Current knowledge about the risks and benefits of raw meat-based diets for dogs and cats

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JAVMA, Vol 243, No. 11, December 1, 2013 Vet Med Today: Timely Topics in Nutrition 1549
The feeding of RMBDs to dogs and cats has received
increasing attention in recent years. The American
Animal Hospital Association,1 AVMA,2 and Canadian
Veterinary Medical Association3 have adopted statements
discouraging the inclusion of raw or undercooked animal-
source protein in dog and cat diets. The Delta Society’s Pet
Partners Program expressed concern that pets in a therapy
animal program could be shedding pathogens in the pres-
ence of immunocompromised humans and other at-risk
human populations. Therefore, they adopted in 2010 a
policy that precludes animals that eat RMBDs from par-
ticipating in their therapy animal program.4 For each of
the organizations, the primary reason indicated to oppose
feeding of an RMBD was that potential pathogen contami-
nation of the uncooked meat causes health risks to the pet
fed the diet as well as to other pets, human family mem-
bers, and members of the public in contact with the pet.
These statements did not address other potential prob-
lems of RMBDs, such as potential nutritional imbalances
or other safety issues of the diets (eg, feeding bones); they
also did not address the reasons people want to feed these
diets or potential benefits of this type of diet.
A major problem in the discussion about potential risks
and benefits of RMBDs is the paucity of good data from high-
quality studies. Information on nutritional risk or benefit is
often from low-quality studies (testimonials, case series, or
poor-quality cohort and case-controlled studies).5 The evi-
dence for infectious disease risks when feeding RMBDs is of
better quality and quantity, but few studies have been con-
ducted to compare the risk of feeding RMBDs with that of
feeding commercial foods,6 and no reports have been pub-
lished on evaluation of the long-term risks and benefits of
feeding RMBDs. The lack of consensus and paucity of good
data can make it difficult for veterinarians to provide in-
formed feeding recommendations to dog and cat owners.
Current knowledge about the risks and benefits
of raw meat–based diets for dogs and cats
Lisa M. Freeman, DVM, PhD, DACVN; Marjorie L. Chandler, DVM, MS, DACVN, DACVIM;
Beth A. Hamper, DVM, PhD, DACVN; Lisa P. Weeth, DVM, DACVN
The intent of the information reported here is
to provide a balanced review of the issue of feeding
RMBDs, types of RMBDs, reasons these diets are fed,
and potential benefits and risks associated with feeding
of RMBDs. The information will also highlight areas in
which additional research is needed to better delineate
benefits and risks.
Definition of RMBDs
Raw meat–based diets are those that include un-
cooked ingredients derived from domesticated or wild-
caught food animal species and that are fed to dogs or
cats living in home environments. These ingredients can
include skeletal muscles, internal organs, and bones from
mammals, fish, or poultry as well as unpasteurized milk
and uncooked eggs. Raw meat–based diets can be divided
into 2 main categories: commercial and home-prepared.
The most common forms of commercial RMBDs
are fresh, frozen, and freeze-dried diets intended to be
nutritionally complete and balanced. These diets are of-
ten formulated to meet values listed in the AAFCO Dog
or Cat Food Nutrient Profiles, and individual diets may
meet values listed for adult maintenance, growth and
gestation-lactation, or all life stages. However, some of
these foods may be labeled as intended for intermittent
or supplemental feeding only, which means that they
are not nutritionally complete and balanced. Commer-
cial RMBDs typically are created from recipes devel-
oped by or for a company marketing a specific brand
of pet food; these commercial RMBDs are made in large
quantities in pet food manufacturing facilities or in-
dustrial kitchens, then packaged into smaller volumes
for purchase and feeding by pet owners. In addition to
the fresh, frozen, and freeze-dried commercial diets,
another less common form of RMBD is a carbohydrate
premix that includes grains, vitamins, and minerals and
is intended to have a raw meat protein source added by
the pet owner to provide a complete diet.
Timely Topics in Nutrition
ABBREVIATIONS
AAFCO Association of American Feed Control Officials
BARF Biologically appropriate raw food
RMBD Raw meat–based diet
In cooperation with
From the Department of Clinical Sciences, Cummings School of Veteri-
nary Medicine, Tufts University, North Grafton, MA 01536 (Freeman);
Royal (Dick) School of Veterinary Studies, University of Edinburgh,
Midlothian, EH25 9RG, Scotland (Chandler); the Department of Small
Animal Clinical Sciences, College of Veterinary Medicine, University of
Tennessee, Knoxville, TN 37996 (Hamper); and Red Bank Veterinary
Hospital, 197 Hance Ave, Tinton Falls, NJ 07724 (Weeth).
The authors thank Drs. Dottie Laflamme, Nicholas Cave, and David
Dzanis for technical assistance.
Address correspondence to Dr. Freeman (lisa.freeman@tufts.edu).

1550 Vet Med Today: Timely Topics in Nutrition JAVMA, Vol 243, No. 11, December 1, 2013
In contrast, home-prepared RMBDs include a va-
riety of highly publicized feeding regimens, such as
BARF (originally defined as bones and raw food but
currently referred to as biologically appropriate raw
food by supporters),7 the Ultimate Diet,8 and the Vol-
hard Diet.9 Published recommendations for feeding of
RMBDs are typically based on opinion and have not
been subjected to rigorous peer review. However, a va-
riety of other recipes and programs for home-prepared
RMBDs have been developed by general practice vet-
erinarians, trainers, breeders, and owners. Many of the
home-prepared RMBDs include by-products (ie, bones
and internal organs), even though these ingredients an-
ecdotally appear to be avoided by some owners because
of misperceptions about what they are (or are not).
