Good afternoon and welcome to today's lunchtime webinar sponsored by Button Up Box. I'm Rich Daley, head of partnerships for the Webinar vet, and I'm delighted to be chairing today's webinar. Before I introduce today's speaker.

And the topic of today's webinar. I just want to do a little bit of housekeeping with you, . Firstly, there are a couple of poll questions, in this presentation.

We really ask you to, ask, answer the questions. The reason being is that it just helps, Kira, our presenter, understand your knowledge of button up but. And how you've heard about them or if you haven't heard about them.

So it just helps round out the presentation. So please do when the time comes, and then you'll see a box pop up in front of you and it's just multiple choice. So click the radio button and that's the rights relevant, and you'll have about 30 to 40 seconds to do that.

We strongly also encourage you to post questions in the Q&A box, which you can find at the bottom of the Zoom screen. We will have time at the end of the presentation to put those questions to Kira. So, you know, as you're, as we're going through the presentation, please type them in in case you might forget by the end of it.

And then as I say, we'll come to them at the end. Also glad to say we're joined by my colleague Dawn. Dawn's on hand to deal with any technical, queries you may have.

You can get hold of Dawn by, going into the chat box, which once again, you can find at the bottom of the screen. Alternatively, if you email office at the webinarvet.com, and you will be able to, pose the question then and Dawn will be responding that way as well.

So, that's enough from me. Let's get on with the webinar. So I'm delighted that we are joined today by Kiera Clark.

Kiera completed an honours degree in microbiology from University College Dublin in 2003, and retained a special interest in the canine microbiome. She qualified as a vet from the University of Pretoria in 2009 with honorary colours. Alongside Buttonut Box, Kiera continues to work in clinics in central London.

And also, she has just informed me that it is her birthday today, 21 again. So, happy birthday, Kieran. I'm sure there's hundreds of people out there singing Happy birthday to you, but unfortunately, we can't hear their beautiful tones.

But without further ado, I'm gonna hand over to Kiera who's gonna be, talking to you about the ins and outs of digestibility and dilated cardiomyopathy. Over to you, Kiera. Thank you very much, Richard, and I did not know you're gonna say that about my birthday.

Thank you, thank you. So, welcome everyone, particularly if you're joining live, well done for somehow wrangling this free time at lunch, and for anyone joining in on the recorded session, I hope you find this very interesting. As Richard said, I'm Kiera.

I have a, primary honours in micro, and then, graduated from Pretoria 10 years ago, which is great. My role here at Butternut Box is, acting as in-house vet. I am not the lead nutritionist.

I am not a veterinary nutritionist. We have a very, very, fantastic, fantastic guy who, who is our lead nutritionist. He is a board certified, vet nutritionist who chairs the, scientific advisory board of PDF, and is far more highly qualified than I.

However, my role here extends from anything from raising brand awareness amongst the community, hence a webinar like this, to writing some of the blog content, helping with health inquiries and running some some research projects, which is just fascinating. So let's get on to the topic at hand. Pet food and dog food, I'm sure you'll find that it's highly emotive and almost overwhelming for a lot of people.

Now people are taking more interest in their own food, and as a result, that off their, their dogs and their pets, and whether you're speaking to someone in the park, or online or one of those Facebook forums. There's, I don't think there's a debate, that is more heatly heatly debated than pet food. And of course the choice is vast.

There are so many options for for our pets right now, which is a good thing, but people are often left a little bit flummoxed. What's better? Is it raw food?

Is it, this grain-free food? Is it a ketogenic diet? Yes, that is a real thing.

Or, how about therapeutic diets, . Yes. Now, a lot of these consumers, pet owners, or if you want to call them pet parents, and now the relationship that we have with our pets has changed quite significantly over the last 10 years, and I would consider myself one of those pet parents.

So whether it's a phrase that makes you laugh or not, and it is shared. By a lot of pet owners. Now, the, the interest and concerns with regards to pet food has become a lot greater since the large scale and pet food recalls and back in the early 2000s, and the largest of which being the melamine and contamination.

Now, for those who have maybe forgotten or if you are a more recently graduated vet, melamine made its way into the pet food chain back in 2007. Melamine is a nitrogen containing a high nitrogen containing compound, and it is, thought that it was purposefully added to wheat flour. Instead of the proposed wheat gluten ingredients that it was sold as, to act as a cheaper source of food.

Now, sadly, pets, this, as I said, this entered the pet food chain and, and many dogs throughout North America, Europe, and indeed South Africa died as a result of this intoxication. . So the, that things like atoxin, and thymine deficiencies or excessive vitamin D has led to a lot of pet owners looking for alternative foods for their pets and perhaps a little bit of distrust in the industry.

Also, if we look at market research coming out of your monitor, a lot of these pet parents are looking for a greater corporate transparency, for example, where are their ingredients coming from, how are they processed, how are they distributed, and, what sort of ethical, ethical values these companies have. So I'm going to break down today's lecture into 6 topics. I will largely talk about what we already know and then hopefully at the end of each little chapter summarise and what we have learned.

So starting off with digestibility itself. So it's very broad, Now, many consumers are pet parents, when they're looking to feed their dog a pet food, often they're having a good read of the ingredients. But now there's another measure that they've started to consider, and that's off the ingredient quality and how digestible it really is.

Now it makes sense that high quality proteins or high quality ingredients supply essential amino acids and lower quality proteins will, will contain less or even be limited in some of these essential amino acids. And the digestibility values will vary quite widely across different dog diets, and this is influenced by largely three factors, the food's formulation, the quality of the ingredients, and how it is processed or how it's cooked or made. So we know that digestibility is just the proportion of the nutrients that are in the food that a dog can absorb from its intestine into the bloodstream and then this is then.

Which, which of these nutrients can be carried along to the tissues and made use by the body. A higher or highly digestible food will have a higher proportion of nutrients that can be used and so it is a measure of the nutritional value and quality of that food. The digestibility coefficient is just the percentage of the food that is absorbed during this process of digestion and generally there are 3 scores for this, a poor, a moderate or a high quality.

Now, these are some acronyms that you may or may not be familiar with PDF are the European and AFCO are the US pet regulatory body. Now, they don't require digestibility levels or even analysis of digestibility to be done on pet food. So it does not need to be done, and they don't have any particular, protocols for this.

And I'll talk a little bit more about that at the end of the lecture and, and, touch on transparency. So let's just look very, very basically at where, where the ingredients are coming from. So if we look at animal sources, there are largely three categories of these.

So an animal source can be human grade, and this is a relatively new term. Animal derivatives or meat and bone meal, is quite commonly used and has been, for many, many decades. An animal derivative, it's quite a vague term, and it can include anything from the very best of meat ingredients to, I'm not gonna say worst, so I'm just going to say the least best, whereas meat and bone meal tends to be things like, Bone, and has a quite a high bone or high collagen content.

