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November 4, 2016

貓的炎症性腸病(IBD):疾病本質以及治療方式


Feline Inflammatory Bowel Disease: Nature and Treatment
貓的炎症性腸病(IBD):疾病本質以及治療方式

Last Updated on Saturday, January 23, 2016 09:20 PM
Published on Friday, March 09, 2012 04:20 PM
Written by Lyn Thomson, BVSc DipHom
 
最近更新:2016年1月23日
原始刊出日:2012年3月9日
作者:獸醫琳.湯姆森(BVScDipHom)
 
原文出處連結:http://feline-nutrition.org/health/feline-inflammatory-bowel-disease-nature-and-treatment

譯註:台灣也有一些獸醫寫了有關IBD的文章,大家可以自行上網找來閱讀參考。翻譯這篇文是因為文中提到可以修復腸壁的修復餐,聽起來還蠻有邏輯的,所以翻出來給大家參考。
 
The inflammatory bowel diseases are the most common cause of chronic vomiting and diarrhoea in cats, and refer to a group of diseases. The term Inflammatory Bowel Disease, or IBD, is applied to a group of poorly understood gut pathologies that are considered to be a consequence of uncontrolled intestinal inflammation in response to a combination of elusive factors that may involve the diet, the environment, the gut microflora and dysregulation of the immune system in susceptible cats.
 
炎症性腸病(IBD)指的是一群疾病,是貓長期嘔吐和腹瀉最主要的原因。人類尚不瞭解IBD腸道病理現象,認為是無法控制的腸內發炎所引起,造成發炎的是許多不確切的因素,包括飲食、腸道菌叢以及免疫系統失調。
 
The main hypothesis for the cause and development of human IBD is that there is a dysregulation of the mucosal immune responses to intestinal microflora and/or dietary antigens.¹ This same abnormal immune response to dietary antigens is often suspected in feline IBD. Recent investigations have focused on attempts to better define the immunopathogenisis of the disease.²
 
人類的IBD成因所做的主要假設性判斷,認為是腸道菌叢以及/或者食物中誘發免疫反應的物質,所引起的粘膜免疫反應。相同的不正常免疫反應,來自於食物中誘發免疫反應的物質,也常被懷疑是貓罹患IBD的原因。近來的研究主要是針對如何對此疾病的免疫病因,做出比較確切的定義。




Top: normal mucosa of the duodenum, featuring healthy villi and intact surface enterocytes.
Lower: flattened mucosal surface with the absence of villi and surface enterocyte injury.
 
上圖:正常的十二指腸粘膜,有健康的手指狀絨毛和完整的腸上皮細胞表面。
下圖:被壓平的粘膜表面,絨毛不復存在,腸上皮細胞表面受損。
 
The absorption of digested food happens in the small intestine, mainly in the first two parts, the duodenum and the jejunum. The walls of these parts of the digestive system form tiny finger-like projections called villi with deep crypts between them. These villi are lined by cells called enterocytes, which work to absorb nutrients and pass them in to the blood stream to nourish the body. The importance of these cells cannot be overstated. These cells are born in the base of the villi, known as the crypts, and travel to the top of the villi where they are shed off, constantly being renewed as in their short life, they work incredibly hard.
 
消化過的食物被吸收是在小腸內進行,主要是小腸的前兩個部位,十二指腸和空腸。這兩個部位的腸壁是手指狀的突出物,被稱之為絨毛,絨毛之間有腸腺。這些絨毛佈滿腸上皮細胞,主要工作是吸收養分,然後把養分送入血管,滋養身體,因此這些細胞的重要性自是不言而喻。這些細胞誕生於絨毛的基底處,也就是腸腺,然後前進到絨毛的頂端之後脫落,短暫的生命週期就是保持如此的循環,而且十分認真的工作著。
 
The changes seen in the intestines of a cat with IBD include clear architectural changes. The villi change their shape and become flat and blunted, fusing together and decreasing the surface area available for absorption of nutrients. Inflammatory infiltrate fills the crypts and flattens the wall of the gut. The cells lining the villi, the all important enterocytes, can no longer function properly. The integrity of the gut mucosa is damaged, and results in increased permeability to toxins from the gut lumen and increased bacterial translocation.
 
