結構的需求,相反的,這種食物會造成疾病.

It is also critical to understand that there is no independent agency overseeing these diets' medical claims.  None. Zero.  Including the FDA. 

沒有一個獨立的機構在監督這些食物所宣稱的療效.沒有.零.包含藥物食品管理局FDA.

The fox is definitely guarding the henhouse and the FDA shows no interest in remedying the situation.

這絕對是一個狐狸看守雞窩的行為,而FDA對修補這種狀況絲毫沒有興趣.

The FDA has 'punted' the responsibility of scrutinizing these diets for efficacy, safety, and suitability to the veterinarian but most veterinarians are very poorly educated in the area of nutrition. This field of study is not emphasized in veterinary schools and the minimal course work that is required, is often taught by people who have strong ties to the pet food industry.

FDA 把審核這些食物的功效,安全性以及適用性等責任踢給獸醫,但是獸醫在營養學這方面的教育是很缺乏的.這個領域的研究在獸醫學校並沒有被強調,而教導這些最低課程需求的人,通常和寵物食品業有密切的關係.

These are also usually the same people who are advising general practitioners on all matters of nutrition.  After recognizing this situation, you will see an obvious and very significant conflict of interest.  In the end, the members of my profession allowHill's, Purina, Iams, and Royal Canin to dictate what ends up in our patients' food bowls.

給予執業獸醫營養學建議的也往往是這同一群人.在認清這種狀況後,你可以看到一個明顯且實質的利益衝突.以致於到後來我的獸醫同業允許西耳司,樸瑞那,艾木司和法國黃家來決定我們的病患該吃什麼.

Here is an excerpt from the "Veterinarian-Prescribed Diets/OTC Options" paper that I am working on:

以下是一篇我正在寫的“獸醫處方食/開架式購買的選項”的論文片段:

'Prescription Diet’ trademark - marketing tool creates false perception

“處方食”的商標 - 製造錯誤認知的行銷工具

As an example of the serious lack of regulatory oversight, Hill’s secured trademark status for the term “prescription diet” in 1990 thus reinforcing the perception that, like prescription medications, their diets are subject to intense scrutiny and testing.  However, nothing could be further from the truth.              

因為法律控管的嚴重疏失,希耳司在1990年獲得了“處方飲食”這個註冊標誌,因而強化了一項認知,那是和處方藥物一樣,他們的食物是有經過嚴格審核和測試的.然而,事實完全不是如此.

There is a strong argument to be made that no trademark protection should be granted for any marketing label containing the word “prescription” given the strong potential to seduce the buyers of these products into a false sense of security growing out of the assumption that anything labeled “prescription” has been put through multiple layers of regulatory and testing paces.                

有一強力的論點應該被提出,那就是商標保護不該被給予任何行銷標籤上標有“處方”字樣的產品,因為那極有可能會誘導消費者產生錯誤的安全感,認為只要有“處方”字樣,就表示該項產品有經過層層的審核和測試.

If any product - including food - is allowed to carry a “prescription” label, it needs to be held to the same standards as a prescription medication.  Otherwise, the word “prescription” becomes no more than a marketing label, and as such, should hold no more credibility than any other marketing slogan.

如果有任何產品,包含食物,可以被充許冠上“處方”標,那麼這個產品必須有通過和處方藥物一樣的測試標準.否則,“處方”僅是一個行銷字眼的工具,它的可信度不應高於任何行銷用語.

To quote the FDA/CVM (Center for Veterinary Medicine) Communications Staff Deputy Director:              

在此引用一段FDA獸醫醫藥中心主任的話:

“‘Prescription diet’ is an industry-coined term and holds no legal meaning.”              

“處方食”是一個業界自創的措詞,沒有法律意義.“

In other words, these diets contain no ingredient that actually requires a prescription.  The trademarked term “prescription diet” is simply a clever marketing tool between Hill’s and veterinarians.  The sale of these diets is restricted (by Hill’s, not by law) to veterinarians only.  In return, Hill’s enjoys a boost in perception of quality brought about by this profession’s endorsement of their products.  However, this perception of quality is undeserved and this incestuous relationship jeopardizes the integrity of our profession.

