# Hill's Prescription Diet C/D question



## Jessica08 (Mar 24, 2010)

Hello,

Our 5.5 month old lab/shepherd mix Cooper was recently diagnosed with a UTI and crystals. The vet put him on 2 weeks of antibiotic and advised us to switch him to Prescription Diet C/D for 6 months. We had been feeding him Wellness Large Breed Puppy and he seems to be doing really well on it. I'm not too keen on switching him to a low-protein, high-carbohydrate low quality food while he's still growing, but at the same time I want him to be healthy and free of infection. The vet did not ask what kind of food we are currently feeding him (didn't ask any questions, actually). I know I'm not a vet, and I know none of you are either, but I'm torn about whether to try the antibiotics first to see if that clears up the crystals, or to just follow the vet's directions and switch foods. It seems like a big trade-off: maybe the C/D will help with the UTI, but will undoubtedly not be as good for his overall health. Maybe the Wellness will be more beneficial by keeping his overall health up and immune system functioning well, and the antibiotics might do the trick in terms of eradicating the infection which will then contribute to the dissolving of the crystals.

Does anyone have an opinion? Is the trade-off worth it? What would you do if it were your pup? From what I've read online, many vets aren't very open to alternative opinions about food and food quality, but I do plan on following up with him about these questions I have. I have looked into Berry Balance and would definitely add that after the course of antibiotics if we stick with the Wellness. Thanks for your help/advice!


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## theyogachick (Aug 2, 2009)

I am most certainly NOT a vet, but these ingedients don't look so good to me:

Ground Whole Grain Corn, Pork Fat (preserved with mixed tocopherols and citric acid), Chicken By-Product Meal, Soybean Meal, Corn Gluten Meal, Soybean Mill Run

In the first six ingredients, there is only one actual meat source that I can see, and it is a by-product meal (unless you count the pork fat)

I would be hesitant to change from such a high quality food to this. Maybe you could call your vet and ask exactly what is in the C/D that is going to help. 

From the Hill's website, I found it claims this:

Reduced levels of protein, magnesium and phosphorus to help limit the building blocks of crystals and bladder stones
Low sodium to maintain normal blood pressure
Added antioxidants to control cell oxidation and promote a healthy immune system 

If this is the case, maybe there are some supplements that can have the same effect.

And it seems the feeding guidelines are only geared towards adult dogs and not puppies.

My guess is that you would have to buy this food from your vet since it is a prescription diet. I'm not sure how good this food is for the rest of his system.

My opinion, though.


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## Miranda16 (Jan 17, 2010)

maybe Mr.V would have different options for you .... with some better recommendations


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## Jessica08 (Mar 24, 2010)

theyogachick said:


> I am most certainly NOT a vet, but these ingedients don't look so good to me:
> 
> Ground Whole Grain Corn, Pork Fat (preserved with mixed tocopherols and citric acid), Chicken By-Product Meal, Soybean Meal, Corn Gluten Meal, Soybean Mill Run
> 
> ...


Yes, the ingredients are yucky. Nothing recognizable. The C/D is high in fat, high in carbs, low in protein, low in phosphorous and magnesium (which is good for urinary health but not so great for bone growth). It seems to dissolve crystals well, but if the antibiotics are going to do that anyway (maybe they will, maybe they won't) then I'd much rather continue with food I know is high-quality and healthy.

Plus I have read that higher protein diets increase the acidity of urine, which is good for keeping crystals from forming. High fat is actually bad for urinary health, as is the high level of carbohydrates (low-quality ones at that). But again, that's the trade off.


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## MegaMuttMom (Sep 15, 2007)

Here's a link to the thread I started a long time ago. I never changed his food and he was fine.

http://www.dogforums.com/13-dog-health-questions/21958-my-vet-wants-me.html


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## Jessica08 (Mar 24, 2010)

MegaMuttMom said:


> Here's a link to the thread I started a long time ago. I never changed his food and he was fine.
> 
> http://www.dogforums.com/13-dog-health-questions/21958-my-vet-wants-me.html


Thank you! I saw your thread, I just thought I'd start my own since my dog actually has a UTI with symptoms (inability to hold his urine in the morning when he woke up). I have read that clearing up the infection will quite likely cause the pH of the urine to balance out, which will in turn resolve the crystals. I am definitely leaning in the direction of not changing foods, as you did. Glad it worked out for you and your guy.