I do include a lot of links and references throughout, but I'm just going to highlight this from the UK governance. So this is a list of different ingredients that can be made to use a processed pet food. And as you can see, it includes anything from category 3, APBs, and animal byproducts.

So those carcasses that are fit for human consumption, right down to anything including hatchery waste, or imported pet food. So let me explain this term human grade a little bit more. It is not a defined or a legal term, and as I said, it's, it's relatively new within within the industry.

But it essentially means that all of the ingredients must be human edible, not just at the time of slaughter, but the time that it is being used as well. So from, the factory to the plate. Whereas animal byproducts are human grade only at the time of slaughter, the food chain or the processing along that along that pathway would not be considered fit for human consumption at the end of the process.

I'm not going to talk too much about butternut box. I do want this to be quite an informative and independent lecture, but I will just say that butternut boxes that we use human grade ingredients and we hold ourselves accountable to the human good manufacturing food chain practise. This would be the same as you would expect to to find with any sort of foods that you, you would buy yourself in the supermarket freezers.

So again, just defining some very basic definitions. So what is the composition of a pet food? Now, pet foods are made from a recipe that includes any sort of ingredients and legally on a pet food label, this will be under listed under the composition.

And this is, this will go in order of of weight per wet weight. So, on an as-ed basis, basically, this means if you've got corn listed first and poultry second, there will be more corn in that food than there is a poultry source. Now, if we read the label a little bit more carefully.

I think it's quite important that we know, and most certainly a lot more pet parents are becoming savvy to this, that what is written on the front of the pet food bag isn't necessarily what's written or reflected on the back of the pet food packet or what's inside the bag. So a pet food can be advertised as beef on the front. However, if we turn that back around, legally it only needs to contain 4% of beef, and with that remaining 96% coming from a combination of any other animal sources.

Now this is fine, and clinically it doesn't tend to be too impactful or relevant to many dogs, unless of course they have an allergy or intolerance. Now this is, as I said, this is a legal term, and this is, permitted, absolutely no problem. Because pet food makers and don't need to spell out the exact contents of their pet food, and this is known as an open recipe.

It allows them to change this recipe, depending on whatever protein or perhaps cereal source is, is more abundant or cheaper at that time of manufacturing. Now I'm certainly not picking on any brands or anything like that. When I was in clinics this week, I literally just looked on the shelf and I, I picked up the first bag that I saw.

So if we look at this Hill's Fed Essentials, you will see in brown at the bottom it says chicken. But if we look at the ingredient list, although it does start with the phrase with chicken, actually the first ingredient is maize, followed by gluten meal, followed by, sorry, wheat followed by gluten meal followed by maize, and then chicken at 14%. And inclusion that there is some turkey.

So we've looked at composition there and we've looked at the two different protein sources, even though it, it just says chicken on the front. Now some very quick revision. Again, this is all just going down to the technicalities of reading the label.

So as I said, nutrient levels on a pet food label will be on an as fed basis. This includes moisture. However, as vets, I think we tend to often compare foods more so on a dry matter basis.

So to make it a little bit easier for you, how do you convert those pet food labels from as fed to dry matter. You just use this formula. So if you want to take out your phones and maybe take a quick photograph, that might help you in the future.

Again, I am not picking on any particular brands, it was just whatever I picked up on the, the shelves from clinic. Here's an example of Pro plan EM so if we look at the crude fat levels, so that's 4.5%.

As on an as-fed basis, on a dry matter basis that ends up being about 16.5%. And if I compare that to button up box chicken, which is 3.5% as fed, it is 10.9% on a dry matter basis.

And just to prove. There are, compositions. OK, so we have, we know that digestibility depending on, depends on a number of different factors.

It depends on the ingredients, how they're processed, and, . And we would wonder then, and, but they, and they don't need to be listed on a pet food label. So what is the most highly digestible type of food?

Can we just go for reputation or for price point? So if we look at a study done by Domas at all, and coming from a lab in France. They did analysis of 8 different types of dog foods.

They did not name the dog foods, but they categorised them anything from economy to super premium brands. And they did a beagle feeding trial and looked at the different factors that affected this digestibility, not just the ingredients, but also the fibre content and the different heat processes. What they found was the different crude protein and crude fat digestibility scores ranged anywhere between 65 and 85%.

That was for protein and 75% and 90% for fat. What was interesting is that the foods that had the highest digestibility coefficients wasn't necessarily the most expensive or the the branded one. And so they concluded that food presenting low digestibility should be fed in a greater amount to provide as many nutrients as a highly digestible food.

Therefore, of course, digestibility should be considered when choosing the best quality. OK, so to sum up, what have we learned about digestibility? Yes, it's a a measure of a food's nutritional value, not necessarily coming from the most reputable or premium branded diet.

There are lots of different ingredients or sources of ingredients that will have different qualities and our pet food labels, they do different from front to back. Looking at AFCO and CDF, the regulatory bodies, and it is not a requirement to conduct digestibility trials on pet foods to list these results on pet food labels, or indeed, if it is requested by members of the public or vets, and they are not at liberty to share this information, which is a little bit sad and disappointing, I think, because digestibility does matter and we can't judge this, this information. If it's not given to us, So let's, let's maybe push that a little bit more.

Now, I'm going to focus on some studies and let's look at the importance of proteins. OK, proteins. What we do know is that proteins come from a number of different sources, whether it's animals, cereal, plant, or these new and exciting emergent protein sources.

Looking at animals, it can be anything looking at human grade ingredients are byproducts, cut ingredients, raw ingredients, and of course, egg is an animal protein source. With regards cereals, it tends to be a lot come from a lot of the the gluten proteins. Plants have been used for as a protein source for the last few decades, but they have become a little bit more into the spotlight recently and I'll, I'll talk about that later.

So that's including our legumes and our emergent protein sources, . Whether that's the black soldier fly, as, which is the primary insect protein source, or our coi fungi, so that's the type of fungi that is used in corn, and Qu ORN are a vegan type sources. All right, so let's look at some studies.

So coming from the Donnelly at our lab in 2018, they evaluated 16 different protein sources, looking at animal types, but also some grains and some legumes. Now what was really interesting, it so when it came to the animal types, they looked at chicken meal byproducts, and fresh and raw, raw sources. The chicken meals, so that is the poorest quality, the highest bone, and collagen content.

It actually performed quite poorly. I was it was expected to perform worse than protein. But it had the the least level of essential amino acids, even when compared to many of the plant-based proteins.

This is it, there was found to be quite high levels of connective tissue, and it was also very low in available lysine. Now lysine, as you may or may not remember, it is an essential amino acid. And lysine is a very good indicator of protein damage that occurs during heat processing.

This is known as a Mallard reaction product. I'll touch on that a little bit later. The steamed chicken, so gently cooked chicken, as we would do here butternut box, followed by the raw chicken, had the highest quality protein and highest digestibility.

