Chronic vomiting in cats

By Dr. Karen Shaw Becker

Chronic vomiting in cats is unfortunately so common that many pet parents and even some veterinarians view it as “normal” behavior. However, in my professional opinion, chronic vomiting, even in kitties with hairballs, is a sign something’s wrong and needs to be investigated. After all, big cats in the wild don’t routinely vomit.

Wild cats also don’t have hairball issues, which is why I believe recurrent hairballs in housecats is also a sign that something’s amiss. Other common causes of persistent vomiting in cats include a poor diet, food intolerances, eating too fast and too much time in between meals.

Other causes include enzyme deficiencies, gastrointestinal (GI) problems that result in hairballs, toxin ingestion and underlying medical conditions like kidney disease and GI cancer.

Problem: Hairballs

If your kitty is vomiting hairballs, you’ll see cylindrical wads of hair and debris, probably some undigested bits of food, and usually a little phlegm to hold the disgusting little mess together.

Long-haired cats and cats who are really into grooming themselves — and often all the other cats (and dogs, and even people) in the house — typically have more hairball issues than normal. Cats eating dry food don’t get enough moisture in their diet, so their organs tend not to function as efficiently as they should. And unlike dogs, kitties don’t make up the deficiency by drinking lots of water, so they often end up chronically mildly dehydrated.

A GI tract that is moisture-depleted is less able to transport a hairball than the digestive tract of a well-hydrated cat eating a species-appropriate diet. Cats in the wild pass hair in their feces on a regular basis. Felines have tiny bristles on their tongues and are designed to process swallowed hair. Recurrent hairballs are abnormal.

What to do: Brush your cat and feed a moisture-rich diet. To help prevent your cat from swallowing so much hair that it forms hairballs in his GI tract, you’ll need to brush him regularly. If he’s grooming everyone in a multi-cat household, you’ll also need to brush the other kitties.

If your cat is eating exclusively dry food and you can’t or aren’t willing to switch to a different diet, I recommend adding bone broth to his dry food and a bit of fiber to each meal, or a petroleum-free hairball remedy, or even a dab of coconut oil on his front paw. I also recommend fiber and coconut oil together. Kibble fed cats definitely need additional GI lubrication to help ingested hair pass through the digestive tract.

Problem: An Underlying Medical Condition

Many cats today have inflammatory bowel disease (IBD), or irritable bowel syndrome (IBS), which causes intermittent vomiting. IBD can progress to GI lymphoma in cats, which is another reason that chronic vomiting in any kitty should be investigated medically.

In addition to lymphoma, other types of GI cancers can also cause vomiting, as can metabolic disorders like hyperthyroidism, which is a very common disease diagnosed in older kitties. Organ disease or a malfunction of the organs of detoxification, including the liver and the kidneys, will also cause vomiting.

What to do: Make an appointment with your veterinarian. Your vet should first rule out all potential medical reasons for vomiting, for example kidney failure, liver failure, hyperthyroidism or GI cancer.

If all those problems are ruled out and your veterinarian is concerned about potential IBD or IBS, I recommend submitting a blood sample to the GI lab at Texas A&M University for a functional GI test. That test can determine if your cat is dealing with malabsorption and maldigestion, or a disease of the small intestine or pancreas.

Many cats have a reduced number of hairballs and vomiting episodes when their unbalanced microbiome is addressed by switching to a species-appropriate diet, or at a minimum, have probiotics added to their food.

Problem: Poor-Quality Cat Food

Cats fed processed diets containing rendered ingredients may vomit due to poor-quality, biologically inappropriate ingredients. Rendered ingredients that wind up in pet food are leftovers from the human food industry, and can include animal pieces and parts like bird feathers, snouts, beaks, eyes, hooves and nails.

These are very low-quality ingredients with low-to-no bioavailability that are difficult for cats to digest, which can cause GI upset. Cats tend to have upper GI issues, so they vomit. Dogs typically have lower GI issues, and are more apt to develop diarrhea.

Since the introduction of processed pet food, many cats have been fed diets that are not species-appropriate, which has led to the development of food intolerances and allergies — a very common reason for intermittent vomiting over a period of months or years.

If your kitty is at a healthy weight with a normal energy level, but just throws up occasionally, food sensitivity could be the culprit. Food sensitivities develop when the same foods are fed over and over, which happens a lot with cats because they get addicted to certain foods and refuse to eat anything else.

Feeding the same type of protein, even if it’s excellent human-grade quality, can over time create GI inflammation and food sensitivities. So it’s not just about feeding good-quality protein, but also switching proteins frequently. I recommend transitioning cats with GI upset to human-grade cat food (which unfortunately can be very difficult to find), and then to a fresh food diet.

What to do: Upgrade your cat’s diet. I prefer a raw diet for cats who will eat it, but even gently cooked fresh food is a huge improvement over processed pet food. I also recommend rotating proteins every three to four months to avoid hypersensitivity reactions.

If you believe your cat may have a food hypersensitivity or allergy, I recommend Dr. Jean Dodd’s Nutriscan saliva test, which can provide help in choosing a diet that’s less reactive for your kitty. The good news is I’ve found that correcting food sensitivities, removing noxious or unnecessary ingredients from a cat’s diet, as well as transitioning to a species-appropriate, fresh food, natural diet eliminates most of the common causes of vomiting in cats.

If you feed your cat treats, be sure to offer only high-quality treats. You don’t want to spend money upgrading your kitty’s diet and then feed junky treats that can create GI inflammation and vomiting. So if you feed treats, it’s important to offer the highest quality you can afford. Or better yet, make homemade cat treats.

