Speaker 1: The content of this podcast is provided for general informational
purposes only and is not intended as nor should it
be considered a substitute for professional medical advice. Hello, this
is Karen Nickel, family nurse practitioner, and you are listening
to Itchy and Bitchy, a podcast that provides answers to
your many unanswered health questions. I have some very exciting
news to share with my wonderful listeners. For almost nine years,
I have been the host of Itchy and Bitchy formally
named Sweaty and Pist. It is time for the podcast
to grow and evolve with new hosts and a slightly
different format. Growth and change is a good thing. My
dear dear friends, Steven Miller and Keith Millica will be
the future hosts of Itchy and Bitchy. As hosts, they
will have a comprehensive approach to wellness with a focus
on connecting human health, animal health, and environmental health. To
provide a transition period for you, for me, and for
Stephen and Keith. We have a series of four episodes planned.
I will introduce Stephen Miller, a fellow nurse practitioner, in
the first of the four episodes. In the next episode,
I will introduce you to Keith Millika, a veterinarian. The
third episode will include all three of us as I
interview both Stephen and Keith. All three of us will
also be in the fourth episode, but this time the
tables will be turned and Keith and Steven will be
interviewing me. Good luck with that. I am confident that
you will enjoy learn from all that they have to share.
So today I want to introduce you to doctor Keith Milica.
Speaker 2: Hello.
Speaker 1: Hello. He is a veterinarian and board certified veterinary dermatologist
who has been in practice for thirty years. Lots of experience.
He has taught at Auburn University, the University of Georgia,
and the University of Tennessee. Go Orange. Keith is currently
an adjunct professor at Lincoln Memorial University here in Knoxville.
But wait, there's more. He is the author of small
Animal Dermatology textbook. He runs an allergy and dermatology clinical
practice called the itch Clinic. He is also the medical
director of doc Itchy Medical Supplements. Keith is also a
dear friend. Welcome Keith, Hello Karen, I'm so happy you
are here met you.
Speaker 3: This is very exciting for myself and Steven and hopefully.
Speaker 1: You absolutely I trust you implicitly, so, Keith, what I
thought that we could do today is pick your brain
about pet food, gut health and diets. Sure, all for
animals in other words, well, so there's actually a lot
of crossover as well.
Speaker 3: And so one of the interesting things about the human
veterinary kind of interaction is that we can do a
lot more interesting kind of tests or experiments in that
trying to get someone to eat the same food for
six months doesn't really work out too well. But with
dogs and cats we can really restrict our diet and
have much more precise control and then say what happens.
So some of the information we have on the vetinary
side actually is better and more detailed than what's available
on the human side.
Speaker 1: Yeah, a little more control involved there.
Speaker 3: Sometimes, yeah, yeah, hopefully depending on the household.
Speaker 2: Yes.
Speaker 1: So I want to ask you, Sae. GLP one drugs
are all the rage or human weight loss. So are
veterinarians using GLP one type drugs on animals yet for obesity? Oh?
Speaker 2: Yes?
Speaker 3: So veterinary medicine has a long history of stealing human
treatments and disease names, I mean pretty much all of it.
Harry medicine evolved from the human literature, and so a
lot of our names, a lot of our understanding of
patho mechanisms comes from the human side, and then as
we have more studies, we figure out that maybe it's
not exactly the same, or sometimes it's even totally different.
But we absolutely don't feel like we have to reinvent
the wheel, and we steal whatever we can steal from
the human side. So with the advent of the GLP
one drugs, absolutely there's starting to be used in veterinary medicine.
Speaker 2: So the limiting factors are always.
Speaker 3: First of all, dogs are not human, so is their
toxicity in dogs and cats, and it turns out they're
not that this is one of the proteins that are
pretty well conserved across species, so we don't have to
worry about that too much. The other problem that we
have is that if the drugs are very hard to
acquire or expensive, which they are right now because of
trendy everyone wants them, then that could be a limitation
to us actually just getting access in a practical formul
A lot of pet owners can you afford a lot
of care, but one thousand dollars a month for a
GLP one for obesity or even behavioral changes like cats
that are food seeking and driving their owners crazy. You know,
money could be a limitation. So there actually are a
few studies. One of the other problems in veterinary medicine
that we have is that the studies are really small.
