DIET & SUPPLEMENTS

FOR VARIOUS HEALTH PROBLEMS

Arthritis (separate page)
Kidney Disease (separate page)
Cancer
Liver Disease
including information on low-purine diets for dogs with liver shunts
Heart Disease
Ear Problems
Diarrhea
IBD, IBS, Colitis, and other Gastrointestinal Disorders
including information on EPI, SIBO and Addison's Disease
Hypothyroidism
Email Lists and Message Boards

I want to preface this webpage by stating that I am not a vet, nor do I have any training in nutrition or other medical fields. The information I am presenting here has been gleaned over several years of study from books, from the internet, and from the knowledge and experience of others. It is not meant to replace your vet's advice or any medications they may prescribe, but hopefully will suggest additional options to think about, and other areas to explore, based on your dog's condition. I welcome any feedback, or any additional information you may want to share that can be added to this website.

Arthritis

This section has been moved to its own web page.

Cancer

General information on diet and supplements

Dr. Oglivie DVM has done research at Colorado State University on a cancer starving diet -- for information on his research and the diet, see Nutrition for Dogs with Cancer. Berte's Immune Blend, which is available from this site, is  based on the supplements recommended by Dr Oglivie. It contains vitamin C, bioflavonoids, vitamin E, l-glutamine and l-arginine (two amino acids he recommends), digestive enzymes, pancreatin, acidolphilus, B complex, and vitamins A & D. The only thing you need to add is fish oil (body oil, not liver oil), which is important, as cancer cells cannot feed on this. Tasha's Immune System Formula is another option that may be helpful for some dogs.

You can read Dr. Ogilvie's article (this is an archive of the article, it appears that Colorado State is redoing their website and the article is no longer available there). See the article entitled Cancer for some good information on alternative treatments for cancer. There is a website at http://www.thensome.com/petcancer.htm with a tremendous number of links to information about traditional and alternative treatments for cancer.

Recent research indicates that Bromelain, an enzyme that comes from pineapples, may have an anti-cancer effect. Bromelain is used with dogs as an anti-inflammatory and for many other conditions, and should be safe to give. It may work best when given away from meals.

The amino acids L-Arginine and L-Glutamine may help inhibit tumor growth. Glutamine can also help with muscle wasting (cachexia) that may occur as well. See the following articles for more information:
Arginine in the Treatment of Cancerous Tumors
Arginine and Fish Oil May Help Cancer Patients Undergoing Chemotherapy
Therapeutic Considerations of L-Glutamine: A Review of the Literature
The Role of Glutamine in Oncology Therapy
Benefits of the amino acid, L-Glutamine
Glutamine: Indicated in Cancer Care?

Cartilage supplements may inhibit tumor growth. I heard one anecdotal report directly from someone with a toy poodle that had a major mass in his chest. After two bottles of Bovine Cartilage supplements, the mass was almost gone, and he went on to live another six years. Since cartilage is safe and inexpensive (and may help with arthritis as well), this one seems like it might be worth a try, though scientific support is negligible.

CLA
CLA (Conjugated Linoleic Acid) is a fatty acid that inhibits the development of tumors. I've heard of a dog with breast cancer metastasis that was having success with this therapy. This nutrient is found primarily in the meat and milk products of pasture-raised, grassfed animals. See the following articles for more information:
CLA: Does Fat Have a Silver Lining?
What is CLA? Dietary CLA in Grassfed Animals
CLA More on dietary CLA in grassfed animals.
Conjugated Linoleic Acid and Dietary Beef -- An Update Includes table of CLA amounts in various foods.
Emerging Health Benefits of CLA (human orented)
CLA Various scientific abstracts (human oriented)

Melatonin
Some new studies suggest that Melatonin may be effective against certain types of cancer. It can also help combat some of the side effects of chemotherapy and radiation therapy, when given in high doses (one person was advised by a cancer specialist to give her 120-lb dog 20-40 mg each night at bedtime while undergoing radiation treatment).. Melatonin has been used with dogs to combat thunderstorm phobias and certain forms of alopecia (hair loss), and is being tried as a treatment for separation anxiety, so it is safe to use with dogs, at least in moderation. See the following for a little more info on its use with cancer (most are human-oriented):
Melatonin and Cancer Treatment
Melatonin includes a link to a Detailed Scientific Review.
Canine and Feline Cancer Links includes some info on melatonin
A Supplement that Works???
Melatonin Could Help Patients on Chemotherapy
Melatonin overview that includes information on possible interactions with other drugs
These scientific studies show the effectiveness of melatonin in combatting side-effects of radiation therapy, and its non-toxicity even when used in extremely high doses:
Melatonin and protection from whole-body irradiation
Antioxidative Effects of Melatonin in Protection Against Cellular Damage Caused by Ionizing Radiation

