Help! My Dog Has PLE!

Here at My Pet Nutritionist, we help pet owners with a host of different health conditions, especially those where dietary changes are paramount to proper management or even cure. One of the conditions we see from time to time is PLE. PLE stands for Protein Losing Enteropathy, which is a daunting diagnosis for pet parents. Those with PLE unfortunately lose excessive amounts of protein from the intestines.

In healthy individuals, albumin and globulins (two important proteins which are required for normal, healthy functioning of the body) circulate round the body in the bloodstream. Their main roles are to maintain the balance of fluid within the body, and also aid in immune function. those with PLE succumb to intestinal disease which causes these proteins to leak out, and they are then excreted in bowel movements. As PLE is a long term disease, this leaking continues to occur, which ultimately leads to hypoproteinaemia (low blood protein levels) and other systemic (affecting the full body) problems.

Findings Here

Continue reading to find out what to look for, how this disease can be caused, how it is diagnosed, what treatment your vet may offer, and how you can support your pet naturally.

Symptoms and Causes

When it comes to looking into the causes of PLE, we almost hit a roadblock. PLE is technically classed as a syndrome as opposed to a disease as it is the culmination of multiple intestinal diseases. Each of these intestinal diseases contributes to gut damage which ultimately leads to PLE in these individuals.

So, rather than looking at causes of PLE, let’s take a look at the intestinal diseases which all contribute to PLE.

• SIBO: Small Intestinal Bacterial Overgrowth occurs when there is an overgrowth of bad bacteria in the small intestine, which the good bacteria is unable to control. This causes damage to the intestine lining.
• IBD: Inflammatory Bowel Disease causes chronic intestinal inflammation which contributes to gut damage.
• Bacterial, Viral or Parasitic Infection: infection in the gut will cause inflammation.
• Intestinal Lymphangiectasia: pets with this disease suffer dilation and/or rupture of the intestinal lymphatic vessels, which leads to direct protein leakage from the bloodstream itself.
• Intestinal Ulcers: ulcers in the intestine will cause inflammation and direct gut damage, which causes protein loss.
• Gastrointestinal Cancer: chronic inflammation is caused as a result of cancer.
• Congenital Lymphatic Disorders: some conditions affecting the lymphatic system may be present, which would directly lead to protein leakage. Breeds commonly affected genetically include Yorkshire Terriers, English Bulldogs, Poodles, Soft Coated Wheaten Terriers, Labradors, Pointers, Borzois and Grate Danes.

Findings Here
Findings Here

There are numerous symptoms owners of pets with PLE may notice; some more obvious than others! An individual can have one, or many of the following symptoms, and each symptom may vary in severity.

• Chronic diarrhoea: this can be constant or intermittent
• Rapid weight loss: even with an increased or normal appetite
• Difficulty gaining weight: when eating more meals or higher calorie foods, these individuals will not gain weight
• Vomiting and nausea: these show intestinal discomfort
• Abdominal swelling: as the proteins in control of fluid in the body are leaking, there will be nothing balancing fluid levels, so abdominal swelling is common in these dogs
• Fluid retention: this goes hand in hand with abdominal swelling, but may be seen throughout the body
• Lethargy: energy levels will lack due to chronic inflammation in the body
• Reduced coat condition: inflammation in the gut causes skin and coat problems via the gut-skin axis
• Difficulty breathing in severe cases: again, with an increase in fluid accumulation due to the lack of albumin and globulins, in the most severe cases the chest cavity may fill with fluid; this is called ‘pleural effusion’.

Findings Here
Findings Here

Diagnosis

There are a multitude of tests performed to determine if a dog has PLE or not. Due to the nature of PLE being caused by multiple underlying diseases, various different methods of testing are required to work together in order to find not only low blood protein levels, but also to find and rule in or rule out which underlying diseases are contributing to the PLE. Treatment options may differ depending on the underlying cause of the PLE.

Lets take a look at the various tests your vet may carry out when diagnosing PLE.

Blood Testing: a full blood panel will be carried out. The results of this test will determine albumin levels, globulin levels, total blood protein levels, and also cholesterol levels among other blood components which may point out other diseases that may be going unnoticed.

Urinalysis: your vet will likely request a urine sample from your pet to determine whether protein may be being lost from the kidneys – this condition is known as Protein Losing Nephropathy.

Faecal Analysis: a faecal sample will also be requested, so the lab can analyse it for potential presence of bacterial infection or parasitic infection.

Ultrasound: to enable the vet to see inside the intestine to assess the thickness or quality of the intestinal wall, your pet may have an ultrasound. The lymph nodes can also be assessed for any further underlaying conditions.

X-Rays: The purpose of an X-Ray here is to detect any fluid build up, and any abnormalities of the intestine.

Endoscopy: this procedure entails a small camera to be inserted into the anus and threaded up into the intestinal tract, giving the vet the ability to see clearly whether there is intestinal inflammation, cancer or any other intestinal diseases often associated with PLE.

Intestinal Biopsy: at the same time as an endoscopy, the vet may remove a small sample of tissue if they suspect a tumour may be the cause of your dog’s PLE. The sample can be tested, and a confirmed diagnosis made.