And looking at the peas and potato protein. Yes, it was limiting in methionine. Now, this is not unexpected because plant proteins don't tend to be a complete protein.

But what was quite interesting that is that it had higher levels of essential amino acids than the chicken meal sources. Another study done by the, the transmitted lab in 2016. They looked at three different types of animal meals.

So again, that, that meal, that byproduct in dry or also known as extruded foods. So they compared lamb to fish to poultry meals. Now, what was worrying was that the lamb meal had significantly lower values for many of the different proteins and, and amino acids, when compared to the poultry and fish.

What is worrying about this is that each of these, each of these meals on paper were a, were formulated to be complete and balanced. However, when they took digestibility into account, the lamb meal was deficient in some amino acids, particularly the essential amino acid methionine, and methionine, of course, being a precursor to taurine, and this is of concern. When they breaking down the digestibility values, it ranged really quite quite drastically anywhere from the low 70s to the high 80s, when compared to lamb, poultry and fish.

So, as I said, though they were all formulated to be complete and balanced after the extrusion or the the process of generating a dry dog kibble, when digestibility was taken into account, the lamb diet was actually deficient in methionine. So to summarise what we've learned, different ingredients have different digestibility values. Tastes like chicken.

Now I've asterisked this because this is not my own term. I credit this, to Linda Case, who is a animal nutritionist over in the US. She is one of the, the leading voices in, in pet food nutrition, and I highly recommend that you go and read, some of her blogs.

She is the sciencedog.com. I referenced that at the very end, and, I thank her for letting me use her very witty phrases like taste like chicken.

OK, so chicken. What do we know about chicken? We know quite a bit.

But when it comes to food, we know that chicken is the most common animal source and protein found in our commercial dog foods. And like our animal proteins, it's considered a complete protein. Breaking that down a little bit further, what does a complete protein mean?

Well, it just means that it contains 10 essential amino acids that dogs require. Now, you'll remember your biochemistry, and there are 20 amino acids. But yes, an essential amino acid.

What this means for dogs is that actually the dogs can't produce these amino acids endogenies endogenously, and they have to be provided by different protein sources within the food itself. So looking at a study, Oba and all, they measured the protein qualities of different types of chicken. They looked at raw chicken, steamed, retorted, and chicken meal retorted is coming from a canned type type type process.

So they want to look at the quality of the proteins, but also looking at how they they were affected by the different processing conditions that is commonly used to generate our pet food. So, did it taste like chicken? Did all these different chicken sources taste like chicken?

Well, yes, maybe, but let's look at the digestibility scores of this. So DM, the dry matter, digestibility of the chicken meal was significantly lower than the other forms. So at 60% for the chicken meal compared to 73% to 76% for either the .

The, the steamed, the raw, or the retorted. Now the highest digestibility score was found for steamed chicken. .

And this was slightly unexpected, or at least there was quite a, there was a belief at least that raw protein, is, it's often hailed as as the very most digestible and of the highest quality. However, when we compare this to the steamed, the, the steamed came out greater with digestibility values for both the essential and the non-essential, were actually greater than 90%. Across the board, the amino acid digestibility levels again were lowest, in the chicken meal.

So again, backing up that previous study from 2016. Again, repeatedly that there were inadequacies found in the amino acids in this chicken meal ingredient. So perhaps it it may have tasted like chicken, but maybe not as nutritious.

So deficient in a number of different amino acids, methionine, tryptophan, reanine, when compared to the AFCO recommendations. Now looking at AFCA recommendations for growth and growth means for growing dogs, so a puppy formulation. Actually this meal meat only met meals only met recommendations for 3 out of the 10 essential amino acids.

Again, this is really worrying. And just repeating, when comparing the raw to the steamed chicken, the, the data in the study showed that the raw chicken, sorry, that the steamed chicken had higher amino acids, than raw, and equally it had significantly higher amounts of those 10 essential amino acids. So if we had to put it in order of least best to best, one would say in the study that chicken meal, was that the poorest and the steamed, the steamed source was the greatest.

So from this, what have we learned? Even the most common and the most ubiquitous protein source that's used in pet food in the US can, can be deficient and, and many amino acids, including methionine. And this leads on very nicely, to our FDA report.

Looking at the statistics from the July FDA report, 113 out of the 515 reports did actually involve a chicken protein source. So, The, the greatly, discussed dilated cardiomyopathy. What, what do we know?

So we know, as vets, as DCM, it is the second most common form of heart disease. This is second to, to valvular disease. However, it tends to be the most common form of heart disease in certain breeds, and so a large and a giant breed dogs.

And it is caused by mechanical. Degeneration? And some electrical dysfunction of the heart muscle.

This is most often the left ventricle. Now, what you might have heard, so in media headlines or perhaps coming from some concerned pet parents, the, the State that grain-free dog food is causing heart disease. Well, I think if we were to believe that at face value, perhaps we aren't the, the, the critical vets and scientists that we, that we would hope, and we would want to learn a little bit more.

So let's look at the FDA report itself. So the FDA and the Food and Drug Administration in the US, and it is important to say that this was a report. It was not a study, and it is looking at retrospective cases.

So in July of 2018, There was a not a note of some case reports of DCM in dogs, some of them being unexpected breeds and a potential association with these dogs eating a grain-free diet. And in particular, legumes and potatoes were were listed as main ingredients. Now this term main ingredient wasn't defined, so that made things a little bit difficult.

However, no other data or details were provided. So that was July 2018. There was a small follow-up released in December 2018.

And then we were left waiting until, until a year later where in July 2019, they, there was some retrospective reports. So over the period of January 2014 to April 2019, there was a statement that 5, there were 515 reported concerns of DCM and dogs. So quite often you'll see this, this number quoted 515.

But I think it's really important that we dig a little deeper. And what's important to know is that actually out of these 515, not all of those cases were confirmed confirmed as having DCM. So 4 340 of these dogs had medical records.

These medical records were reviewed and once reviewed, 202 out of these 515 dogs were confirmed with DCM. Now, of course, this is heartbreaking for the for the dog and for the, the pet parent involved in this. So by no means do I wish to underplay this.

However, I think again, it is important to, to know that you had to dig a little deeper, and it wasn't the initial 515 dogs. Also going to bring to your attention that 95 out of these 515 dogs were golden retrievers. Golden retrievers do have a familial link to this disease, and it was hypothesised that there was a, quite a large number of golden retrievers, that, presented or, or that were reported to the FDA because of social media, social media stories and, and a lot more owners got in touch with the FDA.

So if we look at Lisa Freeman's statement, so Lisa Freeman is a pet nutritionist, sorry, a veterinary nutritionist from Tufts University. And her her reports looking at diet associated DCM, what we know. So that was published in Jama2018.

The extent of this issue isn't clear. Not all the cases were confirmed to be linked to the diet, and a true asso association had not been proven to exist. So let's look at the science behind DCM and our amino acids.

