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Latest health and behavior news and advice from the veterinarians at Tufts University.

Features September 2014 Issue

Feeding the Dog with Liver Disease

In some instances, a change in diet will slow the progression of the illness.

“A lot of owners want to change their dog’s diet if they see any signs” that something’s not right with the liver, says Tufts veterinary nutritionist Cailin Heinze, VMD, DACVM. “But a change in liver enzyme values on blood work does not necessarily mean that a dietary change is appropriate.” Indeed, there are only two main instances where dietary change has been shown to be beneficial for liver disease.

When the liver disease is severe and the dog has protein intolerance

One of the two reasons to change a dog’s diet in the event that she has liver disease is that the disease has become severe, meaning the dog has essentially gone into liver failure and that organ is no longer able to do what it’s supposed to — filter toxins from body tissues and serve as the “control panel” for metabolism.

feeding dog with liver disease


Only certain dogs with liver disease will benefit from a change in diet.

Some dogs with advanced liver disease can show signs of “hepatic encephalopathy,” which basically means a problem with the brain related to the liver. They include the dog’s walking as if she is drunk, feeling really sleepy after meals — “kind of spacy or zoned out,” Dr. Heinze says — seizures, and staring at the wall or even pressing her head into the wall.

If you see any of those signs, it’s obviously an emergency, and the dog has to be evaluated right away. Frequently, a liver biopsy will be necessary to assess the exact nature of the situation as well as the extent of disease.

These concerning signs appear because the liver is less and less able to metabolize protein properly. Normally, the liver breaks down the amino acid building blocks of protein to separate out the nitrogen they contain. This process produces ammonia, which is eventually excreted in the urine as urea. But if the liver substantially loses its ability to function normally, the ammonia remains in the bloodstream with other toxins, and that’s what causes all the neurological issues.

“We can adjust the diet to help reduce the levels of some of those toxins,” Dr. Heinze says, “and one of the ways that we do that is by reducing the total amount of protein in the diet. Every dog has a minimum amount of protein she has to ingest to have normal body function. But in dogs with really severe liver disease, if you give them a lot more than they need, you’re fueling the fire.”

The type of protein counts, too. “Certain types of protein seem to cause worse issues,” comments Dr. Heinze. “Things like organ meats and fish contain higher levels of certain compounds (purines, some of the amino acids) that can be particularly harmful for dogs with bad liver disease. Many do better on plant-based protein or egg- and dairy-based proteins, both because of differences in the amino acid composition and differences in the tissues that the protein is coming from.”

Fortunately, there are therapeutic diets for dogs available by prescription from veterinarians that provide the right kinds of protein in the right amounts. These products are generally egg or soy-based. Owners needn’t worry about the quality of the protein. Both eggs and soy contain high-quality proteins that will provide the necessary nutrition at the same time that they prove more gentle to a failing liver.

Even so, pet owners should note that for a dog in the later stages of disease, there’s a lot of trial and error. “The amount of protein that is tolerated is individual to the patient,” Dr. Heinze says. “How much protein is tolerated depends on the degree of disease, what’s causing it, and also the medications the pet is on.” The aim is to maintain blood protein levels in the normal range and to feed the highest level of protein that is tolerated without causing abnormal blood ammonia or clinical signs. Diet is typically not used alone, however. Medications are frequently used along with diet to improve a dog’s protein tolerance. The combination is what will help control the clinical symptoms.

It is important to stress that most dogs who have problems with the liver based solely on increased liver enzyme levels on bloodwork have reasonably normal overall liver function and do not show signs of hepatic encephalopathy. For dogs with no clinical signs, such as a dog who had increased liver enzyme levels on a blood panel taken before going under anesthesia for something routine like dental work, no dietary change is indicated. Typically the abnormal values are monitored, and if they continue to fall outside the normal range, a biopsy is likely called for to understand the nature of the liver problem.

To emphasize the point, dietary modification using a veterinary therapeutic diet will likely not help a dog with mildly elevated liver enzymes (which can very well go back to normal on their own) or even with mid-stage liver disease. The disease has to be quite far along for a special low-protein diet to have a beneficial effect. The evidence is simply not there to change a dog’s diet in the case of mild or even moderate liver problems.

