In the second part of this two-part series, I will discuss in great detail my holistic approach to cats with Inflammatory Bowel Disease. If you missed the first part, check it out! I discussed the diagnostic process. In this article, I will discuss diet, supplements, and pharmaceutical interventions. Let’s dig in!
You are entering the process of treatment with either a diagnosis of inflammatory bowel disease (IBD) or a suspected diagnosis of IBD. In my practice, many pet parents begin trial treatment after the ultrasound. If the disease has caused progressive and severe weight loss, many will have a diagnosis via endoscopy. Please work with your veterinarian to make a plan that is appropriate for your pet.
Diet
In my experience, this is where cats with severe IBD differentiate themselves from cats with more mild disease. Cats with more mild disease may see immediate relief with diet alone. Cats with more severe disease often need treatment beyond diet.
Low Carbohydrate Diet
This is the easiest place to start. I recommend using a grain-free canned or raw preparation. More about raw diets in the next section. Some cat’s symptoms of vomiting and diarrhea resolve immediately after being placed on a grain free, low carbohydrate diet. Even kibbles that are labeled grain free may contain too many carbohydrates. In order to make a kibble crunchy, a carbohydrate source such as pea or potato is used. Eliminating this carbohydrate source can be transformative.
Raw Diets
While these diets are quite controversial, I have seen absolute improvement for cats with digestive problems. On the flip side, some cats become worse on these diets. You don’t really know until you try. Some cats love raw diets while others absolutely refuse to eat them. Many cat parents make the mistake of forcing their cats to eat raw food without slowly transitioning. The approach of not offering any other food in hopes they will ‘break down’ and eat the raw food can be dangerous. Cats will refuse to eat for so long that they can develop deadly liver disease. Don’t let your cat go hungry.
If you are using a freeze-dried option, make sure that you add water. Also, it is much safer to feed commercial preparation of raw food than go to the supermarket and buy raw meat off of the shelf. Stella Chewy’s is definitely a favorite. If your cat has pancreatitis, be sure to discuss the ideal fat content of your cat’s diet with your veterinarian.
Prescription Diets
In severe cases or cases where we can’t find relief with other diet, prescription diets can be of some use. In my hands, these are the cases that are extremely severe. My own cat, is one of these cases. It is important to understand the different classes of prescription diets for treating IBD. If possible choose the canned version of these foods.
- Novel Protein Diets. This is thought to be the most effective form of diet therapy for IBD in cats. In practice, I have had mixed results. The concept is that you are feeding your cat a protein source that they have never had before. It is less likely, although possible for your cat to have an immunologic response to this new protein. My preference is the Royal Canine line of canned novel protein diets. I use the canned rabbit, duck and venison. If your cat doesn’t have pancreatitis, I generally start with the duck. You can also try novel proteins in nonprescription forms. Keep in mind that most pet foods (besides prescription) contain some level of cross-contamination. This means that other ingredients, not listed in the ingredient list, may be found in the foods. This happens when manufacturing lines are shared and not properly decontaminated. This may not be a problem for all cats as trace amounts may not cause a reaction. For those extremely sensitive cats, this can cause much confusion. That’s why I start with prescription versions and then move to other formulations if the prescription food was successful.
- Hydrolyzed Diets. The body’s immune system recognizes/reacts to protein. Think of a protein has a strand of pearls. Each pearl is an amino acid. The larger the protein, the more reactive it is thought to be. Hydrolyzed diets are made when we take a protein (pearl strand) and break it into smaller strands of amino acids (pearls). Smaller proteins are less reactive and produce less inflammation. My recommendation is Hill’s canned z/d.
- Amino Acid Diets. This is taking the hydrolyzed diet to the next level. Here the protein (strand of pearls) is broken down into individual amino acids (pearls). This is the least allergenic form a protein possible. Royal Canin makes a diet called Ultamino. They just came out with a version for cats that only comes in kibble. I have not yet tried this diet in practice. If you choose this diet, add water if possible.
- Gastrointestinal Diets. Royal Canin makes a few canned varieties that are more digestible but are not hydrolyzed. They make a high calorie version that I found to be helpful in putting weight back on cats that have become emaciated. Again, these are for more severe cases. My own kitty was one such case. When everything else failed, prednisone and the Royal Canin high calorie canned food saved his life.
