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January 13, 2017

維持(貓)泌尿道和腎臟健康的食物


Feeding for Urinary and Kidney Health
維持(貓)泌尿道和腎臟健康的食物

Last Updated on Sunday, January 24, 2016 06:32 PM
Published on Friday, May 20, 2011 12:35 PM
Written by Elisa Katz, DVM
 
最近更新:2016年1月24日
原始刊出日:2011年5月22日
作者:獸醫伊萊莎.卡茲(Elisa Katz, DVM)
 
原文出處連結:http://feline-nutrition.org/health/diet-kidney-disease-and-the-urinary-tract
 
There is a connection between what cats are fed and what diseases they might get. This is an idea that is becoming much more widely accepted. Diet plays a role in disease syndromes such as kidney disease, urinary problems such as stones and crystals, Feline Lower Urinary Tract Disease and gastrointestinal problems such as IBD.
 
貓吃的食物有可能造成某些疾病,越來越多人能夠接受這個想法。有些貓病是和食物有關係的,例如腎臟病、泌尿道問題(例如結石和結晶)、貓科下泌尿道疾病和腸胃道問題(例如炎症性腸病IBD)。
 
The kidneys regulate the water and salt balance in the body, maintaining hydration, electrolyte levels and regulating blood pressure. As proteins are metabolized by the body for energy, by-products are produced and circulated in the blood. It's the kidney's job to remove these toxic substances. Waste products such as urea nitrogen, creatinine and phosphorus, as well as certain drug metabolites, are all filtered from the blood and excreted in the urine. You may be familiar with the names of these by-products of protein breakdown if your cat has had blood work done. These are what are measured in the blood to detect declining kidney function – high levels mean that the kidneys aren't working normally. A complication is that the kidneys possess an amazing capacity for compensation. As much as 75% of kidney function must be lost before we can detect abnormally high blood values for these substances. Sometimes we see increased thirst and urination before the blood values rise above normal, as the kidneys become less able to conserve water, but not always. Since so much kidney function is lost by the time disease is usually detected, we need to do everything we can to help our cats maintain good kidney health in the first place.
 
腎臟規律體內的水和鹽平衡、維持水分、電解質平衡和規律血壓。蛋白質被身體新陳代謝產生能量,副產品因而被製造出來並且在血液中循環。腎臟的工作是移除對身體有害的物質。尿素氮(簡稱BUN)、肌酸酐(簡稱crea)和磷,以及某些藥的代謝物,從血液中被過濾出來,然後從尿液排出。如果你的貓曾經做過血檢,你可能對這些分解蛋白質而來的副產品名稱並不陌生。這些血檢數字被用來判斷腎臟功能是否處於衰退,高於標準值時表示腎臟沒有正常運作。而讓情況更加複雜的是,當腎臟功能開始衰退時,腎臟會提高自身活動力以因應。隨之而來的後果是,當我們看到血檢數字異常時,腎臟可能已經最多失去百分之七十五的功能了。有時在血檢數字高於標準值時,貓就已經出現喝多尿多的現象,因為腎臟已經比較無法留住水分,雖然不是所有腎貓皆是如此。既然在腎臟病被發現前,腎臟的許多功能已經喪失,我們首先要做的是盡可能維持腎臟健康。
 

 
  1. 腎臟動脈:血液帶著廢棄物,從心臟經由腎臟動脈到達腎臟。
  2. 腎皮質:血液進入腎臟主要過濾區域,即腎皮質。此部位含有幾十億的腎元。腎元過濾血液,規律鹽和水分。
  3. 腎盂:血液過濾後產生的尿液聚集在此。
  4. 腎靜脈:乾淨的血液從腎靜脈回到心臟。
  5. 腎輸尿管:尿液從輸尿管離開腎臟,貯存在膀胱中
 
There are only a few definitively known causes for kidney disease. Genetic conditions such as polycystic kidney disease in Persian breeds, toxins such as anti-freeze and lilies, infections and cancer are all known to cause kidney disease. Much of the time, the exact cause is unknown, and a number of things may be contributing to impaired kidney function, including diet. Low-grade persistent bacterial infection in the bloodstream, such as that which occurs with advanced dental disease, may injure the kidneys over time. Preventing dental disease can be an important factor in the long-term health of your cat's kidneys. Other conditions that can cause harm to the kidneys include hypertension due to hyperthyroidism or other diseases.
 
