References
Diet associated canine dilated cardiomyopathy

Abstract
Dilated cardiomyopathy (DCM) is a common cause of heart failure in the dog. Primary DCM is often a disease of exclusion, but inherited genetic breed dispositions have been reported. Secondary causes of DCM include toxins, nutritional deficiency, systemic and infectious disease. The number of dogs diagnosed with DCM has increased significantly in the last 20 years, and has been linked to the rise in popularity of boutique, exotic and grain-free, legume-rich diets. Veterinary cardiologists raised concerns as DCM was being reported in atypical breeds. Subsequently, the United States Food and Drug Agency released a statement in 2018 warning pet owners of the risks of grain-free and novel protein diets. It is assumed that the problem also occurs in the UK because these diets are popular here also. Contrary to primary causes of DCM, dogs have improved clinically and on echocardiograph when their diet has been changed and/or supplemented. No clear cause has yet been identified between these diets and DCM, but the potential reasons seem to be multifactorial and limited by a lack of understanding of the bioavailability, digestibility and metabolism of the novel proteins and legume-rich diets.
This article aims to explain the recent rise in cases of dilated cardiomyopathy (DCM), primarily in dogs, in the United States. Anecdotally, cases are also rising in the UK, which would match the seeming popularity of grain-free diets here. DCM is a common cause of congestive heart failure in large and giant breed dogs. It is characterised by heart chamber dilation, frequently starting in the left ventricle, and affects the heart's ability to pump blood around the body. The exact underlying cause of DCM is often unknown, but there does appear to be an inherited breed predisposition in Dobermans, Great Danes, Irish Wolfhounds and Boxers. Secondary causes of DCM can include toxins, systemic and infectious disease, and nutritional deficiencies. Recently, there has been a growth in the number of dogs being diagnosed with DCM, and in particular, in atypical breeds. In the last couple of years, studies have shown that the rise in cases has been associated with grain-free, legume-rich and novel protein diets. In the United States, the Food and Drug Administration (FDA) issued a warning to pet owners about the risks of feeding grain-free diets in July 2018. The exact link, however, is still unknown. The good news is that studies show that unlike primary causes of DCM, nutritional DCM may be reversed with diet change and/or supplementation.
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