Dr Katie Kangas: Integrative Dental Care for Pets

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Good evening everybody, we are the Raw Pet Medics and we're with Katie Kangas, who is an amazing, amazing vet who we met first of all in, um, uh, where was it, in California, San Diego in California last year. That was really, really great. You gave a great presentation there, and recently you've been working with Connor Brady in Virginia And what was the talk there, Katie?

Awesome talk.

Oh, thank you for asking. So yeah, at the Nautical Dog Conference in Virginia, Amanda Wilborn hosted us. It was such a great event. And the talk that I contributed was titled Empowered Healing. And the tagline behind that was natural wisdom, medical insight, Helping you navigate your pet's health journey. And the reason I put that together is really partly my practice manager really told me this was a topic that needed to be covered. That's Jessica. But also importantly, being in touch with so many pet parents, including my clients and other people that I meet at pet health conferences and educational events, is that there's such— there has been such a growing trend amongst pet health circles, social media, you know, blogs and all this kind of stuff for people. Once we get so excited about holistic and integrative care, it swung the pendulum really far to alienating and even villainizing Western medicine and, you know, conventional medicine. And so I put a really nice first-time-ever, you know, new material for everybody presentation together to really walk people through giving them clarity and discernment around when it is sensible and appropriate to dip into Western medicine. We always want to use our natural tools. That's never in question. There's always natural tools that will benefit whether it's acute or chronic. But in our acute or crisis situations, even if it's kind of chronic smoldering and boom, the body gets tipped into crisis, that's where we may need to dip into our Western medicine tools. And we don't want to throw those tools out of the toolbox. And throw the baby out with the bathwater of, you know, we are staunchly never going to use Western medicine. That doesn't serve us well overall. And I presented some really great cases, including Jessica's dog. She credits me when she met me for saving her dog's life, Rusty, who has had, woo-hoo, IMPA, immune-mediated polyarthritis. I tell people, you know, kind of akin to rheumatoid arthritis for humans. But he was dying And she was plugging into all the holistic, you know, groups and events. And she thought that it was really bad to ever use drugs. So, she was trying to manage it completely without medication. And it got to the point where she was gonna do humane euthanasia because she didn't want him to suffer anymore. And so, not only did we bring him back to complete health, but he was completely off all pharmaceuticals within 3 months. And he is now 2 and a half years pharmaceutical-free, and that dude is thriving. And I showed the funnest videos of him just running around like a maniac. So, it was a really fun way for people just to see the value of staying integrative and being open and having that understanding that, yes, Western medicine has a lot of faults. I presented those, but that there's also some strengths, and there's a time and a place to bring in those strengths. And it's nice to have the discernment of when is the time and the place.

So yeah, the case studies were really effective and you didn't just do one, you hit us with a couple of them. And it starts with kind of nearly the need of Western medicine, something that was quick and effective, but it was where you could get them off that. Like there was, there's an endpoint of this, but it may be necessary at the start because we bumped into a group a while ago. I know them by name and they Everybody in that group won't use pain relief in their dog. And I just think that, I mean, as I said at the back of the class, you were going to quote me. I said, people that say that have never experienced proper pain. They've never had knee surgery. They've never, you know, they just haven't. And so it's just ridiculous that things would be thrown out with, like baby would be thrown out with the bathwater. I think that was a very timely talk to remind everybody. Yeah, it was really effective. And the case studies are so effective. You can bombard people with studies all day long, but when you see people, and then the owner of the dog, Jessica, was standing there very, very, very, very convincing. Yeah. Oh God, I loved it. It was a very good talk.

Thank you so much. And I also kept it balanced in the fact that I presented certain health conditions where I really helped everyone understand this is a health condition that's actually generally treated better with just holistic. If you have to dip into Western, that's never wrong. There's no exact right or wrong margins. This is all individual choice. Every dog's an— hashtag dogs are individuals and treatments are individuals. Treatment plans are individuals. But I did present things like intervertebral disc disease, IVDD, and, you know, diarrhea and things where these are where your holistic tools will often outperform anything on the conventional side. So, I kept it very balanced. But then here's situations where you may, you know, really need to be considering bringing in the conventional to really get this pet back to health. And then, maintain that health with all of our awesome natural tools.

And I'd really like to bring this back then to the subject tonight, which is about the dental care stuff, because really interested in this. And as Conor said earlier, if people are avoiding pain relief, they've never experienced dental pain. And I think the number of reactive dogs and cats that we see that actually have had horrendous dental pain and people haven't realized that's the reason they're behaving the way they are. But I think I'd be really interested because obviously you've got an interest in the dental aspects of what does— what sort of percentage of your practice is around dental care?