只有少數腎臟病有明確病因。基因因素,例如波斯貓的多囊性腎病變(多囊腎)、毒物因素,例如防凍劑和百合花、細菌感染和癌症,都有可能造成腎臟病。大部分的時候確切的病因不明。也有許多其他因素可能導致腎臟功能不全,包括食物。血液中有持續存在的低度細菌感染,例如來自於嚴重口腔疾病的低度細菌感染,可能會慢慢的傷害腎臟。因此要維持腎臟長遠的健康,預防口腔疾病是重要的。其他的狀況也有可能傷害腎臟,例如甲狀腺機能亢進或其他疾病造成的高血壓。
 
The type of diet you feed your cat can directly affect your cat's kidneys. Dehydration in cats causes the kidneys to concentrate urine to try to maintain the body's water balance. Concentrating urine predisposes a cat to renal injury.¹ The chronic, mild dehydration that cats experience when fed dry foods exclusively can cause increased stress on the kidneys, leading ultimately to decreased kidney function. Also, the low magnesium content in diets designed to decrease urinary stone and crystal formation may adversely affect the kidneys over time.²
 
你給貓吃的食物有可能會對腎臟造成直接的影響。當貓身體脫水時,腎臟會濃縮尿液以維持體內水分平衡。濃縮的尿液傾向於傷害腎臟(註1)。只餵貓吃乾飼料,貓會長期處於輕微脫水的狀態,提高腎臟壓力,終至降低腎臟功能。另外,針對尿路結石和結晶而設計的低鎂食品,長期食用也有可能對腎臟造成不利的影響(註2)。
 
Preventing dental disease can be an important factor in the long-term health of your cat's kidneys. You may have been told to feed your kidney-compromised cat a diet that has a reduced protein content. Should you do it? Recent research demonstrates that diets high in protein have no detrimental effect on the kidneys, and animals with mildly decreased kidney function do not benefit from reduced protein diets.³ There is evidence that restricting protein may actually slow down the filtering action of the kidneys.⁴ It is important that cats receive good quality protein in appropriate amounts without excessive levels of phosphorous to help maintain kidney function. This means that the protein source should be from actual meat and not a meat meal. Meat meals can consist of mostly ground up connective tissue and bones. Usable muscle meat is removed before rendering, and so meat meals may contain high levels of calcium and phosphorous, which can harm the kidneys.⁵
 
就腎臟長遠的健康而言,預防口腔疾病是重要因素之一。可能有人會跟你說,腎臟有問題的貓要限制蛋白質的攝取。你應該這麼做嗎?最近的研究顯示,高蛋白質食物對腎臟不會產生有害的影響,而限制蛋白質的攝取,對輕度腎功能衰退的貓而言並沒有正面的幫助(註3)。已有證據顯示限制蛋白質的攝取量,可能反而導致腎臟過濾速度減慢(註4)。所以重點是貓需要攝取適量的、沒有太多磷的優質蛋白質,以維持腎臟功能。優質蛋白質表示應該來自真正的肉,而不是肉粉。肉粉有可能主要是由研磨後的結締組織和骨頭組合而成。在製作肉粉之前,有用的肉就已經先被取走,所以肉粉可能含有很多的鈣和磷,傷害腎臟健康。
 
譯註:肉粉是乾飼料的食材之一。
 
Rather than restricting protein that cats depend upon for their energy requirements, reducing phosphorus in the diet can help many cats with kidney disease. Phosphorous restriction is important in order to prevent the development of renal secondary hyperparathyroidism, a condition where excess phosphorous leads to an altered calcium/phosphorous balance. The end result of this imbalance causes calcium to be drawn from the cat's bones and deposited into the tissues and organs, including the kidneys, further impairing their function.⁶
 
貓需要蛋白質以獲得能量,所以不應該限制攝取。有腎臟問題的貓,要限制的是磷的攝取量。太多的磷會改變鈣磷平衡,引發副甲狀腺(甲狀旁腺)功能亢進,所以限制腎貓磷的攝取量很重要。鈣磷不平衡會導致骨頭中的鈣被釋出,聚集在身體組織和器官之中,包括腎臟,進一步的破壞腎臟功能。
 