Excess copper in the liver

The other reason to change the diet of a dog with liver disease is if the disease is caused by an excess copper build-up. Over time, if a dog is unable to clear excess copper from her liver (it is a genetic condition in some breeds such as Bedlington terriers), it damages the liver cells, and she can develop severe liver disease and even liver failure. As with liver disease in general, a biopsy may be performed even if the dog seems fine if blood liver enzymes are found on a routine exam to be much higher than they should be and do not improve with conservative treatment. If it’s found via biopsy that excess copper in the liver is the problem, dietary changes should be instituted immediately — you don’t want to wait for the dog to reach the point of liver failure to make a difference. Dogs with excess copper in their liver can act completely normally, be mildly sick, or even go into full-blown acute liver failure, depending on the severity of the copper accumulation and how long it has taken to build up.

Once copper toxicity is identified as the problem, medications are administered to help remove the excess from the liver. Instituting a low-copper diet is a complementary measure to help prevent further copper build-up. How do you find one?

The same low-protein therapeutic diets prescribed by veterinarians for dogs with severe liver disease are also low in copper. “It’s kind of one size fits all,” Dr. Heinze says.

The problem, however, is that one size doesn’t always fit all very well. “The challenge,” says Dr. Heinze, “is that many dogs with too much copper don’t need a low-protein diet because their livers aren’t that bad off. If what’s available commercially is not a good fit for the dog, I may recommend carefully adding protein to a therapeutic liver diet or recommend a home-cooked diet for which I’ll provide a specific recipe,” that is, higher in protein but low in copper. Alternatively, there may be non-liver focused commercial diets that are lower, but not the lowest, in copper that might work for a specific dog.

High-copper foods tend to be red meats and organ meats like liver. A lower-copper diet might contain, for example, chicken instead of beef. “We assess the individual patient,” Dr. Heinze says. “The hope is that the liver wasn’t so damaged by the copper that it can’t regenerate. Liver tissue can regenerate to a significant degree if the liver as a whole isn’t too far gone.”

Like for protein, a veterinary nutritionist may alter the copper intake to suit the individual dog — an important point because strictly speaking, the therapeutic low-copper foods available for dogs are so low in that mineral that they could theoretically make a pet deficient in copper, particularly if they are used for long periods of time along with copper-reducing medications. You have to look at the situation in front of you. “Imagine a 2-year-old dog with too much liver copper showing signs of clinical disease who has been eating a lower-copper diet already,” Dr. Heinze says. “Compare that to a dog who at age 10 is diagnosed with excess liver copper and has been eating a high-copper diet her whole life but has no clinical signs. The 2-year-old will have built up her copper levels much more quickly and will need more severe copper restriction, and copper-reducing medications as well.” 

Comments (47)

My 8 year old cocker spaniel had gallbladder removed in June - Put on thyroid meds. Bloods results today show thyroid results good but liver ALT is 372. Ultra sound requested. Please advise if there is diet I can put her on. She is active, normal appetite etc.
Many thanks

Posted by: Elka | December 10, 2019 6:54 AM    Report this comment

Hi. Can you send me low copper home cooked recipes as well. Please and thanks. My dog won't eat l/d or rc hepatic

Posted by: JosieB | November 16, 2019 7:28 PM    Report this comment

Hi. Can you send me low copper home cooked recipes as well. Please and thanks. My dog won't eat l/d or rc hepatic

Posted by: JosieB | November 16, 2019 7:28 PM    Report this comment

Hi. Can you send me low copper home cooked recipes as well. Please and thanks. My dog won't eat l/d or rc hepatic

Posted by: JosieB | November 16, 2019 7:28 PM    Report this comment

If you are looking for recipes. makes free custom recipes for your dog. On the home page click on Homade Food and then on the autobalancer for vet patients. It gives you choices for ingredients and a recipe with the right proportions. They sell a vitamin mix you can add to the food. I use a different one from a local independent dog food store.

Posted by: Mary | January 3, 2019 9:49 PM    Report this comment

Could someone point me to the recipe that helps dogs with high ALT ratings?

Would love to give this a try. Thank you. I've subscribed and bookmarked.

Posted by: MajorMicro | December 6, 2018 4:54 PM    Report this comment

We have a dog with abnormally high ALT readings and would appreciate the link to the low copper home cooked recipe. Thank you.

Posted by: MH | October 17, 2018 6:56 AM    Report this comment

May I please have a copy of the low copper home cooked recipe?