So like where you would do I don't know, a
typical GLP one study, maybe one thousand patients. What's the
typical size pretty big in humans?
Speaker 1: Oh, for something like that, it'd be in the thousands.
Speaker 2: Yeah, thousands.
Speaker 3: So we have now, you know, maybe half dozen studies
with dogs and cats that are like eleven animals here,
twenty animals there. Yeah, And so at that level we
can say, okay, we're not going to kill the patient.
That's an important threshold.
Speaker 1: That is a good one.
Speaker 2: Yeah, that's kind of starting place.
Speaker 3: And then do we have efficacy And it turns out
that we actually do so, Like one of the studies
I'm familiar with, they looked at I think it was
twenty two dogs over a six month period of time,
and they had almost a fourteen percent reduction in body
weight mass which I think is similar to humans. Is
that what's the number?
Speaker 1: Yeah, and typically more than a percentage. Typically on average
people see a twenty six to thirty pound weight los.
Speaker 2: Oh wow, that's a lot.
Speaker 1: But if you're over three hundred and fifty or four
hundred browns, then we see significantly more than that.
Speaker 2: Right, And obviously our dogs are not four hundred.
Speaker 3: Yeah, well yes so, but yeah, I mean breed absolutely.
You know, this is really there are few absolute benchmarks
in medical history that are just mind blowingly revolutionary. And
antibotics was one. You know, how many people died before antibotics.
Insulin was another one. The development of steroids and that
was kind of the whole JFK had Addison. Steroids saved
his life. And then these GLP one are just not
only for weight loss, but addiction for behavioral like in
these cats. There's a study, it's a very small study,
but the cats will drive their owners crazy food seeking
twenty four hours.
Speaker 2: A day, and these compounds seem to help reduce that dramatically.
So cool.
Speaker 1: And speaking of the cost, do veterinarians use compounding pharmacies
sometimes to have the GLP ones compounding because that's where
a lot of the wellness clinics are going so that
they can really lower the cost to one hundred dollars
a month instead of twelve hundred dollars a month.
Speaker 2: Yeah, So the answer is yes and no.
Speaker 3: So if you're looking at doing a study that you
eventually want to publish and have data and try to
expand the knowledge base and the literature, you probably need
an FDA approved brand name so that you know it's
pretty legit and it's standardized and everyone knows what you're
dealing with.
Speaker 1: Right.
Speaker 3: If I just have a patient I want to put on,
then I'm probably going to find the cheapest source that
I believe is reliable. Yeah, And this is I'm sure
on the human side too. Is you can find sources
all over the place, but that doesn't you know, it's
a reliable source.
Speaker 1: Mostly it's used in injectable forms. So you want to
have a compounding pharmacy that has a really good sterile divisions. Correct,
It's that's super important. Such great stuff. I'm so excited,
And we're going to take a quick break and when
we come back, we are going to talk about leaky
gut in dogs and believe it, we'll be right back
welcome back. You know. The other thing is foods for
cats and dogs. I'm like, well, what food should I
get for them? What bad things should I be looking
for in food? I mean, I also have family and
friends who feed them only human food. Is there a
list of ingredients that you say, look at these ingredients
and if this is in there, stay away? Is there
something like that?
Speaker 3: So I'm gonna be the typical academician and answer your
question with like six answers.
Speaker 1: Oh take ay.
Speaker 3: So a short history of pet foods that will answer
your question. There's light at the end of the tunnel,
I promise. But so dog foods especially, and then cat
foods on top of that, were really really useful and
a game changer in the nineteen forties and fifties when
basically dogs lived outside and they would get whatever the
pigs didn't eat because pigs were more valuable than the dogs.
So Peerina came along, one of the big first companies,
and they standardized nutrition with Purina dog Chow, and suddenly
we had dogs that were much healthier and happier, and
that led over the fifty years after that to now
it's a multi billion dollar industry and just you know,
more boutique diets that you can possibly name. As it
turns out, for decades we as veterinarians, we'd recommend that
you shouldn't feed human food, no table scraps, that they.
