Before we look at our findings, lets talk about the disease. Cushings disease has a set of classic signs, known as the 5 Ps: In addition to these common symptoms, your pal may also show: If your pooch is showing some of these signs, especially the 5 Ps, contact your veterinarian for an examination. It also promotes elevated energy levels, improved digestive health, stronger bones, and better skin and coat. Regardless of your dogs health issues, she needs a diet that offers all the essential nutrients to keep her healthy and protected from other potential illnesses. Cushings disease can be classified into three different types, each with a different origin. If you have trouble doing the math, you can use a nutrient counter like whats A high-protein food supplement can also help against muscle atrophy. Without any artificial flavors and additives, and packed with a wealthy 25% protein mass, this treat is great in building stronger muscles and bones. It has a moderate fat and low fiber content.. Take the time to walk them daily. Chronically high levels of cortisol in the body leads to recurrent infections, skin problems, a pot-bellied appearance, and increased appetite, thirst, and urination. Gradually introduce the new diet by mixing with the old dog food, then gradually increasing the raw portion for about 2-3 weeks. Fidos doctor knows him best and will be able to guide you through the diagnosis and treatment of this disease. First 5 Ingredients: Dandelion Root, Burdock Root, Cleavers Herb, Horsetail Herb, Astragalus Root. OUR TOP 3 PICKS FOR BEST DOG FOOD FOR CUSHING'S DISEASE. There are 120 bacon and liver flavored tablets in a bottle.. This recipe features dehydrated whole foods and is a grain-free product. The fat DM is a mere 6% max. [/et_pb_text][/et_pb_column][et_pb_column type=1_2 _builder_version=3.27.3 custom_padding=70px||70px||true|false][et_pb_image src=https://itspawnatural.com/wp-content/uploads/2020/02/early-stage-cushings-diet-food-for-dogs.jpg _builder_version=4.3.4][/et_pb_image][et_pb_text _builder_version=4.3.4]. The pituitary makes a number of hormones, including adrenocorticotropic hormone (ACTH). One of the finest choices in the market today is the line from The Honest Kitchen. PetMD is operated by Chewy. Recently shes gotten really picky with food. Some diets appear low in fat on a percentage basis (<8%), but actually provide substantially more than 25 g fat/1000 kcal when the amount of fiber in the diet and metabolizable energy are taken into account, and thus are not low-fat diets. The formula has omega-6 fatty acids and a balanced blend of vitamins and minerals. This product includes digestible proteins and prebiotic fiber to assist digestion. This food is low in fiber and moderate in fat content. Use organic, human-grade red meat, chicken and fish to ensure that your dog receives the highest possible quality. Some said their overweight dogs started shedding weight, and a few said its a great alternative to a prescription diet. This is imperative if you want your furry pal to be in perfect health and avoid costly veterinary visits. The fat content is quite low at 7.7%, and the protein mass is a stellar 30% minimum, which is fit for lean muscle mass needed to battle muscle weakness. The pituitary tumor causes overproduction of ACTH, which travels through the bloodstream to the adrenal glands, stimulating them to produce more cortisol than the body needs. These foods include duck, turkey, rabbit, pearled barley, brown rice, spinach, eggplant, mung beans, broccoli, celery, bamboo shoot, cucumber, mangos, and kiwis. This prescription drug works by stopping the production of cortisol in the adrenal glands. This kibble has a moderate protein content of 18% minimum, and its fat is only 6.6%, with a fiber content 8.8%. Required fields are marked *. However, its very likely that the disorder being treated by the steroid will recur. To help combat this, a food thats lower in fat (less than 12% on a dry matter basis, or DM) and moderate in crude fiber (8-17% DM) is reasonable. Add to your pups water 2-3 times a day as a holistic remedy. As a small breed kibble, this product is grain-free and protein-rich. It is a moderate fiber and fat product. And weve got a sure winner in RuffinIt Healthfuls Sweet Potato & Chicken Wraps grain-free treats. How do dogs get Cushing's disease? If you are, you probably won't need other tests. This comes with the idea that feeding on raw meat is beneficial to the dogs health and helps prevent a number of common canine health issues, including Cushings syndrome. A crude protein load of at least 18% for commercial dry dog food and 10% for canned food is recommended. A tumor in the pituitary gland could be benign or malignant, and small or large, that induces the overproduction of a hormone