Posted by: Helen M. | October 16, 2018 4:06 PM    Report this comment

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Posted by: asyhleynicole | August 24, 2018 2:26 PM    Report this comment

I am desperately seeking some low copper home cooked food recipes. I have been winging it! I have been using chicken, ground beef, ground turkey and adding rice, squash, green beans, carrots, small lint of peas. Oats, ricotta cheese, cottage cheese, brussel sprouts what else can I use? Sweet potatoes? Potatoes? I have been using the above ingredients to creat different dishes.

Posted by: Shar-Pei mom | August 20, 2018 2:35 PM    Report this comment

Please could I have the low copper diet details

Many thanks

Janie Parker

Posted by: chiqlady657 | July 2, 2018 3:21 AM    Report this comment

My dog is in remission from imha and I would like to make a home made diet for her. Liver and Kidneys were damaged from the medications she took and she was put on vet hepatic food. Her vet said to be on the lower side of copper if I could.

Posted by: davis | June 1, 2018 8:39 PM    Report this comment

Where can I find the recipes for low protein meals to make my dog?

Posted by: mooboo72 | May 9, 2018 12:02 PM    Report this comment

Do you offer the recipe or is this just an educational article?

Posted by: Katec | April 6, 2018 9:15 AM    Report this comment

Can I please have the home cooked recipe as well? Thank you

Posted by: cadias mom | March 24, 2018 11:43 AM    Report this comment

I have a 13 year old Yorkie they rescue and when her blood work was done before her dental they discovered that her liver count was off it was up to 1:20 where it should be around 25 so they suggested that I give her milk thistle recently had her blood work done went from 120 to 75 after reading your articles I would love to stop making her food and would love for you to send me a low copper diet so I can make her food myself and no she's getting the proper amount if you could please tell me how much I should give a 2.5 pound Yorkie I surely would appreciate it being a senior citizen it's really hard we don't always have that money so I'm trying my best with her if you could help me I really really would appreciate it and so would miss

Posted by: Shay | March 18, 2018 11:51 AM    Report this comment

My 12 year old, 74 lb lab was just diagnosed with excess copper. I have ordered Royal Canin Hepatic food, but I am interested in making his food. I see that chicken is used a lot in low copper diets, but I believe he has allergies to chicken. Is there a substitute I could use for the chicken that would be low in copper? He will be taking D-penicillamine to remove the copper. He will also get Vitamin E, Denamarin, PhosChol, Pyridoxine. I appreciate any advise or recipes you can offer for my old boy Sandy!

Posted by: debpatten58 | March 10, 2018 8:57 AM    Report this comment

I'd like to get the recipes thank you kim

Posted by: Alfie | March 7, 2018 5:00 PM    Report this comment

Where can I get the recipes

Posted by: Alfie | March 7, 2018 4:58 PM    Report this comment

My 6 y/o Rotweiller Shepherd (40 kg) was also just diagnosed with CAH. It began with elevated ALT found on routine pre-op blood tests. Since then we've had serial blood work, abdominal ultrasound and finally a liver biopsy which provided the diagnosis. Her copper levels are still low enough that significant liver damage has not yet occurred but she is now on Zentonil and vitamin E and we just started the commercially available Liver Disease formulation of both kibbles/wet food. I would prefer to prepare food for her, both main meals and treats as my vet has indicated she does not need decreased protein at this point - as indicated in the article.

So, to echo as others above have requested, could you please send me the low copper diet recipes as well? Please and thank you!

Posted by: Judy V | March 3, 2018 5:36 PM    Report this comment

My lab was recently diagnosed with Copper Storage disease. How can I find a veterinary nutritionist? My vet is steering me away from a home prepared food but the diet my girl is on is not being eaten very well. I am not opposed to making her food for her. Thanks for any help you can provide!

Posted by: Roosmom | February 25, 2018 8:59 AM    Report this comment

Hi can I please have a low copper home cooked recipe for my Maltese please

Posted by: Jen | February 21, 2018 3:23 AM    Report this comment

Hi could you send me home made recipe for home cooked low copper food please ? thankyou

Posted by: lorna | February 10, 2018 7:25 AM    Report this comment

would appreciate the recipe as well....
thank you for you commendable work with animals and their wellness

Posted by: evelyne | February 9, 2018 4:42 PM    Report this comment

May I please have a copy of the low copper home cooked recipe?

Posted by: InaF | February 3, 2018 12:24 AM    Report this comment

May I please have a copy of the low copper home cooked recipe?

