Bilious Vomiting Syndrome, aka “Hunger Pukes”

Bilious Vomiting Syndrome, aka “Hunger Pukes”

You’d think anyone who uses an impressive term like “Bilious Vomiting Syndrome” to describe a condition in which a dog regularly pukes yellow liquid would know a bit about the problem. However, like so many other examples in veterinary and medical “science”, fancy names are invented for diseases which are complete mysteries and destined to forever remain so.

Astoundingly, there seems to be consensus among vets that the real underlying cause of this condition is an empty stomach. They seem to forget that dogs have been walking around on this planet with empty stomachs 95% of the time during the millions of years they’ve been here. Even the relatively spoiled reintroduced wolves in Yellowstone only eat every third day on average, even when they have enough prey available to gorge everyday. Other wild dogs not so indulged have been known to go weeks or even months without food, with no harmful effects.

The problem of bile vomiting is so common and difficult to resolve that many dog owners have concluded that it is normal. Personally, I had almost given up trying to figure out why my middle aged Cockapoo periodically vomited bile even after years of raw feeding. As is common, I had noticed that it always happened when his stomach was empty, and usually in the morning while I was in the kitchen preparing food. I asked everybody I could think of about this, including vets and expert raw feeders. I was always told that it’s just the sign of an empty stomach and I should feed my dog more frequently.

That was 23 years ago. I wish I could say that knowledge about this condition and how to resolve it has come a long way. Unfortunately, that’s not the case. Here’s a sampling of recommendations from some of the highest ranking veterinary websites:

From A dog may vomit yellow foam simply because his stomach is empty and the bile can be irritating. If your dog is otherwise healthy — and he’s eating and defecating normally — it may help to reduce the time in between meals.

From Many dogs are prone to vomiting yellow bile on a regular basis. Fortunately, this problem often resolves very easily, with some basic changes in feeding frequency, medication and care.

Wikipedia: Dogs with this condition usually vomit in the morning after not eating all night. Treatment is to feed late at night. H2 blockers and anti-emetics can also be used. Bilious vomiting syndrome is a diagnosis of exclusion, meaning that the dog is normal otherwise and no other causes of the vomiting have been found.

From dog health Yahoo Contributor Adrienne J. Farricelli CPDT-KA: Many owners complain that their dogs throw up yellow bile in the early morning. In this case, the bile may simply be the result of the dog’s empty stomach… The solution to this problem is often pretty simple and straightforward. All that may be needed is to feed the dog a small meal right before bed time. This should help settle the stomach and ultimately solve the problem.

And here we have someone who’s at least on the right track Dogs Naturally Magazine’s “Ask the Vet”: Ah, the old common (but not normal) early morning bile vomiting syndrome. There are lots of possible causes for your pups to be doing this, but my first suspicion is that they don’t like or do well with their dry food diet. It is possibly an intolerance to one or more of the ingredients or even a food allergy. Therefore, the first thing I would do in this situation since all four are effected (sic) by this problem is to stop feeding dry food. Although many dogs can do well with this processed food, some cannot tolerate it. Personally, I try not to feed any brand of kibble to my own dog (she eats a variety of raw foods) and advise my clients to do the same.

He goes on to recommend a specific, remedial diet: Start with a bland diet and see if this helps the vomiting. Low fat cottage cheese or boiled white meat chicken plus mushy rice is one of my (sic) that works well. Mushy rice is rice cooked well enough so that there are no whole grains left. Like baby rice cereal. Alternatively, you can “blenderize” cooked rice that you already have made by adding it and a little water or organic chicken broth into the blender.

Almost by accident, this type of diet might well resolve the problem temporarily, although it has little to do with “blandness”. As I will soon explain, these foods don’t contain the particular constituent in excessive quantities that causes bile overproduction. They are not healthy foods, however, and will create disease if fed long term. In addition, when the dog owner goes back to feeding the dog’s regular food, the problem will eventually recur. I should also note that although it is implied in the article that this problem is exclusive to kibble fed dogs, it is not. Bile vomiting occurs in raw fed dogs as well as kibble fed.

When I was trying to unravel this mystery on behalf of my own dog, it didn’t make sense that the cause could be an empty stomach. As I’ve already pointed out, the stomachs of wild dogs are empty most of the time. One key difference seemed to be that when the bodies of wild dogs prepare to eat it’s because the prospect of food is real and imminent. Domestic dogs have no feeding autonomy. They are dependent on us for food, and it seems reasonable that their bodies can be triggered into preparing for it as a habituated response to certain environmental stimuli, whether or not food is actually forthcoming.

So it seemed obvious to me that a combination of conditioning and my activity in the kitchen was causing my dog’s body to prepare itself for food, much like the act of hunting would if he was living in the wild. Since part of that preparation process involves enzymes and digestive fluids being secreted into the stomach to assist with the breaking down of the anticipated foods, I theorized that when foods are not actually forthcoming, bile and other assorted secretions irritate the stomach lining, which causes the body to eject them through vomiting.

However, many others have come this far in their thinking without getting any closer to understanding the underlying pathological cause. To do that requires taking a look at the function of bile. The job of bile in the digestive process is to break down fats. It seems logical that the real cause may be that the body is overproducing bile, and if that is the case, it also makes sense that overconsumption of fat may be the cause of the overproduction.

My own dog’s diet was very high in fat at the time that he was regularly vomiting bile, perhaps as much as 50% or more by calorie. After putting the theory together in my mind, I decided to immediately test it out by cutting way back on the fat content of my dog’s food. Previous to this, I had not been in the habit of trimming the fat from his food and was even feeding a small percentage of cheap ground turkey, which often contains high fat.