Interestingly, now I am really integrative, holistic focused, so I no longer perform surgery. So I personally don't do dental surgery anymore. I used to, but I'm heavily trained with dentistry because I actually have a very good friend who I've known for 2 decades, who is a board-certified veterinary dentist, one of the leading, you know, authorities on this, Dr. Brooke Niemic. And he's actually boarded in the United States and boarded in—

Brandon.

I know.

Brandon.

And boarded in the EU, by the way. So I've done several trips too. And it so happened that I just got extensive training because I also, when I opened my own integrative practice 15 years ago, I was sharing space in the dental specialty hospital because it was a very big facility and they had extra space. So I leased space out of there. So I had this integrative practice inside this dental specialty practice. It was kind of this neat mix. And I ended up getting a lot of training and therefore deep understanding of what's happening with dental disease and how this impacts our pets. You know, I love to tell my clients that you cannot be in whole body health if you are living with poor oral health. It is affecting our bodies systemically, all our organ systems and everything else 24/7. And it tends to be a hidden cause of disease. Oftentimes, people don't realize what's happening in there. It's hard to see. But I gained all this, you know, understanding and training, and I started applying that in an integrative way, but also with being able to guide clients when they needed to do, you know, traditional or conventional dentistry. And it turned out, I was so rewarded because I constantly saw patients who were benefiting and getting back to a much healthier and true health status because I knew so much about dental. And I would pick up stuff that a general practitioner, you know, conventional veterinarian wasn't finding because they didn't have the level of dental training that I did. They come to me for a holistic exam, and I find all— and I could, you know, even tell you a case study right there that's amazing that I didn't present in the recent lecture. That we just talked about. But I did talk about dentistry. I had several slides on dentistry because dentistry is a category of health where we need Western medicine. And not just for the pain, as Brendan so aptly mentioned, because that is true intense pain, dental pain, but also for the other level of removing infection and chronic inflammation out of the body with the ability to do extractions or gingival surgery or subgingival work or whatever.

Yeah, what do you mean by it affects you systemically? How does it do that? How does a rotten tooth affect the body systemically? What do you mean by that?

Yeah, so such a great question. So there's bacterial load, and I like to give people definitions when I present to you because a lot of, you know, pet parents don't understand all these definitions. But plaque is a biofilm of bacteria. So it's a bunch of bacteria in the mouth that form like a sticky goo matrix that we call a biofilm, and it becomes stronger with a biofilm. It's hard to get rid of without mechanical mechanically, you know, wiping it away with a toothbrush, etc. But once there's bacteria hanging around and unwanted, like pathogenic bacteria, and we can talk about, you know, dogs that eat kibble have far more of that than dogs that eat raw, and, you know, we can get into some cool stuff about it because that's a super important piece of this. But once there's bacteria hanging around the gums, and if we're not brushing or getting rid of it or eating our raw bones and our species-appropriate diet especially, But even so, this still exists, that that bacteria starts causing inflammation. The bacteria are releasing toxins. The gums or the gingiva are responding with irritation and inflammation. Once they're inflamed, all the little, you know, microvessels and blood vessels in the gingiva are just a pathway, a superhighway to, you know, the rest of the body. And especially when it gets under the gum line and you've got a tooth root abscess, The pulp cavity is also communicating with the rest of the body, and the pulp or the root canal is the center section. There's 3 layers in the teeth, in a tooth, and the outside layer, at least of the crown above the gum line, is the enamel. The next layer, the middle layer, is called the dentin. And then the inside, or, you know, the, the, yeah, the middle layer between the 3 layers, and then the very center layer is the pulp or the root canal. And once we've got infection or certainly a tooth root abscess, the pulp and the dentin too are loaded with nerve endings. So it is excruciatingly painful to have a tooth root abscess, but also the bloodstream is sharing all that bacteria and inflammation with all the other organs in the body. And most pet parents and most people just generally know already that cardiac disease, you know, heart murmurs, kidneys, liver, all affected by periodontal disease, sharing the bacterial load. But what a lot of people don't fully understand is that the mouth is constantly sharing inflammation with the rest of the body. And so there are oodles of comorbidities that have been very established to be directly linked to periodontal disease. And that goes from anything from brain issues like Alzheimer's or cognition decline, to arthritis, you know, any chronic inflammation. IBD is linked to it. I got a cool case study on that as well. IMPA and rheumatoid arthritis, these things are all linked to periodontal disease because the mouth is constantly showering the inflammation throughout the body, and it's just keeping inflammation levels up. And the one other thing I'd love to tag on that that I have seen in both humans and pets is that chronic periodontal disease also creates fatigue in the body. And there are people who've literally been diagnosed with chronic fatigue syndrome, and they, they have bad periodontal disease, and they get their mouth taken care of, and they're like, oh my God, I feel 10 years younger. I went off my medications. I thought I was depressed. I went off my depression medication. So it is astonishing how much it's affecting the rest of the body, and most people don't understand that level.