IBD貓腸子的改變,包括明顯的腸結構變化。絨毛形狀改變,變腫變鈍,彼此交纏在一起,吸收養分的表面面積減少。炎性細胞浸潤充滿腸腺,腸壁被壓平。佈滿絨毛的細胞,也就是重要的腸上皮細胞,無法適當的運作。腸道黏膜的健全被破壞,結果是來自腸腔的有毒物質的滲透性和細菌移位都提高了。
 
All of this damage leads to chronic vomiting and diarrhoea as the ability of the intestines to digest food is impaired.
 
這些損壞造成長期的嘔吐和腹瀉,因為腸子消化食物的能力受損。
 
Diagnosing IBD
確診IBD
 
The diagnosis of IBD requires the comprehensive exclusion of potential causes of gastrointestinal inflammation, including intestinal parasites, small intestinal bacterial overgrowth, bacterial enterocolitis, dietary intolerances and neoplasia.
 
要確診IBD需要先排除造成腸胃道發炎的可能原因,包括腸內寄生蟲、小腸細菌增生、細菌性腸炎、食物不耐和細胞異常增生(=瘤)。
 
To make a diagnosis of IBD, three features are normally present:
  • A history of chronic gastrointestinal disease.
  • Histopathological evidence of chronic inflammation of the gut with architectural changes to the gut.
  • Exclusion of any known cause.
 
IBD的三個主要症狀:
  • 長期的腸胃道疾病
  • 來自病理組織的證據顯示腸道慢性發炎,腸結構改變
  • 排除任何已知病因
 
A scoring system is in use in clinical practice for defining the severity and prognosis of IBD, known as the feline chronic enteropathy activity index.³ It grades cats on: their attitude and activity levels; appetite, from normal to severely decreased; frequency of vomiting, from none to more than three times per week; faecal quality, from normal to diarrhoea to faecal blood and mucus; degree of weight loss, from 0 to >10%; and also includes appearance of endoscopic lesions and total protein levels. The index is useful in assessing a cat's response to dietary change and treatment protocols.
 
臨床上要定義IBD的嚴重程度,以及預後狀況,有一套計分系統,稱為貓慢性腸病活力指標(註3)。計分是根據貓的行為和活力程度;胃口,從正常到嚴重的沒有胃口;嘔吐的頻率,從每週零次到三次以上;糞便狀況,從正常到腹瀉到血便以及粘液;體重減輕的程度,從零到大於百分之十;內視鏡所能觀察到的損壞程度,以及總蛋白質指標。在衡量貓對食物改變後的反應,以及治療方式,這一套指標是有幫助的。
 
Histopathological evidence is usually obtained by examining a sample of tissue from a biopsy of the cat's gut. Histopathological diagnosis is not straightforward, especially in cats, as the differentiation of lymphosarcoma and IBD can be difficult, if not impossible on a routine section.⁴ The surprising realisation in cats is that the prognosis for IBD may not be very different to the prognosis for lymphoma.⁵ A sequel to chronic IBD can be intestinal lymphoma. These tumours may occur because of the notorious habit of cats to develop tumours at sites of chronic inflammation.⁶
 
病理組織的證據,通常是貓的腸組織切片採樣。以病理組織切片為診斷根據不容易確診,尤其是貓,因為探樣固定的部位,要區別淋巴肉瘤和IBD也許並非不可能,但是有難度(註4)。但是就貓而言,IBD和淋巴瘤帶來的後果,兩者之間的差異可能不大(註5)。長期的IBD可能造成腸淋巴瘤。因為慢性發炎的部位好發腫瘤,在貓身上是已知的事實(註6)。
 