Speaker 2: Need to get their dog food.
Speaker 3: And that again was because we would eat the healthy
part of the pork and then give them the pork fat,
and then the next say, they would have pancreatitis and
be sick.
Speaker 1: So still they're back to eating the leftovers, but this
time not the big leftovers the lender.
Speaker 3: Right, So pork has a bad reputation in dogs because
it makes dog sick, but it's actually the fat, the
you know, leftover pork fat that's making dogs sick. So
we're learning more and more and more. And one of
my favorite do teach veterinary students, so one of my
favorite shocking educational points for them is there's been a
really big study. Again, most of our studies in veterinary
medicine are like ten dogs, twelve dogs. Right, it's a
really good study out of Finland. I don't know why
in Finland, but it's about four thousand dogs. And it
turns out that again and dogs, we can control their diet, right,
So you can't take your teenager and say eat only
sway and corn for six months.
Speaker 2: That's just not.
Speaker 1: Yeah, because they'll be Hiden Snickers bars under the pillow.
Speaker 3: Or taco right now to taco bell. So in dogs
really good studies. So they looked at all of these
variations and it turned out that the overall level of inflammation,
which we know comes from leaky gut syndrome, we don't
quite understand that, but we know it's a problem. But
the overall morbidity, which is the amount and level of
diseases that the dogs get, is reduced if they have
a high variety diet. And what this high variety diet
basically was the table food that they would feed the dog.
So it wasn't necessarily the leftovers, but it was what
the humans were eating. And in Finland, you can imagine
that's going to be a lot of fish or vegetables.
It's not going to be the Ruth Chris' menu, right right.
So out of these four thousand dogs, they feed human
table scraps, fix a plate for the dog, and the
overall level of inflammation allergy decreases relatively significantly. So all
of these years of telling owners that they shouldn't feed
table food.
Speaker 1: Is wrong, but you need to set a place at
the table, well not literally at the table, bake it flat.
The way your plate looks should look like.
Speaker 2: Correct the crisp plate.
Speaker 3: So what I tell my owners in the clinic is
that you don't need dog food, and we can talk
about a whole problem with the mulsifiers and what that
leads to leaky gut syndrome. But basically, if you're going
to eat a Mediterranean diet, which is kind of the
current recommendation, is that what you recommend your patient. So
Mediterranean diet which is mostly vegetables, fruits, fiber, high fiber
with lean proteins, and you fix a plate for you,
fix a plate for the dog, and you're great to go.
Speaker 2: That's probably the best we can do.
Speaker 3: Cats are going to be a little bit more challenging
because they don't really like broccoli and spinach. So that's
a whole other topic, but one of the other big
issues with the diet. So now we don't need dog foods,
and a lot of the fresh dog foods, like our
whole bunch of brands that you can order and it's
basically fresh cooked food that comes refrigerated and it's the
same kind of thing. It's just they're cooking for the
dog rather than you cooking fire dog.
Speaker 1: So it's costing more usually, yes, but.
Speaker 2: It's easy to get.
Speaker 3: It comes in too, but it's more of a home
cooked diet than like a kibbal diet. One of the
big things in dogs, and again this whole leaky gut inflammation,
gut neuro skin access is that we have a lot
of facts about it, but we don't really know how
to fix it. One of the other interesting data points
that I think I have a conspiracy theory about it,
which I need to educate myself better. But calling cancer
is on the rise among young adults millennial gen zs.
And what we know with dogs, again, we can do
a lot of different things in dogs that we can't
necessarily do in people. But basically all of the processed foods,
anything that's highly processed, and that's dog kibble to twinkies
to Oreo cookies to anything you can think of that's
highly processed. Basically in a factor, you have to get
it to flow through a tube, so it has to
float through a tube and then it gets spit out
into molds and then it forms a cookie or a
twinkie or a kibble or whatever that is.
Speaker 2: But it has to float through a tube.
Speaker 3: To get it to flow through a tube, we have
to add things like emulsifiers and a whole bunch of
different chemicals and a Mulcifiers are basically like soaps or shampoos.
