Regurgitation: discouraging but not without solution.

If your cat regurgitates his or her food shortly after eating, the behavior may indicate an underlying medical condition. In most cases, however, management and modification of the dietary intake of the cat can reduce the frustrating behavior to an occasional incident.

First, it helps to get the clarity that your *carpet tiger* is not a lion, and is only very distantly related to the big cats, who hunt big game, and gorge themselves on a kill, followed by several days of digesting and fasting. Our small felines have evolved to hunt prey much smaller than themselves, and must eat, on average, five mouse-sized prey every day to meet their caloric needs. The small felines are not adapted to gorging and fasting, and can easily develop disease of the liver if forced to fast. Equally, eating more food in one sitting than what the average size of a mouse would represent, will result in regurgitation in many cats. 

On more than one occasion, concerned cat owners have contacted us after their cats have repeatedly brought up their entire meal shortly after consuming it. The behavior is alarming to the owner, and rightly so, because repeated incidences of regurgitation can leave a cat dehydrated and malnourished.

A meal before and after regurgitation:

before

A cat eating a 40g portion of food will at least add 15g of saliva and digestive juices. Not only will her stomach need to find room for this additional volume of fluids, but these fluids are also lost if the food is regurgitated. A cat can get dehydrated quickly, if regurgitation is not recognized.

after

Regurgitation often goes unnoticedif the cat in question is allowed to go outdoors, or if a second cat in the household gladly cleans up the evidence before discovery. It is noteworthy, however, that “reverse ingestion” is not entirely unnatural to cats, who regularly induce vomiting by eating grass as a natural process of expelling hair retained by the stomach. Although the process is not unusual in cats, regurgitation of food - especially if it occurs repeatedly - must be remedied.

In our search to eliminate the occurrence of repeated regurgitation, we must first examine three important questions:

• Is the cat regurgitating or vomiting?
• Can an underlying medical condition be ruled out as cause?
• Did the cat eat grass shortly after eating which may have prompted the regurgitation?

The involuntary return of ingested food to the mouth seen in regurgitation differs from vomiting, in that it is a passive process [i.e., unaccompanied by reflex, propulsive movements]. Vomiting occurs most commonly hours after eating, and the vomit has a strong, unpleasant odor. A veterinarian will try to determine if the animal is truly vomiting or if it is regurgitating, because, as veterinary internist Dr. Marcella Ridgway explains, “the two may look the same, but they are signs of different types of illnesses.” Dr. Ridgway, who practices at the University of Illinois Veterinary Teaching Hospital in Urbana, says regurgitation is a fairly specific sign of a problem in the esophagus, whereas vomiting is a general sign seen with problems in the stomach or intestinal tract and with other diseases, such as kidney failure or even brain disease.

Possible medical conditions with regurgitation as a symptom can include a blockage caused by a foreign body, or tumor, or scarring. It can occur as a secondary symptom to diseases that affect nerve or muscle function, such as Addison’s disease, hypothyroidism, lead poisoning, and the muscle disease myasthenia gravis. Inflammation of the esophagus, such as that caused by acid reflux or stomatitis, can cause a transient form of megaesophagus that usually heals if the reflux disorder or inflammation is controlled

There are many things a caregiver can implement to manage regurgitation at home, but here are some of the therapies suggested by Veterinarians:

• Dietary modification should include small frequent feedings of an easily digestible product. The specific disease should be addressed with the appropriate feeding regime. It is recommended to try different consistency foods, ranging from liquid to solid.

• Motility modifying drugs (drugs that promote movement through the gastrointestinal tract), such as metoclopramide (Reglan®), can be used to stimulate movement within the esophagus and promote gastric emptying.

• Gastric (stomach) acid inhibitors (blocking agents) are recommended to block acid secretion, therefore diminish the volume of acid that is refluxed (leaked backward) into the esophagus. Since esophagitis is often a component (cause or effect) of regurgitation, their use is generally recommended for symptomatic relief. Examples include a group called H2 receptor antagonists such as cimetidine (Tagamet®), ranitidine (Zantac®), famotidine (Pepcid®) or proton pump inhibitors such as omeprazole (Prilosec®).

• Sucralfate (Carafate®) suspension (liquid) helps sooth and coat an inflamed esophagus, which is often associated with regurgitation.

• Hospitalization may be indicated symptomatically/supportively for those patients who are extremely ill. Fluid and electrolyte replacement and/or nutritional supplementation may be indicated for certain individuals. Placing a gastrotomy (stomach) tube endoscopically or surgically may be helpful in bypassing a diseased esophagus to deliver adequate nutrition to the regurgitating patient. Alternatively, instituting parenteral (intravenous) nutrition for a period of time, while trying to identify and treat the underlying cause, might be the safer choice for the compromised patient that might be at risk having to undergo an anesthetic procedure.