Some commercial foods are now marketed specifically
as having no by-products. Also, whereas commercial
RMBDs are often developed to meet AAFCO nutrient
guidelines and are intended (when fed exclusively) to
provide sole-source nutrition for a specific life stage of
dogs and cats, home-prepared RMBDs are often based
on a rotation of ingredients with the belief that this ro-
tational variety will provide (over a prolonged period)
a complement of essential amino acids, fatty acids, vita-
mins, and minerals to pets.7–9
Finally, there are a variety of raw dried or freeze-
dried pet treats that have bacterial risks similar to those
for RMBDs. These include products such as rawhide
chews, pig ears, and cattle hooves that have been com-
mercially available for many years but that have now
been expanded to include hearts, tracheas, and bull or
steer penises (eg, bully or pizzle sticks). Most of the
freeze-dried treats (eg, freeze-dried liver treats) are raw.
It has been found in multiple studies10–14 that there is
a substantial risk for contamination of these products
with Salmonella spp and other bacteria, and outbreaks
of salmonellosis in humans have been reported.10–12
These products should also be mentioned when dis-
cussing the issues of risks for raw meat–based products.
Owner Motivation for Feeding RMBDs
Proponents of feeding commercial or home-prepared
RMBDs often claim nutritional superiority of these diets
and important health benefits. Many claims of benefits are
largely unproven and not based on scientific evidence, but
they appear plausible to well-intending pet owners who
want to feed a diet that will optimize health and wellness
of their pets. Anecdotal benefits for RMBDs include bet-
ter palatability of these diets, cleaner teeth from chewing
bones as a part of these diets, a shiny coat, and owner
perception that they are providing their pet with a more
natural diet.
Furthermore, it may be challenging for owners to
comprehend the effects of medical procedures, treat-
ments, and disease processes, but provision of food is
an easily attainable aspect by which they can directly
influence the care and well-being of their animals.
What to feed their pets can be just as important, and
sometimes more important, than what owners them-
selves eat. Many pet owners care for their animals as
they would a human family member, and the act of
feeding for some owners is a way of enhancing and re-
inforcing the human-animal bond. Owners want to do
what is best for their pets, including feeding their pets
properly, but the pet food marketplace is confusing and
complicated with many opposing viewpoints. Some of
the most passionate arguments surrounding pet health
and well-being concern the feeding of RMBDs.
A founding premise in popular lay publications and
on the Internet regarding RMBDs is that these are the
diets that wild, nondomesticated dog and cat species ate
during their evolution into pets, which may provide an
important rationale for some owners to feed these diets
to their dogs and cats.7,8 Cats have remained obligate
carnivores during domestication, and their natural diet
includes a range of small prey species such as mam-
mals, reptiles, birds, and insects that can be hunted,
captured, and eaten by the cats. Conversely, dogs have
adapted to eating an omnivorous diet and can consume
a variety of plant and animal products to meet their es-
sential nutrient requirements. However, both cats and
dogs are able to digest and metabolize many nutrients
provided from plant-based ingredients.15 Additionally,
dogs have undergone an incredible variety of selection
pressures resulting in large phenotypic differences from
their ancestors and among current breeds.16,17 In fact, it
was reported18 that there are 36 regions of the genome
that differ between dogs and wolves, 10 of which play a
critical role in starch digestion and fat metabolism. The
authors of that study18 conclude that these genetic dif-
ferences in the genome between dogs and wolves and
hence the ability to digest starch and fat constituted a
crucial step in the early domestication of dogs. There-
fore, even if the typical diet eaten by a wild, nondo-
mesticated dog or cat can be considered optimal for re-
production and survival in those animals, in which the
lifespan is typically quite short, these diets may not be
optimal for domestic dogs and cats living in a home en-
vironment, with owners who anticipate that their pets
will have long and healthy lives.
The term natural has a specific definition accord-
ing to the AAFCO.19 Natural products cannot contain
chemically synthesized ingredients, except for trace
nutrients, the presence of which must be declared (eg,
a label indicating natural with added vitamins, miner-
als, and other trace nutrients). Nonetheless, the term
natural is used by the pet food industry and pet own-
ers in numerous ways and to imply a variety of proper-
ties. Despite the difficulty in use of the term natural,
some pet owners believe there is a disparity between
commercial dry extruded and moist diets and RMBDs.
Some authors have suggested that physical and heat
processing, rendering, and inclusion of by-products or
chemically synthesized additives and preservatives are
unhealthy and, in some cases, may cause disease.7,9,20
The 2007 pet food recall because of melamine contami-
nation and the associated morbidity and fatalities also
brought pet food safety to the forefront. Anecdotally,
there appears to be a growing number of consumers
who are suspicious of large pet food manufacturers.