Now we all know that taurine is related to DCM. So what is the, the role of taurine? So taurine essentially it stabilises the cell membranes, and it allows or regulates the flux of calcium and potassium ions across this membrane, which then allows our cardiac cell muscles to contract.

Taurine itself has a stabilising effect, allowing the cells to, to contract normally. But if it's deficient, there's then a change in the contractility of the, the heart muscles, the muscle weakens, it loses that ability to contract, and sadly, then that can lead to cardiomyopathy. Now, it's important to note that taurine is a non-essential amino acid for most animals, and that includes dogs, provided there is an adequate supply of precursors in the diet.

Now we do know that cats are an exception, where taurine is an essential dietary nutrient. So these precursors, what are they? They're also sulphur containing amino acids, that's cysteine and methionine.

And if we look at where these, where these amino acids are coming from and food, they are very high in animal tissue. So looking at, meat, fish, shellfish, dairy, particularly in, a lot of red mussel meat and organ meats. However, these, these amino acids are quite low or limiting or maybe even absent implant tissue.

So we largely have two categories of DCM in dogs, a hereditary or non-dietary predispos breed predisposition and dietary. So if we look at our head hereditary ones, this largely involves our large breeds, or a giant breeds like the Irish Wolfhound or Great Danes, Saint Bernard's boxers and adobe. This is, supported by a number of studies, so we'll just look at the full mart all in 2013.

So they studied 115 Irish wolf fans and found that there was no relationship with touring status and DCM in these non-dietary breeds, DCM. It is not a dietary or a nutritional disorder. It is sadly a medical disease and treatment of this is aimed at managing the signs and slowing the progression, not replacing the nutrients, not giving po supplementation.

There are other potential causes for DCM, whether it's idiopathic, viral, or indeed immune-mediated. So sadly there are hereditary tourine deficient breeds out there, the golden retriever being quite a a common and well known breed new fees, definitely the American cocker spaniel, but there are some reports of English cockers as well and some labs and some Portuguese water dogs. I think there are even some setters have been suggested as well.

So these breeds, whether it's an entire breed or indeed just a familial line within the breed, they either have a reduced ability to produce taurine, a reduced ability to metabolise methionine, or they actually have a greater dietary requirement for the amino acid itself. So can we compare the the non-dietary to the dietary pre pre predisposition? What is that prevalence?

So again, Lisa Freeman's group, the study that was published in Jama, they surveyed a, a host of cardiologists from the US, Canada, UK, Austria, and Israel, and found that, 16% of DCM cases did have a dietary taurine association, which obviously that's your maths, that means that 84% is not dietary. OK, so we'll look at some general dietary influences on the amino acid or touring status. And sadly, we learned of this, because of a number of cat deaths, in the, 1980s, with studies being done, roughly around the 1987, .

Confirming these problems. So what they found in cats is that they were developing signs of DCM. And interestingly, it wasn't because their diets were taurine deficient, that there wasn't an adequate supply of taurine in the diets, but it was largely there were differences in the, the protein qualities, the digestibility, the amino acid availability, how these proteins, were potentially damaged during the treatments, the heat treatment and processing of the food.

There was a great generation of my reaction products, the damaged proteins, but also there was an impact of fibre, fibre levels and types. So overall, we know that taurine is conjugated to bile acids, and our bile acids are then involved in fat digestion. We know that.

As these bile acids are then excreted into the intestine, they help with that fat and digestion, but then they can then be res reabsorbed and conserved by the body. So this is known as enterhepatic circulation. However, anything that increases the excretion of taurine, for example, changes in microbial population, in the, the colon, will lead to a decrease in reabsorption of taurine and then will impact its, it's bioavailability to the body.

. So as a result, a lot of the cat food, and particularly canned cat food, was more heavily supplemented, from the, the 1990s onwards. Now, we didn't necessarily learn this from cats, but we do know that methionine, levels are, are going to be greatest in animal-based protein sources. So if there is a very high level of legumes or potatoes, replacing those animal sources as a protein source, this can also lead to limiting methionine to the body.

Specifically looking at dog dietary influences on arty levels. We can look at three studies. So, Fischetti at all in 2013, this was a, an observational or a retrospective study.

So they looked at 12 dogs that had developed DCM, actually over the period of 1997 to 2001. . Where during this period, lamb was quite a quite a novel protein.

It was described as a hypoallergenic protein and rice was described as a novel carbohydrate source. And so many dogs were eating this potentially for elimination diets. Now these 12 retrospective dogs, either had low blood or, or plasmatarin.

And these all improved once taurine had been supplemented. So it was hypothesised that, the lamb meal, and so it's important that that we say lamb meal and not a lamb byproduct, not fresh lamb or human grade lamb, was potentially of a low protein quality. It maybe had low sulphur amino acid levels, or even the, the fibre itself coming from the rice, and influencing that enteropathic circulation.

That was interfering with the, the taurine, metabolism or bioavailability. Now tours are all actually from the same lab, in the same year. They hosted or they they did a controlled study.

So they also chose 12 dogs. They used beagles, and they fed two different types of commercial complete diets. One was a lamb and lamb and meal or lamb meal and rice diet, and they compared that to a poultry byproduct diet.

They did that for around 5 months. And they found that the lamb diet, although it wasn't, largely deficient in taurine, it did have some mar marginal status, and they found that actually the the dogs were conserving taurine in their urine and hypothesised over a period of time, that this taurine levels would become more and more deficient. .

So potentially there is a reduced availability of this touring in lamb meal diets. . Then there was quite a, then there's quite a gap actually so from 2003 all the way up to 2016, and, involving Fischetti again.

So they did a control study and, and this time they want to look at the fibre types. So again, perhaps, investigating the potential of that rice, that rice fibre and the influence it was having. So in this situation, they fed 18 dogs .

A diet of 10% total dietary fibre. They compared rice to beat pulp and cellulose and they did this for 12 weeks. Interestingly, all of these fibres reduced the taurine significantly with beat beat pulp and being having the most impact.

Now, yes, what this showed is that this reduced the protein digestibility and increased the faecal losses of taurine. And overall, we, we can say that it has been established, and there have been links to DCM with lamb and rice diets. So it's it's a little bit strange that these formulations still exist if they are not taurine supplemented.

OK, so what of of grade for itself. So what studies are being done on this? So this coffin at all studies, so, well, a case study or retrospective study, coming out of Josh Stern's lab in UC Davis.

This is quite a, a commonly referenced or, or publicised or quoted study, that they showed that there were 24 golden retrievers. That had taurine deficiency DCM and out of this 24, 23 had been eating a grain-free diet and once changed to a diet that contained grain, but also these dogs were supplemented with taurine, anywhere between 2.5 and 4 grammes daily.

They responded to that, their, their DCM improved. Now, no conclusions can really be made from this from the study because two things were altered. So it wasn't just one parameter, and two things were changed.

So was it the diet change that had the impact or was it the supplementation of that high level of taurine? Now, we should be careful with this as well. This was one set, this is one particular breed.