The Role of Gut Flora 腸道菌叢
 
The main purpose of having a digestive system is to be able to digest and absorb food. Without a healthy gut flora, the digestive system cannot fulfil this function. Anatomical integrity of the digestive tract, its functionality, ability to adapt and regenerate and ability to defend itself are directly dependent on the gut flora. It is established that the density and composition of the mucosal flora is related to the presence and severity of intestinal inflammation in cats, and suggests that mucosal bacteria are involved in the cause and development of feline IBD.⁷
 
消化系統存在的目的是消化以及吸收食物。沒有健康的腸道菌叢,消化系統無法發揮完全的功能。消化道結構的健全、運作能力、調適、再生和保護自身的能力,都需直接仰賴腸道菌叢。粘膜菌叢的濃度和成分,和貓腸道發炎以及嚴重程度有關,這是一個已知的事實,表示粘膜細菌和IBD的成因以及發展之間是有關聯的(註7)。
 
It is hypothesised that IBD could be a variable response to a specific pathogen or an inappropriate or excessive immunological response to normal luminal micro-organisms. The whole length of the digestive tract is coated with a tough bacterial layer providing a natural barrier against invaders, undigested food, toxins and parasites. These indigenous bacteria produce antibiotic-like substances, anti-funghal volatiles, anti-viral substances and they engage the immune system to respond appropriately to invaders. Without well functioning gut flora the gut wall is unprotected and malnourished. Normal gut flora provides a major source of energy and nourishment for the cells lining the digestive tract.⁸
 
根據推測IBD可能是一種對特定病原產生的多變反應,或是對正常管腔(=管狀器官內的腔室)的微生物所產生的不適當過度免疫反應。強力的細菌層覆蓋住整條消化道,提供自然的屏障以對付侵入者、未消化的食物、毒素和寄生蟲。這些原生細菌製造出類似抗生素的物質、抗真菌揮發物和抗病毒物質,而且促使免疫系統對侵入者做出恰當的反應。缺乏運作良好的腸道菌叢,腸壁沒有得到保護而營養不良。正常的腸道菌叢提供熱量和養分給消化道的細胞(註8)。
 
It is increasingly clear that dietary influences on the intestinal flora are involved in health and disease.⁹ It is likely that through interaction with the gut flora, certain diets could protect against the development of IBD whilst other diets actually predispose to the development of IBD. In the management of IBD it is prudent to select diets with a high digestibility. Information on the bioavailability of nutrients for cats and dogs is particularly lacking. The most commonly accepted methods of determining bioavailability of nutrients have not been validated for the cat.¹⁰
 
大家越來越清楚的知道,食物對腸道菌叢產生的影響,和健康以及疾病有關(註9)。有可能是某些食物和腸道菌叢產生互動,保護身體而沒有發展成IBD,但另一方面有些食物卻傾向於引起IBD。在控制IBD時,選擇好消化的食物是比較謹慎的作法。養分生物利用率資料在貓狗方面尤其缺乏。在貓身上最能被接受的決定養分生物利用率的方法,還沒有被健全的建立起來(註10)。
 
Diet and IBD
 
食物和IBD
 
Let's look at diet as a trigger for IBD in cats. Our knowledge of nutrient requirements in cats is still incomplete, although a cat's basic nutrient requirements are amply present in the tissues of their prey animals. Most household cats no longer hunt but are instead fed commercially prepared foods. These foods are rich in plant-derived nutrients because to supply cats with all-animal diets is seen as significantly more expensive. The trend has been to make foods with greater proportions of vegetable based products and to supplement them with the necessary nutrients.¹¹
 
以食物引起貓IBD的角度來看。對於貓的營養需求我們的知識還不夠完整,但是我們知道貓的獵物身體組織,含有貓所需要的豐富基本養分。大部分的家貓不再自己獵捕動物,而是吃商業貓食。這些食物有許多養分是來自植物,因為要提供貓全肉食物是相當昻貴的。所以一直以來的趨勢是採用許多蔬菜來製作貓食,並在其中補充營養品(註11)。
 