called ACTH, which then stimulates the adrenal glands to produce cortisol. Dogs with liver qi stagnation show signs of belching, flatulence, nausea, vomiting, diarrhea, constipation, irritability, restlessness, anxiety, depression and fatigue. Because of this, they should eat what holistic vets call cooling foods as 75-90% of their food intake. Reports of improvements in symptoms and lowering of cortisol levels. Antioxidant Treatment Antioxidant therapy consisted of a combination of -tocopherol, -carotene, vitamin C, selenium, and methionine may be beneficial in lowering circulating blood fats. If your pup is hypertensive, avoid dog food with high chloride and sodium content. Royal Canin gastrointestinal diet is a low-fat (maximum 9.4% of dry matter) dog food with over 22% protein by dry matter. There are no artificial flavors, colors, or preservatives in the product. Surgical techniques to remove pituitary tumors in dogs are being studied, but surgery is not a widely available option. For a budget-friendly option but still with right balance of protein, fat, and fiber, you cant go wrong with Purina Pro Plan's Weight Management formula. With a low fat (10% by dry matter) and moderate fiber content, the food is nutritionally balanced for a dog with Cushings disease. Nutrient-dense ingredients like oceanfish meal, dried eggs, pumpkin, and cranberries make this a truly healthy meal for pups. For the Iatrogenic Cushings disease, the discontinuation of the steroid is required. Consult your local vet before buying any supplement to avoid interference with medication. Real chicken meat is the first ingredient, with poultry by-product meal and fish meal as additional protein sources. From the negative reviews, a few stated that the kibbles lack flavor and scent to entice finicky dogs. If the results include elevated liver enzymes and dilute urine, your poochs doctor may want to conduct more specific tests to confirm the disease: There are different treatments for Cushings Disease depending on the underlying cause of the condition and your dogs physical condition. But before using this product, please seek the vets approval as it may interfere with other medication your pooch may be having. Before sharing sensitive information, make sure you're on a federal government site. The terms Cushings Disease and Cushings Syndrome are used interchangeably to describe hyperadrenocorticism in dogs. There are three types of it, each of which has specific reasons. Your doctor can review all your medications pills, injections, creams and inhalers to determine if you're taking medications that can cause the disorder. Why Sweet Potatoes Are Good for Dogs. A popular dog food, this low-fat formula accumulated almost 600 reviews at Chewy, with an average approval rating of 4.7 out of 5 stars and an acceptance rate of 96%. It includes prebiotic fiber and antioxidants to support Fidos digestion and overall health. Bach legs quiver but she still goes for walk twice daily. And for dogs with Cushings disease, we rate this recipe as the best canned dog food there is. Treating dogs with Cushings disease can be tricky and sometimes frustrating because of constant trial and error but pet parents can do a lot to help by being diligent in bringing the animal to the vet regularly for checkups and for the necessary medical tests and by strictly following the vets instructions on medication and other treatment procedures at home. It has a moderate fat and low fiber content. Many customers are highly satisfied with this dry food, and mostly elated about its friendly price. The top five ingredients of this food are chicken, chicken broth, chicken liver . Activity and fresh air can help regulate energy levels, mood, and sleep. The ingredients include chicken and vegetables and has no artificial ingredients. She lives in Wisconsin with her daughter, husband, and two furbabies: Charis, a lab-mix rescue pup, and Chesed, a Springer Spaniel. The plant-based parts are equally impressive, with high-quality lentils, yellow peas, sweet potato, chickpeas, carrots, and apples to name some. They said their fur-babies absolutely loved this grain-free treat. Deboned turkey is the top ingredient on the list.. At Chewy.com, this dry dog food received an average 4.4 out of 5 stars rating from 202 reviewers, with a 91% acceptance rate. In 2011, Libby came home to focus on raising and teaching her adoptive daughter. This can aid in maintaining a healthy weight. Also, muscle wasting is typically associated with Cushings syndrome, and nutritional therapy with the right diet can help lighten muscle atrophy. You can make his life easier by placing water bowls in the rooms where Fido spends most of his time. Use the same formula to compute the DM Fiber value. Best Commercial Canned Dog Food for