Additionally, recalls of commercial pet foods for bacte-
rial contamination, mycotoxicosis, thiamine deficiency,
and vitamin D toxicosis are evidence that feeding com-
mercial dry extruded and moist pet foods is not com-
pletely without risk.21–25

JAVMA, Vol 243, No. 11, December 1, 2013 Vet Med Today: Timely Topics in Nutrition 1551
Finally, proponents of feeding RMBDs claim health
benefits for the diets, such as improvement in coat and
skin; elimination of breath, body, and fecal odor; im-
provement in energy, behavior, and immunity; and a
reduction in medical conditions including allergies, ar-
thritis, pancreatitis, dental disease, and parasitism.7–9,26
Although changes may be anecdotally reported by pet
owners and veterinarians, potential health benefits
have not undergone scientific evaluation. Investigators
in a recent study27 found indications of lower calcium
excretion in urine of dogs eating a commercial RMBD,
compared with excretion in dogs eating a commercial
dry extruded diet, which suggested a benefit of RMBDs
for dogs prone to calcium oxalate urolithiasis. Howev-
er, the RMBD contained half as much calcium, less than
a third as much sodium, and considerably more water
than did the dry extruded diet, so it is difficult to inter-
pret the importance of these results. Further research
regarding all reported health claims is warranted.
Effects of Cooking on Digestibility
Proponents often claim that one of the benefits of
RMBDs is increased digestibility because essential en-
zymes are not destroyed by cooking. Although most
dogs and cats do not require exogenous enzymes, stud-
ies28–30 have found improvements of food digestibility in
animals fed RMBDs. Digestibility of RMBDs versus dry
extruded diets was examined in exotic felids.28,29 Inves-
tigators in 1 study29 found that RMBDs had significantly
higher digestibility for crude protein, but not for fat,
energy, or dry matter. In the other study,28 investigators
found numerically higher amounts of dry matter, energy,
and protein in RMBDs, but a statistical comparison was
not performed. Decreased digestibility in cooked foods
is believed to be the result of effects of heat processing
on proteins and amino acids.31–33 A study30 that involved
domestic cats also found significantly higher energy
(8.0% higher) and macronutrient (4.6% to 14.3% high-
er) digestibility of an RMBD, compared with digestibil-
ity for a dry extruded diet. The modest improvements
in digestibility for the RMBD, compared with the dry
extruded diet, may be related to positive effects of the
RMBD on digestibility, negative effects of extruded diets
in general, or negative effects of the specific extruded
diet used in the study. In that same study30 of domestic
cats, there was no significant difference in digestibility
between feeding of the RMBD before and after it had
been heated in a microwave to ≥ 71°C (≥ 160°F).
Proteins and amino acids undergo substantial
physical changes during processing associated with
the manufacture of pet foods. Processing conditions,
which primarily involve application of heat but also
can include pressure and water content, can have vari-
able effects on protein digestibility and amino acid
bioavailability. The effects depend on the ingredients,
temperature, and type of processing (eg, canning, ex-
trusion used in the production of most commercial dry
pet foods, and freezing or freeze-drying that would be
performed with commercial RMBDs). In addition, food
proteins can react with other food components such as
sugars, fats, oxidizing agents, acids, alkalies, polyphe-
nols, and food additives. Heat processing during the
manufacture of dry extruded or moist pet foods typi-
cally results in the denaturing of proteins and loss of
secondary and tertiary protein structure. Processing
can increase bioavailability of proteins through col-
lagen breakdown and an increase in exposure to an
animal’s digestive enzymes, but it also can negatively
affect amino acids through proteolysis, protein cross-
linking, amino acid racemization, protein-polyphenol
reactions, oxidative reactions, and browning or Mail-
lard reactions.34 The Maillard reaction accounts for the
most important losses of amino acids.35
Although conventional heat processing can have
negative effects on animal tissue proteins, heat process-
ing improves the bioavailability of some plant proteins
secondary to denaturing of antinutritional factors. For
example, legumes contain trypsin and chymotrypsin
inhibitors that impair protein digestion and reduce pro-
tein bioavailability.36 Heat processing denatures these
inhibitors and therefore increases protein bioavailability.
Improved digestibility results in less digesta in the
colon with less fecal matter. Decreased fecal output has
been found in a study29 of feral cats and in experiments
conducted by one of the authors (BAH). Decreased fe-
cal output is perceived as a benefit by some owners. Al-
though nondigestible carbohydrates in the form of fiber
are beneficial to the host,37 undigested dietary protein
results in increased amounts of colonic compounds
such as ammonia, phenols, indoles, and amines, which
can play a role in diseases, such as colorectal cancer.38
The authors are not aware of any reported studies on
the potential harmful effects of undigested dietary pro-
tein on colonic health in dogs or cats.
Heterocyclic amines are compounds formed when
muscle meat is cooked with a high temperature. Ex-
posure to high concentrations (eg, milligram/gram of
food) of these compounds has been associated with
cancer in research animals.39 Concentrations found in
both pet and human foods are much lower (nanograms/
gram of food), but these concentrations still may have
mutagenic activity.40 The cumulative effects of these
compounds on genomic instability and increased sensi-
tivity to tumor promotion in pets and humans require
investigation.
Another frequently cited benefit when feeding
RMBDs is an improvement in immune function. In ex-
periments conducted by one of the authors (BAH), do-
mestic cats fed an RMBD for 10 weeks had a significant
increase in lymphocyte and immunoglobulin produc-
tion, whereas there were no significant changes over
the study period for cats fed a cooked commercial moist
diet. In those experiments, it was also found that cats
fed the RMBD were fecal shedders of Salmonella spp.