The result is that the majority of cats are eating processed pet food containing poor quality, often inappropriate protein, grains, additives and preservatives, a far cry from the diet they are designed to eat. The pet food producers have recognised that many cats have food intolerances and food allergies, due in large part to the poor quality, biologically inappropriate ingredients in commercial pet food, and the same manufacturers are now offering allergen-free varieties. The need for allergen-free pet food is the result of years of feeding poor quality protein, grains and fillers, toxic additives and preservatives to our obligate carnivores. A damaged gut will allow protein to trigger an allergic response.¹²Marketing claims identify protein as the primary culprit in food intolerances and specifically target intact animal protein. Hydrolysed protein diets are the current craze, the hydrolysed protein being small enough not to trigger an immune response. We need to recognise that the problem lies with the integrity of the gut wall. If we can repair the gut wall, the cat will no longer be intolerant of intact animal protein, the cat's natural diet.
 
結果是多數的貓吃的是加工的貓食,品質差、常含有植物蛋白質、穀物、添加物和防腐劑,和貓真正需要吃的食物非常的不一樣。寵物食品製造商注意到許多貓有食物不耐和食物過敏,大部分是因為吃下品質差、食材不適合肉食動物的商業食品,因此這一批相同的製造商現在提供低敏食物的選項。低敏寵物食品之所以會出現,是因為多年來我們餵肉食動物的貓吃下的商業貓食中,有品質很差的蛋白質、穀物、加大食品分量的植物食材、有毒的添加物和防腐劑。受損的腸道讓蛋白質啟動過敏反應(註12)。製造商提出的行銷訴求是,蛋白質是食物不耐的罪魁禍首,尤其是完整的動物蛋白質。一時之間水解蛋白質蔚為風尚,因為水解蛋白質小到不會引起免疫反應。我們必須認知到問題其實是來自腸壁不健全。如果可以修復腸壁,無法接受完整動物蛋白質的狀況會消失;完整的動物蛋白質才是貓自然的食物。
 
The important point that seems to have been missed is that it is actually the feeding of a species-inappropriate diet that has led to the rise in inflammatory bowel disease in cats and loss of integrity of the gut wall.
 
有一個重點似乎被遺漏,那就是我們餵貓吃不適合肉食動物的食品,造成IBD,破壞腸壁健全。
 
By feeding cats inappropriately and not recognising them as obligate carnivores, we have damaged their intestinal tracts. We live in an era of convenience foods. Any processing of food changes its chemical and biological structure.¹³ The more food is processed, the more nutrient depleted and chemically altered it becomes. To compensate for the loss of taste, flavour and colour during processing, various chemicals are added including flavour enhancers, colours, various additives and preservatives. By negatively altering the gut flora, processed foods play an important part in damaging the intestinal tract. It is increasingly clear that dietary influences on the intestinal flora are involved in health and disease.¹⁴
 
我們沒有認知到貓是絕對肉食動物,餵他們吃下不適合的食品,破壞了貓的腸道。我們活在一個充斥著方便食品的時代。任何處理食物的過程,都會破壞食物的化學以及生物結構(註13)。處理食物的程序越多,養分就被剥奪的越多,結果是化學結構被改變。為了補救製造過程造成的口感、味道以及顏色的流失,許多不同的化學物質被加入寵物食品中,包括調味料、色素、各式各樣的添加物以及防腐劑。過度加工的食物改變了腸道菌叢,而且是負面的改變,因此破壞了腸道。大家越來越清楚的知道,食物對腸道菌叢產生的影響,和健康以及疾病有關(註14)。
 
Feeding your cat a species-appropriate diet, using a variety of protein sources in a highly digestible state, i.e. raw, is the best way to avoid food intolerances and allergies.
 
