The liver, a vital organ in your dog's body, performs numerous essential functions. When the liver is damaged or not functioning correctly, liver disease occurs, impacting your dog's health in various ways. Diet plays a crucial role in managing canine liver disease, and this article provides comprehensive guidelines to help you make informed decisions about your dog's nutritional needs.
Understanding Canine Liver Disease
Liver disease manifests in various forms, each with distinct effects on your dog. Chronic hepatitis, marked by long-term liver inflammation, can stem from infections, autoimmune disorders, or genetic predispositions. For instance, Bedlington Terriers are prone to this condition due to a genetic mutation affecting copper metabolism. Hepatocellular carcinoma (HCC) is the most prevalent type of primary liver tumor.
Several factors increase the risk of liver disease in dogs. Obese dogs, especially those experiencing rapid weight loss due to illness or poor diet, are particularly susceptible. Certain breeds, including Bedlington Terriers, Cocker Spaniels, and Labrador Retrievers, are genetically predisposed to liver issues.
Early signs of liver disease can be subtle, making early detection challenging. As the disease progresses, more apparent symptoms emerge. The liver produces albumin, a protein that maintains hydrostatic pressure in blood vessels. When the liver's ability to maintain albumin, glucose, and clotting factor production decreases, ascites, jaundice, and hepatic encephalopathy may occur.
The Importance of Diet in Managing Liver Disease
What your dog eats significantly impacts the management of liver disease. A well-designed diet can support liver function, promote healing, and improve overall well-being.
Read also: Canine Kidney Diet: Ingredient Breakdown
Holistic Dietary Approach
A holistic diet emphasizes natural, wholesome ingredients that support the liver. This approach focuses on providing balanced nutrition while minimizing stress on the liver.
Protein Management
Dogs with liver disease still require protein, but excessive amounts or the wrong types can worsen their condition by increasing ammonia levels in the body. Vegetable and milk-based proteins are often recommended over meat-based proteins, as the latter may exacerbate hepatic encephalopathy due to higher purine content. Milk products contain tryptophan, which is a precursor for endogenous benzodiazepines. Protein restriction should be implemented only if signs of hepatic encephalopathy are present. Reducing dietary protein in all patients with liver disease is not appropriate as it may lead to protein malnutrition.
Commercial "liver diets" may not contain enough protein for growing puppies; adding ~ 100 g of cottage cheese per 420 g can of a "liver diet" is often recommended. The pet should be reassessed at 2 to 4 weeks and the protein increased to the highest level possible without signs of HE or when the animal is consuming protein levels equivalent to a maintenance food (~ 20-30% protein calories in dogs, ~ 30-40% protein calories in cats).
Copper Control
Excess copper can accumulate in the liver, causing or worsening liver damage. Dog foods labeled as “low copper” are formulated for dogs with liver disease and can simplify meal planning. It has been demonstrated that copper accumulation is often controlled using short-term penicillamine therapy associated with feeding a low-copper diet. Some dogs following chelation can be maintained only on a low-copper diet. Now evidence suggests that most commercial dog foods may contain too much copper for some dogs resulting in abnormal copper accumulation. Currently, the lowest dietary copper concentrations are found in the prescription liver diets.
Fat Considerations
Not all fats are harmful. Increased dietary fat content increases caloric density and palatability.
Read also: Managing Canine Lymphoma with Diet
Vitamin Supplementation
Liver disease often causes deficiencies in vitamins due to impaired nutrient absorption or liver dysfunction. Supplementation, especially with water-soluble vitamins like B vitamins, is often necessary. Vitamin B1 (thiamine) supplementation is highly recommended, especially in cats, as they are particularly sensitive to thiamine deficiency. Dosage for cats is 10 to 25 mg SQ or PO q 12-24 h; for dogs is 50-250 mg/dog SQ or PO q 12-24 h. If intravenous fluids are given, a B vitamin complex can be added at 1-5 ml/l.
Any disorder that decreases the amount of bile acids entering the intestine, enterohepatic bile acid circulation, or intestinal fat absorption can reduce the uptake of the fat-soluble vitamins A, D, E, and K. Vitamin K and E deficiencies are more common. Vitamin K dosage is 0.5 to 1.0 mg/kg IM or SQ q 12 h for two initial doses. This is often administered prior to surgical biopsy because vitamin K is required for the vitamin K-dependent clotting factors II, VII, IX, and X.
Choosing the Right Food
Selecting the appropriate food is a critical step in managing liver disease in dogs.
Commercial Liver Support Diets
Commercial dog foods specifically designed for liver health can be a convenient and effective option. Popular choices include prescription dry diets formulated for liver support. While these may be more expensive than regular kibble, they’re specially designed to address the needs of dogs with liver disease. Two pet food brands offer diets for controlling copper without adding extra copper beyond what's naturally in the ingredients: Hill’s l/d therapeutic diet and Royal Canin Hepatic Support. They come in either canned or dry form and are commonly used to help manage copper buildup in the liver.
Homemade Meals
If you prefer a hands-on approach, homemade meals can be a great option. They allow you to control every ingredient, ensuring that your dog gets a clean, natural diet without any unnecessary additives. Focus on high-quality proteins like eggs, boiled chicken, and white fish (e.g., cod or tilapia).