This is a breed that is known to have a hereditary component to dietary to deficient DCM and we should never extrapolate one particular breed to a general population of dogs. So yes, the study is quite often quoted as the dog's food was changed and they responded well. Well, again, we should always read more than an abstract and and look a little bit further into the paper.

Now there was one potential theory that perhaps microtoxins had a role to play. In, in, in diet, DCM and, and grain free. So teachers at all, last year, 2019, they measured the microtoxin levels, in 60 different brands of food.

Some of these brands were grain containing and some were grain free with the hypothesis that grain-free diets, perhaps they contained a greater level, of this, of the toxin. And maybe that was somehow having an effect on taurine or DCM on our dogs, but actually what they found was, there are greater levels of microtoxins in the, the grain containing foods. Also really nice, paper that came out, mid last year.

So this is Manilla's lab. They looked at the association of these pulse ingredients of pulse leg be legumes, beans and peas, and DCM. So they wanted to, to establish or, or to address some knowledge gaps before jumping to any conclusions or causes.

They, they let us know that these post ingredients have been used in the pet food industry for for over 20 years. And yes, they can be quite a valuable source of proteins to complement our animal-based ingredients. I think it's important to say compliment and not to, not to replace.

They hammered home the point again that there are lots of different factors when it comes to our proteins, and they, and, and essentially in our nutrient digestibility and bioavailability, and again, highlighted the importance of the, the quality of fibre. And how all these different interactions amongst these different food ingredients can increase the potential for development for touring bioavailability or DCM development. So, we know that not that Touring what does play an important role in preventing DCM.

However, the requirements of, of particular amino acids in dogs aren't terribly well investigated, and indeed from a total, dietary content basis, so looking at our AFCO or NCR or CDF requirements, it doesn't take into account, they give us levels, but they don't really take into account or suggest bi bioavailability or digestibility scores. Really great paper, and I would urge you to read that. So we should know that correlation doesn't necessarily equal causation.

There are a few different, figures that go around from the US. If you listen to some, they will say that grain-free food accounts for 25%, and some people will say as high as 47% of all dog food that is sold in the US, and there are somewhere between 77 and 78 million dogs living in the US. Again, looking at our numbers, 202 out of this 515 were confirmed with sadly confirmed with DCM on review of the medical records.

If we dig a little bit again, quite a high proportion of these diets were dry dog food diets. So potentially, does the, the process type have any impact on the nutrient availability or digestibility of these diets? .

And indeed over 200 of these FDA reports involved either chicken or lamb protein sources. Now there has been a phrase that has been quoted going around known as or referred to as beg diets. BEG stands for boutique, exotic and grain-free.

So boutique or exotic meaning a novel protein source. And in this case or in the FDA report, there were 119 boutique or exotic animal sources. They included anything from kangaroo or ostrich to bison.

So yes, there were some boutique and exotic diets in there, but actually fewer than than chicken or lamb or or even fresh fish. I haven't included the the fish in that one. Now, we don't know actually, out of this 202 cases of reported, not reported of confirmed DCM out of this, which were related to touring status or diet or sadly, which were primary or idiopathic DCM.

But we do remember our our figure that the prevalence of dietary DCM is somewhere around 16%. . And that's how ingredients are sourced, used and processed, and how this can impact potential urine deficiency reduced by availability of DCM and how that could potentially lead, sorry tourine deficiency, had that potentially could influence the progression or development of DCM.

So as with anything in science, we need more data. And this is expected to take many, many years. We need to take into account that diet, dietary factors, ingredients, processing, digestibility.

These are all really important. So we need to look at, where our proteins are coming from. Are they animal sources?

Are they plant-based source sources? Are these urine levels available? Do we have an adequate supply of taurine precursors or cystine and methionine?

What effect is the, the heat processing having on this? So again, the, the sad instance of cat cat DCM from the 1980s, . And supporting this And then actually studying grain-free as a food category in itself is very, very challenging.

It's not just as simple as grain-free diets. I think we should rather focus on all of our ingredients, the formulations of our pet foods, because this is fast, and the different types of processing effects. Now what I haven't mentioned is that there are different, Different recommendations for methionine levels in the US when we compare it to those of the EU.

So AO methionine levels are actually lower than what than our CDF methionine levels, and there are some hypotheses amongst European veterinary nutritionists that this could be playing quite a significant role as well. So what are the FDA saying? The last statement from the FDA is that they are continuing to investigate and gather some more information to see if there is a dietary link to the development of DCM and they'll continue to provide, to provide updates as information develops.

So what have we learned? We've learned that actually it's not just that grain-free food causes heart disease. It is a lot more complicated than that.

And grain-free food may cause heart disease, and we may see, studies, point to this in the coming years, but we do need more data, and certainly there are a large number of factors in the development of DCM and whether that's dietary or non-dietary. We know that there are certain ingredients, for example, chicken meal or lamb meal and rice diets, that can be methionine or taurine deficient. And overall, as vets, generally, we should be recommending feeding a high quality, highly digestible, primarily animal source protein.

That the plant source protein isn't a primary protein because it has low or limiting levels of those essential amino acids, particularly the sulphur containing ones, and that it does not contain very high levels of dietary fibre because this can have an impact on the colonic microbial population and see a reduction in taurine absorption or reabsorption. All right, if you've made it this far, thank you. Well done.

Just 2 more to go, so, and it will not take as long. Let's look at pet food processing, and this is really quite simple. So what do we know?

We know that there are a few different types of pet food categories. There is raw food, and there is food that is quite gently cooked or steamed, like the, the method we use here at button up box. There is dry food or canned food, and they're, they're made by either the process of extrusion or retort, cooking, and these are quite higher temperatures and, and pressures.

So I do love my studies. So let's look at the the, the study coming from turnsick at all. So again, 2017.

So they looked at, chicken. So they looked at raw chicken before it was processed, so before it was cooked. And then after extrusion, so after it was processed and included into a a dry diet.

So because it is known that raw meat is more digestible than dry rendered, meat meals, and they had hypothesised that including this raw and fresh chicken sauce would improve the, the food's digestibility. So they looked at the digestibility digestibility of it, before, so it was very, very high, almost 90, sorry, 89%, . Before it was processed versus the the rendered or dried poultry meal at 81%.

But then when it was added to that pet food at a 25% inclusion rate and and processed, actually, that digestibility, those digestibility levels dropped from 88 down to 82%. So this will just tell us that the processing itself does have an impact on digestibility scores. Now, lysine, you will know that lysine is an essential amino acid, and I mentioned just a little bit earlier that it is a, it's a, an indicator of protein damage.

So this is known as a Mayard reactive product. So when different proteins are subjected to different heat treatments, lysine itself, it will bind to sugar and other amino acids, and then a modified form of of the amino acid is formed. This actually is, is left unavailable, so the dog can't use it.