Phosphorous limitation can be accomplished through the substitution of cooked egg whites for a portion of the meat in the diet, which dilutes the overall amount of phosphorus in the serving. Cooked egg whites are high in protein and very low in phosphorus. The phosphorous content of 100 grams of cooked egg white is 15 mg. For comparison, 100 grams of raw chicken has 198 mg of phosphorus and 100 grams of raw beef has 177 mg of phosphorus.⁷ Phosphorous binders can also be used. Binders are added to the food to prevent phosphorus from being absorbed into the body and bloodstream.⁸ A blood test is required to determine blood phosphorus levels, so you will need to work with your veterinarian to choose the best course. It is best to try to keep the phosphorous level in the blood to within the normal range or only slightly above.
 
要限制磷的攝取量,可以藉由在食物中加入熟蛋白來達成,因為熟蛋白可以稀釋磷的總含量。熟蛋白的蛋白質含量很高,但磷很低。每100公克的熟蛋白,磷含量是15毫克(1000毫克等於1公克)。和其他食物相比,每100公克的生雞肉,含有198毫克的磷;每100公克的生牛肉,含有177毫克的磷(註七)。也可以使用降磷藥。把降磷藥加在食物中,可以阻止食物中的磷被吸收進入身體和血管(註八)。要抽血檢查才能知道磷指數。所以你必須和獸醫合作,以決定多久檢查一次。最好把磷指數維持在正常範圍內,或是只有略高於正常值。
 
Limiting protein is still sometimes used in cats with advanced kidney failure, but it has been my professional experience that diuresis helps these cats much more than protein restriction. Diuresis can be accomplished either at home with subcutaneous fluids or in the clinic with intravenous or subcutaneous fluids. Good hydration is a key element in helping cats with kidney disease. You can tell a human with kidney disease to be sure to drink plenty of extra water, but unfortunately you can't do that with your cat. We have to resort to other ways to accomplish extra fluid intake. Increasing water intake through food or, if necessary, through fluids given under the skin, can go a long way towards decreasing the stress on the kidneys and slow the progression of the disease.
 
限制蛋白質攝取,有時候依然會被使用在腎臟受損比較嚴重的貓身上,但就我個人的經驗,補充水分比限制蛋白質的攝取更有幫助。補充水分可以採取居家皮下注射,或是在醫院進行靜脈或皮下補充水分。良好的含水量在幫助貓面對腎臟問題時,是一個關鍵因素。一個得了腎臟病的人類,你可以跟他說要多喝水。但很不幸的是,貓不會聽你的話而去多喝水,所以我們得用別的方式來達成。可以讓貓從食物中攝取水分,或是,如果必要時,藉由皮下注射來達成水分補充,減少腎臟壓力,進而延緩病程。
 
Feline Lower Urinary Tract Disease/FLUTD
 
貓科下泌尿道疾病(簡稱FLUTD)
 
Water intake affects more than just a cat's kidneys, and kidney function plays a role in other urinary problems. The normal instinctual diet of the feline consists of prey animals that are high in protein, have moderate amounts of fat, and little if any carbohydrate. The typical prey animal for a housecat, usually a rat or mouse, consists of approximately 50 to 60% protein, 15 to 30% fat on a dry matter basis and 70 to 80% water. This indicates that 70 to 80% of the cat's natural instinctive diet should consist of water.⁹

攝取的水量不只是影響貓的腎臟而已,腎臟功能和其他尿液問題也有關聯。貓出於本能而吃下去的食物含有很多蛋白質,中等程度的脂肪,很少的碳水化合物,如果有的話。家貓的典型獵物,通常是老鼠,含有50-60%的蛋白質,15-30%的脂肪(前述數字皆為乾物比),以及70-80%的水分。這表示符合貓天性的食物,應該含有70-80%的水分(註九)。
 
譯註:
複習一下美國飼料管理協會(AAFCO)制訂的貓食營養標準:(成貓)蛋白質26%,脂肪9%。AAFCO沒有要求碳水含量,換句話說碳水含量高達65%都是合法的。如此的營養組合距離貓的獵物老鼠這麼的遙遠,竟然是合法的!嘖!
 