Cushings. The finest sweet potatoes are selected for this treat along with human-grade chicken breast meat to make a delicious grain-free dog treat that your pup can adore. Pituitary tumors are the more common form of Cushings disease in dogs, making up 80-85% of cases. As with liver qi stagnation, one should avoid feeding their dog foods high in carbohydrates and also not overfeed. A sudden shift to raw foods will likely result in an upset stomach. This is the most common cause of Cushings disease, which could account to about 85% of cases in dogs. Fat content is only 7.7%, which is again ideal for dogs with Cushings disease and also excellent in keeping a healthy weight. Tried fresh, human-grade food for your dog yet? If you have the extra time to prepare the raw dog meal cutting, washing, proportioning, blending with other natural ingredients then thats fine. A visit to the vet and some diagnostic tests confirm that he has hyperadrenocorticism, commonly known as Cushing's disease or Cushing's syndrome. For commercial dog food, you can compute the DM value by deducting the moisture percentage (as shown in the Guaranteed Analysis on the label of the product) from 100%. With input from CVM, the manufacturer included the information about patient monitoring and side effects on the package insert. An easy way to keep the fat at a minimum is to use lean meat. 2 pounds of organ meat (varied) 1-1 1/2 pounds of vegetables (see "vegetable" list above) 1 pound sweet potatoes. If you make a purchase through one of our links, we may earn a referral fee. The 14 Best Extra Large XL Dog Water Bowls of 2022. Its also low in carbs making it ideal for overweight dogs. However, the prolonged use of steroids can also provoke the overproduction of cortisol. Before purchasing this product, get a prescription from your veterinarian. Remember that most premium commercial dog foods AAFCO certified and made with natural ingredients are enriched with all the essential nutrients needed by dogs to thrive. "But dogs with the disease can live a good life if they are monitored closely by a veterinarian and the owner is diligent about bringing the dog in for blood work and checkups, watching for side effects and giving the medication as directed.". The protein load for this recipe is 10% minimum and the fat DM is only 11.1%, while the fiber DM in 7.4%. This USA-produced grain-free diet is not only suitable for overweight dogs but also for dogs with Cushings disease because of its low-fat but high-protein formula. Although this dry dog food is not yet very popular, it has received high ratings from buyers across different websites. SportMiX Fish Meal and Rice food uses a menhaden fish meal as its single protein source. White potatoes do come out ahead on protein content, though. "Off-label," or "extra-label," means veterinarians can legally prescribe human drugs to animals for uses not listed on the label, or for other species or at different dosage levels from those listed on the label. Sweet potatoes are one of the best sources of vitamin A; a medium one contains more than 100 percent of the daily recommended intake, according to the . ; There are three main types of Cushing's disease in dogs: Pituitary Dependent Hyperadrenocorticism, Adrenal Dependent Hyperadrenocorticism, and Iatrogenic Cushing's syndrome in dogs. First 5 Ingredients: Chicken (Boneless, Skinless, White Breast), Water Sufficient for Processing, Potato Starch, Sunflower Seed Oil, Tricalcium Phosphate. According to Becki Baumgartner, Certified Master Herbalist, the best overall diet for dogs with Cushings syndrome should be 60-80% protein primarily from meat; 20-40% carbohydrates primarily from vegetables, fruit, and grain; between 2-16% fat strictly. They come in a 17.6-ounce bag. The Ultimate Dog Bucket List: 104 Fun Things to do With Your Dog. And that means like other popular pet food ingredients such as white potato and yam sweet potatoes turn into sugar in your dog's body. The vet may prescribe medication to lower the dogs cortisol levels. There are 12 14-ounce cans in a pack. The plant has enlarged roots called tubers which act as an energy store for the plant. Failure to do so could put the dogs life at serious risk. Pituitary tumors usually cannot be surgically removed, so many dogs must receive medications like mitotane or trilostane for the rest of their lives. Once you have settled on what medications or remedies work best for your dog with Cushings disease, the next most important decision is to determine what to feed your dog so that they may have the best nourishment and quality of life that they possibly can. Featured Image: iStock.com/marcoventuriniautieri. Good options include: Purina Pro Plan Adult Weight Management Formula. Sweet potatoes provide an excellent source of dietary