So what makes it lather and the shampoo slippery is
also what can get the processed foods to go through
a diet. So if you can imagine in your intestines
you're eating shampoo every day in a dog kibble, what
that would do to your skin but also the aligning
of your intestines.
Speaker 1: Listen, I'm getting hungry.
Speaker 3: Food with some shampoo in it, but with shampoo. That
so one of the big concerns and that we're now
identifying in dogs that probably is true in humans. Again
I'm not a physician, is that these are multifier actually
do break down the gut barrier and permeability, and already
in the GI track, about one percent of intact proteins
in your GI system will be absorbed into the bloodstream.
If you're eating emulsifiers, if you're adding shampootier diet every
single day, then that's going to increase. So you can
imagine that all of these bacterial components, all of the
beef protein you're eating, all of these things are going
to leak through the gut, and that's probably a big
factor of this whole leaky gut inflammatory cascade. Don't know,
but I'm pretty sure eating shampoo is not a good thing.
Speaker 1: Yeah, I'm thinking, I'm thinking I would agree with you
on that.
Speaker 2: Yeah, for sure.
Speaker 1: I've talked about leaky gut on the podcast quite a
bit because I think it's the source of a lot
of problems for people's health.
Speaker 2: It's huge and dogs too, And yeah, absolutely.
Speaker 1: So you mentioned to me or what kinds of foods
you should feed your dog or cat. Should we be
like carefully measuring how much we feed an animal or
are we just like here, this is how.
Speaker 3: Much I eat, so you can't have that much so
they're too answer to your question. This is classic academician
You ask one question, you get six answers. But you
want to monitor weight. So in America, unfortunately, we have
a lot of overweight dogs and people, and really dogs
should be much skinnier because that decreases the risk of
arthritis and cancer and all sorts of things like that.
So you do want to be measuring calories in and
calories out, and you can do calculations, but you can
also just monitor weight. So if it's a small breed
dog at a baby scale and weigh them once a month,
and you want to, you know, in an optimal weight range,
which years ago we just kind of went for good
and now really we're trying to seek optimal. The other
thing that happens a lot with dogs is that there's
a lot of mythology about having to microbalance the nutrients
and the diet, and so that comes around from the
board surfed nutritionist work for the dog food companies, and
if you're going to balance the diet for a million dogs,
you probably do want to have sort of micro levels
and have a pretty good balanced diet. But in the
real world, the way you eat and I'm not sure
how you eat, I think I've eaten with you, and
you eat pretty healthfully, I would.
Speaker 1: Say, yes, I do. There's a roof right there.
Speaker 2: People, So everything in moderation is good.
Speaker 3: So what I typically recommend is you don't want to
be feeding the exact same thing every single day, which
comes back to this kibble do.
Speaker 2: Dogs really need dog food?
Speaker 3: But really, if you're micromanaging the amount of magnesium and
calcium per milligram and your diet, great, do it for
your dog. If you're just eating a good Mediterranean diet,
you're going to get enough variation that that is absolutely acceptable.
So the myth that we have to micromanage dog nutrients
I think is wrong. That they're just as stable and
you know, stoic nutritionally as we are. So if you
are micromanaging and milligram some magnesium, potassium, calcium, do it
for your dog. If you're just eating a good, healthy
Mediterranean diet as perfect.
Speaker 1: Yeah, there are probably a lot of people who just
grab whatever's cheapest on the shelf for their animal. And
then there's somebody who's micromanaging, like you're talking about. I
don't even know what that would be exactly because I
don't do it, but you know, cooking gourmet meals or
weighing everything or measuring everything out, so somewhere between I
don't really care what bag of food I get and
trying to be a five star.
Speaker 3: Chef for animal exactly right, even you know, buying a
cheap pack of dog food. We have the shampoo and
a mulsifier issue in there. But that's all all processed foods.
But you know, if you bought a cheap pack of
dog food it gave some leftover spinach and tomatoes and
some salmon that would be be acceptable.
