Michelle Moyal, DVM (Host): Welcome everyone to the Cornell Veterinary Podcast, where we do a deep dive into the discovery, care, and learning that happens at Cornell University's College of Veterinary Medicine.

I'm Dr. Michelle Moyal, Cornell's favorite faculty extrovert. Here I am, and I'm very excited for today's guest.

Today's guest is Dr. John Loftus. He is an Assistant Professor of Small Animal Medicine and Nutrition. He is the Section Chief of Small Animal Medicine at the Cornell University Hospital for Animals. He's a Board Certified Small Animal Internal Medicine Specialist and a Board Certified Veterinary Nutritionist. He is also a long time Cornellian. He received his Doctor of Veterinary Medicine degree from Cornell in 2012 and went on to do both of his internship and residencies here as well. Amazing! Welcome, Dr. Loftus!

Dr John Loftus: Thank you. It's great to be here. Yeah, no, I came for vet school and they haven't been able to get rid of me since.

Host: Yeah it seriously seems like you love Cornell. You've done most of your training here. So I would love to know what it was like for you. I know what it was like for me, to go from student to faculty member. Spill the tea on everyone else. Just spill the tea. Just tell us about everybody.

Dr John Loftus: Well, being a resident and an intern in between, it was a natural progression. Being a faculty member, it's sort of the next step from a resident. There's more paperwork involved, more committees.

Host: So many more committees. So many more committees.

Dr John Loftus: I did it. I had no idea how many committees.

Host: Shaking my head. Yes.

Dr John Loftus: But otherwise, a lot of the teaching, I do more classroom teaching, but I do, I would say most of my teaching in the hospital and that is really pretty similar to what you do as a resident. So it was really a pretty natural progression there. And, I have a background in research.

So I'm one of the weird people that did a PhD before they went to vet school. So the research transition too was kind of coming back home in terms of research, becoming a faculty member. I did a little bit as an intern and resident, but for those people who don't know what interns and residents do, we spend pretty much all our time in the clinic, so there isn't much time for doing research or really anything other than drinking coffee being a vet, so.

Host: We love that, and for listeners of the podcast, we love our double D's here. Double D's meaning double doctor, and that's why we're excited also to have Dr. Loftus here. I want to make sure everybody knows this and you mentioned that you're a researcher but you're a clinician and you are a scientist, and you focus on immunology and nutritionally responsive diseases in dogs and cats. So, could you just tell some of our listeners who may not be part of our community yet, what immunology is briefly, and what it means to look into nutritionally responsive diseases?

Dr John Loftus: Yeah, of course. So, immunology is the study of the immune system. So, that's actually where I kind of came from as graduate student in my PhD studies. I was a grad student at UMass Amherst is actually very similar to Ithaca for anyone who knows Amherst. And I'm a small animal clinician now, but I studied a disease called equine laminitis. So a condition in horses of the horse hoof or the tissue that connects their hoof from their bone, really. And how inflammation in that tissue causes this devastating disease. So that's kind of where I came from and that led me to some of the things that I'm studying now or have studied recently and then nutritionally responsive diseases, there are a lot of them. Basically that just means any disease where we can use nutrition to improve outcomes or mitigate disease, and so, kidney disease is maybe the poster child in veterinary medicine for diseases that we can improve with diet but there are many others; bladder stones, gut disease.

I mean, the list is really long and certainly for veterinarians that might be listening, I'm kind of preaching to the choir. Cause if you look at a product guide for some of the veterinary therapeutic diets, I mean, there's I haven't counted them, but there must be over a hundred now easily.

So there are a lot of conditions that we can control with diet and there are certainly things that we probably don't know or couldn't even improve on where we can modify the nutrients that are in a diet to improve disease outcomes probably not cure diseases, right? But at least manage them.

Host: I love that. And, I hope for our non-veterinary listeners what their understanding is that there is a lot of science behind when a veterinarian like me, who is a general practitioner, like yourself as an internist, and nutritionists, when we make a recommendation for a specific diet. It really is intentional to help disease, right, and to help quality of life not just because we're trying to sell a diet and I won't get too much into it, because can get kind of dicey sometimes, but.

