Masticatory Muscle Myositis (MMM), also known as eosinophilic myositis, is an autoimmune disease in dogs where the body's immune system mistakenly attacks the muscles responsible for chewing (mastication). Specifically, the immune system targets Type 2M muscle fibers, which are unique to the temporalis and masseter muscles of the head and jaw. This condition can manifest in acute and chronic forms, each presenting its own challenges.
Understanding Masticatory Muscle Myositis
The onset of MMM can be sudden or gradual. Dogs experiencing MMM often exhibit pain when opening their mouths or attempting to chew. In some cases, they may be completely unable to open their mouths, a condition known as trismus. It's crucial to differentiate MMM from other potential causes of trismus, such as dental issues, foreign objects in the mouth, or growths. Diagnosis may involve a thorough oral examination under anesthesia, radiographs to assess the temporomandibular joints and jaw bones, and a specific blood test (2M antibody ELISA assay) to detect circulating autoantibodies to the 2M fibers. A muscle biopsy may be necessary to distinguish MMM from polymyositis, a more generalized muscle inflammation.
Conventional Treatment and Its Dietary Implications
The conventional treatment for MMM typically involves suppressing the immune system with high doses of corticosteroids like prednisone or dexamethasone. The dosage is then gradually reduced over several months. However, long-term use of corticosteroids can lead to various side effects, including:
- General weakness
- Loss of muscle tissue
- Fat build-up around the organs
- Excessive hair loss
- Increased appetite
- Increased risk of type 2 diabetes, high blood pressure, heart disease, and obesity
- Osteoporosis
These side effects necessitate careful dietary management to mitigate their impact.
Dietary Recommendations During Corticosteroid Treatment
Given the potential side effects of corticosteroids, specific dietary considerations are essential:
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- Weight Management: Prednisone increases appetite, so avoid high-calorie foods and eat frequent, small meals to help maintain steady blood sugar levels.
- Sodium Restriction: Corticosteroids can elevate blood pressure, so limit salt intake to less than 1,500 milligrams per day.
- Calcium and Vitamin D: Corticosteroids can cause or worsen osteoporosis. Consume foods rich in calcium, such as milk, yogurt, cheese, leafy green vegetables (kale, bok choy), almonds, and broccoli. Vitamin D helps the body absorb calcium, so consider supplementation after checking blood levels.
- Sugar Control: Corticosteroids can cause an increase in blood sugars, so limit sugary foods and drinks.
Alternative and Complementary Dietary Approaches
While corticosteroids are the primary treatment for MMM, alternative and complementary approaches, including dietary modifications, may play a supportive role in managing the condition and minimizing the side effects of conventional treatment.
Herbal Remedies
Some individuals have explored herbal remedies as a complementary approach to managing MMM. One account describes the use of a herbal program, including extracts and dietary supplements, resulting in improved condition. The program included:
- Masticatory Muscle Myositis Program: Aims to speed recovery and improve the dog's overall condition.
- Crushed French White Millet and Linseed Porridge: Provides silica, a mineral important for supporting hair, skin, and nails. The recommended dose is 2 dessertspoons made into porridge, fed once daily.
- Rosehip Tea: Added to the diet, with 1 cup lasting for 2 days.
- Maritime Pine Bark Extract: Used as an immune-balancing support in autoimmune conditions. It is a natural antioxidant and an excellent source of flavonoids with anti-inflammatory properties. The human dosage is 10 drops twice daily.
- Elecampane and Liquorice Tea: Used as an interim measure before the herbal extracts arrived, providing a natural cortisone-type action.
McDowells Herbal Approach
This approach focuses on normalizing the immune reaction, optimizing digestion and liver function, normalizing metabolism, and helping the elimination of toxins from the body. Key components include:
- Conditioning Mix: Contains herbs like Chamomile and Dandelion to optimize digestion and liver function, balance and support the immune system, and Bach flowers to address the emotional side of the disease.
- Maritime Pine Bark Extract: A strong, natural antioxidant that protects the body from harmful free radicals, positively influences many organ systems, and supports the vascular system.
- Liquorice and Elecampane Extract: Provides a natural cortisone-type action along with essential tissue repair.