餵你的貓適合肉食動物的食物,使用各種不同的蛋白質,而且是以容易消化的狀態呈現,即生肉,才是避免食物不耐和過敏的最好方式。
 
Treating IBD – Using an Introduction Diet
 
治療IBD-腸壁修復餐
 
It is my professional experience that a healthy balance of gut bacteria and a species appropriate raw diet will protect and nourish the body. The introductory diet allows the gut lining to heal, restores the correct balance of intestinal bacteria and relieves the body of an excessive toxic load. Continuing to feed an appropriate raw diet, once the gut has healed, is the best long term management of cats with IBD.
 
就我個人的專業經驗,健康平衡的腸道菌叢和適合物種的生肉餐,可以保護以及滋養貓的身體。開始吃生肉之前先吃修復腸壁的食物,讓腸道菌叢恢復平衡,排除體內毒素。一旦腸道修復,就可以開始吃生肉,這才是IBD貓的最佳長期控制方式。
 
Cats previously diagnosed with IBD may already be on steroids, and I would suggest that their medication be adjusted as improvement is seen. Steroids can be withdrawn slowly and many cats can be weaned off their medication, under the supervision of their veterinarian, by using the introductory diet, followed by a raw diet.
 
已經被確診IBD的貓可能已經開始服用類固醇,我建議劑量要隨著身體的改善而調整。先吃可以修復身體的食物,然後吃生肉,類固醇的劑量可以慢慢減少,許多貓甚至可以停用類固醇,當然要在獸醫的監督之下。
 
Cats with serious digestive problems may show signs of diarrhoea, abdominal pain, bloating, and constipation. These cats need to be transitioned to a raw diet via the introduction diet, which will reduce the symptoms quickly and initiate the healing process in the digestive system.
 
有嚴重消化問題的貓可能會出現腹瀉、腹部疼痛、脹氣和便秘。這些貓需要先吃腸壁修復餐,再轉吃生肉,這麼做可以快速的減少症狀,啟動消化系統的癒合程序。
 
If it is not clear if the cat has IBD, food allergies or food intolerances, then the introductory diet is suggested in order to heal and seal their gut lining. The reason food allergies and food intolerances occur is due to what is called a leaky gut, when the gut lining has been damaged by abnormal microflora.¹⁵ Foods do not get the chance to be digested properly before they get absorbed into the bloodstream through the damaged gut lining, and cause the immune system to react to them. Trying to identify which foods your cat reacts to is likely to be impossible. Foods leaked into the blood when only partially digested may cause an immediate reaction or a delayed reaction a day, a few days or even a couple of weeks later. As these reactions overlap, you can never be sure exactly what the cat is reacting to. Testing for food allergies is notoriously unreliable.¹⁶ As long as the gut wall is damaged and stays damaged, you can juggle the diet forever and get nowhere.
 
如果不確定貓是IBD、食物不耐或是食物過敏,建議先吃腸壁修復餐,好讓腸壁得以癒合。食物不耐或是食物過敏之所以會發生,是因為腸滲漏,腸壁被不正常的微生物破壞(註15)。在食物被吸收,藉由受損的腸壁進入血管之前,食物沒有機會被適當的消化,造成免疫系統做出反應。想要找出何種食物引起反應不太可能。沒有完全消化的食物滲入血管時,身體可能會有立刻的反應,也有可能是幾天或甚至幾個禮拜以後才會出現反應。這些反應重疊出現,所以無法判斷到底是什麼食物引起貓反應。食物過敏原測試的不牢靠眾所皆知(註16)。只要腸壁被破壞,而且處於被破壞的狀態,要找出食物過敏原是一件疲於奔命,但卻徒勞無功的行為。
 
From my clinical experience, it is best to concentrate on healing the gut with an introductory diet. Once the gut wall is healed, foods will be properly digested before being absorbed, which will remove most food intolerances and allergies.
 