Higher amounts of exposure to microbes and microbial
degradation products, exposure to pathogens, changes
in intestinal microflora, or nutritional differences in the
diets may have stimulated the immune response de-
tected for cats fed the RMBD. However, potential health
benefits and effects of long-term feeding of RMBDs
have not been critically evaluated.
Although there is evidence for improved digestibil-
ity of proteins in RMBDs, compared with digestibility of
proteins in extruded diets, the clinical effects of this dif-
ference are unclear and require further study. Effects of

1552 Vet Med Today: Timely Topics in Nutrition JAVMA, Vol 243, No. 11, December 1, 2013
processing for some commercial RMBDs (eg, freeze-dried
or carbohydrate premixes) are also not fully understood.
In addition, one of the potential effects attributable to
differences in processing is an alteration of the gastroin-
testinal microbiome. Research is needed on differences
in the gastrointestinal biome between dogs and cats that
are fed RMBDs versus extruded foods (and compared
with results for dogs and cats fed home-cooked diets
and canned diets as well as effects among various types
of RMBDs). The function and role of chronic exposure
to bacteria in metabolism and immune function also
should be the focus of future studies.
Health Risks
A number of studies have revealed important con-
cerns about nutritional imbalances when RMBDs are
not formulated properly, health risks to animals, and
public health concerns.
Health risks to pets—Health risks to pets fed
RMBDs include nutritional concerns, safety concerns,
and other health risks.
NUTRITIONAL CONCERNS
A US study41 in 2001 revealed that all of the home-
prepared and commercial RMBDs tested (3 home-pre-
pared and 2 commercial RMBDs) had multiple nutri-
tional imbalances, some of which could have important
adverse effects on the health of the animals. Examples
included a calcium-to-phosphorus ratio of 0.20, vita-
min A and E concentrations below the minimum de-
tectable value, and a vitamin D concentration nearly
twice the AAFCO maximum amount.41 Authors of a
case report42 of a growing dog fed an RMBD (a com-
mercial carbohydrate premix plus raw ground beef pre-
pared in accordance with instructions on the package
label) reported that the nutritionally unbalanced diet
resulted in vitamin D–dependent rickets type I and nu-
tritional secondary hyperparathyroidism. In a recent
study43 in Europe, investigators calculated amounts of
12 nutrients (eg, calcium, phosphorus, and vitamin A)
for 95 homemade RMBDs being fed to dogs, as reported
by the owners. In that study,43 57 (60%) diets had major
nutritional imbalances. Therefore, there is concern that
both commercial and homemade RMBDs may have im-
portant nutrient deficiencies and excesses. In addition,
even if these diets meet the minimum nutrient amounts
and do not exceed maximum amounts, they may not
provide an optimal nutrient profile. For example, many
RMBDs are high in fat, compared with the fat content
of typical dry extruded or moist pet foods. This may
improve coat glossiness as perceived by owners, but it
may also cause mild to severe gastrointestinal issues in
some animals or increase the risk for obesity in others
because it is easy to overfeed high-fat diets.
Whether a pet’s diet includes raw meat or bones,
there are a number of concerns regarding all home-pre-
pared pet foods. It can be difficult to formulate a nutri-
tionally balanced home-prepared diet. Investigators in
3 studies44–46 have evaluated the nutritional balance of
commonly available home-prepared diet recipes. In the
2 studies44,45 on animals with medical conditions, 94
recipes were evaluated and none had adequate concen-
trations of all essential nutrients. In one of these stud-
ies,46 investigators evaluated 200 recipes for healthy
dogs, and 190 (95%) recipes had at least 1 essential nu-
trient below AAFCO minimums and 167 (84%) recipes
had multiple deficiencies.
SAFETY RISKS
In addition to nutritional concerns about RMBDs,
other safety issues related to RMBDs are of major im-
portance, particularly risks of contamination with
pathogens.47 Raw meat, whether sold for human con-
sumption, inclusion in commercial RMBDs, or inclu-
sion in dry extruded or moist pet foods, can be con-
taminated with a variety of pathogens. Although care
is used during processing, meat from healthy food
animals intended for human consumption may acquire
bacterial contamination from the hide, feathers, or vis-
cera during slaughter, evisceration, or processing and
packing.48 A variety of potential pathogens are pres-
ent in raw meat, including meat intended for human
consumption, with Salmonella spp having received the
most attention for companion animal species and their
owners.47,48 Because freezing and freeze-drying do not
destroy all of these pathogens, both home-prepared and
commercial RMBDs are at risk of being contaminated
with these and other pathogens.
