The Gut–Brain Link in Dogs with Chronic Enteropathy

A dog with chronic diarrhea or vomiting might also be telling you something else. That’s the core thread we pull on as we explore the gut-brain axis in dogs and why chronic enteropathy (CE) can’t be fully understood through GI signs alone.

We’re joined by Drs. Ulrika Ludvigsson and Sarah Heath to unpack how chronic enteropathy is defined (GI signs lasting more than three weeks) and why emotional health has historically been sidelined in veterinary care. Then we get concrete about measurement. Sarah explains how a validated canine PANAS tool can capture emotional bias. We also dig into displacement behaviors like yawning, lip smacking, and shaking off in odd moments, using the Heath model “sink” analogy to show how high arousal can overflow into visible behavior.

The conversation turns to what their findings suggest: dogs with CE show higher protective bias and more frequent high-arousal signals than healthy dogs, even when GI disease activity seems well controlled. We talk about what that means for clinical decision-making, when to consider referral to a veterinary behavioral medicine specialist, and how co-management can support welfare. You’ll also hear practical owner steps that connect canine gut health and emotional stability, from fiber-forward diets and microbiome-friendly habits to sleep quality (yes, many adult dogs need 14 to 18 hours daily), environmental adjustments, nutraceuticals, pheromones, and medication when appropriate.

If you care about chronic GI disease, canine emotional health, and better outcomes through whole-dog treatment, this one is for you. Subscribe, share this episode with a veterinarian or dog-loving friend, and leave us a rating and review wherever you listen.

JAVMA article: https://doi.org/10.2460/javma.25.09.0623

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Transcript

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What Chronic Enteropathy Looks Like

Lisa Fortier 0:31

Welcome to Veterinary Vertex, the SSP Epic Award-winning AVMA Journals podcast, where we delve into behind-the-scenes looks with manuscript authors. I'm editor-in-chief Lisa Fortier, joined by Associate Editor Sarah Wright. Today we have Ulrika Ludvigsson and Sarah Heath joining us to discuss chronic enteropathy and emotional health in dogs. Thank you for joining us, Ulrika and Sarah. Thank you so much. Oh, thanks for the invitation. All right, let's kick this off. Ulrica, for listeners who might not know, what is chronic enteropathy or CE in dogs?

SPEAKER_05 1:05

Yeah, so chronic enteropathy is um chronic is defined by chronic or intermittent GI science for more than three weeks. And clinical science can be weight loss, um, loss of appetites, abdominal pain, diarrhea, vomiting, etc.

Sarah Wright 1:22

And Urika, why has most of the focus traditionally been on physical clinical science rather than emotional health?

SPEAKER_05 1:29

So I think the main reason is that uh physical clinical science are more obvious and straightforward, both to assess and to measure. And also that undergraduate veterinary teaching often focuses on physical disease solely. So veterinarians are trained to look for temporary uh behavioral signs that may indicate physical disease, but we're less trained to look at behavioral patterns or behavioral changes that may indicate an underlying emotional problem, which in turn may have a contributing impact on physical disease.

Lisa Fortier 2:03

Yeah, but like you said, that's really hard to investigate. So, what what gave you the courage, or how did you come up with the idea to design this really nice study and how to explore this behavioral side?

How Emotional Health Gets Measured

SPEAKER_05 2:14

I work mainly with um gastroenterology chases. So I see a lot of dogs with uh chronic anthropy, and many of those dogs are also described by their caregivers as stressed or um they always on their toes, they're fearful in many different contexts. So we feel that many of these CE dogs also struggle with emotional problems. Um, and some of the dogs also experience flare-ups every time they experience something that evokes uh stress or a high arousal. Yeah. Um, and we also see dogs where we feel that we cannot get control of the GI disease until we have um managed any concurrent emotional problem.

Lisa Fortier 2:58

Yeah, fascinating. Sarah, how about you? What led you to explore, join Ulrica in this investigation?

SPEAKER_04 3:04

Well, it was very great to be contacted by um Ulrika and Linda when they were interested in it from a gut point of view, because in behavioral medicine referral practice, we certainly see individuals who have behavior science primarily, but also are showing signs of GI disease. So it was a really good collaboration.

Sarah Wright 3:22

It's fascinating to see the gut brain access being explored in veterinary medicine. I know we were talking before the podcast started about how it's being explored in the human side of things. So really, really fascinating, that's for sure. So, Sarah, how did you measure emotional health in dogs?