Even after it's been, digested and absorbed. So this, reactive lysine, the Mallard compound is, an indication of a good indication of a, a dog foods, protein quality and the, the heat, the heat treatment. So in 2014, Van Roy and A all looked at a large numbers, so 67 different types of dog and cat foods, and they were formulated for all different life stages.

So, growth or puppy, adult maintenance and senior, and they, they measured the lysine levels. And what they found is that lysine, could, a large percentage of lysine could be damaged, . After this, extrusion process, and indeed, it, it was left deficient for, our puppy, so our growing stages.

What we've learned from processing, yes, ingredients are really important, but processed methods such as the impact of high heats and high temperatures will also have an influence on the nutritional value of foods. Transparency. All right, so what we know, so the, the FSA, the Food Standards Authority here in the UK, we know that pet food manufacturers have the option to declare their ingredients by category, as opposed to an individual ingredient.

So a category for meat would include the phrase meat and animal derivatives, or for a grain, I could say, cereals, and if we compare that. And named or individual ingredients that could be chicken or corn itself. And as I said before, this allows the the different manufacturers to choose different raw materials depending on supply and abundance of price without having to change their label and.

So, a pet food label could look as Really as simple as this. It can just say cereals followed by meat and animal derivatives, followed by vegetables, or it can look as involved as something like this, where each individual ingredient is listed. And what we know from consumer market research is that pet parents are looking for increased transparency.

So these, these consumers, they are becoming more aware of these categories of open formulations of pet food and that 4% recipe allowance reminder 4%, a pet food can legally say chicken on the front of the bag and as long as it contains a minimum of 4% of that chicken with the other 96% being a combination of any other meat types. Now, when the consumers learn of this, they become quite unhappy and they start to use words like they're being deceitated or cheated, and they're especially annoyed if they've paid quite a large sum of money for a reputable brand or a premium label. Speaking to .

Pet owners in the park, or online or just watching these forums, we know that this consumer confidence is low, and it's even attested by the challenging or Netflix documentaries such as Pet Fools, . Watch it. I don't necessarily agree with everything that's portrayed in it, the same way that human nutritionists will not all agree with game changers and conspiracies.

But I think it's important to know that these are the shows that our our clients are watching, and indeed, it's important to know that they are questioning our veterinary pet food recommendations and . What ties, questioning what ties we have to certain brands. So I've, I've promised that I wouldn't talk too much about but in a box itself, but I do wish to raise brand awareness of the company.

So I'll very, very briefly with two slides, tell you a little bit about our own digestibility studies. But many of you mightn't have heard of butternut box or what we aren't, and how, how it makes us a little bit different. Button up Box is 60% meat coming from single source proteins.

So we have, 4 recipe types at the moment, chicken, beef, lamb, and turkey. All of these ingredients from the, meat to the vegetables are all human grade with our our meats coming from, . Irish and UK red tractor approved farms.

We do have a combination of beans and peas and lentils and freshly prepared vegetables. These meals are all balanced to be complete, so there is a a mineral mix included. And as I said, but on a box, we gently cook our food at 90 degrees, and so there is no Mallard product formation.

Knowing that transparency is really important to pet parents. We do list every ingredient in there. So looking at the composition, you will see that the, the first ingredients will always be, meat and then followed by each individual, food.

these are two of our meals, beef and chicken, and the food looks just like that. it could almost be, described as a lovely shepherd's pie just without some salt and pepper. Now, as I said, one of my roles here put in a box is to is to carry out some research projects and one of the the big pieces that we did was looking at digestibility itself.

So we repeated some in vivo studies, so, animal feeding studies and found that our crude protein and our crude fat digestibility scores were really quite outstanding . Anywhere between 91 and almost 93% for our protein and not quite hitting 100, but pretty close for our crude fats, so 99.3%.

And that is the last, I'm going to say about that. I'm going to summarise. So today, I hope that you take away that, to ensure that there is good nutritional adequacy of the foods that we're feeding our dogs.

And to be able to compare this, we need to see listed ingredients. It's really important to know the protein and the amino acid composition and the processes, the ways that they, these dog foods are, are, subjected to, and the digestibility scores are really very, very important. Yes, Richard, I think we're getting on to our polls.

No problem at all. So, we're just gonna launch the first poll, and the first question is, before today, have you heard of the box? If you can just type yes, click yes or no, I'll just give you 30, 40 seconds to do that.

OK, we'll end that there. So what we've had here, Kiera is, 41% have said yes, they've heard of button up box and 59% have said no, they haven't heard of button up box. So that's interesting for you and hopefully, this webinar has helped raise more profile of a box with the wider veterinary community.

Super. Yeah, that's great to know. And then shall I launch the second poll question?

Yes, please. No problem. And then if you just follow up please, if you have heard of butternut box before, it'd be great if you just indicate how you have heard of them, whether that is you feed your own dogs butternut box, whether one of your clients has come in saying they feed their dog butternut box.

Via social media adverts, a previous CPD events, or at a congress. OK, and we'll just end the pole in there. So no one, is currently feeding their dogs button up box.

30%, have clients who feed their dogs, your products. 63% have seen adverts on social media. 4% have been to a previous CPD event, and 11% have seen button-up box at congresses.

Lovely, great. All right, Richard, I am going to pass the headset over to Dave, our co-founder, and then I will jump on at the end to answer any questions. No problem.

Thank you very much for that, Kiera. So we've just got a, a couple of slides by David Nolan. Dave is the co-founder of London-based Butternut Box who is obviously our sponsor.

For today's webinar. Together with co-founder Kevin Glynn, the two friends started the company so that they can deliver health and happiness to dogs and their humans all over the world. They're serving up a fresh take on dog food.

So I think I can hear you getting ready in the background. So if you're ready, Dave, it's over to you. Yeah, we're here, thanks very much.

Yeah, I just want to say a quick thank you to Kiera for all the hard work and putting that presentation together. She gives a huge amount of confidence and content, to our team, and the vast majority of us come from a non-clinical background, so having Cera as part of the team, is, is just amazing. So thanks very much to Kiera.

Just, trying to keep this away from, a, a shameless plug of our own company, but maybe just to give you, just a bit of background as to kind of who we are, what we've been doing, and I, I guess, you know, what, why we're out here trying to do what we do. For us, yeah, I, I guess. We, we sum it all up as, trying to put the food back into dog food.

We make fresh food, we try and make every box personalised to our own customers' needs. And if we get everything right, on our side, hopefully we're seeing happy dancers guaranteed across the entire country. For us, how it all started, I had, my own farting Staffy, we, we adopted Rudy, as she became known from, from Batsy Dog's home, brought her home.

And I guess, yeah, the company story is built around the fact that she wouldn't stop farting, but she had a bunch of other problems at the time, that we actually like, later found out were food related. So she just had, like, you know, constantly loose stools. She had really irritated skin, you know, kind of weepy eyes, irritated ears, kind of the lot.