Several reports6,49–53 have been published on the
presence of Salmonella spp and other pathogens in
commercial and home-prepared RMBDs. Prevalence
rates for contamination with Salmonella spp in com-
mercial RMBDs ranged from 20% to 48%.6,50,51 Recently,
a Salmonella prevalence rate of 21% for 166 commercial
RMBD samples was reported,51 and 18 Salmonella sero-
types isolated from those samples were resistant to 12
of 16 antimicrobials tested. It is important to mention
that commercial dry extruded foods can also become
contaminated with Salmonella spp and other patho-
gens. For example, there was a pet food recall when
dry extruded pet foods from a single manufacturing
plant were linked to 29 human patients identified with
Salmonella enterica serovar Schwarzengrund infections
between 2006 and 2008.54
Home-prepared RMBDs were evaluated in 1 study49
in which 8 of 10 home-prepared raw chicken–based di-
ets fed to pet dogs had positive results when cultured
for Salmonella spp, whereas none of the commercial dry
extruded diets yielded Salmonella spp. In addition, there
are reports53,55–58 of racing Greyhounds, sled dogs, guard
dogs, and cats with Salmonella infections attributable to
consumption of contaminated raw meat, including re-
ports of dogs and cats that died from Salmonella-related
sepsis. It is not surprising to find high rates of contami-
nation with Salmonella spp in home-prepared RMBDs
because high rates of contamination with Salmonella spp
can be found for raw meats sold for human consump-
tion. Rates of contamination with Salmonella spp differ
among studies59–63 but range from 21% to 44% of chick-
en samples purchased from retail locations throughout
North America. Rates of contamination with Salmonella
spp are lower for beef and pork intended for human con-
sumption, ranging from 3.5% to 4%.64,65
Contamination of RMBDs with other bacteria and
pathogens has also been evaluated. Contamination of

JAVMA, Vol 243, No. 11, December 1, 2013 Vet Med Today: Timely Topics in Nutrition 1553
RMBDs with Escherichia coli was evaluated in 2 stud-
ies.6,41 Nontype-specific E coli was found in 143 of 240
(60%) commercial RMBDs but in only 8 of 24 (33%)
commercial dry extruded diets and 2 of 24 (8%) com-
mercial cooked moist diets.6 A 2001 study41 revealed
that 1 of 5 RMBDs tested (both commercial and home-
prepared diets) was contaminated with E coli O157:H7.
Investigators in another study50 found a prevalence of
20% for contamination of commercial RMBDs with
Clostridium spp. Other health risks indicated in case
reports or case series of animals eating RMBDs include
contamination with Campylobacter jejuni52 or Toxoplas-
ma gondii42,66–68 and increased numbers of infections at-
tributable to Echinococcus multilocularis,69 although the
latter infection was in dogs fed raw viscera from wild
animals and is geographically limited. Meat intended
for human consumption is commonly contaminated
with a variety of pathogens, including Campylobacter
spp (prevalence of 29% to 74% in chicken)59,60,63 and
Listeria spp (prevalence of 15% to 34% in chicken and
25% to 52% in beef and pork)60,63,70 Therefore, home-
prepared RMBDs made with meats intended for human
consumption are at high risk for contamination and can
infect both pets and humans.
Proponents of home-prepared diets, including
RMBDs, often cite recalls of commercially available
dry extruded and moist diets because of bacterial and
chemical contamination as a reason that pets should
not be fed those types of diets. Contamination of some
commercial pet foods with melamine-cyanuric acid in
2007 resulted in dogs and cats with acute kidney in-
jury.71 That episode was caused by the supplier deliber-
ately adulterating a human-grade food ingredient that
was also used in pet food. In response, in part, to this
tragedy, the FDA Amendments Act of 2007 was passed
to strengthen the food recall process, and food safety
legislation has been further strengthened by the FDA
Food Safety Modernization Act that went into effect in
2012.72 A recall is a method of removing or correcting
consumer products that are in violation of regulations
administered by the FDA. Although those pieces of leg-
islation grant the FDA mandatory authority to initiate a
recall in the future, recalls of pet food currently are ini-
tiated voluntarily by a pet food manufacturer, although
the FDA can request a manufacturer to initiate a recall.
The FDA Amendments Act of 2007 requires that manu-
facturers submit a report to the FDA no later than 24
hours after determining that there is a reasonable prob-
ability that the use of or exposure to the food will cause
serious adverse health consequences to or the death
of animals (or humans), which constitutes a potential
class 1 recall.71,72
Of 28 recalls and safety alerts because of confirmed
or potential contamination of commercially available
pet foods with Salmonella spp in 2011 and 2012, 17
were for dry extruded pet foods, 1 was for a raw food
intended for cats, and 11 were for raw or insufficiently
processed treats, especially raw pig ears.22 The relatively
low rate of recalls of commercial RMBDs may be be-
cause consumers or veterinarians do not associate ill-
nesses with potential contamination, there is lack of
rigorous quality-control testing by manufacturers, or
there is a low prevalence of this feeding regimen in
the overall pet population and a more limited market
share for commercial RMBDs than for dry extruded and
moist cooked diets. It is difficult to make an accurate
risk assessment from these data because the percentage
of pet owners who feed RMBDs (commercial or home
prepared) is not known. Investigators of a 2008 study73
on the feeding practices of pet owners in Australia and
the United States found bones or raw foods were pro-
vided as part of the main meal to 16.2% of dogs and
9.6% of cats, and another 7.4% of dogs and 0.9% of cats
received raw meat or bones as a treat or snack at least
once a week. However, it is important to mention that
these data were collected prior to the pet food recall
of 2007; thus, these percentages may differ if the sur-
vey were conducted today. In a study14 that involved
a survey conducted in 2011, 10.8% of 791 pet own-
ers from 44 US states and 6 countries who responded
fed a commercial or home-prepared RMBD as a major
component of their pet’s diet, and 32.9% fed a home-
prepared or commercial RMBD as some component of
their pet’s diet.