Anti-angiogenic therapy
Anti-angiogenic drugs, although still experimental, are showing some success at treating tumors by cutting off their blood supply. See Dog's Cancer Helps Research for more information. This is called the Navy Protocol, after the dog in the story whose name was Navy. See the article on Antiangiogenic Therapy for Canine Cancers for more info. Also see their main page on Cancer for more information about how various types of cancer may respond to antiangiogenic therapy.

Artemisinin
New research being done at the University of Washington is showing promise for treating some specific cancers with an herbal extract that has been used for malaria, called Artemisinin. It has low toxicity when given in proper doses orally, and has shown some effectiveness with osteosarcoma (bone cancer) and lymphosarcoma in dogs when used at a dosage of 50-100 mg twice a day for a large breed. It is also being used to treat breast cancer in humans. It is apparently more effective when given along with iron salts. See the following for more information, several of which mention studies done with dogs:
Pumping Iron: Increasing Muscle Mass or Curing Cancer?
Chinese remedy 'may fight cancer'
Cancer Smart Bomb, Part I: An Idea from Ancient Chinese Medicine
Cancer Smart Bomb: Part II: Artemisinin Follow-Up
New Hope for Treating Cancer
Artemisinin Study Abstracts
Artemisinin_and_Cancer email group

Mast Cell cancer
Surgery is the recommended treatment for all mast cell tumors, whenever possible. Remember that supplements such as those below should be used in addition to surgery, if possible, rather than in place of it. Supplements would not be needed for low-grade mast cell tumors that are completely removed, but could be worth trying if your dog has inoperable tumors, high-grade tumors, or tumors that were not completely excised during surgery.

Turmeric (curcumin)
I recently learned second hand of a dog with aggressive, metastasized Mast Cell cancer that had most of his tumors go away when given Curcumin (an extract from Turmeric). This is a spice used in curry that has been showing promising results in the prevention and treatment of cancer (it is also a natural anti-inflammatory). It works both by cutting off the blood supply to the growing tumor as well as causes tumor cell death (p53 mediated apoptosis). Recommended dosage of curcumin for treatment of cancer is 80 mg/kg/day (36 mg/lb/day), or 400 mg twice a day for a 25 lb dog., administered orally (the highest recommended dosage is 120 mg/kg/day, or 55 mg/lb/day, to avoid toxicity). Curcumin and Turmeric are available over the counter through health food stores. I understand that Emory School of Medicine is going to be doing further research. The information on the web is limited, but the article Antiangiogenic Agents: Studies on Fumagillin and Curcumin Analogs has a little more info. Curcumin is considered a naturally occurring chemopreventative agent. These articles on Curcumin and  Turmeric have more information on its cancer preventative and treatment potential. Also see this article for a good overview of curcumin and turmeric.

IP-6
IP-6 has been around for a long time and I haven't heard much in the way of reliable success stories, but I was contacted recently by someone whose dog had mast cell tumors recur after surgery, and whose tumors reduced substantially in size when she began supplementing with IP6. This dog did succomb to mast cell cancer about 5 months later, but she feels IP-6 helped to prolong his life, and might have done more had she started it sooner. The Cell Forte IP-6 and Inositol brand is recommended.

For more information on mast cell cancer, see Approach to Therapy for Canine Mast Cell Tumor:
    Part 1: Diagnosis and Staging
    Part 2: Surgery and Pathology
    Part 3: Chemotherapy, Radiotherapy and New Directions

Lymphoma/Lymphosarcoma
Lymphoma is one cancer that is very responsive to chemotherapy, which can induce remission for up to a year or even longer, but will not cure the disease. Many people are reluctant to do chemotherapy for fear that it will make their dogs feel awful, but most dogs tolerate the treatment very well. Lower doses of chemotherapeutic drugs are used with dogs than with people, so it doesn't affect them as strongly.

