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DogAware.com Articles: Inappetence in Dogs

Tales of the Lost Appetite: What to do when your dog refuses to eat.

Article by Mary Straus, published in the Whole Dog Journal, March 2008

Introduction

There are few things more frustrating than a dog who won’t eat. I discovered how hard this can be on an owner when my Nattie suddenly stopped eating at age 14. I was a wreck as I tried every trick I could find to tempt her to eat, while my veterinarian did test after test trying to discover the cause of her sudden lack of interest in food. And I couldn’t help feeling rejected when she turned down the meals I so lovingly prepared, making the entire experience even more stressful.

What should you do when your dog won’t eat? The first question that must be answered: Is there something wrong, or is my dog just being picky? Here are some clues that can help you determine what approach you should try first:

• Does your dog usually eat anything you put in front of her, or does she have a history of skipping meals? A sudden change in appetite is likely to be symptomatic of a health problem and cause for a quick trip to the vet, especially in dogs who are normally good eaters.
• Are there any other symptoms? When lack of appetite is coupled with lethargy, fever, panting or other signs of pain, vomiting, diarrhea, jaundice, or anything else out of the ordinary, it is a definite cause for concern, and an immediate trip to the vet is indicated.
• Have there been any changes that might account for the difference in appetite? If you recently switched to a new food, or began adding supplements to the food, perhaps your dog is simply telling you that she doesn’t like it. Try feeding the food plain, or go back to your old brand and see if her appetite returns to normal. Household changes, such as loss of another pet or an owner being away, might also contribute to a dog’s inappetence.
• Is your dog losing weight? I’ve occasionally heard people complain that their dogs won’t eat but are substantially overweight. These are often dogs who turn down meals because they’re getting more treats and snacks than they need. Check with all family members to discover how much your dog is really eating before determining that she is inappetent.

I’ve had two dogs who were real chowhounds, including my 16-year-old Piglet, and even a single missed meal has me rushing them to the vet. With Nattie, who was known to skip a meal on occasion, I waited until she turned down her second meal, which was raw meaty bones (her favorite), before calling the vet and bringing her in the following morning. Remember that animals often try to hide the fact that they are sick, so it’s important to pay attention to symptoms when they do occur and act quickly. Don’t wait several days or longer to see if they improve on their own, particularly if you see any additional signs of illness.

Causes of inappetence

Lack of appetite is referred to as inappetence or anorexia. There are many reasons why a dog may be reluctant to eat. Dental disease, including broken teeth and infected gums, may cause pain when eating. Ear infections are another source of pain that can lead to reluctance to eat, especially hard food. Keep in mind that chronic ear infections are almost always related to allergies (either food or environmental), so try to find and eliminate the cause if at all possible, along with treating the existing infection.

Other forms of pain can cause a dog to stop eating. Panting, trembling, walking hunched over, sleeping more than usual, reluctance to run or jump, and irritability can all be signs of pain. Have your vet check your dog if you think that pain might be contributing to lack of appetite.

If you’re still unsure, you can try giving pain medications, such as Tramadol (prescription medication), to see if the symptoms improve. If so, look further to find the source. Treat pain as needed to increase appetite and improve quality of life.

Dogs who are sick, including dogs with cancer and those undergoing chemotherapy, are often reluctant to eat. Kidney disease can cause nausea and gastric ulceration due to excess acidity. Other conditions may lead to inappetence either because the dog doesn’t feel well enough to eat, or due to the condition itself causing discomfort related to food.

If you recently opened a new bag of your dog’s regular food and he turns up his nose at it, pay attention – this could be a sign that the food is spoiled or moldy, and possibly dangerous. Even if only one dog in your household doesn’t want to eat and the rest are fine with the food, it would be safer to get a new bag and see if that solves the problem.

During last year’s pet food recalls, there were many heartbreaking stories of owners coaxing their dogs to eat the food that was making them sick, before the full story was known. Most stores will let you return a bag of food if you suspect something is wrong with it. If any symptoms are seen, such as vomiting or diarrhea, they should be reported to the manufacturer of the food.

Many medications list nausea and anorexia as potential side effects. If your dog is on medication and becomes reluctant to eat, talk to your vet to see if there is a substitute available, or if there is a way to make the pills easier on the stomach. For example, some meds that are normally given away from meals can be given with food instead to help with stomach upset.

Warning: in some cases, loss of appetite can be a symptom that the medication you are giving is dangerous. This is especially true in the case of NSAIDs (non-steroidal anti-inflammatory drugs) such as Rimadyl, Deramaxx, and even aspirin. Corticosteroids such as prednisone can cause gastrointestinal ulceration and associated inappetence.