Supplements for Inflammatory Bowel Disease
- Probiotics. Most cats with digestive disease have some form of dysbiosis or imbalance of gut bacteria. As we learn more about the microbiome (all the bacteria in the digestive tract and skin) we are understanding what an important role it has in inflammatory disease. What we don’t know yet is what causes some cats to have dysbiosis while other do not. I suspect there is a strong genetic component that may be activated by some external factor. Supplementing with good bacteria (probiotics) can be very helpful. What we don’t know is which strains of bacteria are the most helpful. In my experience, this answer is very individual.
Here are two sources that I use. Please keep in mind that there are many other great sources of probiotics.
Rx Biotic by Rx Vitamins for Pets
- Vitamin B12 Supplementation. Most cats with intestinal disease are deficient in vitamin B12. This occurs because they cannot absorb nutrients properly through the intestinal lining. This is extremely easy to supplement through subcutaneous injection. This is given right under the skin with a very tiny needle. For the most severe cases, once weekly administration may be necessary. For less severe cases or for maintenance, once monthly injections are adequate. Talk with your veterinarian about supplementation and learn how you can do it at home.
- Vitamin D Supplementation. There is a growing body of evidence that is correlating low vitamin D levels to inflammatory conditions in cats and dogs. Vitamin D is easily tested and supplemented. I use VDI laboratories to test blood levels of vitamin D for cats and dogs. Your veterinarian can easily order these test kits. I use Rx Vitamins for Pets RxD3 as a supplement. It can be dangerous to supplement without first checking your cat’s blood levels of vitamin D. This vitamin is stored in the fat and excess amounts are not easily flushed from the body.
- Omega 3 Fatty Acids. Talk to your veterinarian about using moderate to high doses of these fatty acids to reduce inflammation. Depending on your cat’s pancreatic enzymes and current diet, your veterinarian will be able to help you maximize the dose of fatty acids safely.
- Vitamin Supplement. As we discussed earlier, your cat may not be absorbing nutrients as efficiently with all the intestinal inflammation. If your cat tolerates supplementation, I recommend using Rx Essentials for Cats Multivitamin by Rx Vitamins for Pets.
- Chinese Herbal Remedies. There are many great herbal formulas that can be helpful for cats with intestinal inflammation. Find a practitioner of Traditional Chinese Veterinary Medicine near you through IVAS or The Chi Institute.
Pharmaceuticals for Inflammatory Bowel Disease
- Steroids. Ugh, I know. No one wants to use steroids. Check out my article on a more holistic approach to steroids here. I recently started my own cat on steroids for IBD. Trust me, I did everything I could to avoid this. He was miserable and wasting away and constantly hungry. Starting him on prednisone is the best thing I could have done for him. Two months later he is gaining weight, he is happy and relaxed. Oral steroids (prednisone or prednisolone) are a common initial treatment for IBD. They can be used to gain rapid control of intestinal inflammation. Long-term use of prednisone in cats can cause an increased risk of developing diabetes. For that reason, I generally try to use another steroid, budesonide, after I gain control of symptoms with prednisone. This steroid is poorly absorbed by the GI tract and therefore there is less risk of developing diabetes. Steroids are only indicated in the moderate to severe cases of IBD. It is my opinion, that these are a small percentage of cats with IBD. Read more about my holistic approach to steroids.
- Cerenia. This is an anti-nausea medication that is being used for IBD in cats. It can greatly reduce vomiting and might help reduce pain in the belly. Ask your veterinarian if this drug might be a good addition to your cat’s protocol. I have used it many cat patients with no known side effects.
- Metronidazole. This is an antibiotic that has anti-inflammatory properties. For cats with chronic diarrhea, this is sometimes helpful in firming up stools and managing chronic inflammation. Your veterinarian may recommend long courses of metronidazole to help modulate inflammation of your cat’s intestinal tract.
Deep Breaths! That was a lot of information!
Adding a holistic veterinarian and an internal medicine specialist to your team can be valuable when treating inflammatory bowel disease in cats. Listen to everyone’s opinions and remember to keep an open mind. This is a disease that is best managed with an integrative approach.