And actually, the only thing that that improved her condition after trying all kinds of different, different routes was home cooked food for her. And yeah, a a change in condition after, after starting a home cooked for Rudy was, was incredible. And I, I guess 4 or 5 years went past of us cooking food every single day for our dogs.

And, I guess we just got a bit tired of it, to be honest with you. And, a Google search of home cooked dog food delivery to try and see if someone else out there was doing something like this, yeah, yielded no results, and, yeah, essentially me and, my best mate Kev. Yeah, we, we thought we'd give it a go and see if we could, if we could take this and, and make it an offering for, for more people.

And so we started off with giving food away to friends and family and just seeing what the feedback was. And after, you know, receiving amazing feedback and really kind of along 22 main strands, really. When we gave people food and they fed it to their dogs, we got great feedback around improved, improved stool quality, you know, reducing the, the prevalence of farts, and then start.

To help skin conditions that had been prevalent in dogs for, you know, a, a decent amount of time. And I guess the other main strand of feedback was people who'd previously found it difficult to find something that their dog wanted to eat. You know, their dogs were absolutely crushing our food, which was just great to hear.

And I think at that point in time, we, we, like a lot of people probably thought, oh, you know, you know, dogs will eat anything, but there's just this whole subsection of, of the population out there that are really struggling to find, something that their dog wants to eat and enjoys eating every day. So after, yeah, I guess after the testing period, we, we wanted to see if people would actually pay for it, and 70% of people who tried the food for free actually went on to become paying customers. So that was super interesting for us.

That was kind of enough of a proof of concept for us to kind of get going. And just to give you a bit of a sense of the journey that we've been on, I, I guess everything started with Rudy coming home from Battersea, and then it was really kind of tough going for us in the, in the first instance. We weren't really going anywhere fast, and it probably took us about a year and a half to be feeding, to go from feeding kind of 0 to 200 dogs.

But we'd kind of proved that concept enough and customers, you know, once they try. Our food, once their dogs tried our food, they loved it and they stayed with us, and that allowed us to get some investment. And after we, we received our, a million pounds worth of investment, we built a little human grade dog food factory in Northwest London.

And I guess, kind of, you know, the rest from there has, has been history, and we've really started to accelerate. And, you know, we're really proud that in, I guess, the last 24 months or so, we've gone from feeding a couple of 100 dogs every day to now, feeding close to 4. 2000 dogs every single day.

We've had our first customer reach 100 boxes from us. We, we set up another, bigger pet food kitchen, this time located about an hour north of Manchester. And it's been, yeah, it's just been, an amazing experience and one that we've been, you know, privileged to be a part of.

Just culture wise, just to maybe give you a little bit about the personalities behind the business. We really sum up how, and, you know, we're a very values-based organisation. And, you know, every day we're trying to, live out our values, which would be dedicated and determined, open and honest, both, you know, ourselves and our customers, genuine care, again, for our customers and, and for the team and making sure that we're looking out for one another and striving for better.

You know, we, we, we realise that we're not the finished article, you know, we're not as good as we can be, and actually we all come to, to work every single day to try and. This company just a little bit better than it was yesterday. And underpinning the whole thing, as you can see, you know, everything that we're doing here is for the love of dogs.

It's a very dog-centric company, and, you know, we're, you know, 60, 70% of the, of the company, dog owners, you know, have been, all their lives, and it, it really just kind of, you know, it's the thing that brings us together and, you know, binds us all together in the mission. Just, just a little bit about, you know, what we try and do as well as just selling dog food. It's not, it's not just about, you know, revenue and selling as much dog food as possible.

You know, the whole story for us started with Rudy coming home from Battersea, and we wanted to make sure that, you know, we, we recognise that the dogs that eat our food are generally pretty lucky, and, you know, they, they. Their owners are, you know, able to afford a premium product, and, you know, they're invested in their dog's wellbeing and nutrition. And what we wanted to do is we wanted to make sure that the company was a force for good for dogs that are less fortunate, the ones than our own dogs and the ones that we feed.

So for every customer that signs up, we donate food to a homeless or sheltered dog, we, We've got kind of a close relationship with a rescue farm in Kent called Foal Farm, and they've got 22 kennels full of rescue dogs that are looking for their next home. We feed all of those dogs every single day. We'd be, I think we're still the biggest corporate contributor to the Mayhew, the Mayhew An home, and, and, you know, pretty much, you know, we, we try and focus our efforts in, you know, and be as, you know, focused as possible.

But you know, if someone reaches out and, and there's, essentially like a, you know, a dog you'd need on the other end of the phone, we do our best to move heaven and earth to try and help them. And I guess, yeah, to, to bring it back to our, to our purpose, and I guess, you know, we're, we're approaching our 4th birthday now, and it took a long time to be able to kind of distil down what it is that we're trying to do into a neat sentence, but yeah, to, to, to, to convey it, I think it would be just to deliver health and happiness to dogs and their humans all over the world. We, we focused the whole company on the dogs that we serve, and, you know, we keep them at the centre of everything that we do, but we also do realise that, you know, the, the, the human is the person that purchases, the box of food.

And we try and make both the dogs and humans smile from, you know, maybe a product that, you know, I don't think dog food is traditionally, a product that's known for getting a lot of smiles. But for us, you know, we thought that if we could, if we could just make feeding time that a little bit better, that'd be a good contribution, for us. So that's, yeah, that's, that, that's kind of, that's kind of us as a nutshell, didn't really wanna, plug us any more than that, but just to give you a kind of a bit of a sense of who we are and what we do.

And, yeah, thank you very much for listening. Thank you for that, Dave, very, interested in, obviously, thank you to Kira as well. So much information packed into that presentation, and hopefully, you've taken away some very useful information.

As always, these webinars are recorded, and will be available for you to watch in the next 24 to 48 hours. So if you did think I didn't have a chance to take down some of the information off that slide. You know, within the next 24, 48 hours, it'll be available on our website for you to revisit, go over some of the bits again.

So please do take time to do that. Also, including the slides, there are some references as well, because I know that, Kiera, referred to quite a few different studies. Have you got those slides there, Kiera, just so we can I do if I go back a little bit.

So, yeah, those 3 pages at the end, and, yes, you can, I urge you, please go and, and read any of those references, all amazing studies. So there you are as well. So I just wanted to point that out to you because I knew they were in there and we obviously skipped through at the end.

As you can see there, there is a, link, button upbox.com/ebinar bet that is for. Oh.

Hello. Sorry, just accidentally, muted myself there. so, yeah, as I was saying, as you can see, there's a link there, button upbox.com/ebinar bet that is to enable you to claim a 2-week free box, code.

Obviously, that link is not clickable, so I have just popped it in the chat box. So if you click on chat, you'll be able to access it there. I am pleased to say we've had some questions come in, and that we're obviously tight for time and we really appreciate you giving up your lunchtime, to attend today's webinar.