Dr John Loftus: It's a hot topic,

Host: 100%. And I saw that a lot in practice. And so before we kind of dive in, did you always want to be a veterinary scientist? Like, what brought you to this path?

Dr John Loftus: The short answer is no. I always liked animals and I think as soon as I realized what science was, I liked science. I gravitated towards that at a pretty early age, but I actually didn't want to be a vet until high school. And looking back on it now, it was kind of weird for the person I am now to have this reason. And the reason I didn't want to be a vet when I was younger was I didn't want to deal with sick animals. I felt like that was going to upset me. And, it is obviously we have a lot of empathy for our patients and all of that, but I think, now that I see like all of the good that we can do and how positive it can be to help patients that are sick even those with terminal illness and help them through those times, it was kind of a childish reason.

And I was a child. So I guess in that sense, it makes perfect sense. But so in probably middle school, early high school, I actually wanted to be a secret service agent, which uh, you know, I could not imagine me as a secret service agent, but, then I realized in high school that I really liked science and that was probably more my aptitude than being a bodyguard to government officials.

And I think I wanted to be more like a biologist and then for people of my kind of vintage what was the name of the show? It was Animal ER or something like that. It was on animal training. It was the people at out in Colorado. There was a big practice, and

Host: Alameda East.

Dr John Loftus: Alameda East. You got it. Yep. That's it. So watching that, I kind of realized oh I think I would want to do this. And then I started working through a school to career program. I worked at a pet shop and shadowed at a vet clinic and then went to college for animal science.

And, that's how I ultimately ended up here. I didn't realize the research part, the Veterinarian until I was in college and doing research as an undergrad. I sort of always thought general practitioner almost the James Harriot vision of veterinary medicine because I really kind of fell in love with research too I realized you can put that together.

Host: 100%. And so that's why I love talking to people on this podcast, because everybody's path is so different. And so you didn't realize until a little later, some people don't realize, I didn't realize until after college was completed. And so all of us still have this really awesome experience and point of view to bring to veterinary medicine.

And for those people who think that they can't do research, you certainly can. For those of you who think that would be far out like, in left field to even become a veterinarian, you bring a really unique perspective. So don't give up on that dream. I love this. And so, yeah, and actually being a researcher to me, is totally like being an agent in the, hello, you have to do these like sneaky experiments and you have to find out, get data.

Dr John Loftus: Yeah, I hadn't thought of it that way.

Host: Yeah, I'm going to email you now at just 00loftus. That's going to be your code name. We're gonna, going to make that happen. Go for it. And so, well let's dip in into your research because actually you have some really cool research projects happening. And I've been to your website. I creep on my guests, which I think is very helpful. And kind of a big topic was canine longevity and canine aging. So could you tell us a little bit about that and essentially what questions are you trying to answer?

Dr John Loftus: So, longevity is something that I came to kind of indirectly. So, the story is that my mentor in nutrition, Joe Wakschlag got involved with researchers at the Roswell Park Cancer Institute a few years ago now, and they had this idea to think of aging like a viral disease, basically. And the reason for that is that many of us probably have heard that we have a ton of junk DNA, basically. Like, there's all of this DNA that doesn't encode for proteins or anything. It just kind of sits there.

Host: Hanging out. It's loafing.

Dr John Loftus: Well, we wish it was loafing, but sometimes it gets turned on. Some of these quote unquote junk DNA is leftover from viruses that infected our ancestors millions of years ago. And it just sits in our DNA, and our DNA normally knows this shouldn't be turned on. But, as we age, it seems, part of what happens is the ways that our cells say, this is DNA that shouldn't be turned on, starts to fail. And so, these genes get turned on, and because they're viral genes, they act like a virus.

So, they get turned on, and they try to replicate themselves, and they do replicate themselves, and then they go back into your DNA. So if you measure the DNA of a young dog versus an old dog, an older dog will have more of these copies of these viral sequences. And the problem with that is several.