Prednisone can be used as a less expensive alternative to other chemotherapeutic agents, but the remission will be much shorter. It is important to understand that "'“Prednisone is a one-way street'. While many dogs will experience significant short-term improvement, the duration of that improvement is typically on the order of only 1-2 months, and prednisone appears to be a powerful inducer of chemotherapy resistance. In other words, multi-agent chemotherapy is much less likely to be efficacious if a patient has come out of remission after treatment with prednisone alone." (from Advances in Treatment for Canine Lymphoma, Part 2). Veterinary Partner concurs, saying, "Exposure to prednisone will make the lymphoma much more difficult to diagnose should biopsies be obtained later. Plus exposure to prednisone can lead to resistance to other medications. (This is less of a problem for cats, but in dogs even a few days of prednisone can make a lasting remission impossible to achieve.)"

Diet and supplements can help with this form of cancer. "Research conducted at Colorado State University' Veterinary Teaching Hospital supports that high protein and lower carbohydrate diets, associated with higher levels of healthy fatty acids, including fish oil fatty acids in high dosages, and supplemental arginine, has shown statistically significant improvement in survival times in canine lymphoma patients." (Integrative Veterinary Medicine). A high dosage of fish oil (body oil, such as salmon oil or EPA oil, not cod liver oil) is an amount that supplies 300 mg combined EPA and DHA per 10 lbs of body weight daily. Be sure to give vitamin E as well when you supplement with oils.

See these sites for general information on lymphoma in dogs, including chemotherapy protocols and personal stories:
Lymphoma
Lymphoma in Dogs
Lymphoma Nutritional Therapy
Lymphosarcoma (Lymphoma) in Dogs (and subsequent pages)
Advances in Treatment for Canine Lymphoma
    Part 1: Diagnosis and Staging
    Part 2: Chemotherapy
    Part 3: New Directions
Cancer -- Lymphoma
Canine Lymphosarcoma (Lymphoma, LSA)
Lymphoma from Canine Cancer Awareness
Lymphosarcoma in Dogs
Cost Saving Lymphoma Protocol for Canines
Canine Lymphoma: Protocols For 2004
Rescue Treatment of Canine Lymphoma
Hailey's story: Ongoing success at fighting lymphosarcoma
Jamie and Boris - our personal experience- survivors
Nicholas' Story
Living with Canine Lymphoma: Clondike's Story
Hunter's Story
Living with Canine Lymphoma
Roxanne has Cancer Note: this article talks about vaccinating a dog with mast cell tumors. You should never vaccinate a dog with cancer of any kind, especially mast cell tumors. See my section on Vaccination Information for more info on why vaccination boosters are unnecessary anyway.

Malignant Histiocytosis
See these sites for general information on malignant histiocytosis in dogs:

Histiocytosis
Malignant Histiocytosis in dogs (Disseminated Histiocytic Sarcoma)
Canine Histiocytosis -- Frequently asked questions
Histiocytosis in the Bernese Mountain Dog

Studies have been done in 1996-1999 indicating that treatment with TALL-104 induced remission in dogs, but I can't find information about this treatment being available, just the studies:

http://www.vet.uga.edu/vpp/clerk/lamp/index.php
"It has also been reported that treatment with the human major histocompatibility complex, nonrestricted, cytotoxic T-cell line TALL-104 induced complete remission in four dogs with advanced disseminated histiosarcoma for time periods ranging from 9 to 22 months."

Here are the studies themselves, in reverse chronological order:
http://www.wistar.org/news_info/pdfs/scientific2000.pdf (see pages 102-103 of the report, pages 105-106 of the pdf file)
http://clincancerres.aacrjournals.org/cgi/content/full/5/7/1868
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9815565&dopt=Abstract
http://clincancerres.aacrjournals.org/cgi/reprint/3/10/1789.pdf
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8674057&dopt=Abstract

Transitional Cell Carcinoma (TCC)
Piroxicam (a non-steroidal anti-inflammatory drug) has shown success with bladder cancer (Transitional Cell Carcinoma). See these articles for more info:

Canine Bladder Cancer
Urinary Bladder Cancer in Dogs
Piroxicam and Bladder Cancer in Canines
How well are you managing urinary bladder cancer?
Bladder Cancer Message Board
DNA vaccine for malignant melanoma
A DNA vaccine for the treatment of malignant melanomas has recently been approved by the USDA, see the following for more information:
Canine Melanoma Vaccine
    Clinical trials are ongoing at Animal Medical Center in New York -- see results of the first clinical trial showing that the vaccine caused no toxicity and significantly prolonged survival time
DNA-Based Vaccine Triples Survival for Dogs with Melanoma
Gene Therapy Showing Promise in Fighting Melanoma
Cancer Vaccine Program Shows Early Promise
Tumor Vaccines from Gulf Coast Veterinary in Houston, Texas
Malignant Melanoma treatment at Animal Emergency Center in WI

PawPaw for drug-resistant tumors
In 1997, a researcher at Purdue found that a fruit called PawPaw showed promise in fighting drug-resistant tumors. This product has since become commercially available. Most of the information I found is from commercial sites, so it's hard to know how reliable it is, but here are some links to check out:
Pawpaw shows promise in fighting drug-resistant tumors
The Pawpaw (asimina triloba)
Paw Paw Fruit Against Cancer
Paw Paw Alternative Cancer Treatment Comparison

DCA
A compound called DCA (sodium dichloroacetate) is being studied at the University of Alberta, where researchers report seemingly remarkable anticancer properties. This compound cannot be patented, and so pharmaceutical companies are showing little interest, but the University is trying to start human clinical trials. In the meantime, some people have produced this compound and made it available to purchase labeled for veterinary use, which doesn't require the same level of approval as human drugs do. You can read about it at The DCA Site. You may be able to purchase it from a compounding pharmacy, if you can get your vet to give your a prescription. This is very new as of early 2007, so we don't know a lot about the safety of DCA --  serious adverse effects were seen at medium and high dosage levels (39.5 to 72 mg/kg/day), and a few even at low dosage (12.5 mg/kg/day) in this study. It appears that the dosage people are trying with their dogs is 10-15 mg/kg/day, split into multiple doses rather than given all at once. Until more is known, I don't think it would be wise to use this compound unless you know your dog's cancer is terminal and other options have been exhausted.

I have heard indirectly of two people who are trying this treatment for dogs with lymphoma, both Golden Retrievers. These dogs are being fed a modified high-protein, low-carbohydrate homemade diet appropriate for dogs with cancerr, and given immune-boosting supplements such as bromelain, turmeric and grapeseed, along with the DCA therapy. Here is some additional information from someone who is in contact with the owners of these dogs:

"The side effects of DCA are minimal compared to chemotherapy. The main problem seems to be acidification of the blood leading to progressive numbness in extremities. So the treatment is cyclic. For example two weeks of treatment followed by a few days respite to allow the acidity to recover. This first dog started to experience side effects after about 5 weeks of treatment but recovered within a couple of days. At nine weeks following diagnosis, the dog outwardly seems completely normal and not showing the usual symptoms of progression of the Lymphoma. Right now she should be dead. Last weekend she was out upland hunting for the day and maintained a normal high level of stamina throughout." The second dog is also doing well, but is at an earlier stage.

See DCA Therapy Data for a report on the use of DCA in human cancer patients. This site has observational data on 118 cancer patients treated with DCA, but it is not a controlled study. They are using a treatment regimen of 1-3 weeks on followed by 1 week off, with doses ranging from 15 to 75 mg/kg/day (average 25 mg/kg/day). They are also giving vitamin B1 and Alpha Lipoic Acid to try to counteract some of the side effects (see DCA Therapy for more info). They conclude, "It is our opinion that DCA is a useful and relatively safe medical treatment for cancer patients who have exhausted scientifically proven treatment options. However, just like chemotherapy, the response to DCA depends on the individual patient. Based on clinical judgment, it is difficult to predict which patients are more likely to respond to DCA. Chemosensitivity tests like ChemoFit™ may help predict response to DCA. We are not yet able to determine duration of response to DCA treatment. In our opinion, long term treatment with DCA may be limited by neuropathy. We will present more data on this once available."

