Feeding the Dog with Liver Disease

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

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“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.

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.”

33 COMMENTS

  1. Thank you for the information, our 3 year old Labrador just had a biopsy of the liver and they think he may have copper storage disease.

  2. My, soon to be 16 year old, male Schipperke has been living with liver disease for the last 7 years. He came to us as a 9-year old rescue who had been in a shelter for about 2 years. The rescue group that brought Diggum into their fold treated him for advanced dental disease. The dental infection traveled to his liver. No amount of antibiotics cured his liver. With the blessing of my vet, I put him on a homemade diet along with two supplements daily. Diggum chases rabbits and squirrels, jumps up onto and down off of the furniture. and several times a week goes for a 1-1/2 mile walk. The onle evidence of his being ill is a thinning coat. My recipe: 4# red-skinned potatoes, 4# sweet potatoes, 4# fresh zucchini, 1# green beans 4# cod, all boiled and blended together. (This recipe feeds hime 2/3 c of food 3 times a day for 2 weeks.)

    • Hi Mariann. Has your boy had his liver enzymes retested? My 11yr old girl has had liver disease for 2 yrs and recent results have come back higher (1400 ALP 300ALT) keen to try your home cooked plan

    • My Schipperke 13 years old liver enzymes so high they are unreadable. She had a bad dental infection 2 years ok and had to have 32 teeth pulled. She came from a horrible person and I rescued her. Now 2 years later her liver enzymes are so high the lab can’t even read them. What supplements are you giving your Schipperke.

    • Hi, is the liver disease such as Cushionings? My Shih Tzu has been diagnosed with Cushionings and I’m at a loss what to feed him. He’s picky and lately hasn’t been acting himself. I do have to get him to the vet again soon

  3. My 9.5-year-old, 170-pound Labradoodle was diagnosed with copper storage disease last summer. He has been on a low-dose of Penicillamine and on the only two prescription diet liver foods, which he now just hates. HIs last liver values were not good, in fact, worse than previous levels, so we have doubled the dose of Penicillamine to 350 mg two times per day on an empty stomach plus Denamarin. We will test again this week after the new dose for a month. My question is what can we give him to eat to entice him? He is now just refusing the two prescription kibble and canned foods. I would appreciate any other suggestions you have.
    Thank you!!

    • Hi
      We are in the same boat as you described. My doberman was diagnosed with copper storage disease in May. He’s on Penicillamine 2 times a day plus Denamarin at 5 am on empty stomach and my vet added urdisol twice a day. He’s on his third round of penicillamine and his numbers went up again. I feel like we are losing the battle. We have no vets that specialize in copper storage i’m on my third vet. I’ve reached out to a nutritionist from “just food for dogs” He has little interest in eating and it’s hard to keep weight on him. When we give him his medication it almost immediately makes him gag in upchuck. How’s things going at your house any better?

      • I also have a Doberman with copper storage disease. He is on penicillamine, denamarin and ursodiol. He eats a homemade diet prescribed by a vet nutritionist because he wouldn’t eat the commercial food. He is also taking cyclosporine for inflammation. His liver values are improving.

  4. You may try just food for dogs hepatic food. It is fresh frozen food. My dog does not like to eat the prescription canned or dry foods for liver support but will eat the just food for dogs hepatic Food which is low in copper . This food seams similar to the homemade recipe mentioned earlier.

  5. Hello, my 13 yr. old blue healer just came back from the vet yesterday after having blood work done & the vet said her blood work looked gorgeous. However, her belly is kind of pot bellied these days & he thought she might have liver or spleen cancer & prescribed her Prednisone 10 mg. for the rest of her life.

    I plan on researching to find a good homemade diet for her, & I greatly appreciate the article however, I have a question

    If it’s true that she has liver disease, from what I’ve read, wouldn’t this medicine be taxing on her liver.

    • Our 5 year old dog Rooney has liver disease. They say the liver doesn’t process copper out of his system.
      It seems the same medicine is given..its like all the dogs are in the same box. The one medicine is hard on the stomach. We were given medicine for nausea too.
      We were told..sweet potatoes are bad…red meats….not too much…..cooked chicken mashed potatoes or rice a vegetable, homemade baked oatmeal applesauce no sugar cookies, check the copper levels in all the foods. Also, what about the “Drinking Water” Distilled water i think is best..the chemicals they put in water may not be good. I hope i helped a little.

    • Hi Gayle,
      Has your pup had lab work done for Cushing’s disease?
      A pot belly is a classic symptom of it.
      Did he suggest an abdominal ultrasound?

    • My vet said steroids are the worst for any baby who has liver issues. They won’t give Chopper them anymore for allergies or anything.