A quick search of any pet food website regarding the moisture content of most dry cat foods will tell you that they are generally only 8 to 10% moisture. Cats fed a dry diet exclusively are at a significant water deficit compared to cats eating a natural diet. They are only consuming about 12 to 15% of their ideal daily water intake in their food. You may think that the cat can make it up by drinking more water, but cats innately have a low thirst drive, as they evolved to eat prey consisting of so much moisture.¹⁰
 
看一下寵物食品公司的網站,你會發現大部分的乾飼料含水量只有8-10%。和吃天然食物的貓比較起來,只吃乾飼料的貓水分攝取量少很多。乾乾貓從食物中獲得的水量,只有理想飲水量的12-15%而已。或許你會覺得貓自己會去多喝水以補足,但是貓天生不愛喝水,因為他們天生要吃的是含水量這麼高的獵物(註10)。
 
Feline urine tends to be more concentrated than urine of other mammalian species. This is one reason that the urine of intact male cats has such a strong odor.¹¹ The fact that cats produce such highly concentrated urine, especially when fed low moisture foods such as kibble, makes them more susceptible to urinary crystals and stones and to urinary bladder irritation, a contributing factor to Feline Lower Urinary Tract Disease or FLUTD. Basic chemistry tells us that the more concentrated a solution is, and in this case the solution is urine, the more likely any solutes are to precipitate out and form crystals and stones. The more concentrated the urine is, the more likely it is that it may irritate the delicate lining of the urinary bladder.
 
和其他哺乳動物相比,貓的尿液比較濃縮。這是未結紮公貓的尿味很濃的原因之一(註11)。貓尿已經很濃縮,吃含水量低的食品,例如乾飼料,貓尿會更加濃縮,更容易形成結晶和結石,刺激膀胱,造成貓科下泌尿道疾病(簡稱FLUTD)。基本化學知識告訴我們,溶液的濃度越高,就本文而言此溶液指的是尿液,溶解物越可能會沈澱進而形成結晶和結晶。尿液越濃縮,越有可能刺激脆弱的膀胱壁。
 
An important component of the recommended treatment of FLUTD cats is the feeding of canned food or raw foods exclusively, which are about 70% moisture. This increases the cat's water intake, dilutes the urine and decreases the probability of crystals.¹² Raw diets, which contain adequate moisture as well as appropriate amounts of protein and fat, can also help cats get back to a more natural urinary balance of pH and urine concentration. A study of the urine of 198 feral cats eating a natural, raw diet found no evidence of urinary stones in any of the cats.¹³
 
被建議用來治療FLUTD貓的一個重要方式,是餵貓吃含水量有百分之七十的全濕食或生食。提高貓的飲水量,稀釋尿液,降低結晶的可能性(註12)。生食不但含有充分的水量,還有適量的蛋白質和脂肪,可以幫肋貓咪回復比較自然的尿液酸醶值和濃度。根據一份針對一百九十八隻吃全生食的野外貓所做的研究,沒有任何一隻貓有尿路結石的跡象(註13)。
 
Recent research has suggested that higher protein in the diet may help to decrease the occurrence of struvite crystals and stones for two reasons. With increased protein, less magnesium is excreted in the urine, and the increased protein causes an osmotic diureses. Water is drawn into the kidneys and makes the cat urinate more.¹⁴ Additionally, "Dry cat foods with their high plant content, cause a very alkaline urine pH…This unnaturally high concentration of minerals and other constituents in the urine along with alkaline pH, leads to UTI (Urinary Tract Inflammation)."¹⁵
 
最近的研究顯示,基於兩個理由,食物的蛋白質含量高時,可以幫助減少磷酸銨鎂結晶和結石的形成。一)蛋白質提高後,比較少的鎂從尿液被排出;二)高蛋白質會造成滲透性利尿。水分被吸引至腎臟,貓小便的頻率因此提高(註14)。再者,乾飼料的植物含量高,形成非常鹼性的尿。尿液中的礦物質和其他成分,讓貓尿不自然的高度濃縮,再加上高醶性,貓的泌尿道因此而發炎(註15)。
 