SPEAKER_04 3:37

This is really challenging. And I think, as Urika said earlier, is probably one of the reasons that it hasn't had as much attention as physical health. But there are ways in which you can quantify emotional components in the human field, something called PANAS, the positive and negative activation score, is used. And that's been adapted and validated for canine patients by Professor Daniel Mills and his team at the University of Lincoln here in the UK. So we used that validated score to look at emotional bias. And then we also have another component of emotional health called arousal, and therefore we asked about so-called displacement behaviors as a measure of the presence of high arousal as well.

Lisa Fortier 4:18

Sarah, what is a negative activation that you talked about? And how how can we interpret that term?

SPEAKER_04 4:24

That comes from work by an Estonian biologist called Jack Pangsap. He identified different um emotional motivations that lead to behaviors and described them as being either negative or positive in what's called valence. But that terminology can actually be quite difficult, I think, for particularly caregivers to understand because it's quite a loaded term, especially negative, has got quite a connotation of being bad or unwanted or detrimental. In the Heath model, we actually replace those words with the terms protective instead of negative and engaging instead of positive to really give an idea of how these motivations enhance the survival of an individual, either by protecting them or engaging them with things or with objects, situations, people, etc. So that negative activation refers to how motivated an animal is to protect itself from either actual or perceived harm. So we might think of it in terms of being pessimistic or optimistic. So having a negative activation leading to more pessimistic outlook, having a more engaging activation or a positive activation being more optimistic.

Sarah Wright 5:37

And Sarah, what are displacement behaviors and why are they meaningful indicators?

SPEAKER_04 5:42

So these are behaviors which are typically formed by animals when they're in a high state of arousal. So we use those as an indicator of this second dimension of emotional health. In the Heath model, we think of it as the individual experiencing a very high level of emotion, being a bit like water in a sink. So if you've got a very high level of water in a sink, then you're gonna notice that when it gets too high, that water starts going out through the overflow hole. That is there to prevent flooding. And these um displacement behaviors are like the water going out through the overflow hole. So when you see them, the level of water has to be high. You can't have water going out there if the water level is low. It's only gonna happen when the level is high. So those displacement behaviors are related to emotion that could be engaging or protective, or it could be both. It doesn't tell you anything about the valence that we talked about earlier with the activation. It tells you more about how much. And they're usually behaviors that are um quite common behaviors like shaking as if they're wet or yawning or lip smacking. It's really important. Those are normal behaviors if they're in the right context. So when we see them as displacement behaviors, they're performed in an unusual context. So shaking if you're coming out of a river and your coat is wet is absolutely normal. But if they're shaking when they meet strangers or when they're encountering another dog, then that is a sign of high arousal. But we have to remember that could be engaging emotion as well as protective emotion. It doesn't tell you which emotion, just how much there is.

Sarah Wright 7:24

Ulrika, anything you'd like to add?

SPEAKER_05 7:26

Yeah, so we we asked dog caregivers about how often they had seen these uh behaviors in seven different situations. And they were asked to report it on a five-point Likert scale where one represented never and five always. Um and the situations were ones that most dogs experience on a daily basis, such as meetings with unknown people and dogs, unknown people and dogs, and also being uh when being presented with novelties. And um uh if a dog is emotionally stable, um uh these situations are not um uh experiences that should increase emotional arousal to that level um that we see displacement behaviors. Um, and if we should use uh Sarah's inc analogy from the Heath model, we can think of this in terms of the emotional stable dog having a virtually empty sink before the situations are experienced. So the increase in the volume of the water in the sink as a result of any emotional inflow leaves the water still well within the sink. However, if the individual is emotionally compromised and has excessive levels of emotional residue in their sink already, any emotional input from the experience will increase the level to the point where the overflow hole is needed and displacement behaviors are seen.

What The Study Found In CE Dogs

Lisa Fortier 8:47

I love that analogy. Makes great sense in all these situations. And so, Ulrico, why have you what are there's lots of things that you've talked about? What are really the biggest differences that our listeners can take away between dogs with CE and healthy dogs?

SPEAKER_05 9:03

I think the the biggest differences between the C dogs and the healthy dogs were the negative activation score from the PANAS questionnaire, with the C dogs having significantly higher mean negative activation score compared to healthy dogs, which means that the CE dogs were significantly more pessimistic than healthy dogs. And the other major difference was the frequency of displacement behaviors, which was reported higher in the CE dogs in all of the test situations, but with the difference being statistically significant in only five of them. And higher frequencies of displacement behavior indicate higher levels of emotional arousal.