One is that we all know, especially with COVID now, that when you have viruses, it causes inflammation, your immune system gets turned on, and if you're doing that chronically for sort of no reason, that's bad for your cells and for your body. And then the other thing that happens is because these sequences get stuck back in your DNA, they just go wherever they want, so they can pop down in the middle of a gene. So this is one of the mechanisms for cancer, too, is that these genes will disrupt other genes when they get reinserted and will cause mutations and there are genes that suppress cancer and things like that, so all of this can get kind of messed up, to put it simply.

And so, that is a mechanism that's kind of emerging as why the aging process causes disease and things like that. And why we get chronic inflammation as we age. And why, we're more likely to get cancer as we age and things like that. This is one of the probable, almost certain reasons.

And so what the investigators thought was, well, it's a virus and so let's use antiviral drugs that we already have that inhibit this process called reverse transcriptase inhibitors that block this pathway of taking a virus gene and getting it expressed and then having it popped back into the DNA.

So the investigators came here to talk about this idea and they wanted to do this in dogs for several reasons. And, my mentor, going back to Joe Wakschlag, he used to do dog sledding. And so they had thought, well, we'd like to do a trial in pet dogs. And he thought, no, don't do it in pet dogs, because owners may or may not give the drugs, there's going to be a lot of variables. They're going to live in different homes, from a scientific point of view, there's a of reasons why that's challenging, right?

And so he thought, well, sled dogs retire when they're about eight years old, which is when these investigators really wanted to target starting a drug. And turns out to be all of these sled dogs that are just kind of hanging around in retirement. And they're not quite pet dogs, right?

So they would be dogs that people would consider adopting out for something like this, and it turns out that they did. So, we ended up recruiting a little over 100 dogs, 104 dogs exactly, I think it was, that came here. We transported them many ways. My good friend and colleague Heather Husson did a lot to most of the dog traveling.

And we had a Musher truck, which is a big pickup with musher cages. So basically dog crates that are built into the pickup truck. We bought one of those and they went across country and picked up dogs and we got some dogs from through the airways and, several different ways.

So it took us about three to six months to get all the dogs here and then we set up. There was an old facility that was renovated for them and had probably an acre at least of field that was fenced in for them and everything like that. So we set up the project. They, you know, would go outside a couple of times a day. Got tons of pets from staff and stuff like this.

Host: There's no shortage of love in a veterinary institution, I have to say. So anybody's wondering if they're just left to stew, that is not the case. I mean, students alone will go there just to visit. So will faculty, by the way.

Dr John Loftus: I mean, this is not anything about their previous owners, but I think in many cases they get more attention than their previous.

Host: I just believe that. I believe that.

Dr John Loftus: We started that in 2018. And we're still kind of compiling data and things like that, but I was involved in the project because of my background in immunology. And, as I've alluded to, there's a lot of aging that is related to changes in the immune system. And so what we wanted to see is does that drug treatment improve their immune function or reduce inflammation or things like that. So we're still working that out. I don't think we have any, really strong results from the drug effect.

 That's not to say that, this mechanism isn't important or that targeting this mechanism won't be important or help with aging in the future, but my impression from the data so far is we probably need to nuance this a little bit more and dig a little deeper, but what we did, we learned a lot along the way. We've also had other projects just because, we have a hundred dogs, right? And we can do things like measure their thyroid hormones and see what the thyroid hormones in a sled dog are compared to other dogs. So there's been a lot that we've learned.

We've learned just about aging in general in dogs and some of the changes in their immune system. And there's a lot of physical training, exercise parameters that we measured and cognitive behavior. So, one of the things dogs are a really good model for is Alzheimer's. And in dogs, we call it canine cognitive dysfunction because we we probably steal human medical terminology too much. So we try not to do that though. But there are a lot of similarities in terms of what happens with cognition. Obviously dog cognition and people cognition is different, but there are a lot of similarities at a really fundamental level.

And there are similarities from a disease level, when we look at some of the changes in proteins in the brain and things like that; there's overlap. There are also differences too, of course, but they're a great way to study.

Host: Yeah, I do mainly clinical medicine, but I think a lot of times people forget that if you don't get the answer you were necessarily looking for, it doesn't mean this is a failure. Look at all this data you're getting and you're exploring things that I think maybe you didn't even think you would be exploring in this awesome population.