In store-bought treats, you should look carefully at the label and avoid anything containing propylene glycol, FD&C red #4, ethoxyquin, chemical dyes, emulsifiers, surfactants and other questionable ingredients. All those additives, preservatives and other chemicals can cause GI inflammation and vomiting.

It’s also important to note that contrary to what many people think, cats don’t need milk. Animals are only suited to digest and process milk from their own species. Drinking the milk of a different species past weaning can cause or exacerbate GI inflammation. If your cat can’t tolerate cow’s milk, it can cause vomiting, so if you’re giving him milk, I recommend you stop offering it.

Problem: Enzyme Deficiencies

Sometimes a kitty’s pancreas doesn’t produce enough digestive enzymes, such as lipase, protease and amylase, which can result in acute or chronic pancreatitis. Pancreatitis (inflammation of the pancreas), is very common in cats, and even if there are no other obvious symptoms, can be an underlying cause of intermittent vomiting.

What to do: Supplement with digestive enzymes. Cats evolved to eat an entirely fresh food diet, primarily mice, which is a very rich source of digestive enzymes that is entirely missing from processed cat food. That’s why I recommend adding a digestive enzyme to your cat’s diet.

If your kitty’s pancreas is producing adequate enzymes, adding additional enzymes to her food won’t cause any problems. However, if her pancreas is not secreting sufficient enzymes, supplementing ensures she’ll have what her body needs to process her food. Providing a high-quality digestive enzyme can help reduce vomiting as well as the potential for pancreatitis.

Problem: Speed Eating

Another very common reason cats throw up is from eating too fast. Your cat’s esophagus is horizontal and flat. Everything he eats has to travel horizontally before it moves into the stomach.

In cats with a tendency to wolf their meals, the food can back up in the esophagus and push against the lower esophageal sphincter. This can result in regurgitation of part or all of the meal, undigested, within moments of swallowing. This seems to be a special problem in multi-cat households in which all the kitties are fed in the same area at the same time, which can spark competition.

There’s usually at least one gobbler in the group, and when the food bowls hit the floor, he scarfs his own meal in a flash and then visits everyone else’s bowl to see about leftovers. He’s such a little glutton that he often ends up returning all that hastily eaten food to the floor.

What to do: Provide separate eating areas in multi-cat households. If you have a scarfer in the house, you need to feed your kitties in separate areas so they can’t see or hear the others eat. It’s best if you can close the door behind each cat, because it won’t take long for your gobbler to figure out where the rest of the bowls are if he can still get to them.

Give them about 20 minutes of solitude to eat their food slowly and uninterrupted, then remove the bowls. This may slow down your gobbler, reduce or eliminate the vomiting, and keep him from getting fat. It also allows your slower-eating kitties to relax while they dine.

If you have just one cat but she’s a gobbler, you may need to split her meals into smaller portions and feed her more often so the food doesn’t come right back up. You can also use a mini-muffin tin to slow her down. Just put a bit of food in each individual muffin cup. Moving from cup to cup will naturally slow her down.

If you don’t own a mini muffin tin, you can also try spreading the food out over a large cookie or baking sheet. If you prefer something more high-tech, there are slow-feed bowls you can purchase that provide essentially the same benefit.

Problem: Too Much Time Between Meals

Cats fed on a regular schedule, for example, at 7:00 AM and 5:00 PM each day, tend to start looking for their meal an hour or so earlier because their bodies know it’s getting to be that time.

Around the same time, your cat’s stomach begins releasing digestive substances like hydrochloric acid, gastric juices and bile in anticipation of the upcoming meal. If you’re late with her meal, she may throw up a white foamy liquid mixed with a bit of yellow bile.

This is because the digestive substances irritate the lining of the stomach when there’s nothing in there for them to work on, so your cat’s body gets rid of some of the acid to prevent further irritation.

What to do: Offer a pre-meal snack. If this scenario is occurring with your cat, give her a little something to snack on before you feed her, like a treat or a small bite of her meal. This will give her stomach juices something to digest and should alleviate the vomiting.

Problem: Toxin Ingestion

Rarely, poisoning can also be the cause of acute vomiting in kitties. It’s rare, but it happens. If you have a cat who is otherwise healthy, especially an indoor-outdoor kitty, and he suddenly starts vomiting, you should be concerned he has ingested something toxic.

Even if your cat is indoors only, unfortunately, many types of houseplants are poisonous for cats — and many cats like to sample houseplants. It’s important to make sure you’re not bringing anything into your home that could potentially poison your feline family member.

It’s important to note that since cats are designed to eat fresh food, they’ll nibble on anything fresh in your house if they’re not provided a fresh food diet. Since felines don’t have a biological requirement for plants, it’s a good bet most house-plant sampling cats are trying to supplement a processed diet with living foods.

What to do: Offer safe greens to your cat, and safely store all household chemicals out of reach. If you have kitties that like to snack on your houseplants, I recommend providing them roughage that is more palatable and safer than houseplants. You can do this in the form of cat grass, which is wheatgrass, or by offering fresh sunflower sprouts.

Any pesticides, herbicides or household cleaners that are stamped “call poison control” need to be safely stored out of the way of cats. You should assume that any cleaner you’re using in your house will ultimately be ingested by your cat, because kitties lay on surfaces, and they’re fastidious groomers.

All your household cleaners should be cat-friendly. I can’t emphasize enough that if you are still using traditional toxic household cleaners, if you have cats, one of the best gifts you can give them is to switch to nontoxic household cleaners.