With love,
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Hello! My cat Rio is 14 years old and as of recently has been diagnosed with IBD.
It all started 4 months ago when he lost his appetite, started vomiting in the morning and developed a chronic diarrhea that still hasn’t passed.
When it all started we did a stool sample test and it came back with Escherihia Collie present in the stool.
Last year we had a similar situation where the Eserihia was causing pancreatitis and we fixed it with antibiotics.
However, the vet we see now has a very holistic approach and is against antibiotics and steroids.
She started us off with D-Manozin + probiotics + vitamins, and a gradual change from kibble to raw food. We did this for a few weeks and Rio started to be better, even the stool firmed up – but this only lasted a few days and he was back to not eating and diarrhea.
Next we convinced her to try antibiotics – two week treatment, also gave results in firming up the stool, but the day after we stopped giving them to him, his diarrhea came back.
Finally, they said it could be IBD and we tried two doses of corticosteroid Dexafort – that also seemed to give some results, the stool formed up a little bit, though it was less frequent significantly, his appetite was back, and generally seemed better. No weight gain though.
After the second week, she advised we stopped as they are only a “short-term solution” and go back to the first advise she gave us – just the support of the gut flora.
Rio is still not better, he eats little and rarely, some days doesn’t have appetite at all, and the diarrhea is back. I don’t know if we should insist on returning him on the steroids, if they will do him more harm than good. He has lost half his body weight and we are very scared for him.
Can you help us please?
Hi Mihailo. What you and Rio are experiencing is so challenging and I just want you to know that you are doing a fantastic job of advocating for him. We definitely want him to feel better than he does currently. Because this is a bit more complex than what can be answered here, I want you to know that we have some great resources for supporting kitties with vomiting/diarrhea/IBD. Dr. Angie just hosted a course on this topic and it is available for purchase at https://naturalcatvet.com/dr-angies-holistic-approach-to-vomiting-and-diarrhea-in-cats/
She also offers video consultations and can provide a full medical review for Rio. These can be very supportive and help you feel confident in how to move forward. You can find the video consultation link on our website. I hope this helps in some small way and that we can further support you and Rio. Hugs, JoJo, Veterinary Nurse.
Really appreciate this post and Part 1 where you explained the best diagnostic tests for IBD/potential lymphoma.
My cat is 16 years old, male, recently diagnosed with hyperthyroid by my conventional (and very expensive) vet.
I was talking to a holistic healer (not a vet, more like an animal whisperer) and he told me hyperthyroid cats tend to suffer from leaky gut. This would make sense, as I fed my dry food for the first 14 years of his life– until 2 years ago when I learned how dehydrating kibble is.
He understands my reluctance to give my cat prescription medication (methimazole), so he suggested I focus on healing my cat’s gut with better diet & probiotics (kefir to start).
Do you see a possible connection between hyperthyroid & leaky gut in cats, or is my holistic friend off his rocker?
Hello!
I think working on gut health is never wrong. However, I think hyperthyroidism most likely has a genetic and environmental component. There may be a correlation between fire retardants in furniture/flooring and hyperthyroidism in cats. I don’t think working on your cat’s intestinal permeability will cure the thyroid disease. I like using iodine therapy to give cats a chance at a complete and lifetime cure. This means no long term medications. There are some cases when Traditional Chinese Medicine can reverse early thyroid disease. What is your kitty’s T4?
With love,
Dr. Angie
Hello after many test my vet has ruled that my cat has IBD but so far even prescription food has only helped her a little. I’m wondering if she has IBD because the only symptoms she has is loose stool and always hungry. She is extremely over weight and I have tried to get her to loose weight for 2 years now with no luck. Is it possible to have a cat with IBD and be extremely over weight? Thank you.
Hi Valerie,
I think anything is possible. Has an abdominal ultrasound or biopsy been done as well?
This is so challenging. Sending both you and your cat so much love.