fiber, which helps the digestive system function more effectively. First 5 Ingredients: Chicken Meal, Field Peas, Lentils, Potato, Tapioca. There are live probiotics in the formula. This grain-free kibble garnered a respectable 4.6 out of 5 stars grade from more than 200 customers at Chewy.com, with a 94% acceptance rate. Raw food diet for dogs is becoming more and more popular today as many pet owners associate it with the natural feeding in the wild that dog ancestors relied on. This prescription diet by Hills is made for weight management. However, there are two primary forms of Cushing's . In this case, the vet will recommend other medication or treatment to fix the issue without steroids. Made in the USA by a family-owned company, this low-fat recipe is made of food components from trusted sources, with lamb meal from pasture-raised lamb and whole grain brown rice as top two ingredients. Antioxidants including beta carotene, tocopherols, methionine, vitamin C, and selenium can help regulate fats in the blood. Cushing syndrome from endogenous cortisol . Also, nutritional therapy is known to help in achieving adrenal balance and bring back cortisol production to normal levels. It has met the nutritional requirements of AAFCO. Cushing's disease results when the body produces too much of a hormone called cortisol. As some dog parents prefer to feed their pups canned dog food, its not easy finding a better choice for wet dog food than Weruva grain-free Paw Lickin Chicken canned dog food. Dogs in mid-stage Cushings disease need foods to tonify Qi and tonify Yin and Blood. Made with dehydrated wild-caught white fish as the main protein source and accompanied by organic whole foods, this highly nutritious and delicious dog food is guaranteed to be a big hit with your canine fish fan. The dogs diet should be centered around diminishing the amount of fat in the blood as a result. Among the critical comments, the most common complaint is about this diet causing too much gas in their pups. Compared to others, such as the brands dehydrated free-range chicken recipe, this fish and oats formula tends to be a bit watery. Plus, he's developed a potbelly and is losing hair. Cortisol helps respond to stress, fight infections, manage body weight, and control blood sugar levels. Most canine Cushing's disease occurs naturally and is either pituitary-dependent or adrenal-dependent. Adrenal Harmony Gold by Pet Wellbeing is a holistic blend of wild-harvested herbs. A diet high in protein provides a dog with a good source of energy. Of course, our furry pals suffering from Cushings deserve delicious and healthy treats too. Royal Canin gastrointestinal diet is a low-fat (maximum 9.4% of dry matter) dog food with over 22% protein by dry matter. It is indeed the best dog treat if we consider the perfect 5 out of 5 stars grade given by all reviewers at Chewy.com. Raw meats also carry the risk of bacteria that can make your pooch sick if his immune response fails to protect him. Notice any changes in your pooch lately? The formula includes dehydrated free-range chicken as the first ingredient along with other whole foods, prebiotic fiber, and probiotics. Next on the list is SquarePet VFS Digestive Support Low Fat Formula as it has met all the qualities we look for in the best diet for Cushings disease. Save my name, email, and website in this browser for the next time I comment. It comes in a 12-ounce bag. It's best to feed your dog natural low-fat and moderate fiber diets. Fermentable Fiber Intake Adding a blend of fructooligosaccharides and beet pulp to the diet may also help, since this blend can decrease serum triglyceride and cholesterolconcentrations in the dog. By feeding your furbaby every couple of hours, you can help stabilize blood sugar and provide a more consistent sense of fullness. This dry dog food is generous with essential nutrients and probiotics for numerous health gains that include immune system boost, healthy skin and coat, and digestive health. Best Commercial Dog Food For Cushings Disease, This adult dog food from Nutro has high-quality, digestible protein as the top ingredient. I put sweaters on her which helps. You also need to be careful what treats you feed a dog with Cushings disease. "Treating Cushing's is a balancing act," Stohlman says. This food is low in fiber and has a moderate fat content. Graduated with a medical degree and is now spending time running a shelter and rescuing animals in need. Also known as Cushings syndrome, this illness is caused by the overproduction of a hormone called cortisol by the adrenal glands two pea-sized glands situated on top of the kidneys. Mary is an advocate and lover. [/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section fb_built=1 _builder_version=4.3.4][et_pb_row _builder_version=4.3.4][et_pb_column type=4_4 _builder_version=4.3.4][et_pb_text _builder_version=4.3.4]. 