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## monkeykeeper (Nov 9, 2009)

This is a prescription diet that your vet recommended for your animal's health. I strongly recommend that you discuss this with your veterinarian. The ingredients in the prescription diet are made that way for a reason. If you are not happy with your vet's diagnoses then seek a second opinion, but do not take the advice of an internet board in regards to your animal's health. Urinary crystals are a serious, very uncomfortable issue and if left untreated, can develop into even more serious bladder stones that will require surgery. Antibiotics will do nothing for the crystals which develop due to high acidity in the urine, usually due to diet as well as breed predisposition. Yes the ingredients may not look favorable but it is a prescription diet and Hill's has been very successful with their prescription diets. You can ask about Royal Canin, purina or Iams prescription diets if you are really opposed to Hill's.

Please talk to your vet about your concerns. I went through this with one of my pets and the only thing that helped was the prescription diet.
No I don't work for Hill's nor do I feed Hill's (except for the prescription C/d for my cat who almost died from urinary crystals/stones). All the animals that can eat Taste of the Wild and some raw.


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## Jessica08 (Mar 24, 2010)

monkeykeeper said:


> This is a prescription diet that your vet recommended for your animal's health. I strongly recommend that you discuss this with your veterinarian. The ingredients in the prescription diet are made that way for a reason. If you are not happy with your vet's diagnoses then seek a second opinion, but do not take the advice of an internet board in regards to your animal's health. Urinary crystals are a serious, very uncomfortable issue and if left untreated, can develop into even more serious bladder stones that will require surgery. Antibiotics will do nothing for the crystals which develop due to high acidity in the urine, usually due to diet as well as breed predisposition. Yes the ingredients may not look favorable but it is a prescription diet and Hill's has been very successful with their prescription diets. You can ask about Royal Canin, purina or Iams prescription diets if you are really opposed to Hill's.
> 
> Please talk to your vet about your concerns. I went through this with one of my pets and the only thing that helped was the prescription diet.
> No I don't work for Hill's nor do I feed Hill's (except for the prescription C/d for my cat who almost died from urinary crystals/stones). All the animals that can eat Taste of the Wild and some raw.


Well, it isn't that I'm not happy with my vet's diagnosis. I am unhappy with the treatment. I do plan to discuss this with my vet, but I wanted to get a little more information and feedback from people who may have experience with similar issues.

You may be correct that antibiotics will not help dissolve crystals in dogs with alkaline urine. However, my dog has an infection. So my thought is that changing diets may not be necessary if the infection was the primary cause of the crystals. There's no way to know that for sure until after the infection is cleared up, if I understand correctly.

I am going to call my vet and discuss the alternative plan of sticking with his current food, continuing the antibiotics until they are done and the infection is cleared, then adding a cranberry supplement as a maintenance step instead of going with the C/D (which, after more reading, I've discovered is usually used as a maintenance diet for dogs with urinary problems; S/D is used to treat the crystals but is not suitable for long-term feeding). Hopefully my thoughts will not get dismissed by my vet. If they do, that probably signals that it's time to look for another vet.


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## Kathyy (Jun 15, 2008)

The script diets are low value products that are better for the dog than staying on the same quality regular kibble. You can easily formulate your own food that will do the same job as the script stuff at a much lower cost.

Jessica, do the antibiotics, make sure to do the follow up urinanalysis, force fluids and stay on a normal food. The script kibbles magic is that it is high in salt so the dog will drink more and that is about it.


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## Reiko89 (Jul 2, 2010)

The vet just "prescribed" this food without asking what you currently feed because he's taught to do so. In fact, Hill's company pays more money to vet schools in order to be able to push their product to vets in training. They also give vet clinics free cases of their food (in order to entice them to buy more) and the clinic can then sell these bags to you and make 100% of the proceeds for themselves. There's nothing "better" about these foods, they are just in Veterinarians' faces from the time they enter school until they go out of practice, it's not neccesarily the vet's fault, but a wise vet will be willing to compare ingredients and understand the quality (or lack thereof) of the food they are giving you versus something else.


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## Mr. V (Jan 28, 2010)

Hello Jessica,

As you've seen and already know, there are quite a few opinions to be found on the net. I will address a few of the above responses before making my own response. The diet you were prescribed was done so for a reason. Some people that dabble in veterinary conspiracy theory will tell you things like "it's just high in salt" or "Hill's makes them think all of this b/c they donate to school." Statements of this nature usually come from lay individuals who do not know much of anything about the pathophysiology of the disease in question or the treatments it requires. Your vet prescribed this food for a reason and it has nothing to do with how much Hill's donated during his 4 years of vet school. To understand why he did, you must understand the disease...

