In general, no meat products, no yeast, no liver or any type of organ meats, no shellfish, are recommended as these will cause ammonia build up in your dog's system and ammonia is a toxin that's a central nervous system depressant.

Basically, there's a certain level of protein that needs to be ingested to avoid muscle wasting (from negative nitrogen balance) but too much protein will cause toxin buildup. For dogs with very severe issues, or those that have not been stabilised there is a daily tightrope walk between ingesting enough protein to avoid symptoms and ingesting too much protein to avoid symptoms. There are general guidelines for protein grams based on a dog's weight; however, the actual amount of protein varies with the dog's age, activity level, severity of liver disease, medications, supplements, number of meals per day, and the presence of other secondary diseases (kidney or pancreas, IBD).

The best food to give for dogs with severe liver disease is prescription food formulated to take the workload off of the liver, such as Royal Canin Hepatic LS 14 or Hills canned LD. These foods are low protein fro a vegetarian source, as soy and dairy cause less ammonia buildup than any type of meat. Initially, PediaSure Vanilla with fibre can be given as it's low in soy/dairy protein and high in carbs.

To avoid symptoms of HE, as well as to increase a dog's tolerance of protein, the following will be helpful:

1) Medications from your vet (including low dose antibiotics and lactulose). Other medications that may be needed are Pepcid, Carafate or Actigall.

2) Food- low protein/high carb vegetarian prescription food: RC Hepatic LS 14 or PediaSure Vanilla or canned Hills LD.

Number of meals- 6 per day- for eg., 6 am, 9, 1, 4, 7,11pm

Protein grams- amount of food and protein grams vary by the severity of a dog's symptoms and the amount of liver support provided from supplements and medications

No added protein from other foods is recommended until the dog is stabilised. All carbs also have some protein. Amounts of sodium, manganese, copper, iron may be too high if various vegetables are added and it's difficult to control HE with a home-cooked diet.

Dehydration is a risk factor for HE- adding distilled water to food and/or syringing water is necessary for dogs who are not eating/drinking on their own.

3) Supplements- Dogs with liver shunts or other diseases that impair blood flow to the liver need ongoing liver support to prevent fibrosis/cirrhosis. Recommended supplements include specific blends containing milk thistle, Vetri DMG liquid (in place of Denosyl), and probiotics. Zinc is a potent anti-fibrotic, decreases HE, and helps to normalise the urea cycle. Vitamin E is recommended as a basic supplement, with some dogs also requiring Omega 3s from a fish source. Fibre in the form of psyllium husk or apple pectin is important.A new supplement to try for severe HE and decrease ammonia is L-ornithine, L-Aspartate (LOLA).

Avoid further liver damage with medications or other products that are toxic to the liver whenever possible eg. heart-worm preventatives, flea/tick products, vaccines, certain antibiotics. For those with the most severe liver issues, those that have had ascites or with cirrhosis, risks and benefits of these products have to be evaluated carefully.

I'm a dog lover and have been fostering dogs with severe liver issues for about five years. I'm not a veterinarian or nutritionist, but have had great success in controlling severe symptoms of liver disease with many dogs.

More help can be found at www.DogLiverDisease.com with a diet plan based on your pet's individual needs.

I'm the owner of an on-line supportive community which can be found at: http://pets.groups.yahoo.com/group/DogLiverDisease/