For my patients, I do not recommend the feeding of the special prescription diets that contain added synthetic substances to artificially control the pH of the urine. Treating urinary problems in this way may contribute to kidney disease, as recent evidence has suggested that the low magnesium content of these diets may have a detrimental effect on the kidneys over time.¹⁶
 
我不建議我的貓病患吃泌尿道處方食品,因為當中含有合成物質,以人工的方式控制貓尿酸鹼值。以這種方式治療泌尿道疾病,可能日後會造成腎臟病,因為最近的研究顯示,低鎂食品可能會慢慢的對腎臟造成有害的影響(註16)。
 
Dry cat food has only been around for about the past 70 years. During that time period, allergies, urinary problems, digestive problems and kidney disease in cats have all increased. This is in part due to better diagnostics and cats living longer, but it is my professional opinion that the widespread feeding of dry kibble diets plays a significant role.
 
貓乾飼料只有七十年的歷史。在過去的七十年,貓的過敏、泌尿問題、消化問題和腎臟病的病例都增加了。部分的原因是良好的診斷和貓比較長壽,但就我個人專業意見,貓乾飼料被廣泛的使用也是一個很重要的原因之一。
 
(全文完)
 
譯者個人經驗:
百吉在二零一一年四月被醫生診斷為慢性腎衰竭。
 
二零一一年六月我跟美國獸醫莉莎.皮爾森(Lisa Pierson)做線上諮詢,取得百吉的腎貓食譜,食譜的磷含量極低,每一百大卡只有67毫克。
 
二零一一年十月我換了醫生尋求第二意見,第一次看診醫生就開了降磷藥給百吉服用,即使百吉的磷指數還在正常值內。服用兩週後回診crea 有下降。第二個醫生說不用限制蛋白質的攝取,因為絕對肉食動物最需要的養分是蛋白質,需要限制的是磷含量。當時我並不明白腎貓不需要糾結於蛋白質含量,重點是磷。反觀第一個醫生除了要求我換處方乾料以及定期回診外,沒有開任何藥物,對健康貓或腎貓的營養需求沒有任何知識。我以為捨近求遠花比較多的錢,買到是比較進步的知識,沒想到竟是落後的知識,我開除了他。
 
二零一二年我讀了貓書「你的貓」,獸醫作者伊莉莎白.哈吉肯斯描述治療腎貓時,糾結在蛋白質是畫錯重點,控制磷才是關鍵。
 
二零一六年八月,我翻譯的文章「磷是腎臟的關鍵」指出沒有任何研究顯示,僅僅嚴格的限制蛋白質攝取量就可避免腎臟惡化。低磷才是腎貓食物重點。文章連結:http://blog.sina.com.tw/fabulous/article.php?pbgid=3388&entryid=643035
 
把今天這篇文章算進去,總共有五位不同的醫生認為低磷才是腎貓食物重點。
 
如果你有腎貓,而且醫生卡關在蛋白質,不明白控制磷的重要,建議你換醫生。
 
另外,在「你的貓」一書中,作者提到本身使用活性維他命D3(Calcitriol)治療腎貓效果不錯。在我的臉書自製貓食討論區中,有一位貓友分享過她的初腎貓接受D3的治療,crea  指數有很明顯的改善。「你的貓」一書出版於2007年,可見十年前美國就有獸醫採用此療法,但台灣的西醫落後於西方國家也不是新聞了,人醫如此,獸醫更是,所以到目前為止我知道台北只有兩個醫生會採用此一療法,兩位都是女醫生,有興趣的貓友自行 google 可以找到這兩個獸醫的資料,其中一個好像是台大的腎臟權威之類的。西醫是西方醫學,西方醫學的研究報告與重大發現當然都是用英文發表,如果你的獸醫英文不好又不上進,呃,那就讓他/她看看小病就好。
 
 
 我習慣在自製生肉泥淋上罐頭湯當作調味料,而且每天都會變化罐頭
自製貓生食是全世界最棒的貓食物
祝大家週末愉快

Dr. Elisa Katz, DVM, is a graduate of Ohio State University and is the owner of Natural Pet Animal Hospital in Bourbonnais, Illinois. She practices holistic and integrative medicine focusing on proper diet and nutrition. Dr. Katz shares her home with four kitties and one dog.

