Victoria,
You poor thing and your poor dog! That is certainly a lot to be trying to treat at once & in selecting a food.
Have you thought about feeding a therapeutic homemade diet, via your vet & you doing a consult with a board certified veterinary nutritionist (DACVN)? I wouldn’t recommend them all equally, but there are some good ones.
Those are some tough dietary parameters to meet all at once, particularly through a commercial kibble/can and from a quality reputable company, and you might have better luck with feeding homemade.
You might also look into the Vet Support Diets or a custom therapeutic diet from Just Food For Dogs, via their board certified veterinary nutritionists and other vet specialists.
Bear in mind that with EPI, the diet should also be low fiber, especially insoluble fiber — per veterinary guidelines. The main keys for the EPI part, are the pancreatic enzymes on the food + B 12 supplementing.
I would strongly encourage you to reach out to EPI4Dogs. Olessia, the lovely owner of that foundation & moderator, in fact has an EPI dog with diabetes that has been well managed on a combination homemade/fresh and Annamaet’s Lean. Dogs with EPI are no longer recommended to to have low fat, but as Olessia’s dog has needed low fat due to the diabetes, she will be able to help. The enzyme preparation that many use there is called Enzyme Diane, which is less costly. Many of the dogs in that group have done very well, and there is a wealth of knowledge and encouragement, hope there.
I believe most of the EPI dog owners there are feeding grain-free. The issue is with fiber though, as many whole grains found in commercial dog foods are high fiber and much of that fiber is insoluble, which EPI dogs cannot handle. The dogs also notably do not do well with peas, which also happen to be nearly all insoluble fiber. (Ditto for lentils.)
Among whole grains, a very very small amount of oats (higher in soluble, at ~50%), amaranth, or sorghum would be lowest in both fiber and % insoluble fiber; otherwise, white rice (refined). Lowest fiber grains like brown rice and corn contain almost entirely insoluble fiber. Cassava, white potato, and sweet potato are more balanced in soluble/insoluble fiber than most grains — and the fiber in sweet potatoes reduces to half in canned, vaccuum packed.
Elizabeth Hershey DVM, DACVIM is an outstanding, nationally known board certified oncologist you might wish to have your local vet reach out to. She is integrative and evidence based, as she is trained in both traditional western medicine and eastern/Traditional Chinese Medicine, includes diet, and typically combines her approaches. She does have success where other oncologists have not.
If I think of a suitable grain inclusive commercial food from a company that I personally would recommend, I will post it.