就我個人的臨床經驗,最好的做法是用修復餐修復腸壁。一旦腸壁癒合,食物在被吸收前可以被適當的消化,食物不耐和過敏就不會再發生。
 
Introductory Diet of Homemade Meat or Fish Stock
 
肉或魚高湯的腸壁修復餐製作方法
 
Meat and fish stocks provide building blocks for the rapidly growing cells of the gut lining and they have a soothing effect on any areas of inflammation in the gut. Bone broth is rich in minerals including calcium, phosphorous, magnesium, sodium, potassium, sulphate, fluoride, all delivered in an easily absorbable form. The minerals will improve immune function and support healthy digestion. Bone broth is also rich in collagen. Collagen is a protein containing two important amino acids, proline and glycine, and it will help heal the lining of the gut to relieve intestinal inflammation. Broths also contain glycosaminoglycans, also called GAGs, important building blocks for tissue repair.
 
肉和魚高湯提供腸壁細胞快速成長的基礎,而且對腸道中的任何發炎部位都有舒緩的效果。骨頭湯含有豐富的礦物質,包括鈣、磷、鎂、鈉、鉀、硫酸鹽、氟化物,全部都以容易消化的方式呈現。礦物質改善免疫功能,支援健康的消化。骨頭高湯含有豐富的膠原蛋白質。膠原蛋白質包含兩種重要的氨基酸,即脯氨酸和甘氨酸,幫助癒合腸壁,舒緩發炎。高湯中還含有葡萄胺聚糖,是修復身體組織的重要元素。
 
This is why broths aid digestion and have been known for centuries as healing folk remedies for the digestive tract.¹⁷ Do not use commercially available soup stock granules or bouillon cubes, as they are highly processed and contain detrimental ingredients such as MSG.
 
這就是為什麼幾百年來,高湯一直是舒緩消化不良的民間偏方,因為高湯可以幫助消化(註17)。不要使用市面現成的高湯粉或高湯塊,因為那是過度加工的產品,而且含有對身體不好的食材,例如味精。
 
Chicken stock is particularly gentle on the stomach and is very good to start with. To make good meat stock, you need joints, bones, a piece of meat on the bone, a whole chicken, goose or duck, whole pigeons, pheasants or other inexpensive meats. It is preferable to use free range or organic meats when possible. It is essential to use bones and joints, as they provide the healing minerals and collagen, more so than the muscle meats.
 
一開始可以用雞高湯,因為對胃來說特別溫和。你需要使用到含有關節部位的肉,例如大腿或翅膀、骨頭、帶骨肉,或是全雞、全鵝或全鴨、整隻鴿子、雉雞,或其他不貴的肉類。如果可以,儘量使用自然放牧或是有機飼養的動物。使用骨頭和骨關節是很重要的,因為這些部位所提供的癒合礦物質和膠原蛋白質,比肉還要多。
 
If you are using larger boned meats, ask the butcher to cut in half the large tubular bones, so you can get the bone marrow out of them after cooking. Put the bones, joints and meats into a large pan and fill it with water. Bring to boil, cover and simmer on a low heat for 2½ to 3 hours.
 
如果你使用的是比較大塊的帶骨肉,請肉販把管狀部位的骨頭敲開,這樣煮熟後才能夠把當中的骨髓取出來。把骨頭、含關節的肉塊和肉放入一個大的鍋子中,加滿水。煮開後蓋上鍋蓋,用低溫小火煮二個半到三個小時。
 
You can make fish stock the same way using a whole fish or fish fins, bones and heads.
 
也可以用同樣的方式煮魚高湯,用整條魚,或是使用魚鰭、魚骨和魚頭。
 
After cooking, take the bones and meats or fish out and sieve the stock to remove small bones. Strip off all of the soft tissues from the bones as best as you can and encourage your patient to eat them. Reserve the extra for adding to meals later. Extract the bone marrow out of large tubular bones while they are still warm. To do that, bang the bone on a thick wooden chopping board. The gelatinous soft tissues around the bones and the bone marrow provide some of the best healing ingredients for the gut lining and the immune system; your patient needs to consume them with every meal.
 