Findings Here
Findings Here

Conventional Treatment

Due to the nature of PLE, there is no one set treatment for all individuals with the disease. The treatment one receives heavily depends on the cause of their individual dog’s PLE. Typically, regardless of underlying cause however, the main aim in all dogs with PLE, is to reduce inflammation and restore the correct balance of proteins while managing symptoms to give the dog the best chance of a good quality of life. In order to achieve these points, there’s a number of treatments your vet may suggest, such as:

• Corticosteroid Medication: these steroids can help to reduce inflammation
• Antibiotics: these may be used in cases of infection, but it is important these are only given in cases where a bacterial infection is diagnosed due to the risk of antibiotic resistance through overuse or incorrect use of these drugs. Some intestinal infections can be treated with high dose probiotics so as to not further harm the microbiome; the idea of probiotic treatment is that the probiotics outcompete the bad bacteria causing the infection.
• Immunosuppressive drugs: these drugs may be used in some situations, namely those where the PLE is the result of an auto-immune/immune-mediated disease.
• Vitamin B12 Supplement: in many cases of PLE, the B12 level in your pet is low. To help the body regain balance, a good quality B12 supplement may be given.
• Diuretic medication: these help to manage fluid retention because those with PLE often struggle to balance fluids within the body.
• Infusions of albumin, or blood plasma: this will be one of the most expensive options so may not be one of the first options suggested. This procedure can help to restore balance in severe cases of PLE.
• Low fat, easily digestible diet: your vet may well offer a ‘veterinary diet’, however these are usually very low quality and often dry extruded/highly processed foods; keep reading to find out how you can support your dog naturally!
• Frequent blood tests to monitor ongoing protein levels are important so you can see the full picture, and make sure your treatment regime is optimal.

Findings Here
Findings Here

Natural Support for PLE

As always, our approach is often supported by veterinary care, so we tend to look at this as a complementary approach as opposed to alternative. Here’s our top tips to support your pet naturally: Tweaking the diet is one of the biggest changes you will need to make for your dog. But how do we need to tweak it? Of course, that depends what you currently feed your dog, but here’s out top tips when it comes to changing their diet to help those with PLE:

• Feed fresh! A home cooked diet using lean cuts of meat tends to be most easily digestible. A raw diet may be considered in some cases, but we need to make sure it’s low fat! We advocate fresh feeding.
• If using vegetables in the diet, aim for leafy greens for fibre, and easily digestible starchy veg such as sweet potato or pumpkin. We never advise rice or grain for any condition.
• Sometimes sensitivities can affect PLE, so a novel protein diet may be required. Novel proteins are those which are not commonly fed to that individual.

Feed little and often to reduce stress on the intestines. The less stress put on the digestive system, the better. Stress = inflammation, which is something we want to reduce as much as possible.

Using therapeutic herbs and supplements can be hugely beneficial; these are known as Nutraceuticals, which you can read about below! Some handy herb and supplement options are:

• Digestive enzymes: these aid nutrient absorption, however these should be used carefully under a vet or nutritionist’s advice.
• Gut support: mucilage herbs like slippery elm, marshmallow root and DGL help heal the intestinal lining, and probiotics help the gut microbiome flourish, as well as help to defeat any bacterial infections present. Our Gut Guardian supplement may be the missing piece!

• Omega 3: increasing the anti-inflammatory Omega 3 Fatty Acids in your dog’s diet can help target and reduce inflammation in the body. Our dog’s meaty diet is naturally high in Omega 6 which is inflammatory, so balancing this out with Omega 3 is important! You can read more about Omega 3 below!
• L-Glutamine: while the canine body produces it’s own L-Glutamine, those with PLE often require more than what their body can produce. The role it plays I PLE dogs is repairing and supporting the intestinal lining.
• Turmeric: turmeric contains an active compound called Curcumin which has potent anti-inflammatory properties. Using a Liposomal Curcumin makes this compound most bio-available, but it is important to discuss it’s use with your veterinarian due to it’s potency and contraindications with various veterinary medications.
• Quercetin: typically used as a potent anti-histamine in those with sensitivities, quercetin may help to modulate the immune system, and reduce inflammatory responses.

Keep your pet hydrated! Keeping your dog hydrated is essential to enable proper function of the kidneys. The kidneys filer blood, so keeping your pet well hydrated is beneficial to this process. To encourage the consumption of plenty of water, feeding fresh food, adding water to food, giving your pet ice-cube enrichment, or adding bone broth to their dietary regime are all great ideas!

Reducing stress is as equally important as all the dietary changes you can make for your dog. External stress causes internal stress – so if your pet is stressed, the body’s internal response is inflammation. Dogs with PLE can deteriorate if inflammation is not under control, so keeping your pet stress free as much as possible is important!

Findings Here
Findings Here

If your dog has been diagnosed with PLE, or PLE is suspected, we hope this blog has made a sometimes cloudy diagnosis, clearer. It is quite a complex disorder to work with, but with the support of your veterinarian, and our team, your dog has a great chance of a long and healthy life. If you feel you could benefit from 1-2-1 help and dietary advise from our team, please don’t hesitate to book a consultation!



Team MPN x