換句話說,這些食物並沒有包含需要處方的食材.“處方食”只不過是希耳司和獸醫之間一個聰明的行銷工具.這些食物的銷售對象(是希耳司規定的,而不是法律)只有獸醫有了專業獸醫的背書,希耳司得到了品質保證的甜美果實.然而,希耳西根本不該享受這份品質保證,這種互得其利的行為,汙染了我們獸醫界的正直.

End excerpt
摘錄結束

I want to make it clear that probably 99% of all veterinarians who 'prescribe' these diets truly feel that they are doing the best for their patients.  The companies (Hill's, Purina, Iams, Royal Canin) that manufacture the 'alphabet' diets have done a wonderful job marketing their products to veterinarians, making it difficult to refrain from falling into the trap of using them.

有一點我要澄清的是,當獸醫把處方食物當成“處方”開給病人時,其中大約有九成九的獸醫真心認為處方食是病患的最佳選擇.這些製造用英文字母標示處方食的公司(希耳司,樸瑞那,艾木司和法國黃家)用很棒的方式把這種食物行銷給獸醫,讓他們很難落入不去使用這種食物的陷阱.

These companies make it very easy for us.  If a cat comes in with kidney disease?  We can just grab k/d, or NF, or LP without any critical thought.  If a cat comes in with a urinary tract problem?  Easy - take some c/d off the shelf.  Given a veterinarian's busy schedule and stressful life, one can see just how seductive the use of the 'alphabet' diets are.

這些公司為我們獸醫把事情簡化了.如果貓得到的是腎臟病,我們獸醫只要拿出 K/D(希耳司),NF(樸瑞那)或LP(法國黃家)即可,不需要注入任何臨床思維.如果一隻貓得到泌尿道疾病呢?很簡單,從架上取下一些c/d 就行了.獸醫的工作忙碌而且有壓力,你可以看出這種字母食物多麼具有吸引力.

However, contrary to what is often believed by both the veterinarian and the client, the 'therapeutic/prescription' diets sold in veterinary hospitals are not formulated for optimal health of a carnivore and, in many cases, are actually detrimental to the patient's health.  In addition, they are simply not necessary in most cases and do not optimally address the problems they claim to treat.

然而,處方食物並不是如獸醫和飼主所想的那樣:處方配方是肉食動物健康的最佳選擇,而且在許多病例中,處方食是不利病患健康的.除此之外,在很多病例中根本不需要用到處方食,他們所宣稱的療效根本無法解決問題.

Add to this the very high price tag on these diets and we have what I consider to be a very big 'black eye' for the profession. 

除了這個非常昻貴的標籤之外,處方食還讓我們獸醫界被冠上不良的名譽.

The only time I ever use a prescription diet (canned s/d) is discussed here on the Urinary Tract Health page. Canned s/d is occasionally used but only temporarily (~3-4 weeks) pending re-evaluation of the patient.

我唯一會使用處方食(s/d罐頭)的討論列在我的網站尿道健康的頁面,連結如下.

http://www.catinfo.org/?link=urinarytracthealth#Prescription_Diets

我偶爾會使用s/d罐頭,但只是暫時性的(約3-4週),視病患的狀況而定.

Instead of defaulting to the 'alphabet' diets, I can always find an 'over-the-counter' diet or formulate a homemade recipe for my patients that leaves more money in the client's wallet and much better nutrition in the cat's food bowl.

我用“開架式”的產品,或是自製食譜來取代“字母食物”,那不但讓我的客戶省下荷包的錢,而且他們貓碗中的食物也營養多了.