Anti-Inflammatory Diet
An anti-inflammatory diet, similar to a Mediterranean diet, can benefit dogs with autoimmune diseases like MMM:
- Focus on: Fruits, vegetables, whole grains, lean proteins (especially fatty fish), and healthy fats.
- Avoid: Processed and fast foods, foods with high fructose corn syrup, artificial ingredients, preservatives, and pesticides.
- Reduce: Foods made with wheat flour and sugar, especially bread, pasta, and most packaged snack foods.
Specific Food Recommendations
- Fruits and Vegetables: Fresh or frozen varieties (without sauces) are preferred. Choose low-salt, low-sugar preparations for canned options. Limit dried fruit and fruit juice due to their high sugar content. Aim for one serving of fruit OR vegetable OR both per meal.
- Grains: Choose whole grains, such as brown and wild rice, whole wheat bread, whole wheat pasta, rye, oats, quinoa, and barley.
- Meat, Fish, and Poultry: Choose lean proteins such as eggs, skinless poultry, lean ground chicken/turkey, fish, and lean meats (beef tenderloin, 90/10 ground beef, veal, lamb, pork tenderloin). Opt for broiling, baking, roasting, poaching, or grilling over frying.
- Beans, Nuts, and Seeds: A good source of plant-based protein and fiber. Choose unsalted nuts/seeds and their butters. Use low sodium options for canned beans/legumes.
- Dairy Products: A rich source of calcium. Choose lactose-free milk, soy milk, almond milk, and other plant-based dairy products that provide calcium if needed.
- Healthier Fats: Good fats come mainly from vegetables, nuts, seeds, and fish. Examples include olive oil, peanut oil, canola oil, avocados, and most nuts. Limit solid fats, such as butter, stick margarine, shortening, and lard.
- Omega-3s: Important for reducing inflammation. Good sources include fatty fish (salmon, mackerel, anchovies, sardines, and herring), avocados, ground flaxseed, chia seeds, hemp hearts, walnuts, pecans, canola oil, walnut oil, and flaxseed oil.
Vitamins, Minerals, and Supplements
While a well-balanced diet is the foundation, certain vitamins, minerals, and supplements may offer additional benefits:
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- Creatine: Studied in muscle diseases and thought to build muscle. Consult a veterinarian before supplementing.
- Fish Oil: May play a role in chronic heart and autoimmune disease by reducing inflammation. Use with caution and consult a veterinarian, especially if surgery is planned or if the dog is taking blood thinners.
- Calcium and Vitamin D: Bone-building nutrients that may help to prevent or slow down the progress of osteoporosis, especially important for dogs on corticosteroids.
- Coenzyme Q10 (CoQ10): Lower levels have been found in people with muscle diseases, but more research is needed to determine the benefits of supplementation for dogs with myositis.
- Folic Acid: Important for dogs taking immunosuppressants. Found in dark leafy green vegetables, beans, nuts, whole grains, and seafood.
Addressing Swallowing Difficulties (Dysphagia)
Swallowing difficulties can occur in dogs with myositis due to dry mouth and/or muscle weakness. This can lead to complications such as aspiration pneumonia, inadequate nutrition, weight loss, and dehydration.
Dietary Modifications for Dysphagia
- Soften dry food with warm water or canned food.
- Blend food into a gruel to lap up or syringe feed, if necessary.
- Avoid dry, crumbly foods, such as crackers, dry cereal, and chips.
- Cook vegetables until easily mashed with a fork.
- Blend nuts/seeds or tofu into smoothies.
- Add healthy fats, such as nuts/seeds or avocados into smoothies or shakes.
- Use full-fat Greek yogurt, avocado, or tahini in place of mayonnaise for tuna, egg, chicken, or chickpea salads.
Maintaining Nutrition with Swallowing Difficulties
- Incorporate high-calorie, high-protein oral nutritional supplements, such as Boost® or Ensure®, into the diet.
- Use fortifiers like Carnation® Instant Breakfast in smoothies.
- Consider tube-feeding if severe weight loss is a concern.
Importance of Veterinary Guidance
It is crucial to emphasize that any dietary changes or supplementation should be implemented under the guidance of a qualified veterinarian. MMM can be a recurrent condition, and inappropriate treatment, including dietary management, can lead to relapses or worsening of the condition. A veterinarian can provide personalized recommendations based on the dog's individual needs, disease severity, and response to treatment.
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