Although commercial RMBDs and ingredients are
covered by FDA regulations and can be recalled if con-
tamination or other problems are detected, the feeding
of contaminated home-prepared RMBDs that include
foods intended for human consumption may go unde-
tected because foodborne illnesses in dogs and cats are
rarely tracked unless associated with human disease.
There are no data on the number of dogs and cats fed
human foods that have been recalled, nor the number
of dogs and cats that have become ill after eating a con-
taminated human food. Although data are available on
the number of recalls, the lack of data on recalls be-
cause of contamination of commercial and home-pre-
pared RMBDs does not mean that such diets are safe.
To assess the true risks associated with feeding
RMBDs, research is warranted to provide information
that will lead to a better understanding of the potential
health consequences of contamination from RMBDs for
all those at risk (ie, the dog or cat that eats the food,
other animals in the household [or in a kennel, cat-
tery, or clinic], and humans exposed to those animals,
to the RMBDs, and to the animals’ feces). Although the
gastrointestinal tracts of dogs and cats are shorter in
comparison with that of humans,74 there is no evidence
that a shorter gastrointestinal tract prevents infection
with Salmonella spp or other pathogens. Gastric and
intestinal pH do not appear to be significantly differ-
ent between humans and dogs.75 It is clear that dogs
and cats can carry Salmonella organisms, but even if
future studies find an increase in resistance to clinical
salmonellosis, there have been numerous reports53,55–58
documenting that salmonellosis can occur in both dogs
and cats. The prevalence of contamination found in the
studies conducted to date suggests that contamination
rates of RMBDs are much higher than would be indi-
cated on the basis of the number of recalls, so a better
understanding of the potential risks is important.
Some RMBD manufacturers currently use high
hydrostatic pressure processing (also called high-pres-
sure pasteurization) in an attempt to reduce risks of
pathogens in commercial RMBDs. Although this pro-
cess can reduce the numbers of many pathogens, it

1554 Vet Med Today: Timely Topics in Nutrition JAVMA, Vol 243, No. 11, December 1, 2013
usually does not completely eliminate them, and bacte-
ria and viruses differ in their susceptibility to this pro-
cess.76,77 In addition, there is the potential for the devel-
opment of resistance to high-pressure pasteurization by
bacteria and viruses.77,78 Therefore, further research is
needed on the efficacy of this processing method for re-
ducing the risk from pathogens in commercial RMBDs.
Because home-prepared RMBDs are not subject to test-
ing or regulatory oversight, pet owners should be ad-
vised of the risks, from pathogens as well as nutritional
imbalances, associated with these types of diets.
OTHER HEALTH ISSUES
In addition to the previously mentioned health prob-
lems, RMBDs that contain bones (eg, the BARF diet) can
potentially result in fractured teeth and gastrointestinal
injury. Bones can cause obstruction or perforation of
the esophagus, stomach, small intestine, or colon.
Bone foreign bodies were present in 30% to 80% of
dogs and cats with esophageal foreign bodies.79–82
Those who promote the feeding of raw bones claim
that there are fewer problems with raw bones than
with cooked bones7; however, to our knowledge, the
frequency of obstruction or perforation with raw ver-
sus cooked bones has not been evaluated. Research is
needed to better understand the frequency of these
complications.
Another potential adverse health effect associated
with RMBDs was identified in a recent report.83 Authors
of that report83 identified and described 12 dogs with el-
evations in serum thyroxine concentration (6 of which
had clinical signs of hyperthyroidism) caused by eat-
ing an RMBD. All dogs had thyroxine concentrations
within the reference range after the diet was changed.
Even in otherwise healthy dogs and cats eating
RMBDs, serum biochemical values may deviate from
laboratory reference ranges. Serum albumin and cho-
lesterol concentrations were higher than the reference
ranges in cats fed an RMBD, compared with concentra-
tions for those fed dry extruded diets.30 In a studya in
dogs, those eating an RMBD had significantly higher
concentrations of BUN and serum creatinine and a
higher Hct, compared with results for control dogs that
were assumed to be eating commercial dry extruded di-
ets or moist pet food diets.
Health risks for people—As previously men-
tioned, raw meats, whether intended for consumption
by humans or pets, are frequently contaminated with
microorganisms. The most common of these are E coli,
Salmonella spp, Clostridium spp, Campylobacter spp,
and Listeria spp.47,59–65,84,85 In addition, raw meats fre-
quently carry parasites such as T gondii and, less fre-
quently, many other parasites that can infect humans
or pets.48,66–68,86–88 In addition to the health risks these
pathogens pose for pets, environmental contamination
caused by shedding of these organisms by pets is a risk
factor for infection of humans.
It is estimated that salmonellosis affects 1.3 mil-
lion humans/y in the United States, with the cause most
commonly linked to contaminated poultry products.89
Salmonella organisms can frequently live as a transient
member of the intestinal microflora without causing ill-
ness; thus, a human or pet can be a carrier. Direct con-
tact with infected or carrier animals or their feces is a
risk factor for salmonellosis in humans,47,85,89,90 and sev-
eral studies49,57,91,92 have found that dogs eating RMBDs
are at risk for shedding Salmonella spp in their feces.
Results of these studies49,57,91,92 indicate that between
3% and 50% of dogs fed RMBDs intermittently or as a
primary diet shed Salmonella organisms in their feces.