If your dog is on any of these drugs and stops eating, you should discontinue the medication immediately (don’t stop prednisone without your vet’s OK). Get your dog to the vet, especially if any other symptoms are present, such as vomiting, diarrhea, black or tarry stools, or lethargy.

Tests to look for the cause

There are a variety of tests that can be done to try to pinpoint the reason for your dog’s reluctance to eat, if it is not readily apparently. Here are the ones that we did for my Nattie, sequentially over a period of about three weeks:

• Blood tests, which may be repeated in order to identify any trends, or problems that may not become apparent right away.
• Abdominal and chest x-rays, to look for signs of obstruction, tumor, enlarged heart, or anything else that might explain a reluctance to eat.
• Ultrasound, to look further for anything that might not show up on x-ray. The radiologist should check the adrenal glands as well as all of the internal organs.
• ACTH stimulation test, to check for Addison’s Disease, which can cause inappetence even if the adrenal glands appear normal. Note that inappetence can also be a sign of adrenal exhaustion, even when the ACTH test is normal. In this case, the adrenal glands may be enlarged. You can test for this only at certain laboratories, such as the University of Tennessee’s endocrinology lab. If immunoglobulins and cortisol are low (or declining) and sex hormones are high (or rising), it's suggestive of adrenal exhaustion, also referred to as atypical Cushing's disease or hyperestrogenism. This syndrome is treated with low, physiological doses of cortisol, such as methylprednisolone, and thyroid hormones.
• Leptospirosis blood titer test. This test may not become positive until your dog is in the recovery stage. We waited two weeks before doing this test on Nattie.
• Tick blood panel. Tick-borne diseases often cause a syndrome vets refer to as “ain’t doing right,” where something is affecting the dog but the cause is not apparent on tests or exam.
• Endoscopy, which involves inserting a camera down the dog’s throat into the stomach. An endoscopic exam makes it possible to visually check for abnormalities and take tissue samples to look deeper for problems.

Your vet may recommend other tests, depending on your dog’s symptoms and history.

In Nattie’s case, all of the tests were negative other than pre-existing early stage kidney disease, which had not progressed and therefore was not considered to be a likely cause of her loss of appetite. At this point, the specialist said that everything had been ruled out except a brain tumor. She recommended an MRI to check for that, but I declined. I felt the likelihood of a brain tumor being the cause and of a tumor being treatable were not high enough to justify the expense and the stress the tests would cause my dog.

When is lack of appetite normal?

There are times when a poor appetite can be expected. Female dogs in heat as well as the male dogs nearby frequently lose their appetite for a time. However, inappetence following a heat cycle can be a sign of pyometra, which requires an immediate vet visit.

Adolescent puppies, especially of some larger breeds, are notorious for alternating between being extra-hungry and skipping meals. Younger puppies may be reluctant to eat because of teething pain (soft food and chewing on something cold can help in this case). Hot weather can make a dog want to eat less. Some dogs prefer eating at certain times of day and may turn down food offered at other times.

Additives such as supplements and some foods may cause your dog to turn away from his meals. If your dog doesn’t like supplements added to his food, try giving them in pill form instead (see “Giving pills,” in text below, for hints on how to make this easier). Many dogs refuse to eat vegetables, and so may turn down meals if there are any mixed in. Other foods that your dog dislikes may also cause him to turn away if they are added to his meals. While Nattie had enjoyed yogurt in the past, she would not touch it after developing problems with her appetite, so keep in mind that tastes may change over time as well.

Dogs who are fed too much may also be picky about their meals. If you have a picky dog who is overweight, look at how much you’re feeding, both at mealtime and in between, to see if the problem isn’t related to too many snacks and treats. Try reducing the amount you feed by 10 percent at a time to see if you can get your dog to begin to slowly lose weight, along with being hungrier at mealtime.

Some dogs have problems with bile if their stomachs are empty for too long. This can lead to vomiting of yellow liquid in the early morning hours, often accompanied by nausea and lack of appetite. In this case, feeding a late-night snack before bed can help.

When my dogs seem to feel nauseous, I’ve found that if I can get them to eat a small amount of something special to start with, their stomachs seem to settle. Then they’re willing to eat their regular meal.

Picky eaters

If your dog frequently turns down meals but is happy and healthy otherwise, he simply may be more finicky than most. However, to be safe, make sure you mention your dog’s poor appetite/picky eating habit to your veterinarian at your dog’s annual exams.

Picky dogs can be born that way, or you can inadvertently condition them to be picky. Some dogs simply do not have the overweening interest in food more commonly associated with the species, and others may have certain foods that they dislike, possibly because they’ve learned that eating a particular food causes them discomfort. If your dog eats reluctantly, try switching brands of food and protein sources to see if he gets more excited when you feed something different.