Within a few months of sharply decreasing the amount of fat in his diet, my dog’s bile vomiting stopped. After that, it happened a few times a year for a couple years until it stopped completely. Since then, I have passed this information along to others and when they make the same changes, they get the same successful results.

Some dogs vomit bile in late puppyhood but have decreasing episodes as they grow into adulthood even if the diet does not change. Because of this, some people insist that bile vomiting is a normal part of physiological growth and development. We can be fairly certain this is not the case, however. It takes energy for the body to produce digestive fluids like bile. Living organisms are extremely economical. Everything has a function. The body doesn’t over- or under-produce by mistake, it does so in response to some deleterious influence. Our job is to find and remove the harmful influence.

In addition, there’s an important clue to be noted in the fact that the problem doesn’t usually show itself until a puppy is into the teenage months. What this tells us is that it is a condition that develops slowly over time, like many other forms of pathological degeneration. In other words, it takes a while for the body to accommodate the need for more bile as a response to the overabundance of fat in the diet. This most likely occurs earlier in kibble fed dogs than raw fed, because generally the bigger the feeding mistakes the quicker the degeneration.

One would think that symptoms of all kinds would occur less in raw fed dogs, and this is certainly the case generally. When it comes to bile vomiting, raw fed dogs are not spared, as evidenced by the popularity of this topic on raw feeding forums. Ironically, dogs on kibble may not actually exhibit the symptom as much as raw fed dogs since kibble stays in the stomach longer and is typically fed more often, so the stomach is not empty as much. Raw feeders are also more likely to embrace the idea that dogs need to be fasted regularly, which sets up the opportunity for the symptom to manifest.

As a dog gets into adulthood, if the same feeding mistakes continue, the body continues to respond in the only way it can — by producing bile in the quantities it deems necessary to break down the excessive fats in the diet. It is also sometimes noted that dogs begin to bile-vomit less as they get older. However, this does not necessarily mean they’ve “outgrown” the problem, as is sometimes surmised by feeding experts. What it most likely means is that the stomach lining has become tougher as a consequence of frequent contact with the acidic, undiluted bile. Once the membranes are toughened, the cost of having the bile stay in the stomach may be less than the energy and resources required to eject it. Vomiting is a costly emergency device; if the body can find a way to more efficiently protect itself, it will. There will always be a cost, however. Like a callous on your hand or increased tolerance for alcohol in humans, a dog’s body will have to give up in sensitivity and vitality what it gains in protection. Increased tolerance always requires a decrease in vitality. Obviously, a stomach that has had to adapt itself to wrong feeding will not be able to function optimally and efficiently. And since the body operates as a whole unit, there will be other problems caused by these mistakes, although they may not show up until much later in the dog’s life. For our dogs’ sake, it would behoove us to take chronic bile vomiting as an early warning sign that there is trouble ahead if we don’t make changes.

Frequent feeding may be the best advice the veterinary profession has to offer, but using this strategy carries additional costs besides creating the need for the body to continue protecting itself by overproducing bile. Another of those costs will be that the dog will never be able to go a day without eating at all, which is almost universally recognized now (thank goodness) as a very beneficial practice. Digestion represents the greatest drain on energy of all the body’s various processes, particularly for dogs that are overfed or mis-fed. Regular fasting greatly extends the life of dogs because it replicates what they adapted to in their long biological development as a species. The only time a dog’s body can catch up on its eliminative backlog is when the stomach is empty. We can’t expect to have healthy dogs if we never give their bodies a chance to cleanse and heal, the way nature would. The body does lots of multi-tasking but it has its limits. You don’t have to take my word for this. Just watch your dog turn down food next time he’s highly stressed. They know that digestion cannot happen when vital energies are being diverted to deal with a stressful situation. There are a million examples of how various bodily processes shut down when too much is being asked of the body all at once.

In addition, as it turns out, not only does frequent feeding not solve the underlying problem, it doesn’t even suppress the symptom in many cases. It is sometimes noted by vets that in some dogs the stomach will be so irritated by the gastric fluids that adding food to the equation is too much for it to handle, and vomiting will happen anyway.

When frequent feeding doesn’t work, vets will often recommend tests that purport to get to the bottom of the situation. Unfortunately, they don’t really do that at all. When vets go looking for diagnoses, they’re not looking for causes that can be stopped (which costs dog owners very little), they’re looking for something to TREAT (which can be very expensive for dog owners). Diagnosing is all about determining which drugs to administer. It has nothing to do with discovery and removal of cause.

We would do well to consider the suffering of the afflicted dogs as well. Vomiting brings relief from the irritation caused by errant bile but the act itself is downright unpleasant. For this reason alone, wouldn’t it be better to stay open to finding and removing the causes of this problem so our dogs don’t have to experience it at all?

It may be relevant here to point out that the domestically raised animals that we feed to our dogs have a great deal of fat on their bodies because they are overfed and fed unnatural, high-starch, drug-laced foods. By contrast, the natural diet of most prey animals produces a very low toxic load, and typically much less body fat. These are the animals that our dogs are biologically adapted to eat. The foods that domestic dogs are fed, by contrast, diverge sufficiently from this to cause pathogenic conditions so common that they may seem inevitable, unavoidable and even “normal”. Bile vomiting is a perfect example. Bile vomiting is common, maybe even so much so that it is “average”, but it is NOT normal.

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