Be Careful With the Internet — A Lesson in Bloat & Torsion (GDV) — CORRECTION 1/26/12!

I am issuing a correction after corresponding with one of the commenters on this post. She’s a fellow vet, and she astutely pointed out an error I made in interpreting the study abstract I used as the basis for some of the numbers.

I stated that the study found an increased risk of 20 and 52% with elevated bowls. The study’s abstract used these exact words:

“Approximately 20 and 52% of cases of GDV among the large breed and giant breed dogs, respectively, were attributed to having a raised feed bowl.”

‘Attributed’ seems to imply that elevation was the cause for GDV in 20 and 52% of the cases in those groups in the study.

Another source specifically stated that an increase in risk of 110% was found with elevated food bowls.

The bottom line, I believe, is as Dr. Leslie said. There are many factors, and we’re best able to help our dogs by addressing more than any single one. Putting too much emphasis on one factor as if it were the only cause or cure is not the best approach.

—–Original Post Below This Line——————————————————–

Now and then, a non-veterinary blog will post something concerning pets or veterinary medicine. I give these posts careful scrutiny when I come across them. I worry about readers getting poor advice. At best, it might mean small problems. At worst, it could cause death.

Two weeks ago, I read a post about ways to keep a pet’s food and water bowl area clean. It turns out that the post was originally written for a style and design blog based in New York City. The advice was:

…use an elevated feeding station to keep bowls in place and up off the floor. Elevated bowls aid in digestion and prevent strain on your pet’s back and neck. Place near a wall to prevent tipping.

This is very bad advice if you have a large or giant breed dog. Elevated food bowls were tied to an INCREASE in risk for a large or giant breed dog to develop bloat or bloat/torsion. This problem is also known as gastric dilation and volvulus (GDV).

Bloat simply means that the stomach undergoes rapid expansion with food and/or gas. It can get so big and so high-pressure that it starts to squeeze the other organs in the abdomen. While bloat alone can be dangerous for a dog, it’s generally not lethal.

Sometimes as a stomach is bloating, it flips in the abdomen. The stomach literally rotates, which twists the attachment at the esophagus and the outflow part at the duodenum. Once a stomach is twisted (volvulus), no gas can be burped or vomited out, so the stomach continues to bloat. Thi sis highly dangerous. Shock, organ damage, and death can occur rapidly.
Stomachnorm
GDVstomach
GDVLatAbd
TThe dog’s head is far to the left off the xray, and the spine is at the top, running left to right. The big darker circle in the middle of the radiograph is the distended stomach. It’s full of gas. The pylorus of the stomach is seen at the top near the spine in those 2-3 very dark oblong shapes.

Dogs present in bad shape most of the time. The only way to fix GDV is to treat shock and then take the dog to surgery, untwist the stomach, and then deal with any of the many complications that come from the torsion. The risks of complications during and after surgery is often fairly high. Some complications are minor, but some can be lethal in and of themselves. GDV is a nasty, nasty problem. It’s extremely hard on the dogs and costly to handle.

When I read that tip, I was horrified. I emailed the original authors. They told me they would issue a correction on the blog. Three days later, the correction went up and the post was removed from the authors’ main blog. The site that I read it on first has not been corrected.

The study I cited recruited 1,637 dogs. Owners were contacted yearly to see how many had developed GDV. Several factors were considered for increased risk. The results showed a 20% increase in large breed dogs and a 52% increase in giant breed dogs with elevated bowls. That’s a huge increase in risk!

Body shape/size, temperament, and breed may play a part in developing GDV. We can’t affect those factors. We can lower risk with meal frequency, meal size, time of exercise, food/water bowls. Dogs should have 2-3 smaller meals spread out across the day instead of one big one. Exercise should be avoided for a few hours after a meal. We certainly should NOT elevate food and water bowls.

Today’s moral: be careful what you read and check with your vet!

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27 Comments

Filed under internet, practice, surgery

27 responses to “Be Careful With the Internet — A Lesson in Bloat & Torsion (GDV) — CORRECTION 1/26/12!

  1. Val Lewis

    I remember being told to elevate food/water bowls to prevent bloat. I’m wondering how I missed this advice being reversed. How long ago was this study done?

  2. Tasha

    I’m so glad to get the official verdict from you. When I first adopted my 2 greyhound girls, I was told by the rescue to elevate their bowls to avoid bloat. I have since read conflicting arguments, and gone onto a raw diet (it makes no difference whether the meal is elevated or not to start, it ends up on the ground for consumption). Thank you!

  3. You’re welcome! After looking up the study, I checked in to see what the prevailing opinion was among other vets. Most are of the opinion that even though the study may have some shortcomings (association vs. causation), we should NOT elevate bowls. There will always be some dissent, unfortunately, but that’s about all we can go on at this point in time. There haven’t been any big studies published since the one I cited.

