Liver Disease in Dogs: How Gently-Cooked Nutrition Can Help

There are numerous conditions that plague our beloved canine friends. Some more common than others; some more severe. Despite the effects of aging in our pets, organ infections, dysfunction, and failure do also happen, even with our best efforts at hand.

The liver is the second largest organ of a dog's body and performs about 1500 essential functions¹. It's a very important organ!

It's needed for drug metabolism and the removal of toxins. It synthesizes albumin and clotting factors. The liver also plays a large role in food digestion and metabolism. It stores glucose and triglycerides (fats), vitamins like A, D, E, and K, along with minerals like iron and copper.

The liver also has a profound ability for regeneration - this is unique!

But because of its contribution to many different cycles in the body, hormonal balances, nutrient absorption (and more), when it becomes diseased, it can be very challenging to manage.

What Liver Disease in Dogs Is and How It Affects the Body

The hepatobiliary system (liver and gallbladder, respectively) is a complex system and in a diseased state, becomes even more complex to treat. There are various conditions that relate to this system, and multiple other conditions that can cause breakdowns of it (e.g. pancreatitis).

Some conditions of the liver that we can see present in dogs include¹:

• PSS (portosystemic shunts) - congenital abnormalities to the vascular system contained in the liver and connected to circulation
• HE (hepatic encephalopathy) - complex neurological syndrome stemming from a shunt or severe liver disease
• Tumors/Masses - benign growth(s) on or within the liver
• Cancer - malignant tumors/masses (also called neoplasia)
• Chronic or reactive hepatitis (acute or chronic inflammation of the liver)
• and more….

Other conditions that can negatively affect liver function in dogs are³:

• Ingestion of poisons
• Infectious diseases like Leptospirosis
• Diabetes mellitus
• Cushing's disease

What Hepatic Encephalopathy Is and How It Affects Dogs with Liver Disease

HE, or hepatic encephalopathy, is a condition in which dogs with liver disease can experience neurological problems because of their poor liver function. This is because of the liver's role in removing toxins from the blood. For dogs with liver disease, the liver's ability to remove toxins is reduced, and this can lead to various neurological signs such as⁴:

• Mental dullness
• Inability to respond to basic commands
• Circling or aimless wandering
• Head pressing
• Weakness and poor coordination
• Blindness
• Behavior changes (e.g., aggression)
• Seizures

Sadly, it is not completely understood and more research is needed to understand this syndrome in dogs.

How the Bile Duct and Gallbladder Are Affected by Liver Disease in Dogs

The liver secretes bile which is a liquid solution that helps with the breakdown and absorption of fats (and some waste products). This is stored in the gallbladder which is adjacent to the liver, and has a duct or tube that connects it to the small intestine, where the bile is released³.

This is important because liver disease not only affects the liver itself, but can also affect the gallbladder and bile duct. Some issues with the gallbladder include:

• Bile duct inflammation
• Bile duct obstruction (a block preventing the flow of bile into the small intestine)
• Reduction in bile flow (sometimes referred to as "sludge")

Common Signs of Liver Disease in Dogs

Symptoms of liver disease in dogs can come in many forms. You might see:

• Lethargy or low energy
• Reduced appetite
• Vomiting
• Weight loss
• PU/PD (polyuria/polydipsia, or drinking and urinating excessively)
• Exercise intolerance (reduced endurance)
• Ascites (fluid accumulation in the abdomen)
• Jaundice (yellow color or hue to their skin)

How Liver Disease Is Diagnosed in Dogs

The first step in diagnosing a dog with liver disease (or inflammation, malfunction, etc) is to investigate any changes in levels of certain components of the blood. Your vet will look to see if there are changes in the red blood cells like anemia, or to see if there are elevations of "liver enzymes" or plasma enzyme activities like:

• ALP (alkaline phosphatase)
• AST (aspartate aminotransferase)
• ALT (alanine aminotransferase)
• GGT (hepatic y-glutamyl transferase).

These values can change if there is something wrong in the liver, gallbladder or bile duct.

If the blood tests suggest that there could be a problem with the liver, your vet will follow up with further diagnostics. It's important to note that elevations of blood parameters are not a diagnosis, but a symptom of an underlying problem. That is why it is best ruled out through further diagnostics like an ultrasound or biopsies. With symptoms ranging from mild to debilitating, finding the root cause, if feasible, is of the utmost importance.

Treatment Options for Liver Disease in Dogs

Treatment for liver disease in dogs can vary considerably on a case-by-case basis depending on the disease. The myriad of treatments can include the usage of:

• Diuretics
• Gastroprotectants
• Antibiotics
• Ursodiol (bile altering medication)
• Vitamin/mineral supplements
• Liver protectants (SAMe, silymarin)
• and even hospitalization with fluid therapy¹.