煮好後,取出骨頭和肉,或是魚,高湯過濾以移除小骨頭。儘量把骨頭上的軟組織剥下來,鼓勵病人(病貓)吃下去。剩下的部分留下來當三餐吃。要在管狀骨頭還有溫度時取下裏面的骨髓。可以拿骨頭敲木製砧板以取出骨髓。骨頭週圍膠狀的軟組織和骨髓,是癒合腸壁和免疫系統的最佳食材,是病人每餐都需要吃到的食物。
 
The meat or fish stock will keep well in the fridge for at least seven days or can be frozen. Warm meat stock can be served to your cat at any time of day. Provide warm meat stock as a drink with meals and between meals.
 
不管是肉高湯還是魚高湯,都可以在冰箱冷藏保存至少七天以上,冷凍保存也可。任何時間都可以餵貓喝溫溫的肉高湯。也可以在餐與餐之間給高湯,當水喝。
 
It is very important for your patient to consume all of the fat in the stock and off of the bones, as these fats are essential for the healing process. 
 
病貓吃下高湯中的所有脂肪很重要,因為在癒合的過程中脂肪是不可或缺的。
 
Probiotics are Essential to Introduce Right from the Beginning
 
你還需要一開始就餵益生菌
 
Probiotics are found naturally in fermented foods, such as green tripe. For people, probiotics are found in foods such as kefir, sauerkraut and yoghurt. Probiotics provide a healthy balance of gut bacteria to protect and nourish the body.¹⁸ Probiotic bacteria ensure the gut is an effective first line of defence and ensure the effective digestion of food.
 
發酵的食物中有天然的益生菌,例如反芻動物的胃。而人類的食物中,例如酸奶、酸白菜和優格,含有益生菌。益生菌提供腸道細菌健康的平衡,保護並滋養身體(註18)。益生菌確保腸子是第一道有效率的防禦線,以及消化可以有效率的進行。
 
For cats, I use Bio-Kult® capsules. Some probiotics available in North America are Fortiflora®, Proviable®, Benebac® Plus and many brands made by smaller companies. Start with just a pinch on one meal a day, building to a pinch on every meal and in every drink of the broth. To avoid any reactions, introduce probiotic foods gradually. There can be a die-off reaction, which may present as lethargy in cats, as the body has to deal with the clearing of the bacteria which die off and any associated toxins they produce. A bit like a hangover/toxin overload. Make sure that the food is not too hot when adding the probiotic powder, as the heat will destroy the beneficial probiotic bacteria.
 
我給貓用的是Bio-Kult®膠囊。北美可以買到的益生菌有Fortiflora®、Proviable®和 Benebac® Plus,以及許多比較小的品牌。一開始每天只要有一餐灑上一小撮,漸漸的提高到每一餐以及每一份高湯都加一小撮。為了避免引起不良反應,要用漸進的方式餵益生菌。開始餵之後,身體可能會出現關機的反應,也就是貓懶洋洋的,因為身體要開始清除已死的細菌,以及死細菌衍生而出的毒素。有點類似殘餘物/毒物過多的狀態。注意加益生菌時食物不要太熱,因為熱會殺死益生菌。
 
You can feed your cat more and more of the meat and soft tissues mixed with the broth until the signs of diarrhoea, bloating, abdominal pain, and constipation have gone away. In most cats, this happens quite quickly, within a week or two, but in severe cases it can take months.
 
你可以逐漸的增加高湯中肉和軟組織的分量,直到腹瀉、脹氣、腹部疼痛和便秘消失為止。在大部分的貓身上,這些症狀都會很快的消失,大約一到二週,但嚴重的病例可能要幾個月才會改善。
 
I would then introduce highly digestible species-appropriate raw food. In my practice, we usually start with rabbit fillets. We then progress to rabbit mince, which is ground meat, bone and organs. If fillets and mince are tolerated, we like to get cats chewing on pieces of raw meaty bone, such as rabbit shoulders, as quickly as possible. Introduce new raw foods regularly. Every week a new type of raw meat can be added, watching for any recurrence of clinical signs.
 