Dr John Loftus: Well, to wax philosophical, I guess for a minute, I mean, I learned so much from my PhD advisor, but if there's one little takeaway phrase story that I could tell is I got this data once that didn't kind of fit what we were expecting. And, I forget how I, I must've displayed some disappointment or something like that. And his response was, but John, when your data doesn't support your hypothesis, that's the best thing in the world, because that means that the universe is far more interesting than you thought it could be.

And so, it's one of those things that I try to tell my trainees, too. I think even in the clinic, I mean, you're not doing research and you don't really have hypotheses, but you kind of do, actually, right?

Host: 100%. 100%. You think one thing's going to happen and it doesn't.

Dr John Loftus: Yeah, yeah, So, I try to share that with my trainees because I think it's a really good message and I think it actually really hits at something important about science is that, to put it simply, you know, we don't try to prove our hypotheses, we test them and results are the results, so.

Host: The other reason I love this and again as a general practitioner listening to this, it's so neat to think about all of the things that you're doing that can help the patients that I see. I would often see cognitive dysfunction in some of our senior pets and our geriatric animals. And it was really distressing both to the dog and to their families, like they're pacing, they're up and then the ramifications of what this can do for human medicine.

So I love this. This is all like super collaborative and I really appreciate that Cornell is involved in all this, and you are, and so that's awesome. So let's jump, because I want to keep going, because there's so many interesting things, because you also do a lot of work in animal nutrition.

And, ooh, this is a big topic on my side of the world. And with the families you see, and it seems like every day, by the way, sponsored ads, you're doing a good job because I'm getting sponsored ads for all sorts of things, and then raw diets and then processed diets and human grade.

So I would just love all those hot click, click bait words kind so just, I would love to hear more about some of the research that you're doing in this area. Anything like, maybe some past discoveries that you've made or have encountered that you expected or didn't expect. What you're working on now? No one can see my hands flying around, but they are because I'm excited about this.

Dr John Loftus: Yeah. So we're actually doing a study right now with the sled dogs. And one of the things that unfortunately happened with the sled dog study is that we lost a lot of our funding through the Ukraine war. You know, we won't get into details, but we were able to transition over to a study where looking at fresh food versus a commercial diet.

And I think we're starting to see that there are some potential benefits to these fresh foods versus traditional kibble. To be clear, I feed traditional kibble to my dog, and I don't think it's bad per se, but I think when we start to look at really granular outcomes or changes in physiology between the two, we can start to see some benefits.

But in the real world, I think the commercial dog foods, the high quality ones are a really good source of nutrition. So I, don't want anyone to feel bad out there who's listening who's feeding traditional commercial dog food, kibble or canned food to feel bad because as I said before, I do it too.

Host: It's very easy.

Dr John Loftus: Yes.

Host: People work, people do all these things. Yeah.

Dr John Loftus: And the nutrition has been worked out really well. So, well, to that point, I think what this might prove or it may help us find ways to make the more convenient traditional dog food better. Because we can say, okay, so these are the differences between what processing does, and maybe we can fix that.

 We're working on that with the sled dogs. We have a couple of years of that. And that just started a couple of months ago, a month or two ago now. I've lost track of time. Obviously too early to say anything there. And then there are a few projects that I've done directly or indirectly with food or collaborated on. I think one that is not necessarily food related, not like a food study, but nutritionally related is vitamin D. And we published something a couple years ago. We have a study that is hopefully about to be submitted pretty soon. We're just waiting for collaborators and finishing touches on a manuscript.

But the study that we published was looking at links between blood levels of vitamin D metabolites and immune mediated diseases and outcomes in those dogs. So, we usually think of vitamin D as important for bones, and it certainly is, and it's important for calcium regulation and all of that. But vitamin D actually has a lot of important roles in the body, and one of them is helping to maintain immune system health.

So, it actually has almost dual role in improving some of the responses we have to organisms, microorganisms, pathogens. But at the same time, shifts the immune system to away from autoimmunity and things like that. So, really balances it out the right way. And one thing with dogs and cats and vitamin D that is different from people is they have to get it from their diet. We can go out in the sun.

Host: Sunbathe?

They can't

Dr John Loftus: sunbathe.