全文完
以下為酒鬼註記

註1 – chicken by-product meal 雞肉副產品餐
Chicken by-product meal consists of the ground, rendered, clean parts of the carcass of slaughtered chicken, such as necks, feet, undeveloped eggs and intestines, exclusive of feathers, except in such amounts as might occur unavoidable in good processing practice.
資料來源:http://cats.about.com/od/catfoodglossary/g/chicbyprodmeal.htm
 
雞肉副產品餐是雞脖子,腳,未成形的蛋,腸所絞碎的乾淨部份,不含有羽毛,除非是在處理過程中不可避免的情況下.
 
酒鬼見解:
如果你可以給你的貓吃雞肉,為什麼要去吃這種所謂的“雞肉副產品餐”.這是一個多麼奇怪的名稱!! 不過是一個美麗的名稱來包裝很糟的食材罷了.我覺得這個名稱十之八九是寵物食品製造商創造出來的.
 
再者,如果你的獸醫覺得直接吃雞肉(不管生或熟)蛋白質太多會造成腎臟負擔,不管你的貓沒有沒有生病,還是吃乾料好,那請認真考慮換個對營養學較有知識或經驗的獸醫.一個有經驗的獸醫會告訴你很多事情.過去幾個月我看到一些換食的貓出現胰臟炎的問題.我請教了一個獸醫,她說:食物轉換過程中,如果出現腸胃道的問題,例如嘔吐或是腹瀉,胰臟指數會立刻上升.如果你的貓在換食過程,出現腸胃道問題,帶去檢查驗出胰臟炎,醫生叫你改吃胰臟處方,請先仔細確認你的醫生沒有“腸胃道問題會導致胰臟指數上升”這項知識.如果他有這項知識還叫你換處方,或是真的沒有這項知識,而且對於不同的食物沒有一個開放的,接納新知的胸襟與看法,請認真考慮換一個醫生.獸醫有很多,但你的貓只有這一隻.

再次提醒你, 換食請慢慢來, 不要心急. 百吉的醫生說用 2-3 週的時間改變食物, 給大家做參考.
 
註2 –Brewer’s rice 釀酒用碎米
Brewer's rice refers to the small pieces of broken rice that remain after the milling process is complete.
 
As the name suggests, brewer’s rice is often used as ingredient for beer brewing.
In rural areas, brewer’s rice has a variety of uses and is commonly ground into rice flour.
資料來源:http://www.knowledgebank.irri.org/postproductioncourse/Additional/MilledRice/3._Brewer_s_rice.htm
 
釀酒用碎米指的是在碾米的過程中,所產生的碎米.
 
如同名稱所示,釀酒米通常被使用來做為釀啤酒的材料.在鄉村,這種米有很多不同的用途,而且常被磨成米粉.(不是新竹米粉那麼米粉,是米的粉末)
 
註3: corn gluten meal 玉米麩
the dried residue from corn after the removal of the larger part of the starch and germ, and the separation of the bran by the process employed in the wet milling manufacture of corn starch or syrup, or by enzymatic treatment of the endosperm.
資料來源:http://cats.about.com/od/catfoodglossary/g/cornglutenmeal.htm
 
這是玉米粒取走較大部份的澱粉和胚芽後剩下的乾燥殘餘物(原文寫residue,我並沒有刻意要醜化它),以及在濕磨製造取得玉米澱粉和胚芽時所脫落的玉米皮,或是胚乳(玉米粒內部的一層組織)酵素製程中得到的乾燥殘餘物.
 
註4:纖維素粉末 Powerded cellulose
Cellulose powder is a white, odorless powder derived from the fibers of plants. Cellulose powder is insoluble in water and many other liquids; instead it tends to absorb water and other liquids and helpshttp://images.intellitxt.com/ast/adTypes/lb_icon1.png to flush impurities from the body. It is most often marketed as a powder, is reasonably priced and can be found at most health food stores.


資料來源:http://www.ehow.com/about_4680517_what-cellulose-powder.html
 
這是一種白色的無味粉末,取自植物的纖維.無法溶解於水和其他許多液體,相反的會吸收水份以及其他液體,幫助排出體內廢物.此產品幾乎都是以粉末狀在銷售,價格合理,健康食品商店有售.

 

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