Sometimes treatment of liver diseases in dogs may include more than one therapy as well. Nutrition is also an important component in managing liver disease in dogs.

Nutritional Needs for Dogs with Liver Disease

Because of the nature of the liver, and how complex and intermixed the systems are, nutrition for these cases are to be based more so on the individual; what their symptoms are, diagnosis is, and treatment options.

One also needs to consider how their appetite is faring and the severity of the disease process. There are many moving parts in liver disease, and the nutritional requirements are not well defined².

Like with many chronic conditions, we worry about poor appetite in dogs with the subsequent reduced calorie intake. But in this case, it can become more worrisome as malnutrition in dogs with liver disease can occur and something we want to avoid.

Potential causes of malnutrition would be²:

• Vomiting
• Nausea
• Reduced appetite
• Impaired nutrient absorption and metabolism
• Increased energy requirements
• Increase in protein breakdown with the subsequent impaired protein creation/synthesis

Remember how the liver is also involved in nutrient digestion and absorption? Liver disease can cause alterations in the metabolism of carbohydrates, proteins and fats. It can also cause vitamin and mineral deficiencies. Nutritional needs may vary, but like with all conditions, maintaining a healthy appetite and body weight is crucial to longevity.

How to Feed a Dog with Liver Disease

Here are some common nutritional needs for most cases of liver disease, but with some key notes regarding specific needs we know are recommended (e.g. copper storage disease). Overall, diets for these dogs should be highly digestible, super tasty, calorie dense (high calorie), easy for the client to feed to their pup, and to be fed in small, frequent meals⁴

Protein: Adequate Levels to Support Liver Regeneration

Goal: Reduced, but only in specific cases

Protein plays a major role in many parts of the body and for the liver, it plays a leading role in regeneration. The diet needs to provide adequate, high quality protein for adult maintenance. The goal is to provide enough protein to support liver regeneration (and all other bodily functions) while avoiding excess protein in the cases that require it (like HE, kidney disease, etc.). Unless otherwise recommended, protein restriction in liver disease is not required (and could be detrimental).

Protein is also crucial as part of the treatment for dogs with liver disease leading to hepatic encephalopathy. When the body breaks down proteins, it produces ammonia. A healthy liver will filter this and convert it to urea which is then transported to the kidneys to be excreted out of the body via urine. The more protein a dog consumes, the more ammonia will be produced. This is no problem for a healthy dog with a functioning liver!

However, a dog with advanced liver disease and/or hepatic encephalopathy has a damaged liver which cannot filter the ammonia properly. This leads to an accumulation of ammonia that gets into the blood stream, making its way to the brain and leading to the neurological symptoms of hepatic encephalopathy! Under these conditions, your veterinarian may suggest a diet lower in protein.

Carbohydrates levels then become important, as they can supplement the reduction in protein to provide energy. Some dogs also tolerate dairy or plant-based proteins better than animal based proteins as these have less nitrogen based waste².

Sodium: Keeping Levels Low for Dogs with Liver Disease

Goal: Reduced (<0.3% sodium on a dry matter basis)

The amount of sodium restriction for dogs with liver disease is similar to that of kidney and heart disease. It is generally geared towards more severe cases showing symptoms like ascites.

When minimizing the amount of sodium in the diet for dogs with liver disease, the diet should contain less than 0.3% sodium on a dry matter basis.

Copper: Important Only in Specific Cases

Goal: Reduced, only in specific cases

This is mostly important in cases of copper storage disease or copper associated hepatotoxicosis. This is another strict case of monitoring levels in individuals before making adjustments.

For dogs who need a reduced copper diet for managing copper storage disease, the diet is recommended to contain 5 mg of copper per kg of food on a dry matter basis or less.

This is actually lower than the recommended amount of copper for a normal, complete and balanced dog food which means that for a dog who needs this type of diet, the pet parent would be looking for veterinary therapeutic (prescription) diets or home cooked diets specially formulated by Board-certified veterinary nutritionists and monitored by your veterinarian.

Fiber: When Increasing Intake May Be Beneficial

Goal: Increased might be beneficial

A change in fiber might be beneficial in some cases of liver diseases in dogs. Increased total dietary fiber content between 3-8 % on a dry matter basis, with a specific focus on soluble fibers, is recommended.

Increasing the soluble fiber may help reduce the production of nitrogenous wastes from protein breakdown in the gut, leaving less waste products to get absorbed into the bloodstream.

Tom&Sawyer® Meals for Dogs with Liver Disease

Unfortunately, dietary recommendations for dogs with liver disease are not always straight forward!

Unless there is a specific need for protein or copper restriction (with close monitoring), then overall, the best diet is one that the dog will eat!

For dogs with liver disease who do not have specific dietary requirements, then choosing a healthy, high-moisture, gently-cooked meal might be a good option - though it is always best to discuss with your veterinarian.