• Antibiotic therapy may be recommended in cases where secondary pneumonia is suspected, specifically if a regurgitating patient begins to cough, has difficulty or a change in breathing or becomes febrile.

Personally I have spent considerable time investigating and experimenting with the problem of cats regurgitating raw meat or a raw meet diet, or food in general. Two out of my own ten cats do this if not managed.

Our now 14 years old cat "Avena" - my greatest challenge and teacher in managing regurgitation.

 The following are triggers for regurgitation in cats:

- PORTION SIZE: many cats do not tolerate eating a portion larger than 1/4 cup in volume (60g weight); with some cats regurgitation food if food volume exceeds 2 level Tablespoons (36g weight). The cat’s stomach, when not distended, is the size of a walnut. Some cats are particularly sensitive to distension, especially when the food bolus is fortified with saliva (adding additional volume). Once a certain capacity is exceeded, the cat receives a signal, prompting regurgitation. This is common in cats eating dry food, which has little volume when ingested, but exceeds the stomach’s capacity when expanding with the cat’s stomach juices.

- LIVER: there are many cats who will promptly regurgitate their food when eating raw liver (any kind), even if the amount of it in food is small. We have been successful in many cases to abolish this problem by introducing our InstinctsPLUS formulas which contain spray dried liver.

- RED MEATS: foods which prompt regurgitation in some cats, regardless of amount ingested, include raw beef, raw liver (any kind), raw heart (any kind), and most other red meats (like venison, elk). Regurgitation is almost entirely prevented if these foods are given cooked. The thought has occurred, that enzymes in red meat might be suspect.

- CHUNKS: a raw diet prepared with little meat chunks is more difficult to digest than one made with ground meats. Using ground meat almost provides a means of pre-chewing your cat’s feed for better digestion. Meat chunks can sit in your cat’s stomach for a long time before finally dissolved, and may be regurgitated soon after ingestion or hours later.

- DRINKING WATER: many cats get thirsty after eating, and will drink water after emptying their food bowl, which will often cause regurgitation. We make a point to remove water bowls during feeding time, and put fresh water back down an hour after feeding.

- MOISTURE CONTENT: preparing the food with too much water (making it too soupy) can be a cause, and we have seen great success in feeding cats a firmer food in smaller quantities, and restricting access to water one hour after feeding.

- GRASS: some owners are not aware that their cats go outside to eat grass after their meal, which will prompt them in most cases to bring their food back up.

- FIBRE supplements are suspect of causing some cats to regurgitate.

- AGE appears to play a role. Cats eight years and older seem to be more inclined to regurgitation, although the same cats may have never before had any trouble indulging in any types of food or quantity. Despite the fact that cats can have a life expectancy of 20+ years, middle age brings physical challenges even for them, which may require attention.

- CIGARETTE SMOKE: exposure to cigarette smoke will cause regurgitation, and cats may develop a predisposition to regurgitation, or hypersensitisation through previous exposure to chemicals.

"Roslyn" was instrumental in giving us clarity, that cats do not thrive with grain in their food. She threw up every meal containing grains. This prompted us to go grain-free from early on.

- CEREALS and VEGETABLES: inclusion of cereals (grains) and vegetables (especially raw) has long been established as a cause for cats to bring food back up.

- TEMPERATURE of the food when ingested may be a factor, with food being to warm or too cold causing it to be regurgitated. Although less aromatic, we have had personal experience with food at “sandwich temperature” being tolerated best.

- TIME OF DAY: most cats prone to regurgitation will do so in the morning with the first meal of the day which breaks the fast of the night. We call this “morning sickness”. Even if all the above triggers are observed, the food may still come up. In this case, feed no more than a teaspoon or two of food to your cat in the morning, followed by more food an hour later later. Alternatively, you may be inclined to start your cat’s day with a few pieces of kibble.

Intolerance to any one ingredient in a diet can not be ruled out. Trial an error, or an elimination diet can help pinpoint sensitivity to a certain food or supplement.
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Action plan for feeding a cat who regurgitates:

1. Try to determine, if your cat regurgitates mostly in the morning (”morning sickness”)
2. Feed the daily ration as small, frequent meals.
3. Try preparing your homemade cat food with cooked meat.
4. Prepare your homemade cat food without excessive water.
5. Use chicken, turkey, or pork as your choice of meat.
6. If sensitivity to liver is suspected, try our InstinctsPLUS formula.
7. Do not allow your cat access to water or grass right after eating.
8. Reduce stress in your cat’s life.
9. Have an underlying medical condition ruled out.
10. Have your cat’s teeth cleaned to prevent inflammation of the gums and throat.