The Six Pillars of Dog Health: Looking for the Root Cause

Reading time: about 10 min

I read holistic veterinarian Dr Odette Suter’s discussion of the foundations of canine health. She describes something I have heard all too often: “I’ve tried everything.” The real question is frequently what exactly was tried, and why. I like her point that a symptom may not tell the whole story. An integrative veterinarian once described visible skin problems as potentially just the tip of an iceberg. Sometimes the problem really is in the skin; sometimes it has a broader cause. Both possibilities deserve investigation rather than assumptions.

Dr Suter describes a four-year-old German Shepherd that had suffered chronic diarrhoea for more than two years and was being considered for inflammatory bowel disease (IBD). Her clinical approach looked beyond relieving diarrhoea to potential contributing factors. That is the value of the story: different causes can lead to the same symptom, and the solution must suit the individual dog. This is a veterinarian’s case report, not a controlled study, so it cannot promise the same outcome for every dog. Evidence-based dietary, diagnostic and treatment options for chronic enteropathy are also available.

A more logical approach

I like how Dr Suter distinguishes cause from effect. Think of a car’s dashboard: when the engine warning light comes on, the light itself is not usually the underlying fault. Covering it with a sticker does not fix the engine. Similarly, diarrhoea, itching or pain can signal different problems. The analogy has limits, though: symptoms themselves may need treatment. A vomiting dog or one in severe pain cannot wait for every investigation to be completed.

For me, the most useful question remains: “But why?” Why did the problem arise? What do we know? What are we only assuming? Which tests or carefully planned changes might distinguish the possible causes? This prevents us from simply moving from one product or supplement to another.

In the German Shepherd case, Dr Suter identified issues associated with food intolerance and investigated thyroid and adrenal function. Such an approach is characteristic of integrative care: diet, environment, hormones, stress and movement are considered together. But not every dog with diarrhoea needs a full hormone panel, and not every abnormal result is the actual cause. Test selection must follow symptoms and clinical findings.

Two possible sources of illness

Dr Suter frames potential causes through two simple questions: is something essential missing, or is something interfering with normal function? She compares this with a plant that may wilt from too little water or from pests. It is a practical way to think beyond symptoms and consider nutrition, environment and overall condition. Of course, not all illnesses fit two categories. Genetics, infections, immune responses and other factors can matter. Still, asking what else should be investigated is worthwhile.

For a dog with chronic diarrhoea, start by assessing what it eats and how it responds. At the same time, do not overlook parasites, pancreatic disease, hormonal disorders or other conditions. Inflammatory bowel disease is not automatically the same thing as “bad food”, and one dog’s recovery does not prove that the same intervention will help all dogs.

Finding the root cause

We live among many different substances, and dogs encounter their environment in their own ways: sniffing, licking, moving close to the ground and sometimes picking things up in their mouths. This does not mean every harmful substance accumulates near ground level, but reducing unnecessary exposures is worth considering.

I share integrative veterinarians’ interest in supporting liver health and consider preventive attention to nutrition, exposures and liver function important. Peter Dobias also recommends regular liver-cleansing programmes in his practice. We can describe that as his clinical approach, but there are currently insufficient high-quality studies in dogs showing that regular cleanses prevent disease or improve organ function in healthy animals. Equally, this lack of evidence does not prove the opposite.

When we understand what is causing a health problem, choosing treatment becomes easier. But illnesses can have several contributing factors, and the exact root cause may not be immediately clear. Good care then includes symptom relief alongside systematic investigation. We should not cover the warning light with tape, but neither should we keep driving a broken car while waiting to understand every detail of the repair.

Dr Suter emphasises seeing the body as a whole, and I agree. Relieving symptoms is reasonable while continuing to investigate their causes. Helping an allergic or intensely itchy dog feel better may be essential for welfare while triggers are being explored. A shampoo may be a perfectly appropriate part of treatment. The problem arises when relief is the only step despite persistent disease.

The gut, skin, nervous system, hormones and movement influence one another. That does not mean treating every system at once. Record the main complaints, assess risks and make changes in a controlled sequence. Otherwise it becomes impossible to tell what really helped.

The six pillars of health

Dr Suter describes six pillars that form a whole-dog clinical framework: considering several interconnected areas rather than focusing on a single symptom. In later materials she also discusses seven pillars. This does not invalidate the six-pillar model as a way of thinking. We should, however, distinguish observations and recommendations from clinical practice from treatments whose effectiveness has been tested in canine studies.

Pillar one: nutrition

The first pillar is food. I like the holistic question: is the dog receiving enough energy and all essential nutrients, is its body weight and muscle mass appropriate, and how does digestion respond? I prefer high-quality complete food and have fed my dogs combinations of dry, wet and occasionally raw foods.

Conventional veterinary nutrition guidance generally recommends that treats and other nutritionally incomplete extras account for no more than 10% of a dog’s daily energy intake. That leaves most of the menu to a complete and balanced diet.

Some integrative veterinarians take a more flexible view. They suggest that up to 25% of complete dry food may be replaced with fresh or raw food without causing significant nutrient imbalance. Their aim is to introduce more fresh and minimally processed ingredients into the dog’s diet.

However, the safety of such a substitution depends on the composition of the staple food and what replaces it. The 25% threshold is not a universally proven guarantee that all nutrients remain balanced. Overall dietary adequacy is particularly important for growing puppies, pregnant or nursing dogs and animals with certain illnesses.