Yeah.

So what level of checkups do you talk to pet parents about having for their pet's teeth? You know, do you, um, do you tell them that make sure that the vet has gone through that? Do you talk about desensitizing them and training their pets specifically? What's, what's your big thing for dental checkups?

Yeah, that's such a great question. Thank you. Uh, I think with With any dog, regardless of breed and age, minimum of a year, obviously we need to be looking in the mouth and doing a very good oral exam. But there's a couple things to say about that. So I'll get back to that because also important piece of that little comment is that small breed dogs and toy breed dogs and brachycephalic breed dogs with the flatter skulls, the pushed-in faces, they are so much more prone to earlier, you know, in life periodontal disease and severe periodontal disease. And veterinary board-certified dentists joke around like, you know, all dogs less than 10 pounds should, you know, literally they're better without teeth kind of thing. And now they're basing that on these, you know, kibble-fed dogs, but that's been kind of like an ongoing joke because a lot of Yorkies, by the time they're 5 years old, they've had full mouth extractions. And so the small breed dog and then the brachycephalic breeds like the pugs and the Bostons and the Frenchies their teeth are all packed in. They have the same number of teeth as a big German Shepherd or, you know, Lab or Collie that has this big nose. And they're all crowded in there and twisted and a bunch of, you know, plaque and bacteria are hanging out there all the time. So they get far worse dental disease and even earlier in life. So when you're talking small and toy breed dogs, I would have them evaluated honestly every 6 months to be your most proactive, you know, step. In keeping them healthy and literally keeping their mouth healthy, they will live longer, they will live better, and they will have less comorbidities. I mean, it's almost a slam dunk. So it's so worth doing.

That's fabulous. Thank you. When I speak to board-certified specialists who are universally keen on kibble, kibble and ultra-processed food feeding and ultra-processed treats and all these things, And I say, well, listen guys, if we look at, you know, 100 10-year-old dogs that are fed raw and bones and all the good stuff, they've got great looking teeth. And if we do the same to the same, a similar population of ultra-processed fed dogs, they are going to have worse teeth and they probably would have had 3 or 4 dentals during those 10 years as well. And they say, And quote, I have heard this from a certain board-certified in the UK saying, well, it's all very well having good-looking teeth, but there is subgingival problems going on. What is your response to that interesting observation from our friends?

Thank you, Nick. And I can come in on sort of two angles of that, but it's so great that you brought that up because I was going to backtrack to Brendan's question and you just did it for me.

Okay.

In that I would definitely recommend to have small breed dogs especially looked at a few times a year, large breed dogs once a year with an annual exam obviously is very prudent. However, even that said, and this will answer your question, Nick, when we look in the mouth with an awake oral exam, meaning the dog's not sedated, the dog's not anesthetized, that is a very limited view of what's going on. So we can be very fooled into thinking that dental health is better than it is because up to 60% of dental pathology, meaning any problems, are under the gum line and they're hidden. And so we're only getting about a 40% perspective of how healthy the teeth are, or the mouth is, I should say. It's not really just about the teeth, it's oral health. So, but that said, the other thing I can— yeah, and so I guess I'll finish that thought there, is that truly, in order to know what's going on, we've got to get that pet under anesthesia or sedated so that we can probe around each tooth, sinking a periodontal probe as far as it'll go. A normal subgingival sulcus for a dog is the same as a human, 0 to 3 millimeters. Anything deeper than 3 millimeters is a problem. Anything deeper than 6 millimeters requires a surgery, you know, either a gingival flap or extraction or something bad's going on. So we need to be probing, which we can't do in an awake animal. And then any suspect areas we're finding problems, they need to be imaged and X-rayed so we can see what's going on. And then we can identify the problem and know what to do about it. Obviously, for humans, it's a way easier, you know, event because we don't have to be anesthetized to let our hygienist and our dentist do that. But that is a very difficult thing to achieve in an awake dog, even a very tolerant dog, and certainly not X-rays. So that's the level of where there it goes. Now, that said, I will absolutely agree with you, Nick, 100%, that dogs and pets that eat, no matter how— you know, no matter what size they are, small breed or large breed, when they eat a fresh species-appropriate raw food diet, by far they have better dental health for sure. And so we can surmise that their health under the gum line is still a lot better statistically than the group that's eating kibble. But indeed, we don't really know what's going on However, you know, if there's no gingivitis, and this is another thing that's a cool tag-on to this question, is that one of the myths when I give my dental presentation to pet parents, I love to bust, and even vets, I love to bust dental myths. And one of them is that tartar is a good indicator of level of dental disease. And there are even veterinarians all the time, conventional veterinarians, that will write on a chart, 2+ tartar, 3+ tartar. That's their notation of the mouth, and there's no mention of gingivitis. And so, tartar in and of itself, which is calcified plaque, you know, once the plaque's been hanging out and the minerals in the saliva harden it and it's calcified and now it's tartar. But tartar in and of itself is essentially cosmetic. It's not a level of disease. And it usually correlates with worse gingivitis, but not always. Sometimes you can look in a mouth and you can have horrific gingivitis and there's not that much tartar. And then you can look in another mouth and there's a crap ton of tartar and there's minimal gingivitis. And so one way to tell in these dogs that are eating species-appropriate diet and their teeth look good is, is there any— even if there isn't tartar, is there gingivitis? Is the gum line pink or red or purple? Is it receding? You know, that sort of thing. Is there anything swollen looking? Those sorts of things. And that's definitely not totally telling you what's under the gum line, but it's a darn good start to, you know, elucidate any problems.