Host: ask. No

you shave

Dr John Loftus: no theu they

Host: Okay, darn it. Gotcha.

Dr John Loftus: No, it's it's related to enzyme activity.

Host: Gotcha. Now I studied to be a human nutritionist, a dietitian before I became a veterinarian. And if I recall, vitamin D is one of those fat soluble vitamins, right? And so we actually have to be careful. So if someone's listening, they can't just go give my dog vitamin D. I need to help its immune system.

Dr John Loftus: Yeah, thank you for pointing that out. A good kind of disclaimer to this, is that vitamin D is really a Goldilocks nutrient, I would say. So, too little is not good, too much is not good. So, don't just give your dog vitamin D without veterinary guidance because it can definitely be toxic.

In fact, there are rodenticides, toxins that are vitamin D based and we've seen that. There have also been manufacturing issues with dog food diets where there was an issue with a product or formulation error and there was too much vitamin D in a product and made dogs sick.

Host: And that's when we get those huge recalls, right? That made it sound very scary and out right.

Dr John Loftus: I think they are scary, but I wouldn't take them as a reason to think a pet food is doing a bad job because these things happen in human foods and things like that. And people who want to make their own food, they feel like there's more control and sometimes there is, but every food needs a vitamin mineral mix. And that could happen to any vitamin mineral mix, potentially. So, it's just part of living in our life and manufacturing all of that.

Host: For great pet owners, again, if pet owners are listening or future veterinarians or future scientists, that vitamin mineral mix is not just us popping in a quote pet vitamin or adding in pumps of like salmon oil, right? Like they have to be in the right ratios and that can be difficult to manage.

Dr John Loftus: Yeah, and so that's one of the things that I do as a nutritionist formulating home cooked diets. And there are different ways that you can come up with a balanced home cooked diet. And it really requires looking at all of the nutrients and getting them in the right amount because there are a lot of nutrients that could be toxic if they're in excess. Certainly, if they're not getting enough nutrients, that's bad too. But

Host: Sure. People have the FDA, and they look at things, although not all supplements are regulated, everyone listening. So, what would you say about is there a governing body for anyone listening? I think it's important for you to know this information for pet foods.

Dr John Loftus: There are two kind of entities, and one is called AFCO, the other is the FDA, and they do different things. And so what AFCO does is they establish really more kind of benchmarks for nutritional adequacy. So AFCO isn't regulatory, they don't necessarily mandate things. The way it works is states have their own regulations. So what AFCO has done is, states feed officials come together and they say, can we standardize what we want in pet food across the board? So that you make a food in California that, you know, isn't okay, to sell in New York.

So basically the AFCO system and AFCO uh, come up with a way to label a food that says it meets our nutritional adequacy. And so that regulatory agencies in different states will say this is thumbs up or thumbs down. But they don't, but AFCO itself doesn't regulate that.

That's at the state level. Then there's the FDA, which is when you think about recalls or you think about foods. Another hot topic in nutrition recently is the grain free diet phenomenon with cardiomyopathy, the heart disease in dogs. And so, that was the FDA that was involved in investigating that and issuing statements that these are the foods that have been reported. So if there's an issue with food safety or things like that, that you would report to the FDA.

Host: Got it. So when new diets come out, all of these new, I see a new diet all the time. Do they have to be regulated by any of these governance? So just state?

Dr John Loftus: Yeah, so the state essentially regulates what's sold within the state. The way AFCO would play into this is, if you create a new diet, you have to do some sort of testing to say this meets AFCO adequacy for whatever life stage. And so there's a few ways to do that.

There's a few different life stages. So like adult maintenance versus growth. So puppy food versus adult dog food. And the way they can say, oh, it's nutritionally adequate for adult maintenance, for example, is basically the two main ways are they do a food trial or they do kind of a nutritional adequacy. So they say the nutrients in this, it's analyzed and they meet our benchmarks for nutritional adequacy.

Host: Got it. Oh, that's very helpful. And so when we're thinking about nutrition in pets, the lab at home, our mixed breed that's hanging out, hiking in Ithaca, by the way, which is beautiful. What do we want owners to be thinking about for their pets. Is there something you'd like them to keep in mind when they're looking for a diet?