  6. My 11 yr-old black lab mix (rescued as puppy) was found with high copper values after blood diagnostic prep for dental 5 yrs ago.. She was put on Penicillamine for about 4 weeks. Also started hepatic dog food. There were only two – the first she refused. The second, l/d heptic dry she loves (actually food smells decent). Two years later she had two mast cell tumors removed from hind left upper leg. Since she would be under, we had a biopsy of the liver. It came up negative. I have a blood draw every 6 months to monitor the levels and they have remained fairly constant – bit higher than normal range, but lower than when we discovered the problem. I’m lucky for each day that she is still with me. 🙂

  7. I too am desparate to find something my 12 yeAr old shih tzu will eat she has hepatic encephalopathy and refuses all prescription diets for liver and kidney disease. She has lost 3 pounds and grows weaker by the day
    I’ve also tried chicken and rice and eggs nothing appeals to her Help!!!! She is my Life.

  8. Our toy poodle is 18 and rescued from an amish puppy mill where he lived in a wire cage for 6 years. We eventually had to get all teeth out. Lost hearing at 15, lost sight this year. Last week he vomited and wouldn’t eat. He was in the hospital 2 days with an IV with an anti antibiotic (clavamox) and a pill (Denamarin) for high enzymes (6000) been home 3 days doing well on special diet. (Rice & Chicken) today doesen’t want to eat. Had 2 seizures last night a minute a piece. May need to return to hospital, if no improvement.

  9. Larry Hundagen My 17 old chi whinny was given clavamox and Denmarin and both made her have seizures. I immediately took her off them it took me several days to get her walking again. We were worried that she was going to pass away. Didn’t think we would get her moving again. I only gave her 1/2 pill off Clavamox first day to try it and she had a seizure was suppose to give here 2 a day. Waited a few days to try the Denamarin and only 1/2 a pill and was suppose to give her 2 a day then she had another seizure. I threw all that medicine away immediately. I am going all natural way and she is walking and running again. I am not happy with these medications because they just made her health issues worst. We will not be taking her back to the Vet any more she is seeing a nutritionist and all homemade meals. What is sad is she was doing better before taking all these medications. Sometimes the body just needs a little help to get back on track. So do some research and learn there is a better way to help your little rescue puppy. Clavamox and Denamarin are very hard on them but we did not figure this out right away. It took trial and error but once we did we took her off it asap and she made it. She is doing great now and walking again we thought we were going to lose her or just have to carry her everywhere because it caused her to not be able to walk. But thanks to God Almighty we got her walking and playing again. Taking them to a Vet to see what the problem is not a bad idea but from there on its our job to find a way to help them heal naturally. So many books and people who have great knowledge to help you get past that stage. Cranberry juice works great for bladder infections that’s what got her well from her bladder infection. The Clavamox was given to her for the bladder infection but didn’t work just made her have a seizure. If she is going to pass away it would be nice to just let her be in peace instead of having seizures all day and all night long no fun for our puppies. It is sad that we pay all this money to the Vet and then have to deal with these situations but live and learn. God will direct us in a better way. Hope all is well..Blessing for you and your puppy!

    • Hi there. I have a 13y/o chihuahua with out of this world numbers and had an ultrasound. No tumors but suspicious spots on one area of her liver and her gall bladder, and a kidney stone. She was put on Clavamox (liquid) and seems to be tolerating it (when I can manage to sneak it in her food, and if she actually eats) and Demerol. I didn’t want to use the Demerol after reading the bad effects. So glad your baby got better. Can I ask… what did you end up feeding her in your homemade meals? Any advice is appreciated… thank you!

  10. My 10 yr old Spaniel Sophie has bright gold runny stools. My Vet has been treating her with
    antibiotics to no avail as a matter of fact its made it worse They are not equipped to do Blood and Liver cultures so I am trying to find the best way to try treating her as though she has Liver disease. She has a good appetite and I’ve been feeding her Chicken & Rice which does not seem to change the problem. I am at a loss what to try

    • Sandra Evans: How is your dog now? Would suggest you get an ultrasound. It would tell you a lot about the health of all her internal organs. Gold stools may be a sign of liver or biliary disease. To confirm, search “yellow stool” or “shades of dog poop” on internet. (My 13 year old 10 lb mix just had a liver tumor removed and is recovering. Wish I’d gotten an ultrasound sooner, in July, one year after his second one, which was fine. Tumor was found in September; so it seems to have grown during the last 15 months. It was large, 5 X 6 cm.) Best of luck to you.

  11. Hello. My 14 y girl just had blood tests lasts week and they told me her liver was bad, high levels of enzymes. I am devastated. They mentioned a liver biopsy, which she might not survive, risk of bleeding. And the other suggestion was caned food and dry food, specific for liver disease, plus Denamarin( pills) for the rest of her life. I went with the option number 2, because I am afraid of the biopsy. Did anyone have the same situation ? I hope it is the right choice.

    • Please get a liver biospy where they actually take a piece of her liver – they did a specific blood tes before the surgery to make sure her b lood clots properly – anyway doing the biospy her liver was totally abnormal color then did a panel to see why – turns out she has high level of copper – she will have to be on SAM-E LQ and a medication called Penccillamine plus special royal can heptic food – Been doing things since August because her levels were so high – antibotics – bile acid test Ultrasound – I didnt want to do it but had to find why nothing was working – please get it done

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