Okay. So for parents, you're saying don't just look at the teeth and the tartar. You're looking at what those gums look like. Do those gums look like yours, assuming you have decent gum gums, or, or do the teeth look relatively clean? But from the gingival margin down, there is redness, there's inflammation, there's puffiness, all that stuff. Okay, that's a really great, that's a really great message for people to take home.

Thank you. What are the little black patches I see on some dogs' gums?

Pigment.

Yeah. Why does that change in an animal where it wasn't there initially and then a year later there's a lot of pigmentation? Is that, are they born with that? Why does it change?

You know what, that's something I'm not totally sure of. And I mean, I think the skin mimics that because there are certain areas of the skin that may take on pigment as they age. I'm not sure that there's any pathology. I've never heard that there's a pathology associated with that.

You mentioned previously something about the difference in the bacterial kind of makeup of a dry-fed dog versus a raw-fed dog. Is there anybody— has anybody published on that? Is there any any actual evidence that, uh, feeding a high carbohydrate diet is going to fuel different communities and those communities are far more likely to cause you issues?

You know, I, I'm not aware of, although, um, Anna Björkman in Finland— did you guys see that, that study? I did see just recently the modifiable early risk factors for Dental Calculus in Dogs: Cross-Sectional Retrospective Study in Finland. And I was really excited to see this. I actually just sent it to one of the board-certified dentists, you know, a friend of mine, because she, you know, lists the results in this study of that puppies that were fed raw food diets from early in life, from weaning anywhere between 1 month of age up to 1.5 years of age, had far less dental calculus throughout life in older ages if they were started out on a species-appropriate diet. And that is a phenomenal study. So that I didn't know about. There's probably others that I don't know about that are on, you know, the same kind of context. She did make a mention in the results section at the end, or conclusions, that small breed dogs did have higher levels than large breed dogs, even, you know, amongst the group, but that it was very statistically significant that dogs that were fed kibble and high-starch foods earlier in life literally set the stage for the rest of their lives, even if you change their diet later, which is so fascinating because that suggests that the bacterial population that was there to begin with was a healthier oral microbiome and more protective than what they end up with if they get started out on, in inappropriate food.

And so that's— so following that, I mean, it's great. Yeah, I've seen that paper and it's great to see. And I think there's some more developments on the stats that are coming out from that study that are going to be published later in the year, which we're really looking forward to. But from a point of view of what you've just said there about the microbiome, because there's a few products out there that talk about adjustment of the microbiome within the mouth as a protective mechanism. I think there's a great one in the States called Teef as a prebiotic option. I know there's some people that suggest that the seaweed extracts— I think there's somebody in the room that might have one of those— that does also something similar. There's also some people that use probiotics within the mouth. What's your sort of experience? Where do you sort of lie with those treatments? Do you use them? Do you think they're good? Do you, how do you think they work?