Sarah Wright 9:43

And Sarah, the study mentions increased distress in certain situations. Can you give examples of what that looks like in everyday life?

SPEAKER_04 9:51

Yeah, so we we asked the caregivers here to report their perception of their dog's distress, and we looked at two common scenarios that are potentially problematic for domestic dogs. So these were when the caregiver prepared to go out or leave a house, and then when the dog was exposed to sound stimuli such as fireworks or thunder or gunshots. And so the presence of distress signals such as pacing, panting, vocalizing in those contexts could be an indicator of emotional compromise. So these questions were added so that we just got a bit more additional information about the dog's emotional health.

Lisa Fortier 10:25

Such a cool thing to look at, uh so much to learn. Uh Ulrika, of all the findings, uh, what really stood out as surprising to you?

SPEAKER_05 10:37

As uh surprising. I I think um yeah, the surprising thing was that many of the CE dogs uh that were included had a low disease activity index of their GI disease. So meaning that their GI disease at the time of the study were under quite good treatment control for most of them. And the fact that we still could see very clear differences between CE dogs and the healthy dogs, even though their GI disease activity were low. Um, that was surprising to me. And I also think it suggests that investigation of emotional health can be relevant even though the GI disease activity and the GI disease is being effectively treated.

Sarah Wright 11:17

Ulrika, what do these findings tell us about the connection between physical illness and emotional health in dogs?

SPEAKER_05 11:24

So our findings indicate that there is an interplay or connection between chronic GI disease and emotional health in dogs. And of course, our study is highlighting a correlation and not giving any information about causation at this stage. Um, but the dogs we see in our study were reported with behaviors that may be consistent with pessimism and compromised emotional health more frequently or to a higher extent than healthy dogs. And in addition, it suggests that they experience higher levels of emotional arousal more frequently than healthy dogs. Um and the resulting physiological and psychological stress may in turn uh affect their GI disease negatively. And it may also result in dogs with C having an enhanced risk for developing secondary problematic behavior changes.

Lisa Fortier 12:15

So, Sarah, how might this change how veterinari approach treatment?

SPEAKER_04 12:19

I think we are our hope is that the results will raise awareness among veterinarians that this is a possible connection, encourage them to ask more questions about emotional health in dogs who have chronic enteropathy. And then if they identify a core, a core a connection or a concern, we'd like them to feel confident about referring that dog to a veterinary behavioural medicine specialist. So even though at the moment the evidence is um of an actual direct effect between the GI disease and the emotional health is largely anecdotal. And we hope we'll be able to use future research to confirm that. But in the meantime, the clinical input coming from a behavioral medicine analysis of the case as well as an internal medicine one will help to enhance the overall well-being of any dogs who are in need of emotional support. And I think we need to consider that emotional assessment in dogs with CE, just as part of our continuous evaluation and treatment plan, because dogs with emotional compromise need ongoing support and intervention for their emotional health alongside the management of that GI disease. And that's going to give us the best overall welfare impact.

Sarah Wright 13:33

Yorrika, do you think emotional interventions could realistically improve GI outcomes?

SPEAKER_05 13:38

Yeah, I think so. In in um in um in many cases, we in in our GI team, we certainly do see cases where emotional interventions and supports are associated with improved GI outcome, especially in dogs who continue to experience flare-ups of their physical disease. And also interestingly, when I've talked to Sarah about all of this, she has mentioned that her caregivers often report improvement in things like fecal consistency and frequency when their pets received uh behavioral medicine treatments, even though these dogs have not previously been identified with uh CE. So um even and even if the emotional interventions um are not seen to directly influence the GI outcome, I think that the dog's overall quality of life can still improve significantly. And this is a positive outcome in terms of animal welfare.

Lisa Fortier 14:34

We've been focusing a lot on what veterinarians can do. So for Sarah, uh what are the key warning signs that pet owners can can notice that maybe something more than just a tummy issue is going on?

SPEAKER_04 14:46

So I think it's important here to understand that that emotional component is part of the gut disease. So they're like not something additional, it's like two sides of the same coin, if you like. And the emotional health impacts the functioning of the GI tract, but also vice versa. So the sort of signs that are indicative of the emotional dimension are things like hypervigilance, you uh um said earlier about being on their toes, um, being very over alert to things around them, difficulties coping with everyday situations such as social interaction with dogs or people, or being left alone or exposed to noises. And also a really noticeable sign of emotional compromise can be difficulties in relation to settling or resting, and definitely alterations in sleep, both in terms of duration and quality.