Dr John Loftus: Actually think the simplest thing, I mean this is such a complicated topic actually when you start to get into all the details, but one thing that is really simple is to look at the label and look for an AFCO statement because that will tell you that it's at least met these nutritional adequacy benchmarks.

So that's the first thing. There are a lot of resources on the web. I think one that owners can go to and veterinarians can go to is the WSAVA website and they have a nutrition toolkit and it tells you how to evaluate a food company and diets and all of that. So it's a really great resource if you wanna take a deep dive.

Host: I love that. And please, everyone, use your veterinarians as a resource, right? And so, for the flip side of this, what do we want the general practitioner, like myself, again what do we want us to know? Is there something we should be mindful of when advising clients? Because I would talk about AFCO certification, if you will. And sometimes it's tough for owners to understand. So is there something a general practitioner should be mindful of?

Dr John Loftus: Well, I think that's one of the main things and I think WSAVA would be a great resource for veterinarians, too. think one of the challenges, too, is that as you mentioned before, are so many food. It's not uncommon for someone to mention a food I've never heard of. And, there's just no way that I could keep up with that.

 So I'm an internist, right, and do research. I probably have some nutrition colleagues that they do all nutrition, right? So they probably know more brands than I do, but. But even, I'm sure that every nutritionist, there is a diet that would stump them, I would be surprised. I mean, there's just that many diets. So anyways, the point is that I think you need to have this set of resources and places to go. One thing that for practitioners in addition to WSAVA, AAVN, American Academy of Veterinary Nutritionists they have resources on their website.

And there's a blog that the nutritionists at Tufts have put together called Pet Foodology. It's just petfoodology.com, Or if you just Google pet foodology, you'll find it. It's through Tufts Nutrition Service. And I think that's really good for pet owners themselves in particular, but also veterinarians and especially veterinarians to direct pet owners.

Cause those hot topics like grains. Are grains good? Are they bad, byproducts, are they good? Are they bad? There are blog posts on all those kinds of different topics.

Host: Then that allows for our clients to have really educated, lovely discussions with their veterinarians. And that's what we want. Believe it or not, your vet doesn't just want to say no or yes to diets. We would like to talk to you about it, but it's very helpful for our clients to know a lot about it ahead of time. And I will say even talking, especially talking. This is for my family. No matter what I say, my lovely mother-in-law still makes like the most amazing diet. She makes a diet for her dogs. I could not do it. And talks to her veterinarian about it. And I'm sure they eat better than I do, but it is hard for your family to listen to you. And sometimes it's hard for clients to hear all of this data. It's overwhelming. And they just want to really provide for their pets and make them healthy. So it can be

Dr John Loftus: Yeah, I think one thing to remember especially as veterinarians, is that there are what I would consider food values and then food science, right? And I think veterinarians are often much better at the food science but remember that there are a lot of different food values that will fit with food science in, for cats and dogs.

So, what might seem might not be good nutrition it might be if you do it the right way, so and that's where getting veterinary nutritionist involved can really help because they can say, Well, yeah, if your food value is a vegetarian for a dog that's not easy to do, but you can do vegetarian for a dog. You know, you just have to do it the right way.

Host: That's neat. So we can really, instead of telling a family member no or a client no if we can get them hooked up with a resource like a Board Certified Nutritionist, then we can align with their values. I always talk about goal oriented care, right? That family's goal is to give them certain things, whether it be natural or something to vegetarian and really help with their dog's like longevity and health long term. So I love that. I love that. Well, I'm going to give you one more hot ingredient topic. Talk to me just quickly. Give me like, give us two sentences on coconut oil. Everybody loves it. Put it on their skin. Put it in their food.

Dr John Loftus: I'm not anti-coconut oil. In most cases for cats and dogs, cats, don't usually like coconut oil, so, a cat might take care of that itself. But for dogs, in most cases, there isn't a clear health benefit, per se, but there can be some conditions where they can be beneficial.