From the Tom&Sawyer® menu, some of the following recipes might be a good option for your dog in consultation with your veterinarian:

VetChef Pasta Primavera

A low fat, plant-based meal with chickpeas, lentils and pea protein Protein content is 26% on a dry matter basis and contributes to 25% of the calories

Pasta Primavera offers a plant-based meal option that could be supportive for dogs with liver disease and reduce the strain on the liver for dogs with HE.

Fisherman's Best Friend Supper 🇺🇸

Our lowest protein option at 25% dry matter basis, contributing to 23% of calories, Fisherman's Best Friend for dogs who have a need for a slightly lower protein option.

This recipe also has a low sodium level at 0.11 % dry matter basis.

Kangaroo 🍁

A low fat novel protein option with a high total dietary fiber content (14.54% dry matter) and relatively low copper content (14.48 mg/kg dry matter*)

Beef & Broccoli 🍁

Our Beef&Broccoli provides a delicious protein option that is low in fat, has low sodium (0.2% dry matter) and lower copper content (14.81 mg/kg dry matter*).

While our meals are great for supporting a healthy, functioning liver, for dogs with liver diseases, specifically severe conditions, then veterinary therapeutic diets will play a large role.

However, palatability is a common problem with the veterinary therapeutic diets. If your dog has been recommended to feed one of these diets, but is not eating it or not eating enough to maintain their body weight, you can discuss using Tom&Sawyer® meals as a potential for encouraging food intake by using our recipes as a topper, or discussing them as more options as needed to help them through their condition with your veterinarian.

*Because the copper levels recommended in copper storage disease are below AAFCO nutrient guidelines, our meals do not cover this. But, if there is no copper storage disease present and/or it is recommended to monitor copper levels, then these two meals are available.

Tom&Sawyer® Meal Toppers for Dogs with Liver Disease

These meals are low in sodium, super tasty and are elevated in total dietary fiber!

• Turkey Gobbler Feast 🇺🇸
• Italian Beef Pasta 🍁
• Berry Beefy Breakfast Bowl 🇺🇸
• Thai Coconut Chicken & Rice Dinner 🇺🇸
• Classic Pork Stew* 🍁

* Classic Pork Stew is our most calorie dense meal at 742kcal/pack. It's also our highest fat meal at 55% of calories coming from fat and is 33% fat on a dry matter basis. In advanced stages of liver disease (or liver failure), dogs might become fat intolerant due to their reduced ability to remove dietary fats from the blood².

Practical Feeding Tips for Dogs with Liver Disease

Helping a pet through progressive, chronic illness is stressful, and management becomes a part of the daily routine. But small changes in feeding can help!

Make Food More Appealing

• Warming up the meals to enhance the aroma and taste.
• Add variety with safe, appropriate options when possible

Use Meal Rotation

If your Veterinarian approves, you can discuss feeding on a rotational basis offering a few different options. This means having up to three meals available to help once they "tire" (or become food averse) of one. If your dog gets bored with one, switch to another and rotate back to keep interest high!

Feed Smaller, Frequent Meals

By offering small, frequent meals you can help your pup to:

• Meet calorie needs
• Maintain digestive health
• Improve appetite

Monitor Weight Closely

• Weigh your dog regularly
• Track changes in weight over time
• Pending the size of your pup, consider purchasing a baby scale to monitor and trend their weight

This way you can catch weight loss sooner and get them the help they need.

Supporting Your Dog Through Liver Disease

Caring for a dog with liver disease can feel overwhelming. But nutrition is one of the most powerful tools you have to support their health.

By focusing on:

• The right nutrients
• Managing their weight
• Keeping meals appealing

You can help your dog stay comfortable and enjoy a better quality of life!

If you're unsure what to feed, talk to your veterinarian. Together, you can build a nutrition plan tailored to your dog's needs.

🍁currently available in Canada only

🇺🇸US recipe; available in the US

References:

1. Hand M.S. et al. (eds) (2010). Small Animal Clinical Nutrition 5th ed. Mark Morris Institute
2. Fascetti, A. J., & Delaney, S. J. (Eds.). (2012). Applied Veterinary Clinical Nutrition. Wiley-Blackwell.
3. Center DVM, DACVIM, S. A. (n.d.). Disorders of the Liver and Gallbladder in dogs. Merck Veterinary Manual. https://www.merckvetmanual.com/dog-owners/digestive-disorders-of-dogs/disorders-of-the-liver-and-gallbladder-in-dogs#Complications-of-Liver-Disease_v3203062
4. Center DVM, DACVIM, S. A. (n.d.-b). Nutrition in Hepatic Disease in Small Animals. Merck Veterinary Manual. https://www.merckvetmanual.com/digestive-system/hepatic-diseases-of-small-animals/nutrition-in-hepatic-disease-in-small-animals