接下來我會給貓吃好消化、符合物種的生肉餐。以我個人的實際執業經驗,一開始我們通常是先餵兔胸肉,然後餵含有肉、骨和內臟的兔肉泥。如果貓的身體可以接受兔胸肉和肉泥,我會開始訓練貓啃帶骨肉塊,例如兔肩,越早訓練越好。固定的餵貓不同的生肉。每一個禮拜可以給一種新肉,觀察有沒有任何復發的臨床症狀。
 
The Keys to Improved Health
 
健康改善的關鍵
 
What is important is that a cat has a healthy mucosal flora in the gut, and a species-appropriate diet. By optimising these two factors we give the cat the best chance of repairing the inflamed gut. So, a restorative diet and the restoration of the bowel flora are two key components of helping a cat with IBD.
 
重點是貓的腸道要有健康的粘膜菌叢,以及餵貓吃符合物種的食物。強化這兩個因素才能給貓最好的機會,修復發炎的腸道。所以腸壁修復餐以及修復腸道菌叢,是幫助IBD貓的兩個關鍵作法。
 
There is a definite connection between the functioning of the gut and the functioning of the rest of the body.¹⁹ When food is not digested and absorbed properly, our cats suffer from multiple nutritional deficiencies. Inflamed guts become a source of toxins, rather than a source of nourishment. Healing and sealing the leaky gut is the key to improving health. The gut has great capacity for repair when fed a species-appropriate diet.
 
腸道功能和身體其他功能之間有絕對的關聯(註19)。當食物沒有被良好的消化和吸收,貓的身體會承受多重的營養不良。發炎的腸道變成有毒物質的製造源,不再是營養來源。治療腸道使其不再滲漏,是健康得以改善的關鍵。吃下符合物種的食物時,腸道才會有良好的修復能力。
 
(全文完)
 
譯者補充:
在網路上找IBD的資料時,看到貓友分享照顧IBD貓的經驗。貓友說生病的貓更怕細菌,所以不要餵生肉。其實不管生什麼病,我都看過相同的說法。大家都覺得這聽起來理所當然,但我卻覺得怪透了,畢竟我是個生食魔人。生病的貓不是更應該吃真正符合身體需要的食物嗎?而對肉食動物的貓而言,最符合身體需要的食物不就是生肉嗎?
 
餵乾飼料又方便又便宜,幹嘛大費週章的餵生肉?吃飽了撐著沒事做喔?我所翻譯的食譜中,Anne 和 Pierson 這兩位食譜作者都是因為家中有長期腹瀉的IBD貓而走上吃生肉這條路的,她們兩人都和貓的長期腹瀉奮戰多年,試過無數種的食物,直到餵生肉才拉出成型的大便。我想在一開始面對腹瀉這個問題時,她們應該也是害怕生肉的,心想都在拉肚子了,還要吃可怕的充滿細菌的生肉嗎?在幾年徒勞無功的努力之後,心想那來試試可怕的生肉好了,結果貓的大便竟然就正常了。可怕的生肉讓幾年的軟便一夜之間變成正常的大便,你說生肉可不可怕?真的是太可怕了XD
 
Dr. Lyn Thomson trained at the University of Bristol in England and is studying with the Australasian College of Nutritional and Environmental Medicine. A dedicated and experienced advocate of bio-appropriate nutrition, Lyn practices in Auckland, New Zealand. Her Raw Essentials stores have grown to seven retail locations, providing a variety of raw diet products for cats and dogs.
 
本文作者獸醫琳.湯姆森(Dr. Lyn Thomson)畢業於英國的布里斯托大學( University of Bristol) 獸醫系,目前在 Australasian College 研讀營養與環境醫學(Nutritional and Environmental Medicine)。在符合物種的營養學方面,她是一位經驗豐富的提倡者.她目前在紐西蘭的奧克蘭執業,同時也經營 Raw Essential 生食商店,目前已經有七個零售點,提供貓狗各式各樣的生食選擇。
 
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Read more at http://feline-nutrition.org/health/feline-inflammatory-bowel-disease-nature-and-treatment 
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