These two recommendations therefore need not be treated as mutually exclusive. Understand why you are adding something and ensure nutritional requirements are still met. Raw animal products also carry pathogen risks.

When food-responsive chronic enteropathy is suspected, a properly selected and conducted dietary trial is important. Randomly removing a little of this and that will not provide the same clear answer. A veterinarian can advise on diet, duration and further tests. Make planned changes, monitor the outcome and do not confuse coincidental improvement with identifying the true cause.

Pillar two: gut health

Dr Suter pays close attention to gut health, the microbiome and the intestinal barrier. In her integrative approach, imbalance in the gut may be one factor worth investigating in chronic conditions. This is a relevant area: links between the microbiome and immune system are actively studied in conventional veterinary medicine too.

However, not every case of itching, diarrhoea or fatigue is necessarily caused by so-called “leaky gut”, and the label is not a substitute for a specific diagnosis. The question is not whether the gut matters, but how to identify which intervention helps this dog.

For chronic enteropathy, a carefully selected dietary trial is among the better-studied options, alongside further diagnostics and medication where necessary. Dr Suter’s emphasis on diet and digestion fits this approach. Integrative practice also considers probiotics and other microbiome-supporting methods. Some results are promising, but effects depend on the bacterial strain, dose and the dog’s condition. No single solution suits every dog.

Pillar three: detox and supporting the body’s natural processing

Dr Suter’s third pillar is “detox”, meaning support for the body’s normal processing and elimination mechanisms. Her approach asks how the body deals with metabolic waste and environmental compounds and whether its protective and excretory systems are working properly.

Integrative veterinarian Peter Dobias also discusses liver support extensively. The liver is essential for nutrient metabolism and processing and neutralising many substances, so its health deserves attention even before obvious signs of disease develop.

Milk thistle is one plant often discussed in integrative veterinary care for liver support. Its compounds, collectively called silymarin and especially silibinin, have been studied for possible antioxidant and liver-cell-protective effects. However, clinical studies in dogs are limited, and benefits have not been conclusively established for every liver condition.

Importantly, detox does not necessarily mean a separate cleansing course. These processes occur continuously. The integrative idea is to look at diet, environment, liver and kidney function and whether a specific supportive intervention might help the individual dog. Dr Peter Dobias prefers regular liver cleanses because, in his view, they help the liver function optimally.

As always, ask “but why?” If liver values change or a dog develops health problems, the cause needs investigating. Supporting the liver may form part of a broader approach but does not replace diagnosis or treatment when needed.

Pillar four: hormones

Dr Suter recommends considering hormones, including thyroid and adrenal function, as part of the wider picture. Hormonal changes can affect weight, energy, coat and sometimes digestion. In her case report, evaluating hormonal balance was part of the search for underlying factors. That can be reasonable when history or symptoms support it. Not every chronic problem warrants automatic testing of every hormone; tests and interpretation should follow the clinical picture.

Pillar five: the nervous system

The nervous system is Dr Suter’s fifth pillar. She uses the image of a hose: if flow is obstructed, water cannot pass freely. This draws attention to connections between the nervous system, movement, pain and overall function. Integrative veterinary practice may use rehabilitation, manual therapies and acupuncture in this area. Some can be useful supportive options, but evidence depends on the specific method and indication. Chronic diarrhoea, for example, cannot be attributed solely to disturbed nerve impulses without investigation. Her point that the nervous system should not be overlooked is nevertheless worth considering.

Pillar six: movement and fitness

I cannot overstate the importance of movement and fitness, but that does not mean every dog should do the same workout. For an older dog, one with heart disease or one experiencing pain, the best plan may involve short walks and rehabilitation exercises. Dogs also need rest. Consistency and suitable intensity matter more than “more is always better”.

Appropriate activity helps preserve muscle strength and mobility, offers mental enrichment and may improve quality of life. A sudden change in a dog’s ability should not simply be blamed on age or laziness; a health assessment may be needed.

In conclusion

Dr Suter reports that the German Shepherd improved after she addressed dietary and other health factors she considered important. For me, this is valuable clinical experience and a reminder to ask more than how to suppress a symptom. A single case cannot tell us which change caused improvement or whether it would work for another dog.

This is how integrative thinking and scientific caution can coexist: listen to clinical experience, investigate possible mechanisms and test outcomes where possible.

Dr Odette Suter recommends:

Do not stop at the symptom when its cause is unknown.

Ask “why?” and distinguish what you know from what you assume.

Look at the whole dog, but choose investigations and treatment according to the individual condition.

Now consider your own dog. If they itch, have loose stools or vomit occasionally, look at the wider picture: food, environment, medication, stress, movement and other possible factors. Track how often symptoms occur and discuss them with a veterinarian. Dr Suter’s six-pillar framework helps organise the questions, but does not mean every dog needs the same panel of tests or supplements.

For me, the most important question remains “but why?” Clinical experience offers valuable clues; rigorous research helps determine how widely those findings apply.

Sources and further reading

• Dr Odette Suter, DVM. The Seven Pillars of Health.
• ACVIM-endorsed 2026 Consensus: Diagnosis and Treatment of Chronic Inflammatory Enteropathy in Dogs.
• Merck Veterinary Manual. Overview of Integrative Veterinary Medicine.
• CVMA. Integrative Veterinary Medicine (2026).
• AAHA. Raw Protein Diet: documented risks.
• AAHA. Feeding Plans for Healthy, Appropriate Weight Cats and Dogs. 

 

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