I do. I think they're all effective and they all have, you know, obviously some different strengths that they're bringing to the equation. And I will just mention the probiotic one out of the UK, Joe Flanagan, I believe, from the Luka Company has a probiotic version, which I'm very interested. I'm going to pick that up and bring that into my practice also to offer that. Very thrilled about that. It changes the bacterial composition in the mouth and also helps to get rid of some of the food components that plaque, you know, uh, that bacterial plaque, uh, like to use. So then it's diminishing plaque growth that way too. So that is a phenomenal product. I'm glad you brought up teeth though, Brendan, because that is one of my favorite dental products because I've seen it to be extraordinarily effective even in humans, because there's human version of it too. There's a drinkable version and a little lozenge, you know, mint tablet that you can let dissolve in your mouth. And for pets, it was designed as a water additive. Although if they're eating a fresh species-appropriate raw diet, you can put it in the food. It doesn't lose much efficacy that way. But if you put it in a high-starch diet, it loses a lot of efficacy. So it's designed to be in drinking water. The reason is because that product focuses on prebiotics. And there's essentially— it's all natural, but there's 3 active ingredients in it. 2 of them are, uh, supporting the healthy oral bacteria, the healthy microbiome, and that's vitamin B6 and L-arginine, I believe. And then the 3rd ingredient is the really unique prebiotic fiber that molecularly mimics sugar, and it's even more attractive to bacteria than sugar itself. And generally, pathogenic bacteria and yeast— so I've seen this really help skin too, that's another cool side topic— But bacteria, pathogenic bacteria and yeast are generally sugar lovers. So they see this molecule with their drinking in their water, if it's on the food, and they all glom onto that going, "Woo, sugar!" No way. It is so cool, Conor. And they can't use it for food, so they just starve and die off. So you literally just have a die-off and an environment that doesn't support new growth of these bad bugs. All the while, you are supporting the good bacteria. And boom, you got this awesome microbiome shift in the mouth. And I have had many clients who are like, my dog's 15 or 17, and I can't even get anywhere near them. Their breath is so bad. I don't even want to be in the same room, let alone let them lick my face. But they have heart disease and they're, you know, super ancient, and I don't want to put them under anesthesia. And, you know, what can I do? And teeth literally people are like, within 1 week of using that, the breath is so much better, they're astonished. And I love to tell people that is a good, you know, demonstration that the bacterial population has changed, because that bad odor is coming from the release of, you know, these bad bacteria, bacteria farts, odors. So it's pretty fantastic. And then you will see gingivitis come down and etc., etc. I've, I know several humans who have also gotten extraordinary results out of that product. So it's definitely worth people knowing about that one.

Love it. Tell us about this one, Katie. This is your one. This is the one that you gave me. My tooth broke in whatever. Where were we? I can't remember.

We were in Orlando at Dr. Conor Brady Morgan's. We were in Orlando.

Talking to the tooth vet and my tooth falls apart as I'm talking to her. It's like, oh, what's this? And so, yeah, you were actually— you were what convinced me to kind of get my teeth sorted out and I have. I'm halfway there. In 2 more weeks, I'll be fully there. So tell us about your product, Katie. Why? What's, what's different about yours?

Thank you. So mine is a gingival rub-on, or you can brush teeth with it. You can put it on a toothbrush. I actually oil pull with it every day. If you guys are familiar with oil—

what does that mean?

Oil pulling is an Ayurvedic traditional health, you know, practice. Where you take coconut oil, or you know, you could do MCT oil. Coconut oil is even better because the lauric acid, etc., and swish it around in your mouth for 10 minutes. And not only does it absorb toxins, but it really helps to support, you know, it's anti-inflammatory and all these other good things. So anyway, Ayurvedic medicine has been talking about that for a while. My product is based in— obviously a pet wouldn't do that, but I just thought I would mention that I oil pull with it because it's, it's great for that. But it's coconut oil, it's organic coconut oil, it's actually Kokotherapy coconut oil, so it stays in a liquid fractionated form but it still has the lauric acid component, which is a bonus. So, it's Kokotherapy coconut oil and then I also add organic essential oils of myrrh and peppermint. And myrrh is known for a lot of benefits as an essential oil but it's really well known for gingival health and oral and periodontal health too. So that's a great one. Peppermint, we know, is breath freshening but also naturally antimicrobial. So those are in there. And then interestingly, and this is a good segue to talk about Conor's product and seaweed in general, I also put trace minerals in there. And so the trace minerals are very helpful for numerous reasons, but also you know, because just the intake of trace minerals has so many benefits. But they help to remineralize the enamel, enamel, sorry, and keep the enamel strong. And so one of the things I like to tell people too is once the enamel is damaged or thinned, we only create enamel once. It comes in as the new tooth is being erupted, and once the enamel is created, it's inorganic, it's done, there's no nerve endings in it, you're not going to create more. But it can be damaged or thin throughout life, and we can help to keep it stronger by remineralizing with those trace minerals. And sometimes human dentists will have you wear those little trays with minerals in them to strengthen your teeth.

Cool.

Katie, are you talking about calcium appetite? And if so, does it actually help to remineralize? Because there are, there are US toothpastes that you can get. Yeah, some apatite in them to try and rebuild any, any tooth that you've lost.

Yes.

Can you tell us about that?