Most UTIs occur when bacteria make their way up the urethra and into the bladder. Now, normally these bacteria can never set up shop in the bladder and they're normal inhabitants of either the dog's intestinal tract, prepuce, vagina/vulva. Due to variations in either host factors or virulence factors of the bacteria, the situation becomes altered in such a way that accommodates attachment by the bacteria and subsequent colonization. So, once these bacteria get on a roll they begin to break down the urea (which is naturally in the urine) and ammonia is produced. Ammonia causes the urine to become more alkaline in nature. Alkaline urine is a fantastic medium for both crystal formation (and subsequent STONE formation) and also serves as a great medium for bacterial growth. One study I've read actually compared alkaline urine and nutrient broth in their ability to support bacterial growth. Nutrient broth is what a lab uses to grow bacteria. The study found that the alkaline urine was almost as good of a medium as the broth was, so, you can image what a hay day the bacteria in your dog's bladder are having. Another thing to note is that crystals in the urine act as little pieces of sand paper against the epithelial cell lining of hte bladder. Well, this causes irritation on the bladder wall and provides even better environment and locations for bacterial to further colonize and grow. A nasty cycle...
You should also know that alkaline urine and subsequent crystal formation can occur without bacteria being present first. There are cases in which the crystals (and subsequent uroliths/stones) form first and predispose the bladder to bacterial colonization. 

Also, do know that while the bladder has natural defenses against bacteria, the ureters (in which urine flows from the kidneys to the bladder) and the kidneys themselves have little to no defense against bacterial colonization b/c it is normally assumed that the urine in the bladder is sterile. So, it's definitely good to get a hold on all of this so that you don't have an ascending infection b/c once it hits the kidney's you've really opened up a can of worms...

So, why the food you ask? Urine must be saturated with magnesium, ammonium, and phosphate for struvite uroliths to occur. Excess protein consumption results in increased formation of urea that will end up the urine. Extra urea = extra ammonium = more alkaline urine. Dogs (and humans for that matter) usually consume way more protein than is needed. The extra protein (which is composed of amino acids) is broken down so it can be used for energy by the body. This results in urea formation. Phosphate and magnesium follow suit. The concentrations of both phosphate and magnesium in the dog's urine are directly related to the amount consumed in the food. The dog food prescribed to you is lower in protein, phosphorus, and magnesium. 

If you just have a major hangup with Hill's, ok, no big deal. But, I strongly encourage you to seek a Rx diet from another brand that is formulated to treat this condition for at least 2 to 3 months if not the entire recommended time. Can a diet be cooked/made at home that meets these specifications? Sure. But unless you're a nutritional expert that can effectively evaluate the protein, mag, and phos content (on a dry matter basis) of the food you make, i wouldn't try it.


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## Active Dog (Jan 18, 2010)

*claps* Great info Mr.V its always nice to know a little more on these things!


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## Jessica08 (Mar 24, 2010)

Thank you so much for the thorough explanation of bladder infections and crystal formation, Mr. V. That was very helpful. I do understand the role of diet in struvite urolith formation. I guess my confusion is where the role of diet interacts with the role of the bacterial infection and whether it is possible to wipe out the crystals when you take care of the infection; I suppose that addressing both contributing factors to struvite urolith formation is the best plan of attack. I certainly do not want to risk further infection (the antibiotics should hopefully clear that up) and bladder stones are absolutely something to be avoided as well.

I spoke with my vet last night and he said that we could hold off on switching the food and do another urine pH test this weekend to see if the pH is heading back in the acidic direction. He said usually a diet change is required to get the pH back in the acidic range. My guess is that one week of antibiotics isn't going to be enough to show an appreciable change in pH.

I will probably just switch over the C/D, very slowly, and see how he does. If he doesn't seem to be as energetic and healthy overall, then we'll go from there. My guess is that the C/D won't agree with his stomach -- he seems to have fairly sensitive digestion, as many puppies do. But we'll see! Thanks to everyone for their help!


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## Kathyy (Jun 15, 2008)

Compared to NRC levels all the minerals you mentioned are still very high in C/D. Perhaps lower than in premium kibbles but still much higher than NRC requirement. The protein offered in C/D is low quality. Since these crystals precipitate out in alkaline urine created by the bacterial infection and supported by the low meat protein kibble I stand by my suggestion to fight the infection, force fluids and feed the quality food already fed. This is a large breed puppy and the food is already lower in calcium and phosphorus than most premium kibbles. The magnesium and other mineral amounts are not posted online but given Wellness's approach I would suspect it is in line with the amount of Ca/P in the food.