Speaker 1: Oh, that'd be good with that. Yeah. Oh well there
you go. Yeah, that's surprising. Yeah, so you mentioned leaky gut,
but do you have a regimen, like, are some of
your vitamins things that you could do for animals when
they have signs and symptoms of leaky gut? And what
are the signs and symptoms and a pet our listeners
can know, Oh that must be leaky. Yes, I better
take my dog into the vat.
Speaker 3: Yeah so I and I would actually love to hear
your take on this as well. My take on leaky
gut is that we know it's a problem. We know
what some issues are, like the emulsifiers and processed foods
for humans or dogs. We know that there are a
trillion bacteria in the gi track over one hundred different species,
and with the diseases, the balance of those different species changes.
But we, at least on the veterinary side, we don't
really know how to fix it. So we have a
lot of theories, but we don't absolutely know, so in
ventary medicine again we can you know, feed very specific
things and see what happens. So we actually do have
probably about twelve different probiotic organisms that we know improve
everything in dogs from dental tartar to HIE staining. They
decrease inflammation associated with allergy inflammatory ball disease, So we
know specific bacteria can do things, but that leaves the
ninety other species in the gut that we're not quite
sure what to do with. The other reality with probiotics,
which is kind of the main focus in animals variety
of diets. Good but probiotics is kind of because people
are making money with it, is that it turns out
that unless you're refrigerating the probiotic, probably a lot of
those organisms are dead where they don't survive the acid
in the stomach, and marketing wise, they're now called post biotics,
so they're dead bacteria that may have some benefit in
their cell walls, but so we know it's a problem.
We know they have inflammation, they have a variety of
chronic diseases, but we don't really know yet how to
fix it. So good diet, good exercise. You know, probiotics
right now, we don't think they hurt, but we don't
know the correct organisms, the mixture, or the doses, at
least on the veterinary side.
Speaker 2: So what's happening on the human side.
Speaker 1: Well, well, you know we have pre pro and post biotics,
and the prebiotic, obviously I've talked to my listeners about
this is basically sort of an advanced fiber. So do
you ever recommend doing a combo pre and pro or
do you just say make sure they get some fiber
in their diet.
Speaker 3: Yeah, So we're again steal everything we can from human medicine,
so we don't reinvent the wheel. So we're in the
process of this, but just even getting the dogs off
of kibble and trying to add in you know, a
variety of spinach and pumpkin and some just natural foods
is kind of where we are. So in dogs were
not at the advanced fiber or even like measuring lipid
profiles and dogs that's nothing that we were not even
close to that level of optimization.
Speaker 1: And you don't do things like immuno globulin through claustrum. Yeah,
to reintroduce immun globulins into the gut.
Speaker 3: Or so clostrum is one of my pet peeves. We
I may disagree with this, but I love this. So
we as veterinarians, we are very, very h focused on
clostrum like baby cows and those kinds of things. But
so colostrum that has a bunch of stuff in it.
But the main thing that clostrum does is has antibodies,
which are large proteins and they're going to be transferred
from the mother's immune system to the baby's immune system
and give them a jump start on fighting off infections
and those kinds of things.
Speaker 1: And we should remind our listeners thats the first stuff
that comes out.
Speaker 2: Correct, within the first twenty four hours.
Speaker 1: Yeah, sort of thick stuff before the milk comes in, right.
Speaker 3: So my pet peeve with colostrums, that is it's very trendy.
Now it's in a whole bunch of pet and human supplements.
Speaker 1: I know it's in human supplement, yes, and.
Speaker 3: It's bovine colostrum that's in human supplements. So the deal,
the scientific deal with colostrum is that if you're a
baby cow, within the first twenty four hours, colostrum is awesome.
Speaker 1: Yeah, if you're a baby shower, a baby con.
Speaker 3: If you're a baby cow, after twenty four hours, colostrum
is not going to get absorbed because the GI track
is closed and ninety five percent of the antibodies just
go into the GI tract and aren't absorbed. If you're
not a baby cow, then you really don't get any
benefit from cow antibodies because you're not going to get
the same disease as cows.
Speaker 2: Get right, and if you're not twenty.