Read also: Diet for Seizures in Dogs
Here are some diet plans with approximately 300 kcals and a relatively low copper content when using an all-in-one supplement from Balanceit.com:
BEEF (~300 kcals)* Pan cooked 95% lean ground beef: 3 oz (85gr)
- Cooked Long grain White rice or couscous: 1/2 cup (79 gr)
- Vegetable oil (soybean): 1 tsp
- Fish Oil - Nordic naturals or Welactin: 1/2 tsp
- Balance It® Canine-Cu: 2 tsp
- Copper per 1000 kcals: ~0.4 mg
CHICKEN (~300 Kcals)* Oven Roasted Chicken breast: 3 oz(85 gr)
- Cooked Long grain White rice or couscous: 1/2 cup (79 gr)
- Vegetable oil (soybean): 1 tsp
- Fish Oil - Nordic naturals or Welactin: 1/2 tsp
- Balance It® Canine-Cu: 2 tsp
- Copper per 1000 kcals: ~0.3 mg
SALMON (~300 kcals)* Oven baked Salmon: 3 oz(85 gr)
- Cooked Long grain White rice or couscous: 1/2 cup (79 gr)
- Vegetable oil (soybean): ¾ tsp
- Balance It® Canine-Cu: 2 tsp
- Copper per 1000 kcals: ~0.4 mg
All the meat weights mentioned in the diets are for cooked meat.
Ingredients to Avoid
When formulating a diet for a dog with liver disease, it's essential to avoid certain ingredients that can exacerbate the condition. These include:
- Organ meats
- Complex grains
- Shellfish
- Mushrooms
- Fewer green leafy vegetables
Supplements for Liver Support
Supplements can play a significant role in supporting liver function, promoting healing, and reducing inflammation.
Milk Thistle
Milk thistle is a well-known natural remedy for liver health in both humans and dogs. It contains silymarin, an antioxidant and anti-inflammatory compound that helps protect liver cells from damage. Milk thistle is available as a powder, liquid, or capsule, making it easy to add to your dog’s diet. It is a part of many commercial liver support supplements, such as Denemarin.
SAM-e (S-Adenosylmethionine)
SAM-e is another excellent supplement for dogs with liver disease. It is a nucleotide molecule synthesized by all cells derived from methionine and ATP. It is essential for major biochemical pathways of the liver and the production of glutathione (GSH), the major soluble hepatic antioxidant. This supplement is typically given on an empty stomach for better absorption.
Other Supplements
- N-acetylcysteine (NAC): Given IV, also replenishes GSH.
- Vitamin E: Another antioxidant that is generally well-tolerated and helps protect cells.
- Zinc: This mineral reduces the absorption of copper from the diet, trapping it in the gut.
- L-Carnitine: A recommended dosage for supplementation of carnitine in cats with HL is 250-500 mg per day.
- Cobalamin: A suggested dose for B12 in cats is 125-250 µg per cat subcutaneously q 7 days for 4 treatments, then q 2-4 wk as needed. However, serum cobalamin concentrations should first be determined to document the presence of a deficiency.
Monitoring Your Dog's Progress
When your dog is dealing with liver disease, monitoring their progress is crucial. Liver disease can fluctuate, so it's important to track how your dog is responding to treatment, diet changes, and supplements.
Key Monitoring Steps
- Track Changes: Keep a close record of any changes in your dog’s condition.
- Appetite: Keep track of how much your dog is eating.
- Energy Levels: Note any changes in energy levels, as fatigue and lethargy are common symptoms of liver disease.
- Stool Consistency: If you're feeding a new diet, note whether there’s any change in consistency or color.
- Digestive Issues: Watch for signs of vomiting, diarrhea, or other digestive issues.
- Jaundice: Monitor for jaundice (yellowing of the skin or eyes), a sign that the liver is under stress.
- Coat Health: Observe your dog's coat for improvements, such as increased shine and reduced dryness.
- Swelling or Ascites: Monitor for fluid buildup in the abdomen, which can occur when the liver isn’t working correctly.
Remember, liver disease can be progressive, so signs of worsening might require changes in treatment, diet, or medication.
Case Study: Nutritional Management of Hepatic Enzymopathy
A 4-year-old American Bulldog presented with hepatic enzymopathy and suspected copper-associated hepatitis. The dog had a history of gradually increasing serum ALT levels. Diagnostics revealed elevated hepatic copper levels.
The dog was prescribed ursodeoxycholic acid and a homemade diet (HMD). Initially, an unbalanced homemade diet (HMD1) was fed, which resulted in normalized ALT levels but had nutrient deficiencies. A new homemade diet (HMD2) was formulated, addressing key nutrients while maintaining low copper content.
After two months on HMD2, all bloodwork values remained within the normal range, including ALT. This case highlights the importance of a balanced, low-copper diet in managing liver disease.
Hepatic Lipidosis in Cats
Hepatic lipidosis (HL) is a unique liver disease that is very common in the anorexic cat. Severe lipidosis results in hepatic failure and alteration of many metabolic functions. The mainstay of therapy for idiopathic or secondary hepatic lipidosis is aggressive nutritional support. Force feeding or the use of appetite stimulants, such as mirtazapine, is generally not adequate to meet caloric needs of the patient. Force feeding can result in food aversion and stress to the patient. Tube feeding is the best way to administer adequate calories in a stress-free setting.
In general, dietary fat and protein should not be restricted in these cats because calories and protein are so important in providing nutritional balance. Protein and amino acids are particularly important in cats with HL, as protein deficiency may play a major role in disease development.
The Role of Copper in Liver Disease
Copper (Cu) is essential for multiple metabolic processes. Excessive accumulation of Cu could result in an increase in oxidative stress in the hepatocytes, consequently leading to cell damage and inflammation. Hepatic accumulation of Cu was first described in pure-breed dogs, such as Bedlington Terriers and Labradors among other dog breeds. Recent reports have questioned the current guidelines for Cu content in pet foods, suggesting an association with an increased incidence of Cu-associated hepatitis in dogs.
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