the scientific study of pet nutrition by veterinary nutrition specialists and experts.

Double Trouble: What’s The Best Diet When Your Pet Has More Than One Disease?

Double Trouble: What’s The Best Diet When Your Pet Has More Than One Disease?
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We’re written before on the benefits of therapeutic diets for pets with medical conditions, such as heart disease, kidney disease, bladder stones, or obesity.  For many diseases affecting dogs and cats, nutrition is an important part of the overall medical therapy.  In many diseases, optimizing a pet’s nutritional plan can not only make the patient feel better but can sometimes help to improve the underlying disease.  Although there are therapeutic diets designed for pets with a particular disease (kidney disease, for example), there is not a single diet that is appropriate for all pets with kidney disease.  Instead, it’s important to consider animals as unique individuals and to feed them according to the underlying disease and their unique characteristics, such as their symptoms, test results, and physical features like body condition score and muscle condition score.

But what happens if your pet has more than one disease?  Many dogs or cats have more than one health condition that may benefit from nutritional changes and this makes selection of an optimal diet even more complicated.  A common example is cats with lower urinary tract disease, such as idiopathic cystitis or bladder stones.  For cats with this urinary problem, our nutritional goals are to feed a diet that will help dilute the cat’s urine, and that will also modify the urine’s properties so that the cats are less likely to re-form stones (although it’s also important to make changes in the cats’ environment).  Many of the therapeutic diets for this condition are high in sodium because that helps to dilute the urine (because cats will drink more water).  But if a cat with lower urinary tract disease also has heart disease (which is a fairly common combination), then we need to feed a diet that is lower in sodium in addition to the nutritional changes needed for the urinary disease. Some of our patients have four or five different diseases that may benefit from nutritional changes which can make things very challenging!

To determine the best diet, I assess the pet for their body weight, body condition score, muscle condition score, and collect current diet information.  I also review the medical history, physical exam, and test results. Then, I make a list of nutritional goals for each disease.  Most diseases do not have conflicting nutritional goals and we can come up with one or more diets that address all of the pet’s needs (more on when there are conflicting goals later).  The diet option may or may not be a therapeutic diet.

In the last several years, a number of therapeutic diets have been developed that address two diseases at once.  A few examples include diets for pets with kidney disease and arthritis; those with food allergy plus urinary disease; or overweight pets with urinary disease.  These can be great options but not always optimal for every pet.  Depending on your dog or cat, the diet marketed for her combination of diseases may be too high in calories or fat, or too low in protein or other nutrients.  In these cases, talking to a Board Certified Veterinary Nutritionist® can help to individualize a nutritional plan for your pet (

In the uncommon situation when a commercial diet that addresses all the goals is not available, nutritionally balanced home-cooked diets that are individualized to your pet’s unique needs can provide more flexibility for pets with multiple conditions.  If you are going to feed a home-cooked diet, it’s critical that it is formulated by a Board Certified Veterinary Nutritionist®.

Occasionally, the nutritional goals for a pet’s diseases conflict with one another.  An example would be a dog that needs a low fat diet for digestive issues but also needs a high calorie diet to maintain weight.  In this situation, we prioritize the goals based on what medical issues are the most serious.  And just as important is to ensure that the pet enjoys his food.  In addition to the pet’s main diet, it’s important to develop a plan for everything your pet eats .  This includes commercial treats, people food, dental products, rawhides and other chews, dietary supplements, and the foods used to give your pet medications.  These can be just as important as the main diet in managing diseases.  For more tips on therapeutic diets, see our post on this topic.

Nutrition plays a critical role in maintaining good health and helping to treat disease which emphasizes the importance of using nutrition in a pet’s overall medical plan.  The more diseases a pet has, the more complicated the plan becomes, but there are more options available than ever before and more Board Certified Veterinary Nutritionists® who can provide expert help.


Dr. Freeman is a veterinary nutritionist and a professor at Cummings School of Veterinary Medicine at Tufts University. She is on the cutting-edge of science, with hundreds of articles in prestigious journals, speaking engagements at national and international conferences, and awards for her scientific achievements. However, she also is passionate about providing objective and accurate information on pet nutrition to veterinarians, pet owners, and other animal enthusiasts.

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