One of the most difficult factors about nutritional DCM is that it is often a silent killer. Many symptoms of nutritional DCM (such as low energy or muscle loss) are easily ignored, missed, or associated with other things (such as aging). It is not uncommon to hear about Great Danes who appear otherwise healthy and normal to suddenly die, or to have a heart attack during anesthesia. These are dogs who often have shiny coats and good stools, two things that many people assume mean that the dog is the "picture of health". Unfortunately, most dogs who die like this go undiagnosed and their diet thus, doesn't get the blame it deserved.