The two that come to mind right off the top of my head are this one's maybe a little controversial, but condition called lymphangiectasia. It's a gut condition where low fat diets can really help them. And by giving them coconut oil or some source of medium chain triglycerides. So when we think about coconut oil, what we're really thinking about nutritionally is medium chain triglycerides. Those are probably helpful in those cases. The other one is with cognitive dysfunction, actually, to go back to that. So medium chain triglycerides and the other antioxidants.

So there are a few diets out there that kind of support brain health, I guess you could say, in general. There's some over the counter diets, so Bright Mind and then there's the therapeutic diet NeuroCare.

Host: So cool. So their form of coconut oil, right? So those fatty acids are in there, right? I'll put the coconut oil in quotes in that one. That's awesome. And so, well, you mentioned cats and not liking coconut oil. I could see my cats rejecting it. But you also do a little bit of research, not a little, you do quite a bit of research with cats as well. And so could you briefly tell our audience about, and me as a cat lover with three cats, can you talk to me about what you do with cats right now?

Dr John Loftus: The main study that we've been doing and we're working on the data now is investigating feline hyperthyroidism. And so this is a pretty common condition in cats. Many listeners will probably be familiar with it.

Host: My own cat has hyperthyroidism.

Dr John Loftus: Oh, yeah.

Host: One of my three.

Dr John Loftus: We have a few different treatments for that. One is medication, one is actually radioactive iodine, which we do a lot here. And then there's a diet, actually, that's low in iodine that can be helpful. Surgery is also, potentially an option, although most veterinarians don't do the surgical route. So because we do a lot of radioactive iodine therapy, it gives us an opportunity to look at cats that are hyperthyroid, and then get this, in 95 percent of cases, definitive treatment for hyperthyroidism, and then look at what happens when they're better, basically.

And so what we did was we use this approach called metabolomics which is a systems biology approach where we're looking at all of these small molecules in a sample. In this case, we were looking in blood but you can look in urine, you can look in feces, you could look in saliva, you could look in cerebrospinal fluid. You can look in cells but it's looking at all these small molecules that are part of metabolic pathways, and it measures depending on, you do it, hundreds to thousands of these molecules, so it gives you a ton of information about what's going on metabolically with a patient or an individual, and so what we were interested in was what is different in hyperthyroid cats?

So what changes in their metabolomes with hyperthyroidism? And then what happens when they're treated? Does it go back to normal completely or are there still some changes that persist? And basically what we found is that there are a lot of metabolic changes, which is not surprising because the thyroid hormone is a huge metabolic regulator, right?

This regulates your cell energy pathways and all of that, heart rate, et cetera. And so, they're very metabolically abnormal. We'll put it that way. But what was also interesting is that there were some changes that persisted at least up to three months.

So I think one of the things that we need to do is look longer. But what we found was there were two things that we found didn't go back to normal. One was vitamin E levels, and then the other one was a molecule called carnitine, and that's important for energy metabolism. But also importantly is both of those can be nutritionally or nutraceutically supplemented. So you can give carnitine supplements.

You can obviously give vitamin E, I'm sure everyone who's listening is familiar with that. So the question is now should we be supplementing them? So obviously we need to do some more work say in six months they normalize, maybe, right after they get I-131, should we be giving them some vitamin E and carnitine to help with that metabolic transition? Or has their hyperthyroidism kind of reset their metabolism and maybe they never go back to normal?

Host: Right, that's their new normal.

Dr John Loftus: Yeah, and so maybe we need to supplement them longer. You know, a lot of work to do there. So that publication is in review right now and we also got poop samples from those cats and so we're going to look at their microbiomes next.

Host: So, you can't be a vet without mentioning poop at least once a conversation.

Dr John Loftus: No.

That's

Dr Michelle Moyal (Host): really the truth.

Dr John Loftus: Yeah, if you're not a vet it becomes uncomfortable, maybe, at dinnertime, but,

Host: Over the sushi. Yeah. Okay. We're going to do a quick little, I want to be mindful of time again, but I have just, this has been such an amazing conversation. So we're going to go into a lightning round before I answer like a final question. Okay. Lightning round. We're ready? We're going to try to keep this really prompt. Star Trek or Star Wars?

Dr John Loftus: Star Trek.

Host: Wait, he knocked me out with that answer. I'm going to keep going. The one biggest issue you think a nutritionist or general practitioner as far as nutrition in veterinary medicine today, like the biggest issue you think they face.