You can also try adding various fresh foods and flavorings to his meals, such as meat and eggs (raw or cooked), cottage cheese, yogurt, gravy, healthy leftovers, etc. These foods are good for your dog and they make him look forward to his meals; there is nothing wrong with that! Unless you have a healthy dog who is picky about everything, indicating a training problem, I see no harm in feeding dogs foods they enjoy rather than trying to force them to eat foods they clearly dislike.

There is one caution to this approach, however. Offering something else whenever your dog turns down a meal can condition him to be picky. Hovering over your dog while he eats, or otherwise making mealtime stressful, can also create eating disorders.

If you have a healthy dog who is a picky eater, put his food down for a limited amount of time – say, 10 to 15 minutes – while ignoring him. Then calmly pick up any remaining food and offer him nothing else until the next meal. It’s fine to offer something different at the next meal, but not right away, as you don’t want your dog to learn that you will give him something better if he turns down a meal. That’s a recipe guaranteed to create a picky eater.

Competition with other dogs may either increase or decrease your dog’s desire to eat. If you feed dogs together, try feeding the one who doesn’t want to eat in a crate or another room, to see if he feels more comfortable eating alone. If you feed your dogs separately, maybe letting another dog eat his food if he doesn’t want it in a reasonable amount of time may convince him that being picky isn’t a good idea (be sure this won’t trigger a fight before trying it).

Exercise can increase appetite and, of course, offers other benefits, too. Many picky dogs eat with more interest after a long walk.

Some dogs like variety, and will tire of any food after a few days, weeks or months. Feeding a variety of different foods is healthier for your dog, so again, there is no harm in rotating between brands, anywhere from daily to every few months, which may also serve to keep your dog interested in his food.

A dog who is consistently picky no matter what you feed him, despite your doing nothing to create such behavior, is likely to have some kind of health problem. In this case, veterinary examination and testing is called for.

Treating the symptoms

Until you can find and eliminate the cause of your dog’s inappetence, you can try treating the symptoms with supplements and possibly medications. Purchasing information for all of the nonprescription remedies can be found below.

Resources

Slippery elm is an herb available from health food stores that can help with problems related to stomach pain, as it coats and soothes. See “Soothe Stomach Pain with Slippery Elm” below.

Another option is to use Phytomucil from Animals’ Apawthecary, a liquid glycerite that contains slippery elm and other herbs that benefit the digestive system. It is sweet-tasting and easy to administer. Just put a dropperful into your dog’s cheek pouch.

L-glutamine is an amino acid that helps to heal the mucosal lining of the intestines, so it may be beneficial if your dog is experiencing diarrhea. Give around 500 mg per 25 lbs of body weight daily. Higher doses are also safe.

Seacure (see “Securing Seacure,” WDJ April 2003) is a highly nutritious supplement designed to treat malnutrition. Seacure can also help to heal the digestive tract and provide other health benefits. Made of hydrolyzed whitefish, Seacure has a fishy smell. Sprinkled on your dog’s food, it helps make the food more attractive to your dog.

Ginger Tummy from Tasha’s Herbs, Ginger-Mint from Animals' Apawthecary, or Minty Ginger from Herbs for Kids can help if inappetence is caused by nausea. You can also use ginger capsules or ginger tea. Some studies have found ginger to be as effective as metoclopramide (Reglan) for treating nausea and vomiting.

Antacids such as Pepcid (famotidine), Zantac (ranitidine), Tagamet (cimetidine) and Axid (nizatidine) can be tried, with your vet’s approval. Antacids are best given at bedtime, to reduce acidity that develops during the night.

Tums, which is calcium carbonate (the same as is found in eggshells), can also be used. The acid-inhibitors Prilosec (omeprazole) and lansoprazole are sometimes prescribed for dogs. Don’t give any of these medications without first checking with your vet.

Other medications your vet may prescribe include Reglan (metoclopramide), used to stop vomiting and increase gastric motility, and Carafate (sucralfate), used to treat gastric ulcers. The antihistamine promethazine (Phenergan) is an older, inexpensive medication that can help with nausea and vomiting. It is actually an antihistamine. Dosage is 1 mg/kg twice a day according to this site on Antihistamines.

A bland, low-fat diet may help if the symptoms are caused by digestive disorders. You can make rice congee by boiling one cup of white rice (not Minute Rice) with four cups of water for 20 to 30 minutes. The liquid portion helps soothe the stomach and stop vomiting and diarrhea. Add a little chicken baby food or honey for flavor, if needed. The whole mixture can also be combined with cooked chicken breast or boiled ground beef.