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## Jessica08 (Mar 24, 2010)

Mr. V said:


> Excess protein consumption results in increased formation of urea that will end up the urine. Extra urea = extra ammonium = more alkaline urine. Dogs (and humans for that matter) usually consume way more protein than is needed. The extra protein (which is composed of amino acids) is broken down so it can be used for energy by the body. This results in urea formation.


After doing a bit more reading, I'm confused on this point. My understanding (which is probably wrong, but please correct me because you are the vet student and I was just a psych major): Protein is broken down into amino acids, and those amino acids are then broken down and the waste is ammonia. Ammonia is toxic, so the liver converts it into urea which is then excreted in the urine. However, urea is basic. How could it contribute to alkaline urine? I have read in many sources that a high-protein diet will actually cause more acidic urine, so I'm a little perplexed. Thanks!


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## Kathyy (Jun 15, 2008)

Urea is supposed to be neutral. The uric acid content of the urine probably brings the pH down below neutral.


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## Jessica08 (Mar 24, 2010)

Wikipedia to the rescue: "Struvite stones are caused by a bacterial infection that hydrolyzes urea to ammonium and raises urine pH to neutral or alkaline values. Urea-splitting organisms include Proteus, Pseudomonas, Klebsiella, Staphylococcus, and Mycoplasma." So the bacterial infection causes urea to split, going back into ammonia, which would raise the pH. Thus, the idea of keeping dietary protein low is to lower the amount of urea that is in urine to begin with, right? But I still wonder if the bacteria is killed off by the antibiotic, would it be necessary to continue to restrict protein and stay on the low-quality food (especially in a growing puppy)?

Sorry I have so many questions. I have a rather scientific mind -- I like to know the why of things.


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## Miranda16 (Jan 17, 2010)

i knew you would come through mr v haha


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## Jessica08 (Mar 24, 2010)

Okay, so I found this article (http://www.whole-dog-journal.com/issues/13_4/features/Detecting-Urinary-Stones-Dogs_16215-1.html) from the April 2010 issue of Whole Dog Journal (which seems to be a respected source of information) about struvite crystals/stones. I would love it if Mr. V could take a look and address the issues within. Specifically:



> Fact or fiction?
> All of the following statements are believed by many veterinarians and their clients. Yet none of them are true. Which have you heard before?
> 
> 1. Urinary struvite crystals represent disease and require treatment.
> ...


Also, sorry to the mods if this thread is crossing over between belonging here in the Food section or in the Health Questions section. I wasn't exactly sure which section it best belonged in.


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## Mr. V (Jan 28, 2010)

You should definitely not apologize for questions. They're what brings out the truth. I feel like you've kinda answered some of your own questions which is good. So, if you eliminate the bacteria, shouldn't a more acidic pH follow suit? In theory, yes. But dogs are never the textbook models that we study in school. As I said, some dogs come up with an alkaline urine for no apparent reason and those crystals form. If no concurrent infection is around it's really not that big of a deal (like your last post says). But your vet dx a UTI and crystals - this is a problem. So we know that your pup has alkaline urine (I don't know how alkaline, keep that in mind) and bacteria ( I dont know which bacteria, hold on to that too). The article you posted is talking about veterinarians treating a dog that DOES NOT have UTI and DOES have crystals. 

'*Without an infection, struvite crystals in dogs will not be associated with struvite urolith formation.”(Our emphasis.)* So, question is why can't we just treat the UTI? What that article doesn't tell you is that forming uroliths (aka stones) doesn't have to take weeks upon weeks. In the right conditions, those little harmless crystals can turn into stones quickly. Like a matter of days. 

*Low-protein diets do not prevent stone formation. A low-protein diet can speed the dissolution of struvite stones -when accompanied by appropriate antibiotic treatment -but it is not necessary for the prevention of struvite formation* -- This is talking about struvite stone formation, not further struvite crystal formation. You want to achieve both when in the presence of bacteria (remember, those crystals are only harmless when they're alone). By itself, no, I wouldn't expect lower protein to prevent stone formation. As I said the goal is to lower urine pH, mg, and phos content and also increase dilution of the urine. I said in my first post what conditions were necessary for stone formation. The dilution of urine is acheived via reduced amounts of urea in the medulla of the kidney - this results in a more dilute urine.


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## Jessica08 (Mar 24, 2010)

Mr. V said:


> But your vet dx a UTI and crystals - this is a problem. So we know that your pup has alkaline urine (I don't know how alkaline, keep that in mind) and bacteria ( I dont know which bacteria, hold on to that too). The article you posted is talking about veterinarians treating a dog that DOES NOT have UTI and DOES have crystals.