Speaker 3: Four hours cown disease, yeah, well that would be saying
I wouldn't worry about that.
Speaker 2: Yeah, so don't you worry about that in the cluster.
Speaker 3: But so, unless you're a twenty four hour year old
newborn cow, colostrum is totally irrelevant. It's a source of
dairy protein and like a powdered milk, but it is
doing no benefit. There are a few other things in there,
but for the most part, it's not doing any benefits.
All of these supplements with colostrum are again, unless you're
a twenty four hour baby cow, it's just ain't working.
The other thing that when owners pet owners ask me
this because it's very commonly used, it's trendy.
Speaker 2: Doctor TikTok says.
Speaker 3: It's now, oh gotcha, But what happened to the baby
cow if you took the colostrum from the moment and
the baby cow didn't get it?
Speaker 1: Colostrum thieves.
Speaker 3: I know, it's like really sad. So that's my pet peeve.
So what do you think about colostrum?
Speaker 1: Do you think it's Well, you know, there are supplements
that I recommend very specific and they have to be
written or prescribed. They're not really prescription, but you have
to get them from someone, a practitioner who has an
account to purchase those things for you.
Speaker 3: Medical grade, yes, medical grade, and doctor TikTok is not
a thing.
Speaker 1: That particular supplement comes with other supplements that are designed
for you to take for twelve weeks to heal the gut.
And I've seen it do marvelous things for my patients.
You can't just be buying it off Amazon. That's the thing.
I mean. These are what I recommend to people is
medical quality. They have to order it through me, so
it's very different than somebody just searching colossrum on Amazon
and getting the first thing that pops up.
Speaker 3: And I do think that we're very much in an
era where we have a lot of facts, you can
use this combination product and it helps. The skin is
also very slow to respond. The turnover times twenty one
to twenty eight days, So these chronic things don't happen
magically overnight. But so so the supplement combination, the cocktail
works well. But it may be different things in the cocktail.
It may be the way they interact and maybe together. Yeah,
so one of my actual favorite supplements of all like,
I think every single mammal should be on Omega three
fatty acid, specifically EPA acosa pentanoic acid. And what we're
learning in allergies is that it actually works as like
a co factor where it binds other proteins to decrease inflammation,
not just in a single manner. So what we thought
was simple turns out that it's you know, three dimensional
chests and it's crazy.
Speaker 1: Yeah, that's great. I have an allergy sheet that I
put together and gave to my patients and EPA was
definitely on the list of things they should take. And
you know, here we are in East Tennessee, the allergy
capital of the world. At least I think it is
that it is.
Speaker 3: They rank the top ten cities every year. In the
top six are in East Tenness. He so it's Knoxville's.
Speaker 2: Chatting you good?
Speaker 1: I didn't even have proof.
Speaker 2: Well, there you go.
Speaker 3: Yeah, it's basically because all of the pollen zones from
the north to south the east just merge right here,
and so it's beautiful here.
Speaker 2: It's lovely but allergy. Yeah gotcha.
Speaker 1: Yeah. Well this has been fantastic, very fun. I think
I think our listeners are learning a lot because I'm
learning a lot. Good.
Speaker 2: That's the goal.
Speaker 1: Yeah, I know, I think so. I want to thank
Keith for being with us today, and many thanks to
all of you for listening. Wherever you listen to this podcast,
please leave a review and rate the podcast. Your reviews
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I encourage you to visit our Facebook page imb Podcast,
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or questions for me. Our website is itchymbitchi dot com,
where there are blogs with some of our subjects available
for you to read. Thank you to Forrest winsle my Son,
our producer and composer of ar theme music and the
person who does all the behind the scenes work to
make this podcast possible. Thank you so much. Forest and
Forest continues to thrive at Peabody Music Conservatory and is
finishing up his final semester of the Master's program, and
he has informed us that he has been admitted to
the Peabody Doctoral Program to receive a Doctor of Musical
Arts in Composition. His dad and I are so so
very happy for him. It's fun to see his immense
musical talents recognized. If you want to listen to what
he's creating, you can go to his website forestwinsl dot com.
Remember that your health is in your hands.
Speaker 3: Attat