In Nattie’s case, Pepcid seemed to help, and I left her on it long term. I stopped it about a year later and oddly enough her appetite improved at that time. When dealing with inappetence, check with your vet to see if it’s safe to try stopping any medications your dog is on. If your dog’s appetite returns when the medication is stopped, ask the vet if there is an alternative medication that your dog can be given.

Appetite-stimulating meds

There are a number of medications that can be used to increase appetite if necessary. The decongestant

Benadryl (diphenhydramine) may help with nausea.

Cyproheptadine is another antihistamine that has the side effect of stimulating the appetite, though it's used more with cats than with dogs. Other drugs that your vet may prescribe include:

• Entyce (capromorelin) is the first oral appetite-stimulating drug approved by the FDA for dogs in 2016. This approval may make it harder to get the other drugs listed below that have not been approved by the FDA for use in dogs.
• Meclizine (Bonine, Antivert) can help with nausea. One dog I know with advanced kidney disease started eating well and gained more than 10 pounds after being put on this drug.
• Mirtazapine (Remeron) is an antidepressant that has anti-nausea properties and acts as a strong appetite stimulant.
• Ondansetron (Zofran) is a human chemotherapy drug that can be used to stop severe vomiting.
• Cerenia (maropitant) is a new anti-vomiting drug approved for dogs.
• Corticosteroids also increase appetite as a side effect. In Nattie’s case, after ruling out all the possible causes that we could, my vet put Nattie on a low dose of prednisolone, which was effective in stimulating her appetite.
• Medical marijuana is known to increase appetite, but you must be careful with dosage. See my article, Dogs Going to Pot? Marijuana Toxicosis and Medical Uses for Dogs for more information.

Foods to tempt your dog

A lot of effort may be required to find foods to entice your dog to eat when he is not feeling well. In most cases, it is more important that your dog eat something than that he eat the best foods for his condition (check with your vet to be sure). Don’t worry about feeding an incomplete diet in the short term, up to a few weeks. Experiment with different foods and different ways of preparing and serving them to see what appeals to your dog.

When Nattie stopped eating, I was shopping daily at both the grocery store and the pet supply store, trying to find anything that might tempt her to eat. I would bring home a half dozen or so different foods and treats each day, some made for people, some for dogs. She would not eat anything consistently or in large amounts, or mixed together with anything else.

I would offer meals of at least four different foods in small amounts, each separated from each other, two or three times a day. I eliminated foods that she had no interest in, but continued to periodically offer any food that she would eat at least once, even if she subsequently turned it down.

I found that she did best when she was not fed the same food twice in the same day, or two days in a row, though there was one treat she would eat daily. I gradually developed an inventory of foods that she was willing to eat, if prepared just the way she liked them (for example, she would eat scrambled eggs with cheese, but not plain), and not served too frequently. This was a lot of work and a lot of stress, but it kept her from losing too much weight while we continued to search for the cause of her inappetence.

Almost any food can be offered, with the exception of a few foods that are toxic to dogs, such as chocolate, onions and macadamia nuts. Here are suggestions that have worked for some dogs:

• Baby food, especially meats. You can use water, low-sodium broth, or even ice cream to slightly thin baby food and then use a syringe to put it in your dog’s cheek a little at a time.
• Nutri-Cal and Nutri-Stat, high-calorie palatable food supplements designed to provide nutritional support and stimulate appetite.
• Rebound and DogSure. These are nutritionally complete liquid meal replacement products.
• Try different brands and types of commercial foods, including dry food, canned food, dog food rolls, dehydrated foods, premixes such as those made by The Honest Kitchen, commercial raw diets, and even cat food. Try various treats, too.
• Smelly foods such as liverwurst and braunschweiger sausage. Chicken or beef liver braised in butter is another food that appeals to many dogs. Feed foods such as these in small quantities, or add them to other foods to enhance their appeal.
• Foods from your plate. Sometimes dogs are more willing to eat if they get the same thing that you’re eating. Chicken nuggets, cheeseburgers (no onions) and pizza are also worth a try.
• Fresh foods. Experiment to see what your dog may like, such as eggs (try scrambling them with cheese, or hard-boiling), canned fish, canned chicken or ham, seasoned and grilled meats, beef stew with gravy, macaroni and cheese, homemade soup, crab cakes, cheese, cream cheese, cottage cheese, yogurt, deli meats (can be rolled with other food inside), milk shakes and ice cream (avoid chocolate and coffee flavors). Even foods like bread and pizza crusts are better than nothing, if your dog is willing to eat them.
• Flavor enhancers, such as gravy, soup, broth, stock, sauces, butter and drippings may help make other foods more enticing, either when added on top or when cooked together. (Note: We do not recommend the commercial flavor enhancers for squeezing onto dog food; most we have seen contain artificial colors, preservatives, and other unhealthy ingredients.) Be careful about feeding too much fat, though, as it can cause stomach upset in some dogs, and even lead to pancreatitis in dogs prone to this disease. You can also try sprinkling Parmesan cheese, feta cheese, or a little garlic powder on top.
• Honey is a tasty and healthy addition that may entice your dog to eat (see “A Honey of a Cure,” September 2007).
• Bone broth is nourishing and flavorful, and can be fed alone, or mixed with other foods to make them more appealing. Use any type of meaty bones, such as chicken backs with skin removed. Chop the bones into pieces, if possible. Put them in a stock pot and cover with water. Add a small amount of apple cider vinegar to help leach the minerals from the bones. You can also add vegetables such as celery, carrots and potatoes (no onions). Bring to a boil, then simmer anywhere from 12 to 36 hours (or use a pressure cooker to save time). Pour the liquid off and remove the fat after it cools (a little can be left for flavor). Using a blender, liquefy the veggies and meat from the bones (and the bones as well, if they are soft enough), then mix with the liquid and store in the refrigerator, or freeze for later use.
• The temperature of food can affect its appeal. Cold food straight from the refrigerator has little odor, and may cause an upset stomach. Warming food increases flavor and aroma, making it more enticing. Food can be warmed in a microwave or by immersing the container in a bowl of hot water.

Giving pills

It can be very hard to get dogs who don’t want to eat to take pills. I hate to force them down the throat, especially when a dog is not feeling well, and if you try adding them to food, it may make your dog less willing to eat.

The best solution I've found is Pill Pockets -- the smell is very enticing, and you can pinch off just enough to cover the pill, making each one last a long time (I used to think they were too expensive because I thought you had to use a whole pill pocket each time you gave pills). Note that Pill Pockets are now available in a Duck and Pea Allergy Formula for dogs with food allergies.

Other things to try including dipping pills in cream cheese, spray cheese, or peanut butter; wrapping them in a bit of soft cheese, braunschweiger, or liverwurst; or inserting them into mini marshmallows or small pieces of crab cakes or dim sum dumplings (these worked for Nattie). Be careful about adding too much fat to the diet when you do this, which can cause digestive upset or even pancreatitis.

You can also order DOGCaps flavored gelatin capsules and combine meds into them. Give only those pills that are needed, skipping any that are optional, such as vitamin supplements. Liquids may be easier to administer, if available. For example, herbal glycerites can be squeezed from a dropper into the cheek pouch, which is simpler and may be more effective than using capsules of dried herbs.

Another option would be to put bad-tasting pills into capsules for easier consumption. See Spaniel Antics blog post for details.

Don’t give up

We never determined what caused Nattie to suddenly stop eating. Although her appetite never returned to normal, I was able to get her to eat well by rotating through foods that she liked and preparing them the way she preferred. I weaned her off the prednisone that we had used to stimulate her appetite, though eventually she returned to it to control chronic bronchitis. It was complications of the bronchitis that led to my having to euthanize her two years later at age 16.

Many people warned me that Nattie might be manipulating me to get better food, but there is no question in my mind that was not the case. She had never been manipulative nor a picky eater in the past. When a dog’s behavior suddenly changes, especially at age 14, health issues rather than behavior are likely to be the cause.

Fortunately, even though I never knew exactly what went wrong, I learned through a lot of trial and error what meals Nattie would eat willingly, without fuss. I was lucky enough to be able to share my life with her for two more years, making it all worthwhile.

Soothe Stomach Pain with Slippery Elm

The following instructions for using slippery elm are from Dr. Pitcairn's New Complete Guide to Natural Health for Dogs & Cats, used with permission.

Thoroughly mix 1 slightly rounded teaspoon of slippery elm powder (available in your local health food store) with 1 cup of cold water. Bring to a boil while stirring constantly. Then turn the heat down to simmer and continue to stir for another two to three minutes while the mixture thickens slightly. Remove from the heat, add 1 tablespoon of honey, and stir well. 

Cool to room temperature and give ½ to 1 teaspoon to small dogs (up to 40 lbs), 2 teaspoons to 2 tablespoons for medium dogs (40-75 lbs), and 3 to 4 tablespoons for large dogs (more than 75 lbs). Give this dose four times a day, or about every four hours. Cover the mixture and store at room temperature. It will keep for a couple of days.