The large variation may be related to whether the diets
were home prepared or commercial and the prevalence
of contamination of the diets. In 1 study,92 investigators
found that when a single meal of a contaminated com-
mercial RMBD was fed, 7 of 16 dogs shed Salmonella
spp in their feces for up to 7 days.
Other bacteria also can be of concern for humans
who might be exposed to pets shedding bacteria. In a
study91 of dogs fed RMBDs over a 1-year period, the
point prevalence rate for extended-spectrum cepha-
losporinase E coli in the feces was up to 45%. Inves-
tigators in another study93 reported on 16 pathogenic
Yersinia enterocolitica 4/O:3 isolates cultured from the
feces of 5 dogs and 2 cats in Finland over a 1-year pe-
riod; 5 of the animals were known to have eaten raw
pork. Although the authors are not aware of any stud-
ies conducted to evaluate fecal shedding of other E coli
or Clostridium spp in pets eating raw meats or RMBDs,
the high prevalence of contamination of raw meats and
RMBDs makes this of major concern for humans ex-
posed to pets eating these diets.
Toxoplasma gondii can be acquired from raw or
undercooked meats or from environmental exposure,
including contaminated soil or feces. Toxoplasmosis
is of greatest danger to people with compromised im-
mune function and to pregnant women and the de-
veloping fetus. Toxoplasmosis in a fetus can result in
mental retardation, blindness, epilepsy, and death. It
can cause severe encephalitis and death in immuno-
suppressed individuals.94 Although the prevalence of
T gondii in retail meats sold in the United States is low,
it is sufficient to induce active toxoplasmosis in cats fed
raw food samples.68 Toxoplasmosis can be passed from
cats to humans through exposure to oocysts in the cats’
feces. The consumption of raw meat significantly in-
creases the seroprevalence of T gondii in cats.95,96 Cats
that spend time outdoors, hunt prey, or eat raw meat
are more likely to shed oocysts. Such cats can increase
the zoonotic risk to their owners, and cats allowed to
roam and defecate in gardens or sandboxes may pose
a risk to a broader range of people in the surrounding
neighborhoods.94
The potential risk for human disease has been
clearly documented. However, further research is need-
ed to quantify the actual risk and prevalence of disease
associated with feeding RMBDs to pet dogs and cats.
Clinical Recommendations
Whether as a means to reinforce the human-animal
bond or in response to concerns about the production
of commercial dry extruded and moist diets, commer-
cial and home-prepared RMBDs have grown in popu-
larity over the past decade. Proponents of RMBDs claim
that they are a safe and natural way to promote ani-
mal wellness; these claims are made without long-term
supportive evidence and largely ignore the potential

JAVMA, Vol 243, No. 11, December 1, 2013 Vet Med Today: Timely Topics in Nutrition 1555
life-threatening consequences to pets and their human
caregivers when contaminated RMBDs are fed.
When comparing various types of RMBDs, some
general assumptions can be made by veterinary practi-
tioners regarding both commercial and home-prepared
RMBDs. Fresh, frozen, and freeze-dried raw animal
products are palatable to both dogs and cats and are
readily consumed when offered. These types of diets of-
ten include higher amounts of protein and fat, with rela-
tively low total carbohydrate and dietary fiber amounts,
than are typically found in commercial dry extruded
and moist foods. Pets often consume RMBDs without
developing any health problems, but sometimes even
healthy adult dogs and cats can develop adverse effects,
ranging from relatively benign effects (eg, increased co-
lonic fermentation and gas production with higher pro-
tein intakes) to more overtly life-threatening concerns
(eg, higher fat diet fed to an animal with a history of
pancreatitis), as a result of consumption of these diets.
Additionally, raw meat has an inherent risk of bacterial
and parasitic contamination, and animals that consume
RMBDs may pose a risk to other pets and people in
the household and surrounding community, including
veterinarians and veterinary support staff. All individu-
als are at risk for infection, but high-risk humans and
companion animals should be of particular concern.
This includes those who are ill as well as those who are
immunocompromised, young, elderly, pregnant, or lac-
tating. Veterinarians may wish to consider instituting
procedures regarding pets that eat RMBDs to ensure the
safety of other pets and the veterinary staff. These poli-
cies should take into consideration the potential legal
implications,97 that there is a period of fecal shedding
after eating a contaminated RMBD (up to 7 days),92 and
that common cleaning and disinfection practices do not
eliminate Salmonella contamination from food bowls.98
If a commercial RMBD is formulated to meet AAFCO
nutrient guidelines for a particular life stage (ie, growth-
reproduction or adult maintenance) of a dog or cat, there
should be minimal risk of nutritional inadequacy. How-
ever, few manufacturers of raw diets conduct AAFCO
feeding trials or digestibility studies on finished products,
and manufacturers differ with regard to their attention to
quality-control procedures. Thus, the assumption that
these diets are truly complete and balanced for long-
term feeding relies heavily on the expertise of the indi-
vidual formulating the original recipe and expectations
about the stability and degradation of dietary nutrients.
If these diets are manufactured in accordance with cur-
rent FDA regulations for handling of foods and require-
ments for microbial testing during food manufacturing
and storage,99 there should be minimal risk of exposure
to foodborne pathogens. However, variation in quali-
ty-control testing practices or inadequate testing con-
ducted by a manufacturer of a raw food may allow for
introduction of pathogens into pet-owning households.