Warmly,
Claire
Hi Dr. Angie, Thank you for your very informative article on inflammatory disease in cats. My make 7 year old male cat possibly has IBD or low grade lymphoma. He is extremely thin even though he eats. He has been on .05 mg of PrednisOLONE (transdermal) for about 1 year and I just started him on a liquid B12 supplement because he wasn’t tolerating B12 pills. He tolerates the liquid B12 that I put on his. I’ve noticed since liquid supplementation his fur is shinier and his appetite has greatly increased. When I increase his food thought to satisfy his appetite ( and also to help him gain weight), he vomits. It’s a real catch 22. How can I help him ? I’m currently feeding him Hills prescription id (digestive care). I’m wondering if the Royal Canin high cal diet that you mentioned in your article would help him gain weight. Maybe adding CBD to his diet as well? If you think the Royal Canine high can diet is worth a try where can I find it? I only found “Royal Canin Gastrointestinal Moderate Calorie” on line. Or is this the same thing? Thank you so again for your article and for any advice you can pass along. Sincerely ~ Anne
Hi Anne,
Thank you so much for reaching out. I am so sorry that your kitty struggles with vomiting, IBD (and I so hope not lymphoma) and maintaining healthy weight.
The moderate calorie vs high calorie Royal Canin are different. If you can find the high calorie, that would probably be a great food to try!
Additionally, I would absolutely love to have Dr. Angie answer this question directly. That said, may I have her do so via her upcoming Instagram Live Q&A?
These Live Q&As stay up indefinitely, so you can also just watch the replay through her page here.
I also believe other cat parents would benefit from her response!
Let me know and big hugs.
Warmly,
Claire
My 3 yr old Persian had a severe case of IBD. He had a pyloric mass of polyps. Two vets were certain it was cancer. After extensive tests, no cancer detected. His primary put him on .3ml prednisolone, then we lowered to .125. He was on it for 5 months and did exceptionally well. He had tons of energy, gained his weight back and looked great. His tumor shrank over 50%. HOWEVER, the prednisolone affected his heart and sent him into congestive heart failure. I rushed him to the ER and almost lost him. After the diuretics and blood thinners a week later his heart was back to normal with a mild case of HCM. He’s off the blood thinners now and his diuretic dose has been lowered. But, he’s lost weight and is not the same playful cat. I cannot put him back on steroids, it’s a catch 22.
There needs to be extreme caution and consideration when using steroids. I am hoping to find an alternative to keep the IBD at bay. He’s been off the steroid for three weeks and hasn’t thrown up his hydrolyzed protein, but then again, he’s not eating as much since the diuretic has a loss of appetite side effect. He has an ultrasound and cardiogram in a few weeks to assess what the overall treatment should be.
Hi Tricia,
Oh my goodness, how terrifying! Thank you so much for sharing your experience with us!
Warmly,
Claire
Thank you, this was incredibly helpful. My cat may be suffering from IBS, however he experiences chronic constipation, not diarrhea. Do you have any recommendations for constipation? He eats only wet food high protein.
Hi Penny,
What is his diet? Does he get a lot of moisture? You can also try some canned pumpkin, if you haven’t taken that route yet!
Keep us posted!
Warmly,
Claire
I’m curious what is getting a lot of moisture in the context of an all wet food diet? I do understand some wet foods can be quite dense, aside from pumpkin and fresh drinking water are there other other ways to hydrate?
Hi Mark!
Canned food definitely has a lot more moisture content than dry, so that’s a great place to start! Experimenting with increasing water consumption (tips here) is also an excellent way to boost hydration. Flavoring water or adding warm water to wet food can also help.
I hope this helps!
Warmly,
Claire
Thank You for this article. It was very helpful and informative. I didn’t see anything in regards to digestive enzymes. Do you recommend them for kitties with IBD?
Hi Mercy,
Thank you for reaching out!
We love the RxZyme for digestive enzymes. If you are trying multiple things (different supplements, diets, etc), make sure you are trying one at a time. This way, if you are seeing results, you know exactly where they are coming from.
I hope that this helps!
Warmly,
Claire
This was amazingly informative – and easy to understand. Thank you so much for this. Would you happen to have any vets in the Chicago area you would recommend?
Hi Sarah,
So glad to hear that this was helpful!