Practical Support For Owners

Sarah Wright 15:36

Yeah, I definitely have a friend's dog that comes to mind when we're talking about this that has also been scoped multiple times. So we'll be passing this information along to her. Speaking of pet owners, um, Enrica, what are a few simple ways owners can support both gut and emotional health?

SPEAKER_05 15:52

Yeah, for the gut health, there are some important aspects that we can think about. So the caregivers can use a high-quality diet that the dog appears to tolerate well, which can be manifested at a shiny coat, a normal defecation, two to three times a day, and the dog being able to keep a stable body weight. And in order to feed the good microbiome, the diet should ideally contain high-quality fibers. So look for ingredients such as psyllium, and of froctolycosaccharides, and beet pulp in the list of ingredients. And daily exercise has also been shown to be beneficial for the microbiome. Um, and it's important to avoid antibiotic treatment as far as possible because we know it can have profound negative effects on the microbiome. And another thing that we know can have it can affect the microbiome negatively is obesity. So it's important to maintain an ideal body weight.

Sarah Wright 16:48

Sarah, any action items from the behavioral perspective?

SPEAKER_04 16:52

Yeah, from an emotional perspective, I think a good starting point is actually to think about sleep. Many caregivers are quite shocked that adult dogs have a sleep requirement of between 14 and 18 hours in every 24. So just talking to them about making sure their dog is getting adequate sleep in duration, but also good quality. So it has the right sort of sleeping environment. And then addressing the issues of negative or protective emotional bias. That will involve lots of different approaches, such as environmental adjustments, both physical and social, so that we can increase the animal's perception of safety and security while making sure they're also having a degree of autonomy and agency. We might also think about nutraceuticals that can aim to alter neurotransmitter balance. And we may use pheromones, they can be useful adjuncts to the toolbox in these sorts of cases. If we actually identify that the animal is emotionally unwell, so they have emotional ill health, then obviously the appropriate use of pharmacological interventions may also be appropriate.

Lisa Fortier 17:57

Yeah, it's come a long way, that's for sure. I feel like both of you have done a great job of like, these are the important things. This is the surprising part. But Eureka, if you had one big takeaway that you'd like to re-emphasize or emphasize greatest from this study, what would it be?

SPEAKER_05 18:12

Oh, yeah, I think it would be that the um that's dogs with CE might suffer from compromised emotional health. And that it's really important to really keep that in mind and assess it.

Future Research And Closing

Sarah Wright 18:23

So our final question for today, Eureka, what questions still need to be answered in future research?

SPEAKER_05 18:29

Oh, there are many. Um, and first we need more studies evaluating the potential relationship uh between CE and emotional health in order to support our results further. And we also need studies on the effect of co-management. So, what effect might emotional treatment have on GI disease? Uh and the other way around, what effect may uh emotional health does CE treatment give?

SPEAKER_04 18:55

Sarah, what are your thoughts? We know that a very um sort of rapidly developing field of interest is the role of the gut microbiome. Um and that's both in physical and in emotional health as well. So things like microbiota modulation and fecal myocrobial transplantation, they've all been suggested as possible treatment modalities for um cases that have GI disease, but also in patients with potentially compromised emotional health. So there was a study that was published actually with dogs with epilepsy, which were reported to show improved scores in a range of behavioural indicators after FMT. So this area of research is really fascinating, but it is in its infancy. We do have to be really cautious about sort of putting too much stay by the results of our microbiome or making conclusions about things like that without too much evidence. But the future is exciting in terms of thinking about how research can help us to understand the potential interplay between physical, emotional, and cognitive health in our veterinary patients and really improving that interplay between internal medicine and behavioral medicine.

Sarah Wright 20:07

Zurika, any final words to add for this episode?

SPEAKER_05 20:10

Yeah, I think another aim of future research will also be to determine if there is a directional cause-effect relationship between GI and emotional health, or if it may be a bidirectional um relationship. And this is something that we are uh trying to look at in our next phase of our research together.

Lisa Fortier 20:28

Ulrika and Sarah, uh, thank you so much for taking time out of your busy schedules to be with us here today. Thank you so much.

SPEAKER_04 20:36

Thank you.

Lisa Fortier 20:37

For listeners' viewers, you can read Ulrika's and Sarah's article in Javma. I'm Lisa Fortier, joined by Sarah Wright. Be sure to tune in next week for another episode of Veterinary Vertex, and don't forget to leave us a rating and review on Apple Podcasts or wherever you listen.