Actually, the article talks mostly about struvite crystals that occur with infection. See this quote:



> Struvite stones usually form when large amounts of crystals are present in combination with a urinary tract infection from urease-producing bacteria such as Staphylococcus or Proteus. Urease is an enzyme that catalyzes the hydrolysis of urea, forming ammonia and carbon dioxide. It contributes to struvite stone formation as well as alkaline (high-pH) urine.


I think the point of the article is that a diet change will not affect the infection, if one is present (which it is in this case, and it's being treated with antibiotics, which will hopefully be effective although a culture and sensitivity test was not done). The infection is the most important thing to treat, because without treatment, the crystals will turn into possibly deadly stones. But if an infection is not present, the crystals pose little risk.

The bacteria is what causes the pH to pop up. So I still don't understand why, once the infection is gone (and thus the pH goes back to normal), the crystals will still need to be treated with diet? As the article mentioned, diet won't treat the infection. Sorry if I'm not grasping something obvious.


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## Mr. V (Jan 28, 2010)

B/C you're not going to clear the infection in only a couple of days and you don't know what is in your boy's bladder right now. Stones, even small ones, are still a real possibility here. And as I said, they're not picked up on a urinalysis and are formed within a day or two, not weeks. You can't say for sure so it's safer to attack this from both sides. We want to prevent further crystals from forming while we know the bacteria are around and afterward b/c of the high prevalence of resistant UTIs. The antibiotics are obviously the most important factor here. Again, you're asking me questions based on the principles of this infection. The actual nature of the infection, the actual pH of the urine... just 2 factors for a complex problem that are unknown to me. Maybe cooper has a very mild case and the antibiotics will be all that's needed. I hope so. These are the limitations of the internet. It's never black and white a clear cut answer is never available. I make a recommendation based on what's in the literature and cases I've seen (which I have had plenty of UTI dogs end up with stones, weeks after the infection was cleared).


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## Jessica08 (Mar 24, 2010)

Just wanted to follow up on this. We decided not to change foods, but added canned food and water. Cooper's been off the antibiotics for a week and on Berry Balance for the past 5 days. He had his follow-up urinalysis today and he has no infection, no crystals, and a pH of 6. Yay!


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## cavaliermom (May 28, 2008)

My 4 year old cat has this problem - diet seems to be extremely important. He's been on antibiotics several times to clear it up and now I have changed his diet to: Only beef canned food, which is considered a "cool" food as opposed to fish and chicken which are "hot" foods. He also only drinks distilled water so that he is not ingesting minerals. He then gets a supplement from Wysong (see their website) and Cosequin from the vet. Since I made all these changes, appox 7 months, he hasn't had a incident of irritation by crystals.

This can and often is chronic - so just because your pup is better - that doesn't mean the crystals won't surface again. 

Good luck - and be prepared!!!!


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## Jessica08 (Mar 24, 2010)

Thanks! Yeah, I think it is more commonly chronic in cats than dogs. But we will definitely be keeping our eye out for any symptoms in the future.


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## flipgirl (Oct 5, 2007)

A dog can have struvite crystals and be fine. However, if a UTI develops, it can cause these crystals to stick together and stick to the bladder wall as well, causing both stones and bladder wall inflammation. Get rid of the UTI, this is no longer a problem. My dog had struvite crystals and was supposed to be on Hills c/d but the mounds of poo she was creating disgusted me so I went back to feeding her raw and adding Wysong's Biotic ph- to acidify her urine. The next urinalysis showed no crystals and no infection (of course, she had to take antibiotics as well). I strongly believe it was the increase in water intake and the antibiotics that produced the results. The aforementioned information is from the Small Animal Clinical Nutrition book that the vets use. The Biotic ph- supplement is made of natural ingredients so that's why I chose to use it. And the thing with Hills is that it has been shown that struvite crystals aren't affected by food; they are usually accompanied by an infection. But Hills still markets c/d as a food to treat struvite crystals. So I cannot believe that Hills prescription food is created solely for the purpose of "increasing the quality of life" (as Hills puts it on their labels) and not for marketing purposes. And yes it does make a difference if Hills sponsors the education of the vets who look after our pets. Do you not think that whatever scientific evidence they use will be the evidence that only shows the positive results of their food? My dog was cleared of struvite crystals without their food. Not that one dog is proof of c/d's false advertising but you can't believe everything just because it says prescription. Yes Rx food has its place but you also have to do some research on your own to see if you're not being scammed by the companies' marketing ploys.


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