To strengthen the mineral component. And that is something that is, you know, all pretty much biologic dentists and, you know, natural dentists are recommending that now. So I think that's well proven and, you know, very appreciated across the board. So that is really good. And even just simply trace minerals, you know, I did a lot of, you know, research on this recently when I was putting this product together. Even just trace minerals alone can be beneficial. And then, we have seaweed also. And seaweed, of course, is bringing in trace minerals. But turns out that seaweed has also some unique properties in being able to break down biofilm and, you know, break down some of these plaque bacterial groups. And then one of the seaweeds that's been studied very specifically to do that is the brown algae called Ascophyllum nodosum. And I believe the Ascophyllum is the variety that is in Dr. Conor Brady's product. Is that right?

That's right. Yeah, that's the active ingredient in all seaweed-based— they don't even know the compound yet. It's a type of fucoid and some sort of polysaccharide, and they know it works through the saliva. So it works from the inside out. So they eat, it doesn't need to make contact with the teeth. So there's so many different approaches in what you're saying there, 3 or 4 different approaches for keeping the dentist's kind of drill away. So even for a raw-fed dog eating her raw meaty bones, how often should they be going for a dental exam? Because it requires a general anesthetic and some people might be a bit wary of that in a toy. What's the, what's What's the advice there with this subgingival issue that you said is worth keeping an eye on? What's the way up?

Yeah, yeah, you know, and I wish I had a perfect answer for that. What I would say is that if it's a toy breed or a, you know, brachycephalic breed or something like that, in my clinical experience, even when they're on a phenomenal raw food diet, by far they have way better dental health, you know, than dogs that eat processed food, but they still get a higher level of problems in general, you know, with decay or, you know, periodontal disease than a large breed counterpart would eating the same diet. So if it's a small breed dog, I still think that it is very worthy of taking that proactive step of putting them under anesthesia and doing that dental prophylaxis to see if there's a problem. Because if there is, then, you know, it's really going to be impacting their heart and their life quality and, you know, everything else. If it's a large breed dog, even though a board-certified veterinary dentist would still tell you that it's totally worth, no matter what they eat, to put them under annually. If it's a large breed dog, depending on, you know, the pet parents, you know, desires and intuitions, if there is no sign of gingivitis at all, and we should talk about broken teeth, If there's no sign of a broken tooth, you know, maybe they don't put them under anesthesia every year. Maybe they— but, but being really astute at looking for everything we can look for, and maybe they do it every other year, or, you know, whatever resonates with them.

Katie, just to jump in, Jenny Edwards has said, please, could you give out details of the products mentioned? You held up Dr. Katie's tub of stuff. But it was too blurred on my screen to see clearly. So could somebody just—

Yeah, Dr. Katie, if you make a comment on the post at the end, just with your favorite products.

And the teas.

Yeah, and the teas products.

Yeah, we'll link to that. We'll do a post after. We can also reply to these comments. Most of the comments come through on Facebook. The comments you can see there on YouTube, but most live listeners, it's not on Facebook. So any questions or comments that come up there product-related, we'll link to Katie's products so you can check it out.

And I can answer Diane that we do ship internationally for my products. So I have, because I do telemedicine, I actually have quite a few international clients. So we do, you know, we are able to ship. So that's great.

Are you taking consults, Katie?

I am. You do?

Awesome. They'll find you at Integrative Vet Care or IntegrativeVetCare.com is where they'll find you. What are the, are there any other causes of Before we get into broken teeth, that's an interesting one. But is there any other causes of tartar on teeth? I'm finding with the dental products, if it ever fails, which is rare for tartar, it's rare. We investigate those people, we drill into them. What happened to you? Are you a Yorkie owner? And invariably they are. And other than that, we find dogs with recurring gut conditions. And what I heard recently was that dogs with recurring gut conditions, particularly if there's any regurgitation going on, the acidity builds up in the mouth and the body can pump calcium into the mouth, like taking a Rennie or an antacid to cool things off in the mouth. And that, of course, invites tartar. Have you heard of anything like that? That was kind of new to us in the last year, and we're just trying to get our head around it. And genetic causes— is there any genetic causes?

They believe that there's certainly genetic causes. Interestingly, in the large breed dog, you know, section, Greyhounds are known to have really bad dental disease. I mean, they get severe periodontal disease, yet they have the long nose and the large breed dog. So there's got to be a genetic predisposition there. And then with small and toy breed dogs, it is felt that there is some— there's definitely an anatomical predisposition, you know, with the smaller heads. But even Chihuahuas who have, you know, longer noses and stuff like that, I mean, small breed dogs dogs just generally get a lot more periodontal disease and earlier. So it is believed that there's a genetic predisposition there as well. Interestingly, I do talk to my clients a lot about reflux because I typically tell people too that when it comes to halitosis or bad breath, that the number one reason usually is from pathogenic bacteria releasing those odors. But another reason for bad breath is poor gastric or, you know, gastrointestinal health. And there are so many dogs that have reflux, which Conor may remember I actually put that in my presentation just in Virginia because I like pet parents to understand that the majority of the time that there's reflux going on for a dog, that hypoacidity in the stomach is often part of that equation. And so giving an antacid doesn't help them digest because they need that acid. But what we need to do is correct the reflux issue from the stomach juice and any little acidity that is in the stomach coming up. And when it does chronically come up, not only is it uncomfortable, and a lot of times they're gagging and doing that gagging cough because they're trying to clear their, you know, their throat or their esophagus, but it also is coming up into the mouth, just as you said, and that is definitely changing the breath. I have people that tell me all the time, dogs that gulp and burp and act really refluxy, that their breath is awful. That's coming from the stomach. And we know that's got to change the bacterial composition as well. I'm not super keyed into, you know, any studies that have looked at that, but you're inspiring me to go down that rabbit hole.