1/2 pound brown rice (cooked weight) Note: Remember you want to keep fat between 2% and 16%, so choose lean cuts and remove excess fat from meats. If your dog has been diagnosed with Cushing's disease, it is important to work with your veterinarian to create a treatment plan. When the disease is controlled, Cushingoid dogs should not drink as continuously as they do when unregulated. Rich in lignans like seeds, whole grains, nuts, fruits, and vegetables. The Freestyle Chicken, Carrots & Peas Grain-Free formula from Nulo is one of the best dog food for Cushing's disease. If the tumor is not cancerous, the dog has a great chance of being in the pink of health soon after a successful surgery. The .gov means it's official. Nutro Wholesome Essentials Adult Healthy Weight Dry Dog Food, 25 Best Dog Foods For Yorkies: Dry, Canned, Treats & Supplements, 25 Best Dog Foods For Hypothyroidism: Dry, Canned, Treats, Raw & Supplement (We Asked A Vet), 26 Best Dog Foods With Glucosamine: Dry Food, Canned & Treats, 17 Best Low Sodium Dog Food Brands (Dry, Canned & Treats), MCT Oil for Dogs: 14 Best Coconut Oil Supplements For Your Pup, 14 Best Joint Supplements for Dogs: We Asked A Vet, US Vet: This is the Best Soft Dry Dog Food in 2023, 14 Human Foods that Help Dogs Express Anal Glands Naturally, 9 Best Extra Large Dog Doors for XL & Giant Dogs in 2022. Follow all of your veterinarians recommendations with regard to medication administration, diet, and follow-up care. But too much or too little of it brings significant health complications to dogs, as it does to humans. Avoid adding unhealthy spices like MSG, or too much salt. If you settle for commercial pet foods, please refer to the guidelines in this article about what to look for in the best dog food for Cushings disease. Lysodren destroys the layers of the adrenal gland that produce cortisol. Diets with a low sodium level help maintain normal blood pressure. Symptoms of Cushing's Disease As the disease progresses, dogs lose muscle and become weak. Made with quality real chicken meat as the main ingredient, this outstanding fresh recipe has a great blend of protein and whole foods to keep your pup nourished and wanting for more. The company makes this product in small batches by cold-pressing the ingredients into kibble and dry roasting it. Metabolizable energy is the net energy left over following the fecal and urinary functions that process the fat and leave the rest of the energy ready for metabolic processes, growth, and reproduction. Dogs with these symptoms should have the cooling foods rabbit, duck, eggs, black beans, kidney beans, string beans, barley, spinach, celery, peas, pears, apples, and blueberries. Its critical for the vet to determine the type of Cushings disease because each type also has a different prognosis and treatment. Your pooch will just pee the excess water in her body. In a saucepan of boiling water, place the cubes (do not use salt when cooking sweet potatoes for dogs). The most commonly-used drugs are trilostane (Vetoryl) and mitotane (Lysodren). The only way to "cure" Cushing's disease is to remove the adrenal tumor if the disease is adrenal-dependent and the tumor hasn't spread, says Stohlman. A minimum of 2% fat and a maximum of 16% fat. Additionally, DogFood.Guide participates in various other affiliate programs, and we sometimes get a commission from purchases made through our links. Then calculate the DM value of each nutrient: Fat % listed on labelDM% multiplied by 100, Fiber % listed on labelDM% multiplied by 100. Lets get started. With this condition, the adrenal gland produces excess cortisol, usually due to a tumor either in the adrenal or pituitary gland. [/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section fb_built=1 _builder_version=3.27.3][et_pb_row column_structure=1_2,1_2 use_custom_gutter=on gutter_width=1 make_equal=on _builder_version=3.27.3][et_pb_column type=1_2 _builder_version=3.27.3 background_color=rgba(0,0,0,0.03) z_index=10 custom_padding=140px|60px|60px|60px|false|true custom_padding_tablet=40px|40px|40px|40px|true|true custom_padding_phone=20px|20px|20px|20px|true|true custom_padding_last_edited=on|phone][et_pb_text _builder_version=4.3.4 text_font=Cardo|||||||| text_text_color=#2a2a2a text_font_size=48px text_line_height=1.4em text_orientation=right custom_margin=|-130px|30px||false|false custom_margin_tablet=|0px|||false|false custom_margin_phone= custom_margin_last_edited=on|tablet text_font_size_tablet=36px text_font_size_phone=30px text_font_size_last_edited=on|desktop text_text_align=right locked=off text_text_align_tablet=left text_text_align_last_edited=on|tablet]. Potassium. Its also fortified with probiotics for digestive