Posted by: InaF | February 3, 2018 12:24 AM    Report this comment

Could I please have the home cooked recipe also. I am desperate. My dog has high copper and is very jaundiced. Had her gallbladder out and is on tons of medications and The vet has her on the science hill liver care food but she still throws up daily. She has lost half her body weight.

Posted by: Doc7770 | January 31, 2018 10:00 PM    Report this comment

Please send me a copy of the home cooked liver diet dog food please.
Thank you!

Posted by: dogmom | January 15, 2018 9:46 AM    Report this comment

Can you recommend a home cooked diet for a 12 lb. Schnoodle, diagnosed with SARDS 6/17, with severely elevated GGT 88, Bilirubin 7.6, ALT > 1000 and Alk Phos > 2000. Had inconclusive ultrasound. No obstruction in GB just distended and diffusely enlarged liver. No masses found.Only meds are Thyro tabs, Ursodiol and Denamarin Ultra. Thank you so much!!

Posted by: SheasMom | December 30, 2017 9:55 AM    Report this comment

How can I get a copy of the home cooked recipe for low copper diet?

Posted by: JudyChir | December 8, 2017 8:14 AM    Report this comment

Can anyone send me the low-copper home diet?

Posted by: eraffelt | November 10, 2017 10:24 AM    Report this comment

Great Article. I am releived to know that a low protein diet is not recommended for moderately higher liver enzymes. However, I would like to get the homemade diet to cook once in a while for lower copper. Thank you again for this article!!!

Posted by: smilewithsandra | September 25, 2017 8:56 PM    Report this comment

I would also love the homemade diet for my Beagle with level three liver and level three kidney disease!! Thanks!! Love the magazine!

Posted by: cjcbton | September 21, 2017 1:53 PM    Report this comment

I really need a home diet for CSD in my dog of 80 lbs. won't eat prescribed diets

Posted by: OliverHP | September 3, 2017 12:52 PM    Report this comment

I too am desperate for this homemade diet. I have a Dalmatian that has stopped eating the prescription diet and has lot 11 lbs in the last 2 months. Please help.

Posted by: jfreyvas | September 1, 2017 2:00 PM    Report this comment

I would also like the DIY recipe.

Posted by: rosia | August 17, 2017 9:57 AM    Report this comment

I need the low copper recipe ASAP... did the meds, liver scores normal in past 9 months. Hates the Hills LD unless I put white chicken tenders made at home. I'm not sure 1/2 can of the Hills laced with white chicken is enough for 24 lb. West.

Posted by: Ethel | August 14, 2017 10:14 AM    Report this comment

I have a 16lb 6 year old Cairn Terrier with Copper Storage Disease. I have tried one homemade recipe with, white rice, sweet potatoes, chicken, egg, and supplement from vet. My dog does not like any of these ingredients except chicken.

Can you please provide another recipe without including sweet potatoes, white rice, and egg?

Thank you

Posted by: lshannon | August 11, 2017 7:23 AM    Report this comment

I would like the home recipe for the low copper diet as well. My 11 year old Husky has been diagnosed with the high copper disease. Thanks!

Posted by: bbeck500 | July 25, 2017 5:42 PM    Report this comment

I would very much like to have this home-cooked recipe for our darling Westie. Please post! Thank you.

Posted by: kat | July 1, 2017 9:03 PM    Report this comment

Need liver home cook diet ASAP our 13 year old lab buddy is not doing well. Where can I find?

Posted by: Kd | July 1, 2017 11:29 AM    Report this comment

Please,send me the low copper home cooked recipe.

Posted by: Gjdietz | June 19, 2017 8:24 PM    Report this comment

May I please have a copy of your low copper home cooked recipe? Thanks!

Posted by: KathyC | June 12, 2017 11:14 PM    Report this comment

Can I get a copy of low copper diet? My dogs level are elevated

Posted by: Betnj | May 12, 2017 7:28 PM    Report this comment

Can you please send me the low copper diet for dogs? Thank you.

Posted by: Lennicant | May 7, 2017 8:11 AM    Report this comment

I'd also like the low copper home cooked recipe if possible. Thanks a lot!

Posted by: ArchieCincy | August 25, 2016 1:09 PM    Report this comment

Where can I find the low copper home cooked recipe? Thanks!

Posted by: LisaC | August 4, 2016 6:26 PM    Report this comment

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