We don’t know any veterinarians in the Chicago area unfortunately. 🙁
However, I would check out both of these sites for veterinary resources:
1) American Holistic Veterinary Medical Association (under the “find a vet” tab).
2)TCVM (under “resources”).
I hope that this helps!
Warmly,
Claire
Hello Dr Angie,
My cat is 14 and was diagnosed with IBD when he was 9 but has had symptoms all his life. He takes prednisolone and probiotics every day but recently I’ve noticed his pain and his diarrhea is getting worse. He is on prescription food as well, wet and dry. He cries in pain and rarely makes it to his box in time. I don’t want to increase his prednisolone, what can I do to help him? I’ve been researching CBD oil but I’ll honestly try anything if it will help. Thank you!
Hi Jennifer,
I’m so sorry to hear about your kitty’s IBD diagnosis.
Have you consulted with a veterinary internal medicine specialist? This may be a great addition to your guy’s team!
We definitely see CBD help with IBD related symptoms! For cats, we usually recommend HempRx and our dosing chart is here.
I hope that this helps! Please keep us posted!
Hugs,
Claire
Dr Angie, my cat is on half Metronidazole and half Flagyl 250mg every other day. His diarrhea was stabilized but worsened recently. Can I use CBD while he’s taking the medication?
Hi Kimji,
Good question!
We have not seen any negative interactions when giving these medications and CBD together.
I hope this helps!
Warmly,
Claire
Hi Dr. Angie,
My kitty was tentatively diagnosed with IBD after a number of the tests you recommend. Her only real symptom is weight loss, but we decided to treat her for IBD to see the results. I have been giving her Prednisolone for about 6 months and is essentially stable. She is 15 years old and also has FIV. I very recently started giving her 1 drop daily of the CBD oil I got from you and acts much more comfortable, so I am going to make it 2 drops per day. Other than the additional treatments you recommend, which I will work on, is there anything specific you would recommend for an FIV patient? Thanks, Gail
Hi Gail,
You are doing a great job!
We are absolutely thrilled to hear that the CBD has helped your girl so much.
Another supplement that may be worth checking out is ImmunoSupport. This is a nice mushroom blend that helps support immune function. With FIV, this may be a great option.
Keep us posted!
Warmly,
Claire
Hi, I found this about AnimalBiome and it couldn’t be more confusing to me! https://www.the-scientist.com/the-marketplace/animalbiome-selects-loop-genomics-to-expand-microbiome-testing-capabilities-to-support-clinically-actionable-decision-making-for-veterinarians-65542
Hi Rachel!
We have seen a few pet parents have great success using AnimalBiome! There is a lot of information showing that fecal transplants are a great way to get better bacteria in the gut!
Warmly,
CLaire
Are you (or anyone else reading this) familiar with or have any experience with a company called AnimalBiome? It’s the same principle as fecal transplants to treat IBD, but administered in pill form. They also offer an analysis of your pet’s microbiome to tell you what probiotics and such they may be lacking and options to optimize their health based on the findings. The science behind it is sound, they’ve got some good press, and there is some anecdotal evidence of it’s effectiveness, but there doesn’t seem to be anything reflecting hard scientific research on the product itself (and it’s a little expensive, ranging around $100-250 depending on what you get). So, as my vet said, while it may not necessarily hurt, it may or may not help. If anyone has had any experience with this product, I’d love to hear about it.
Hi Elle,
Thank you for reaching out!
We have only briefly heard about AnimalBiome, but have not personally used them for their services.
If you give their services a try, will you keep us posted on your experience?!