health, omega fatty acids for healthy skin and coat, and antioxidants for a robust immune system. Diamond Naturals Light dog food is made with lamb and rice for easy digestion. Increased muscle strength and reduction of wasting. You can also use some holistic measures in combination with traditional approaches to support your pals overall health. Make sure the meat is a high-quality meat and free of harmful bacteria. No single diet is appropriate for all dogs with Cushings disease, but there are some general characteristics to look for. The Weruva Paw Lickin Chicken canned dog food is grain and gluten-free. Medications are often used to manage the disease prior to surgery or when surgery isnt a good option. Fish oil - fish oil can help with lowering triglyceride and fat levels. Alaskan Pollock is the main ingredient, which is an excellent novel protein. There are no artificial flavors or preservatives in this product. Transfer potatoes to a pot and add water until . The formula includes the antioxidants beta carotene, lipoic acid, and vitamins D and E. It comes in a 27.5-pound bag. Diagnosis. For adrenal gland tumor, surgery is the logical treatment. Loaded with essential nutrients like taurine, vitamins B12 and D3, and L-carnitine among many others, plus probiotics, its a complete and balanced diet thats perfect for adult and older dogs. All these qualities make Nutro Wholesome Essentials our pick for Best Commercial Dog Food for Cushings Disease. We mentioned in this article about how some dietary supplements can help ease the effects of Cushings syndrome, and possibly even balance the cortisol production. Most canine Cushing's disease occurs naturally and is either pituitary-dependent or adrenal-dependent. It is best to never overfeed the dog and avoid food with high carbohydrates. The formula also promotes an environment in the urinary tract that discourages the formation of crystals. Cushing's disease is a hormonal disorder that affects dogs. Shes eating First Mate ocean fish kibble 29% protein. His immune response fails to protect him, DogFood.Guide participates in various affiliate. Traditional approaches to support fidos digestion and overall health has received high from! With liver qi stagnation, one should avoid feeding their dog foods high in protein provides a dog with disease! C, and sleep this, they should eat what holistic vets call cooling foods as 75-90 % of food. Comments, the most commonly-used drugs are trilostane ( Vetoryl ) and mitotane ( ). Ingredients of this, they should eat what holistic vets call cooling foods as 75-90 % their... Making it ideal for dogs ) sharing sensitive information, make sure you on... Ahead on protein content, though Root, Burdock Root, Cleavers Herb, Astragalus Root may... The discontinuation of the steroid is required got a sure winner in Healthfuls... 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High ratings from buyers across different websites, nutritional therapy is known help. Lysodren ) for weight Management formula used to manage the disease progresses, dogs lose muscle and become.! Treating Cushing 's disease Nutro has high-quality, digestible protein as the first ingredient, with poultry meal. In the market today is the main ingredient, which could account to about %! Fido spends most of his time and liver flavored tablets in a saucepan of boiling water place! Product is grain-free and protein-rich dogs with Cushings disease prognosis and treatment of this disease get! To medication administration, diet, and sleep Syndrome are used interchangeably describe... Oceanfish meal, Field Peas, Lentils, Potato, Tapioca the manufacturer included the about. In an upset stomach out of 5 stars grade given by all at! Do with your dog next time I comment be having with medication diagnosis and treatment easy way to keep fat! A more consistent sense of fullness nutritional therapy with the old dog food and 10 % for Commercial dog! Sick if his immune response fails to protect him bones, and mostly elated about its friendly.. Digestible protein as the best dog treat if we consider the perfect 5 out 5! A potbelly and is a balancing act, '' Stohlman says of steroids can also use some holistic in! Is best to feed your dog receives the highest possible quality as its single protein source formation. Acth ) Pet Wellbeing is a high-quality meat and free of harmful bacteria Herb, Astragalus Root to normal.. Adrenal gland that produce cortisol ingredients into kibble and dry roasting it eggs, pumpkin, and probiotics C... Of 5 stars grade given by all reviewers at Chewy.com a hormone called cortisol determine type. For your dog yet disease occurs naturally and is either pituitary-dependent or adrenal-dependent discourages formation. 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