Dr John Loftus: Misinformation. I think there's a lot of misinformation on the internet that is inadvertent. Maybe it's part of marketing and isn't meant to be misinformation, but is kind of taken that way. So there's a can of worms, but, we'll leave it at misinformation.

Host: 100 percent. Best thing about working at Cornell as a veterinarian. You cannot say dining hall because we just got an upgrade and it's really good.

Dr John Loftus: Oh, it's so much better. Oh, wow. It's probably the people. I mean, we have really good facilities and all of that, but my colleagues and clients and everyone really make it for us.

Host: I love that. And watching people grow, you get to work with all of these amazing people and do these good things for the world. Okay. My final question, cause we've talked a lot about what you're hoping to answer in the future and all the things you're looking forward to.

Is there one case, you know, there's always a case that stays with you, right? Is there one case from your career, as an internist, as a nutritionist, as a scientist; is there one thing that you remember that you were like, oh my gosh, this was, I can't believe how fascinating that was, or like satisfied, like you were like, yes, I got the answer? Like usually I ask this from a practitioner point of view, cause it might be quote unquote easier to solve a problem than a scientist who's doing months of research. So is there anything that sticks out to you?

Dr John Loftus: Of course, there are a lot of things, but I guess this also goes back to one of the things that I'll often bring up with my house officers, because they're just learning to be a veterinarian usually. And so there are cases, I think that make you think about how you approach cases in general.

 And the case I often go to is this cat that came in when I was an intern and came in for abdominal distention or something like that, or mass in abdomen. I forget exactly. It had a mass in the abdomen. It had fluid in its abdomen and we were working it up and the owners wanted to try to do everything and so we were I think realistically pessimistic.

I'll put it that way. And so, we did a CT to evaluate the mass a bit better and the way it looked on CT we couldn't really tell where it was coming from. It was just like in the abdomen and the surgeon, very experienced surgeon said, there's like a one in 10,000 chance that we can get this mass out.

And the owners were like, we really want to try. And so we were all surprised that the owners want, cause they also had some financial concerns and things like that. You know, that's one of those empathy things I think for veterinarians is when, owners are pursuing things like that and their finances are limited.

But anyways they wanted to do that. And I remember that day, I actually was covering the overnight for one of my intern mates. So, I actually found a place to sleep before the cat went to surgery. And so the cat was in surgery when I was sleeping, and I got up, and before I went to my ER shift, I went and checked on him.

And I went into the ICU, and he was just mowing down on food. Like, this cat had not wanted to eat in weeks or months. Not voraciously just chowing down. And then I checked in to see how, well, obviously the surgery went, but to get more details in, they were like, this thing was just like held on by a thread to the liver, and basically Dr. Flanders said, as he incised the abdomen, it basically popped out, and he just had to like, snip. And we are so glad that they went to surgery, because this was such a great outcome. So, the point is, I think there are a lot of times where there are cases where we think that, things are not going to go well.

 And in many cases we're right because we've done this enough times, but I think we have to remember that there are those cases that where you give it a try as long as you aren't certain that it's hopeless.

Host: Yeah.

There

Dr John Loftus: are a lot of cases that will go really well. So it's always good to give things a try.

Host: Oh, I really appreciate that perspective. And for that family, I'm sure it made a huge difference. And this is the struggle that veterinarians face, right? Because you don't want to lead a family astray and you understand that finances can make things so difficult. And I think this is the struggle in when we teach students what can happen. So I very much appreciate that story. Dr. Loftus, it has been wonderful talking to you. For anybody who wants to check out his website and stalk like I did, it is loftuslab.vet.cornell.edu. Hope I got that right. And for thank you again. Despite being a Star Trek lover, being interviewed by a Star Wars lover.

Dr John Loftus: Well, I don't dislike Star Wars.

Host: I know, but you know, vanilla or chocolate. Is there redemption here?

Dr John Loftus: I don't know now.

Host: He loves both everyone. loves both vanilla and chocolate lovers out there. We are safe. Thank you so much for joining me today and thank you everyone for listening. And I hope everyone has a great day.