But I think there are some interesting questions come in. So I'll just go over a couple of them now if that's all right. Great.

I did not realise how long I had spoken for. So my apologies to anyone who really needs to get away after that hour. Yes, but please bring on the questions.

All the information you put was very useful, and, you know, I can see that everyone has stayed with us, so it just, tested to, so the, relevancy of the presentation. So thank you very much for that. I've got a question here from Helen.

Has there been any research done on the most sustainable, you know, or eco-friendly diet for dogs, i.e., commercial, raw, etc.

Hi, Helen, not to my knowledge, not or not that I'm aware of, I know obviously different ingredients will carry a different type of carbon footprint. There are emergent, emergent, protein sources that are coming out. I can't point you to any particular paper, but, you know, this is so, so interesting, and certainly something that that but in a box are really focused on.

So when, when it comes to the, the ethics and, and the sustainability around our food, all of the ingredients are locally sourced, so they're coming either from Ireland or the UK, so keeping those travel miles low. They, we do use, as much wonky vegetables as possible, and our delivery partner is, DPD who is a carbon neutral delivery partner. We're constantly trying to reduce our carbon footprint.

So I'm really sorry I can't point to any. Sustainable papers, but I'll actually get our green squad onto that. We, we have a whole dedicated team to that.

And if you want to leave your email or indeed anyone who'd like to to ask me any questions, can email me there. My my address is Kirabox.com.

Thank you, Kira. Jacqueline's, messages saying, she's just playing devil's advocate, saying, yes, digestibility is critical. However, I totally agree, especially performance and highly active dogs.

However, given the level of obesity issue in a large proportion of the pet dog population, is reduced digestibility of some ingredients not actually useful. I think it should, we should rather look at the the nutrients, profiles. So instead, should we be focusing on fat levels or carbohydrate levels?

Is this a digestibility thing or is this an excess? Of calories coming from certain nutrients. I don't have an absolute answer for that.

So if, if it is digestible, it is available. I think it will rather, the composition of that food will have a greater influence on, on our dog's health. And, and largely, when it comes down to it, it's, it's going to be best volumes as well, how much food is fed.

As opposed to the digestibility of, lot of devil advocate questions though like definitely pushed me on things. No problem. Claire, Claire's a behaviourist.

She says, thanks for an excellent presentation. You spoke about the quality of proteins, but she doesn't think you mentioned the dry matter percentages of protein content. As a behaviourist, she often has concerns about high levels of protein affecting behaviour adversely.

And find that dogs who are sensitive to protein levels in terms of behavioural reactivity need levels below the mid-20s. In her experience, the higher quality commercial foods are available, have levels of 40 to 50%. I wondered if you could comment on why these high levels are used and whether you're aware of potential behavioural effects.

So certainly this is something that I have heard, anecdotally. So some behaviourists will say that, in their experience when dogs are fed a low, a low protein level, that behaviour improves. Sadly there's no research to to back that up or to support it.

And equally other behaviourists. Say that once a dog is fed a lower carbohydrate source or a low simple sugar source that they see the behaviour issues improve. So, I have answered your question with another question.

I'm sorry, it is something that, that's certainly I, I've heard of, but there's nothing to, to back that up apart from experience. No problem. Thank you very much.

More people sending in, coming in saying, hugely informative, webinars, really, really enjoyed it, so some great feedback there for you. Thank you. This might be a question for Dave, if Dave's still there.

He's, he's run away, but I could get him back. It's right, you might be able to answer it, but, will Button up Box be looking at a recommendation service to reward vets for referrals? Oh, I can answer that.

. So that is something that, that's actually one of my roles within the company, is to develop relationships with, with vets and whether that is a, an individual vet or a veterinary practise, certainly there is a The scheme that we have at the moment called the Ambassador scheme and we work with a lot of dog trainer and behaviourist. If that is something that anyone who is listening would like to learn more about, please email me and I'll send you on the the pack information. Absolutely.

Fantastic. So that's Kierra, C I A R A at Button up box. Dot com.

That's it. Quicker, is Button up Box available in the USA at the moment or is that something you're looking at developing? We aren't at the moment.

We are UK only, always looking at different regions and potentials. However, there are in Number of fresh food options in the US. The one is called Nom Nomow and their lead nutritionist is a highly respected veterinary nutritionist, nutritionist, Doctor Justin Schmalberg.

We, we chat regularly, but there are lots of other brands as well. Brilliant, thank you for that, . Ritesh has, messaged saying, what is the best way to measure reactive lysine?

Biochemically, so looking at, Looking at that that damaged protein within the food. So, if anyone is interested, I could Potentially put you in touch with certain labs in the UK that do that. Equally, just something that I forgot to mention if DCM is a concern that you have for any of your patients, we do recommend measuring, blood taurine levels.

There aren't any labs in the UK that do this. They may offer it, but many send off, those bloods to labs in Germany. Alternatively, you can directly send samples to the UC Davis amino acid lab.

It's really important that those blood samples are, non-hemolyzed. So, yes, if anyone there has patients that you're worried about, taurine levels and DCM, I urge you to either get in touch with UC Davis or any of the UK labs, and they can point you in the right direction. Fantastic.

Thank you very much. Well, we did say it was your birthday, so, we won't keep you much longer because I'm sure you've got a large, GNT or a glass of wine waiting for you. Well, maybe in a couple of hours' time anyway, but, Tanya, says, best webinar I've ever listened to.

So if there was ever a birthday present to be had, I think that is it there. Isn't it? Oh my goodness, thank you.

And, she says, please bring button up box to Australia, so I'm sure you'd be first in line to, put yourself forward to go in there, get the product, known over there as well. I'll, I'll let Kevin Dave know that would be a nice trip. Thanks, Tanya.

So all that leaves me to do really is say thank you to all of yourselves for attending. Hopefully you've really enjoyed it. As my colleague Dawn said in the chat box.

It will be available on our website in the next 48 hours. So what you do is log in using your email address and a password, that you should have already set up. If you've got any problems, you can email office at the webinarett.com or dawn at the webinarvet.com, and we'll be able to assist you with that.

Thank you, of course, to Buttonut Box, for sponsoring today's webinar. I hope you found it really useful and informative. Please do also check out Butternut Box if you've got, interested in any more, either for your own pets or just get a bit more information, for when you're, talking to your clients.

Butternutbox.com is where to go for that. We have got a short survey that will pop up at the end of this presentation, so please do take time to fill that in.

Any feedback, I'm sure Kira will be, delighted to receive in feedback about the presentation, but also, information for button up box as well. So please do take your time to complete that. And, last but not least, thank you to Dawn for being on the, On the technical side, supporting me and supporting the rest of the team on delivering such a great webinar.

So, I'll let you enjoy the rest of your day. Hope it goes smoothly. I won't say the keyword because I know that is banned in veterinary talk.

And obviously, all the best for the rest of your day. Thank you very much. Goodbye.