  4. The study was published in 2001. There haven’t been many others since then, either. The most recent update I could find in conference proceedings was 2006, and those almost always said NOT to elevate the bowls. There are still some vets out there recommending elevation, but I think it may have more to do with a particular patient’s other problems (neck pain, arthritis, etc.).

  5. Lisa Woodworth

    Wow! I was unaware of this issue with elevation! Good to know!! I have always purchased the elevated bowls because it seemed as though it would cause less strain on the neck and back. I guess I should’ve asked!! THANKS!!

  6. Glad to have helped! Saving the neck from strain was the original theory for elevating bowls, but it turns out it’s a risk factor.

  7. Chris

    It’s great to finally have definitive advice on this issue. There has been a lot of conflicting advice. It’s a relief to know we’re doing it the right way!

  8. Glad to have helped! Sadly, like most things in medicine, there is still debate. I think that as long as we take reasonable steps like keeping bowls on the floor we’re at least not raising chances of GDV. I’m sure another study will be done at some point to illuminate the issue more fully.

  9. Cat Secomb

    Thank you for the advice. I have a Great Dane who is 96cm at the shoulder. I have raised his bowel 20cm off the ground which stops his legs from going outwards when eating. Do you think that this is to high?
    Thank you again for your information
    Kind regards

  10. Leslie

    I am a veterinarian in Denver and am wondering what article you are citing? I think you have to be very careful to state that keeping the bowls on the floor will not always prevent bloat. Similarly, feeding dogs from an elevated surface will not always cause a GDV. Unfortunately, no true risk factors other than breed and size of the dog have been linked to GDV……not that I have read or been taught, anyhow. Just because it was stated to increase the risk of GDV in one article does not make it scripture; just like srutinizing stuff found on the internet, it is important to look into the specifics of the study of the journal. Please email me the journal reference that you cited.

  11. I wish that I could provide you a more specific answer! Sadly, none of the sources I found as I researched this post stated how high “elevated” bowls are, nor did they make a recommendation for what is an acceptable height. I would personally advise that you strike a balance between comfortable eating and elevation at/near head-level.

    As Dr. Dawson indicated in the post after yours, the bowls are not the only risk factor identified, so making sure that you lower risk on as many as possible is the best strategy.

  12. I’ve emailed you quite a bit of additional information, and as promised I have a correction to issue.

    Above, I stated that the study found an increased risk of 20 and 52% with elevated bowls. The study’s abstract used these exact words:

    “Approximately 20 and 52% of cases of GDV among the large breed and giant breed dogs, respectively, were attributed to having a raised feed bowl.”

    Another source stated that an increase in risk of 110% was found with elevated food bowls.

    The bottom line, I believe, is as Dr. Leslie said. There are many factors, and we’re best able to help our dogs by addressing more than any single one. Putting too much emphasis on one factor as if it were the only cause or cure is not the best approach.

  13. Cat Secomb

    Thank you for answering quickly. I have researched GDV and found so many conflicting articles but I am aware of the other factors such as exercise amount/timing and amount of water etc. I have watch utube videos and believe that I would recognize the early symptoms. Most importantly I have a vet who is experience in the surgery and only 15 minutes away. So with all these tools I hope that I will never need it

  14. You’re very welcome. It sounds like you’ve got things well in hand! A very close friend of mine had a Dane for nearly 9 years. She was a wonderful dog! We only have a few that are with our practice currently, which is a bummer. They’re fun dogs. 🙂

  15. Lazaro

    hello i find interesting the article though i believe that is meaningless to pay attention at the height of the feeding bowls if they are elevated or not , i have 8 danes i feed them in elevated bowls all of them at 35 cm high for the adults as it easier for them to eat like this , my beliefs are that most important is the quality and the quantity of the food and by that i mean that i feed my danes 6 years now raw and barf diet only, 2 meals per day, dry food leads the dogs to dring huge amounts of water plus the dry food contains air , so with dry food you get after water huge volume in the stomach with less weight excactly the opposite than when you feed natural food where you get less volume of food with analogical reasonable heavier weight to maintein the right balance in dog’s stomach, (plus 2x air , 1 the air dry food contains and 1 the air they get as they swallow the food gluttonous especially when they eat among other dogs ) my dogs are playing freely everytime after food as this is the most common behaviour in social life among members of the pack that makes stronger bonds between them (we do not go for agility or running, only free playiing between them)
    also one more thing i have to mention is that we believe that after 2 hours of every meal is safe enough to let them play, well i have seen many dogs to vomiting excactly what they ate before 3,5 hours intact and unaltered every litle piece only bigger in size because of the water that has absorbed in the stomach , so also the time after every meal is another myth .. i am not a scientist to explain better my observations ,these are just what i have observed with my common logic for the best safe of my fury friends , i think that researces are focusing on secondary issues in this matter , who κnows maybe food companies are behind and founding every research and they misslead so many doglovers away from the truth ps: excuse me for my english if are not so correct at some points but it is not my native language..
    with kind regards
    lazaro gr

  16. Thanks for taking the time to write, especially in a 2nd language. This post has had some very far-reaching comments.