本文作者獸醫伊萊莎。卡茲(Dr. Elisa Katz)畢業於美國俄亥俄州立大學(Ohio State University),目前在伊利諾州(Illinois)的 Bourbonnais 經營一家名為「自然的寵物動物醫院」(Natural Pet Animal Hospital)。她的執業是以整體和綜合醫學為主,重點在適當的食物和營養。卡茲醫生家中有四隻貓一隻狗。

 
 1. Timothy A. Allen, David J. Polzin and Larry G. Adams, "Renal Disease," Small Animal Clinical Nutrition, 4th ed. Walsworth Publishing Company, 2000, 582.
 2. K.L. Hughes, M.R. Slater, S. Geller, W. J. Burkholder and C. Fitzgerald, "Diet and Lifestyle Variables as Risk Factors for Chronic Renal Failure in Pet Cats," Preventive Veterinary Medicine,no. 55, 2002, 1-15.
 3. D.R. Finco, S.A. Brown, C.A. Brown, W.A. Crowell, G. Sunvold and T.L. Cooper, "Protein and Calorie Effects on Progression of Induced Chronic Renal Failure in Cats," American Journal of Veterinary Research 59, no. 5, May 1998, 575-82.
 4. Kenneth C. Bovée, DVM, MMedSc, "Mythology of Protein Restriction for Dogs with Reduced Renal Function," Supplement to Compendium on Continuing Education for the Practicing Veterinarian 21, no. 11, 1999, 15-20.
 5. "The Biologically Appropriate Food Concept and the Dietary Needs of Dogs and Cats," ORIJEN White Paper, Proceedings, Purina Nutrition Forum, University of Pennsylvania, 1998. 
 6. L.A. Ross, D.R. Finco and W.A. Crowell, "Effect of Dietary Phosphorus Restriction on the Kidneys of Cats with Reduced Renal Mass," American Journal of Veterinary Research 43, June 1982, no. 6, 1023-6.
 7. USDA National Nutrient Database for Standard Reference, Release 23, 2010.
 8. Peter J. Markwell, BSc, BVetMed, MRCVS, "Recent Advances in the Dietary Management of Chronic Renal Failure in Cats," Proceedings of the 23rd Waltham/OSU Symposium, 1999, 50-54.
 9. Ellen S. Dierenfeld, PhD,  Heather L. Alcorn, BS, and Krista L. Jacobsen, MS, "Nutrient Composition of Whole Vertebrate Prey (Excluding Fish) Fed in Zoos," U.S. Department of Agriculture, May 2002.
 10. Michael W. Fox, Elizabeth Hodgkins and Marion E. Smart, Not Fit For a Dog: The Truth About Manufactured Dog and Cat Food, 2009, Quill Driver Books, 107.
 11. A.D.J. Watson and H.P. Lefebvre, "Using Urine Specific Gravity,"International Renal Interest Society, 2007.
 12. Peter J. Markwell, C. Tony Buffington and Brigitte H. E Smith, "The Effect of Diet on Lower Urinary Tract Diseases in Cats," The Journal of Nutrition, no. 128, 1998, 2753S-2757S.
 13. Y. H. Cottam, P. Caley, S. Wamberg and W. H. Hendriks, "Feline Reference Values for Urine Composition," The American Society for Nutritional Sciences, The Journal of Nutrition, no. 132, June 2002, 1754S-1756S.
 14. M. Hashimoto, M. Funaba, M. Abe and S. "Dietary Protein Levels Affect Water Intake and Urinary Excretion of Magnesium and Phosphorous in Laboratory Cats," Japanese Association for Laboratory Animal Science, Experimental Animals 44, no. 1, January 1995, 29-35.
 15. Michael W. Fox, Elizabeth Hodgkins and Marion E. Smart, Not Fit For a Dog: The Truth About Manufactured Dog and Cat Food, 2009, Quill Driver Books, 107.
 16. K.L. Hughes, M.R. Slater, S. Geller, W.J. Burkholder and C. Fitzgerald, "Diet and Lifestyle Variables as Risk Factors for Chronic Renal Failure in Pet Cats," Preventive Veterinary Medicine 55, no. 1, September 10, 2002,1-15.


 


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