Although the FDA has provided a safety guidance doc-
ument for the manufacturers of RMBDs, manufacturers
are not legally required to comply with these guidelines
if an alternative approach meets applicable statutes and
regulations.99
In contrast, home-prepared RMBDs rely heavily
on each particular recipe or feeding program as well as
the pet owner’s interpretation of and compliance with
published recommendations, understanding of nutri-
ent requirements for dogs and cats, and understanding
of the nutritional value of individual ingredients. On
the basis of published diet reviews,41,43–46 most home-
prepared diets (both raw and cooked) are deficient in 1
or more essential fatty acids, vitamins, or minerals or a
combination thereof. Although the perceived benefits of
home-prepared diets may be reinforced daily to owners
through a pet’s appetite or coat quality, nutrient deficien-
cies and excesses in adult animals are insidious and can
lead to long-term complications if not detected and cor-
rected. In young growing animals and pregnant or lactat-
ing animals, nutrient deficiencies and excesses can cause
severe and sometimes life-threatening complications.
Additional studies are needed to provide information
that will allow a better understanding of the long-term
health effects of RMBDs for dogs and cats. In the absence
of reported studies, an animal eating a home-prepared
diet (raw or cooked) should undergo an annual physical
examination and health screening, which should include
serum biochemical analysis (with thyroxine concentra-
tions), hematologic analysis, and urinalysis. Results of
routine hematologic analysis and urinalysis will provide
veterinary practitioners with a general overview of an
animal’s health status, but they will not enable practitio-
ners to identify specific nutrient deficiencies or excesses.
Thus, owners should be cautioned that nutritionally re-
lated disease can mimic other forms of chronic illness. A
complete diet history (including all foods, treats, table
foods, supplement-type products, and foods used to ad-
minister medications) should be obtained from owners
at each visit to be able to assess their pet, accurately in-
terpret the results of laboratory tests, and make appro-
priate recommendations.100,101 Even when the primary
food fed to a pet is not raw, other components of the
diet (eg, pet treats such as pig ears, rawhides, or bully
sticks; foods intended for human consumption; or foods
used to administer medications) may be raw and carry
the same inherent risks.
Owners that elect to feed a commercial or home-
prepared RMBD should be counseled on the risks to
themselves and their pets as a result of this feeding
strategy, and the conversation should be documented
in the medical record. For commercial foods (regard-
less of whether they are raw, dry extruded, or moist), it
is important to be aware that there is wide variation in
quality-control standards among manufacturers of raw
or cooked commercial pet foods. Recommendations
for selection of a commercial pet food have been sum-
marized (Appendix). Unfortunately, the necessary in-
formation may not be apparent from reading a label or
advertisements. However, asking manufacturers about
these topics can be enlightening and useful for selecting
a food that is of high quality and not just the one with
the best marketing. For home-prepared diets (whether
raw or cooked), the authors also strongly recommend
consulting with a board-certified veterinary nutritionist
to ensure that the owners are using a safe and nutrition-
ally balanced recipe. Additional resources, including a
list of board-certified veterinary nutritionists, can be
found on the website of the American College of Vet-
erinary Nutrition.b

1556 Vet Med Today: Timely Topics in Nutrition JAVMA, Vol 243, No. 11, December 1, 2013
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in healthy dogs fed raw food diets (abstr), in Proceedings. Am
Acad Vet Nutr Clin Nutr Res Symp 2003;10.
b. American College of Veterinary Nutrition website. Available at:
www.acvn.org. Accessed Aug 11, 2013.
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Appendix
Recommendations for selecting a commercially available pet food.
1. The manufacturer should employ at least 1 full-time qualified nutritionist. Appropriate qualifications are a PhD in animal nutrition or board-
certification by the American College of Veterinary Nutrition or European College of Veterinary Comparative Nutrition.
2. The manufacturer should test its diets with AAFCO feeding trials. If AAFCO feeding trials are not conducted, the manufacturer should, at a
minimum, ensure that diets meet AAFCO nutrient profiles through analysis of the finished product.
3. The manufacturer should own the plant or plants where the food is manufactured.
4. The manufacturer should practice strict quality-control measures. Examples include certification of a manufacturer’s procedures (eg, Global
Food Safety Initiative, Hazard Analysis and Critical Control Points, or American Feeding Industry Association); testing ingredients and end-
products for nutrient content, pathogens, and aflatoxins; materials risk assessments; and supplier audits.
5. The manufacturer should be able to provide a complete nutrient analysis for any dog or cat food of interest (not only the guaranteed analysis,
which is listed on the label, but the average [typical] analysis as well). The manufacturer should be able to provide exact values for all
nutrients. This should ideally be provided on an energy basis (ie, grams per 100 kilocalories or grams per 1,000 kilocalories), rather than on an
as-fed or dry-matter basis, which does not account for the variation in energy density among foods.
6. The manufacturer should be able to provide the number of calories for any food on any requested weight or volume basis (eg, per gram, per
pound, per cup, or per liter).
7. The manufacturer should conduct and publish research in peer-reviewed journals.
Recommendations are on the basis of information included in the nutritional assessment guidelines published by the American Animal Hospital
Association100 and the World Small Animal Veterinary Association.101