    I think that you have the right idea about dry food. Many big dogs gulp it down and don’t chew. They also then drink a lot of water. The food expands in the stomach and that is one of the big risks for developing bloat or GDV. Raw foods won’t do the same thing, so I think they are less troublesome.

    I still think that the research in this paper was good enough to advise my clients NOT to feed with elevated bowls because almost all of them feed dry food. I would personally avoid the things that we know as possible risk factors. To me, it’s just not worth risking a dog’s life.

    I’m very happy that you have not had any problems with your Danes! I try not to argue with success. 🙂

  17. jennifer s

    There’s a major flaw in this study – of the 1650+ dogs followed for study virtually ALL of the dogs followed used elevated bowls! In order to make a true scientific study and conclusions you need a fair and even study. That is you need two study groups, with one set using raised bowls and the other set not using them. If basically every dog is using evelvated bowls there is nothing to compare against.

    Must say I am amazed this hasn’t been brought up before. Perhaps actually reading the Perdue Glickmam study might help.

    It seems wrong to me to start telling people raised bowls lead to Bloat based on a highly flawed so called scientific study.

  18. The design for that study is a prospective cohort study. It’s a recognized methodology that can produce good results.( http://en.wikipedia.org/wiki/Prospective_cohort_study ) It is often best to then follow with a randomized clinical trial, but there are ethical concerns with that kind of study for a problem like GDV. If I understand correctly, not all of the dogs in the Glickman study were using raised bowls.

    The Glickman study is, to date, one of a relatively small batch of studies looking at the bloat/GDV phenomenon. I agree that we shouldn’t take just ONE study as the right and only answer. However, we do need to recognize the fact that other qualified minds have looked at the Glickman study and found it to be reasonable in method and analysis. Association doesn’t equal causation, so we need to be careful with that, of course. More study is needed. On that we can agree.

    In the meantime, owners can speak to their vets and research on their own. If it were my dog, he’d be eating off the floor.

  19. vilas

    i have been giving my great dane food from elevated bowl for 7 1/2 years, and he is in good and healthy condition. so should i continue giving him the food sme way

  20. There is still a lot of disagreement about the danger of elevated bowls. Personally, I would -not- elevate, and I would also feed smaller, more frequent meals instead of one or two big feedings per day.

  21. Deenie

    Animals in the wild eat off the ground.

  22. They do indeed. Interestingly, some do so lying down, which puts the food even up with the head and the remainder of the body on a horizontal plane. I’m not sure how much effect that geometry has on the incidence of digestive problems. That in turn brings up the question: do any wild animals get GDV?

  23. Steve

    Has anyone taken the time to find out that if 1000 Danes “in this new study” were monitored, was there an even number in each study case. As in, 500 of the Danes used elevated bowls and 500 of the Danes used bowls off the floor. If so this might be something to consider. If the study was simply collecting data on Danes who were diagnosed with bloat it would certainly create a huge amount of false data. Especially since most Dane owners have been told to use raised bowls for years. For instance, if 900 of the 1000 Danes used elevated bowls and only 100 were eating off the floor then we could really manufacture some alarmingly false percentages!

  24. some friends brought this issue to my attention when i posted a photo of my Scottish Deerhound (who has an ongoing neck pain issue and is in treatment for it) eating from an elevated table which we made decades ago for a previous Deerhound. Also my current boy has had a gastropexy. should i be concerned? he seems to enjoy it, and he’s very tall.

  25. Good question! This is an interesting mix of ‘benefit outweighs risk’ for your dog. It sounds like he needs the elevated bowls for his neck, which would outweigh the possible risk of GDV as far as I’m concerned. You have also had him pexied, which decreases risk for the twist part of GDV. Are the two equally balanced out? No way to know. I think that if I were in your position I’d keep the elevated bowls and try to decrease all of the other risk factors as much as possible. I wish I could give you a more concrete, clear answer. The complexity of the interaction of the risk factors make it a very hard question to answer.

  26. leroy

    Yes they eat off of the ground but try to imagine what you are saying, they are carnivorous and eat meat, unless its a halibut lol the animal the dog is eating around the top side of the abdomen (instinctively) which is anywhere from 4-18″ off the ground depending on the downed animal. only little scrap would they eat of the ground and scarps are scraps, not a whole meals worth coming the ground.

  27. Thanks for taking the time to comment! While at first glance it seems like a pretty logical comparison, we have to take some additional factors into consideration when looking at wild canids compared to our domestics.

    Wolves do not always eat standing.
    Wolves are not eating dry food.
    Wolves have not adapted over time to eating a more omnivorous diet as domestic dogs have.

    I also have no idea if anyone has studied the incidence of GDV in wolves. Not a bad question…

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