You said hypoacidity. I remember this from your talk. I was blown away by that. Because I assumed acid reflux is because I've got so much acid, it's gurgling away and it's coming up, you know, my food pipe. And so tell me about the hypo— means low. So what do you mean low acidity?

Yeah. So low acidity occurs— it's more common for anybody who has reflux, human or dog, vastly more common for that to be a low acidity and poor enzyme structure, you know, in the stomach. Versus too much acidity. The problem is once it's coming up, and what happens when there's low acidity, and here's this like a cool tangent I can go down, but dogs, carnivores, dogs and cats require, it's critically important to have a very acidic stomach, a very low pH, because acid is most important for digesting protein. It's still important for fats and carbs and digesting, you know, period, in the stomach, but it's It's critically important for digesting protein. Also, the majority of protein breakdown, all the big cleaving of big old, you know, protein molecules down to little peptides occurs in the stomach. But it requires two things for that to happen: good acidity levels, way down at like 1, 1.5, you know, pH, and pepsin, which is an enzyme that gets secreted by the stomach. But it needs acid to activate it. So even if you have pepsin, if you don't have good stomach acidity, you don't get to activate your pepsin. Your protein doesn't digest well. You got protein sitting in there and just kind of starting to ferment. It's not breaking down. And then you have gas bubbles created, and they need to come up. And so then you got acid, you got stomach juice coming up in the esophagus. Any amount of acid, even if it's too little, coming in the esophagus is very uncomfortable and can be harmful to the esophagus. So you can end up obviously with esophageal strictures and, you know, problems from chronic reflux, but you can end up with dental issues too. But one of the big take-home nuggets I wanted everybody to get out of my presentation that day in Virginia is that the use of chronic antacids, which is a very conventional medicine-driven thing on the veterinary side and the human side, and I presented this at the HVMA a year and a half ago, and I blew vets away. They were like, oh my God, I never knew that. And I presented papers from ACVIM internal medicine, you know, group in, you know, college where they literally did a retrospective review paper or whatever in 2018 saying, guys, we gotta stop overusing antacids. This is causing more harm than good. And so, I presented on that and I also talked about how there are studies that that show dogs and cats postprandial, meaning after they eat, as soon as they— their baseline acidity level in their stomach between meals is like ours, but as soon as they eat a meal, boom, they release their acid, get their stomach gets even more acidic than ours, which makes total evolutionary sense because they're carnivores and they eat raw meat, you know. And so they need super good acidity to break down that raw meat, or they're going to struggle and they're going to have really crummy digestion. So, if it's one thing I can educate everybody on, on stop overusing antacids. And I tell my clients, I'm not going to freak out if you give Pepcid once or twice or for a week or whatever, but please don't give it for 5 years straight and call that a solution for reflux. Because conventional veterinarians tell people, oh, it's— there's no harm in that, just keep them on it. And they just don't know. They just don't know that.

We're going to get you back to talk about this because there's so many people out there who want to talk about it. It is an enormous, enormous thing.

Seriously interesting.

And there's some great studies out there. I mean, even when it comes to treating some of the bacterial diseases in the stomach and people are using automatically antacids alongside that for Helicobacter and things like that, and they've realized that it doesn't improve the resolution of the condition by using antacids. Acids.

And right. And you know what, Brendan? I found in my studies, because I did a ton of research to present to veterinarians at HVMA, when humans have poor acidity in the stomach, hypoacidity, hypochlorhydria is the medical term, they are more prone to Helicobacter pylori. Dogs, in my experience, I haven't seen a study on it yet, although it does say that if you have poor acidity in your stomach, that leads to dysbiosis, hands down. We know that. Acid helps keep the microbiome in check. Obviously, when you're eating raw meat, that's important. My personal clinical experience, because I do a lot of microbiome testing with, you know, stool testing, AnimalBiome, is that a large majority of the dogs that demonstrate chronic reflux symptoms have an overgrowth of E. coli and other, you know, dysbiosis issues. So overgrowth of harmful. And so once we get their acid in their stomach working well again, or get them on the digestive enzymes with the acidity, it's etc., apple cider vinegar, whatever, you know, there's different methods, then that sets the stage for their microbiome to correct as well.

