A diet for a dog with liver shunts (portosystemic shunts)
This is my full research on liver shunts and what any diet, homemade or prescription diet should be for a dog with liver shunts. Unfortunately, you will not find a veterinary diet suitable for liver shunts.
What are Liver Shunts?
Liver shunts, also known as congenital portosystemic shunts, refers to an abnormality in the transport tubes of the liver, which is a key organ in your dog’s digestive system. A healthy liver processes all blood that leaves the stomach and intestines in order to support digestion, break down toxins, metabolise proteins, fats and carbohydrates, store essential vitamins, minerals and nutrients, and eliminate waste from your dog’s body.
If, however, your dog has liver shunts, the abnormality in their liver will allow blood to bypass your dog’s liver and enter their blood circulation, enabling toxic substances such as ammonia to accumulate in the blood. This can lead to hepatic encephalopathy, which is a reduction in brain function and brain damage due to toxic build up.
How Do You Know If Your Dog has Liver Shunts?
The following symptoms are indicators of liver shunts:
- Loss of appetite and weight loss
- Vomiting
- Diarrhoea
- Seizures or other neurologic problems
- Jaundice (a yellow tinge noticeable in the skin, mucous membranes, and eyes)
- Excessive urination and thirst
- Blood clotting
- Gastrointestinal bleeding can be seen in animals with liver disease due to ulcers or problems with blood clotting
Current Treatment for Liver Shunts
Generally, surgery is recommended for animals with liver shunts because surgical intervention leads to higher survival rates and a better quality of life when compared to non-surgical treatment (3). This is because non-surgical interventions aren’t able to affect your dog’s blood flow.
However, studies have also shown that non-surgical treatments can improve the quality of life of dogs with liver shunts (1).
How Can I Treat My Dog’s Liver Shunts with Nutrition?
Changing elements of your dog’s diet can control their symptoms of live shunts, including hepatic encephalopathy, vomiting, diarrhoea, and ammonium-urate urolithiasis.
You can improve ammonium-urate urolithiasis by feeding your dog a diet that has lower levels of protein (approximately 40g per 1000 calories) and a high branched-chain amino acids to aromatic amino acids ratio (4).
Furthermore, sources of soluble fibre such as lactulose help to reduce ammonia intake from the gastrointestinal tract; it transforms ammonia into ammonium that is not absorbed, and its laxative effect ensures the rapid expulsion of bacteria and ammonia (5). An antimicrobial treatment may also have a similar effect (2,6).
Diet Breakdown
Protein
A low protein diet of 40g per 1000 calories is recommended.
In a study exploring the life expectancy of dogs with an Eck fistula, a model for liver shunting and hepatic encephalopathy, it was found that the life expectancy of dogs who were fed fish or milk-based proteins was almost twice as long as that of dogs fed a meat-based diet (7).
Fat
An increase in fat content will increase caloric density and palatability. This means the dog is consuming less quantity digesting less, but equal in calories. As well as being much tastier for the dog. Fat is tolerated by dogs with liver disease unless they are suffering with severe cholestasis, which results in fat maldigestion.
Carbohydrates and Fibres
If your dog has liver disease, they may see a decrease in hepatic glycogen storage, which potentially increases the risk of low blood sugar levels and increases the use of protein catabolism for energy. Therefore, feeding your dog high-glycaemic treats (carbohydrate treats that break down quickly) between meals will prevent low blood sugar.
The inclusion of some fibre, especially soluble fibre, will increase the speed that food is transported through your dog’s gut, which gives toxins less time to be absorbed.
Vitamins and Minerals
Any disorder that decreases the amount of bile acids entering the intestine, enterohepatic bile acid circulation, or intestinal fat absorption requires the reduction in fat-soluble vitamins A, D, E, and K. Vitamin K and E deficiencies are common in dogs with liver shunts.
It has been demonstrated that copper accumulation is often controlled using a low-copper diet. Dietary zinc can also block intestinal copper absorption, and zinc supplementation in a low-copper diet may also be beneficial following chelation therapy.
Recommended Supplements
Silibinin (Milk Thistle Extract): Antioxidant that suppresses fibrinogenesis, promotes fibrinolysis, and helps protect against hepatotoxins (8).
References
- Favier, R.P., de Graaf, E., Corbee, R.J. and Kummeling, A., 2020. Outcome of non-surgical dietary treatment with or without lactulose in dogs with congenital portosystemic shunts. Veterinary Quarterly, 40(1), pp.108-114.
- Berent, A.C. and Tobias, K.M., 2009. Portosystemic vascular anomalies. Veterinary Clinics: Small Animal Practice, 39(3), pp.513-541.
- Tivers, M.S., Lipscomb, V.J. and Brockman, D.J., 2017. Treatment of intrahepatic congenital portosystemic shunts in dogs: a systematic review. Journal of Small Animal Practice, 58(9), pp.485-494.
- Proot, S., Biourge, V., Teske, E. and Rothuizen, J., 2009. Soy protein isolate versus meat‐based low‐protein diet for dogs with congenital portosystemic shunts. Journal of veterinary internal medicine, 23(4), pp.794-800.
- Bajaj, J.S., 2008. Management options for minimal hepatic encephalopathy. Expert review of gastroenterology & hepatology, 2(6), pp.785-790.
- Mankin, K.M.T., 2015. Current concepts in congenital portosystemic shunts. Veterinary Clinics: Small Animal Practice, 45(3), pp.477-487.
- Condon, R.E., 1971. Effect of dietary protein on symptoms and survival in dogs with an Eck fistula. The American Journal of Surgery, 121(2), pp.107-114.
- Twedt, D. C., Chandler, M. 2014. Clinical Nutrition for Common Liver Diseases. World Small Animal Veterinary Association World Congress Proceedings