Warmly,
Claire
Hi Elle- I sent my cat’s stool sample to animalbiome to have his microbiome tested. He has suspected IBD and has been fairly stable on daily prednisolone for 2.5 years now. he is 9 yrs old. His microbiome pattern was definitely different from what they said was a normal healthy cat . Hard to know what exactly to make of the results tho. So after a month or two thinking about it, I ordered their supplements ( prepared from a donor healthy cat) and started my cat on one capsule a day as recommended. It was shockingly easy to pill him using a pill popper! Anyway, on day 4, I get an email from animalbiome to tell me stop using that batch of capsules, because the donor cat had vomited, and erring on the side of caution they wanted to stop using supplements prepared from that donor. They quickly sent me a new batch of capsules to use. This made me very wary and I worried that maybe the capsules I gave my cat would be harmful. then about 2 days later, I noticed that he was having diarrhea- small liquid poops 4 or 5 times a day. First time he ever had that. His butt became sore looking too- a first for him. I am currently keeping an eye on him. Started giving him a little pumpkin with his usual food ( all grain free, wet and dry, different brands) and also some plain good quality yoghurt as a probiotic (which he loves). He seemed to stabilize a bit- not seeing complete liquid poops uncovered in the litter box anymore, but a bit better. Thought he was on the mend and had not brought him to the vet. This evening however, his butt looks sore again, his rear end is all dirty and I notice him going to the litter box 3 times already and each time only a very small bit of runny poop coming out. When I try gently clean him, he yelps a bit. I will make an appointment to bring him into vet as soon as I can. I don’t know if the Animalbiome capsules ( only 3) that I gave him precipitated this or not, but it is a big coincidence, However, complicating things too is the fact that I had started brining him out on a harness-just around my house and yard the last two weeks- which he loved! He became accustomed to that very quickly and begged to go out all the time. Maybe he picked something up out there to cause his diarrhea? I don’t know. All I know is that now he has this new uncomfortable toilet issue and I am spending all my time trying to fix it. I will say that animalbiome have been very responsive to my questions and concerns and explained how they screen donor cats and screen samples for pathogens etc. I think it is early days for this potentially promising fecal transplant therapy, but the fact that donor cats health can fluctuate after being used as donors is always goings to be a problem. I too would love to hear from others that have tried this in their cats for IBD. My other question is whether it would be expected for a cat with suspected IBD on long term steroid use be likely to eventually progress from soft serve poop to liquid diarrhea?
Eileen
Hi Eileen,
Thank you for sharing your experience!
Warmly,
Claire
Eileen,
Your comment was from 2019 so you might not see my reply, but I’m curious if you continued with the fecal transplant pills for your cat?
Would you recommend it in 2023? I dont think I can afford the testing or the pills, but it does sound promising for hard-to-treat cats.
I wonder if it’s normal for a kitty to have runny poops when you first start them on those pills? How long are you supposed to administer them? Is it a week long supply, or something they take everyday over the long term?
You sound like a very loving pet owner. I hope your kitty’s health issues improved.
My cat has been diagnosed with IBD and potentially lymphOma. He is on a raw food diet which has helped but he continues to loose weight and throws up occasionally. I have heard that hemp and or CBD oil can help. I live in CO and have access to these products. Can you please suggest some products that can potentially help? I would like to get him started on something as soon as possible. I rescued him about three months ago and he’s been sick the entire time I’ve had him. He’s about 10 years old and I feel bad that it took me this long to schedule an ultra sound which revealed his diagnosis. I would like to get him started on some type of CBD oil or anything else you suggest.
Thanks and I’m so thankful I found your website.
Gina
Lolany07@gmail.com
Hi Gina,
Yes, we have absolutely seen CBD help with IBD cases!
For kitties, we recommend HempRx and our dosing char is here.
I hope this helps! Please keep us posted!
Warmly,
Claire
Dr. Angie, this is so so so helpful. Do you have any experience with Licorice Root extract in cats for managing acute flares of mild IBD, with its very mild steroid activity & anti-inflammatory action?
I’ve never heard of licorice root extract. I did purchase the CBD oil from your website last night. Can I give him both the extract and the CBD oil at the same time?
I left a message for my vet but still have yet to hear back from her. As of right now he’s not taking a steroid which I hear can help him. I’ve been giving him hemp oil with a little CBD and he seems to be doing better.
Where can I purchase the Licorice extract.
Gina Writz
lolany07@gmail.com
Hi Gina (and Gina)!
I’m sorry that we are just seeing this initial comment!
Dr. Angie has definitely used licorice root, however she hasn’t used it by itself. We generally recommend Nutrigest ensure you are using deglicerized DGL kind. Nutrigest has it, which has licorice as well as many other great ingredients for gut healing.
When and if you are searching for licorice, just ensure you are using the deglycerolized (DGL).
I hope that this helps!
Warmly,
Claire