Love it. That is a whole show. Acid reflux, guys, how have we not done that in 3 years? We haven't done it.

Thank you for taking us down that rabbit hole.

Oh, you've got the reflux. We are, we are at time here, guys. We're at 19.

I have to answer one person on Facebook. Okay, there is, uh, Mary Lamy, uh, has asked, look, she's huge issue. She doesn't think she can afford a full anesthetic sort of checkup every year. I just wondered whether you'd come across a product called OraStrips.

Okay.

Yes, I have. Why? Yes, I have.

Biol testing to look at that. What's your thoughts on those?

You know, what's funny is I'm actually a co-author on a study that just was submitted to be published that talks about OraStrips, and it was part of the study. And it was actually a study where we were looking at dogs that had— so the board-certified dental, you know, my colleagues recruited me to be in on this because I'm integrative and I see a lot of dogs that do anesthetic-free dentistry where it's just— and so we're gonna have to have a part 2 because there's so much more cool stuff to say. But it was looking at dogs that had just a non-anesthetic teeth cleaning where they're just scaling and polishing the teeth. Scaling means, you know, you're, you're, you know, scaling away, scraping away the tartar, and then polishing the teeth. But that's just a cleaning above the gum line. What's happening under the gum line? So this study actually used not only getting in there and doing the anesthesia and the x-rays to prove everything, but it used those oral strips as a non-invasive indicator before they put the pet under anesthesia. And they showed statistically good relevance that those oral strips predicted whether these— so I'm so glad you brought that up. I didn't think to do that. So for this person, you know, asking this great question about, you know, if I don't or can't put my dog under anesthesia, is there a tool that could at least be an indicator of are we probably pretty good or do we have issues that we need to go looking for? And that those oral strips do, and they're measuring thiols, which I guess is the gases released from certain pathogenic bacteria, bad bacteria.

So that's awesome. Yeah, we'll link to that product too. That is awesome info. Yeah, listen, I want to hear about— Nick, I know you want to say something, but what we're going to talk about over on Patreon, Katie, we do an extra 10 minutes. It's called A Bit on the Side. And so you don't have to change at all. You stay right there and Bren's going to do all the magic. Nick's just going to finish off, but we're going to be talking about broken teeth and Katie's advice on that because that is a whole other show as well. But I need to to know about it.

I think we've covered some fascinating areas here. This is great, Katie. Thank you, thank you, thank you. I'd like to— in the bit on the side, which I saw you laugh at that, which is good, well done— I'd love to ask you about the link between oral biome and certain bacteria in the mouth and pancreatic cancer. I think that that's a very interesting link, and I'm gonna love to leave that as a cliffhanger. Just want to say a big thank you to you and to everybody watching and to everybody on YouTube and who— those who are listening on our podcasts. And it's great, we are bringing a community together here, and it's so exciting. It really is absolutely wonderful. Yeah, thank you for sharing so much information in such a short time. So guys, absolutely great. I think we're going to can it there. What are we doing next week?

It's another guest, but— oh no, it's an FAQ. And then it's an FAQ. Yeah.

Oh yes, I've got a guest. Probably we're going to be talking hormones.

Oh yeah. Okay, cool.

Very good.

We can start to look at hormone replacements, things like that. That's 2 weeks' time, just to give people a heads up. And and we might have two special guests on that day because there's a couple of people—

Hormone replacement.

Yes.

Hormone replacement in desexed male dogs. What's the story?

Well, not just desexed male dogs.

Is that sneaking into the chat?

Yeah, yeah. Well, there's all sorts, all sorts going on, but we've got to talk about hormones. We've got to talk about, you know, what happens if, you know, they've been surgically put through menopause. and we'll go through all of that and how to replace it. So that's 2 weeks. Next week, get your questions in if you want to know anything from the 3 of us. Okay, then just ask a question. We usually fire through a massive number of at least 3 questions.

3 in the hour.

Patreon, if you're lucky.

Patreon.com/rawpetmedics. Get the questions in there, guys. Share the questions we deal with for us the price of a cup of tea or coffee for the month. We much appreciate it. Those that can are great, those that can't, it doesn't matter. We're going to be here anyway, giving you this awesome content. So you hang about, Katie, we're going to jump over to Patreon and give those guys a little bit of extra juice for their contributions. Thanks everybody for listening. And thanks for being here, Katie, really appreciate your time.

Totally cool.

Thanks for having me. It was so wonderful to join you.