Blood test to detect cancer
There is a new blood test that shows promise in identifying cancer in the early stages. This may be useful when cancer is suspected, but a biopsy would be difficult or is inconclusive. The test is called AMAS (Antimalignant Antibody and Serum) and is offered by Oncolab. The cost is $135 (plus whatever your vet charges to draw and ship the blood). It does not identify the type of cancer, or where in the body it is found. Although the form only mentions humans, it is being used for dogs as well, with similar results. See the following for more info:
An Accurate Blood Test For Cancer
AMAS Cancer Test

Warning about chemotherapy for dogs with MDR1 gene mutation
Note about Chemotherapy: The drugs Doxorubicin, Vincristine and Vinblastine are among those that Collies and related breeds (Australian Shepherds (including miniatures), English Shepherds, McNabs, German Shepherds, Old English Sheepdogs, Shetland Sheepdogs, Longhaired Whippets and Silken Windhounds) may react to. Also see MDR1 Problem Drugs List with North American Brand & Trade Names for a more extensive list of drugs and their brand names that should be avoided if your dog carries this gene.

Books, email lists and web sites with more info
The Natural Vet's Guide to Preventing and Treating Cancer in Dogs by Shawn Messonier. I have not yet seen this book myself, but it  has been recommended to me. It provides a good overview of both conventional and alternative methods of preventing and treating cancer.

Help Your Dog Fight Cancer: An Overview of Home Care Options by Laurie Kaplan. I have not read the book myself, but it has been been recommended to me and appears to be a good resource for those looking for information on how best to help their dogs with cancer.

Herbal Medicine, Healing & Cancer by herbalist Donald Yance. Apparently recommended by some holistic veterinarians. It includes information on herbs to help with chemotherapy and other conventional treatments, as well as alternative treatments for various forms of cancer.

If your pet does not want to eat, try Dr. Goldstein's Radiation Cocktail .

See Email Lists and Message Boards below under Cancer for support groups and more information on dogs with cancer.

Links to more information:
Canine Cancer Care
Diets for Dogs with Cancer
Cancer in the Canine
Human Cancer Treatment Goes to the Dogs
Robin's Canine Cancer Files
Cancer and Tumors in Dogs
Cancer in Dogs: The 28th Annual Canine Symposium
Nutrition and Cancer: Exciting Advances for 2002!
Nutrition and Cancer: New Keys for Cure and Control 2003!
Supportive Care and Rehabilitation
The Perseus Foundation
The Role of Nutrition in Cancer Therapies
Integrative Treatment of Cancer in Dogs
Canine Cancer Awareness
The Veterinary Cancer Society
Cancer Links
Clinical Research Trials

Liver Disease

Diet for dogs with liver disease is controversial. I have often seen low protein diets recommended, but recent studies indicate that too little protein can actually make liver problems worse. Low fat is also often recommended, but is only needed for dogs having problems with fat malabsorption. Dogs need fat for energy, and again, too little can cause problems. A low-purine (not low-protein) diet is recommended for dogs with liver shunts (see below for more info).

Please remember that mildly elevated liver enzymes do not necessarily indicate liver disease. Check out the following excerpts from Diagnosing Liver Disease: A Roundtable Discussion:

"So the question becomes, “What percentage of animals with abnormal liver enzyme activities truly have liver disease?” I suspect it’s less than 10%."
"Something as simple as dental disease may be causing the increased liver enzyme activities."
"Out of 100 dogs with a twofold or threefold ALT elevation, only a few develop liver disease requiring treatment."
"In animals with twofold to threefold ALT increases, I’d recheck them in three to four weeks. If the enzyme activities are persistently high—that red flag has gone up two or three times—practitioners need to pursue additional diagnostics, even in clinically normal animals."
"I perform additional diagnostics immediately in patients with a fivefold to sevenfold increase in ALT activity, even if they don’t have clinical signs. But in cases with up to fivefold ALT elevations, I monitor them and add other tests as needed."
"Of my canine patients with greater than fourfold ALKP elevations, about 80% have Cushing’s disease, long-term corticosteroid administration, or some other condition—not cholestatic disease. So I would say 20% of dogs with fourfold ALKP elevations have cholestatic disease, but that’s purely an estimate."
"The bottom line is that if practitioners obtain abnormal serum bile acid concentrations in patients that probably don’t have liver disease (based on the entire clinical picture), they should consider malabsorption diseases, such as small intestinal disease and pancreatic insufficiency, which are often associated with changes in the intestinal microflora."
See the chart on page 10, "The steps for Investigating Liver Disease," for some easy to follow input on liver tests.

In general, no diet changes are needed unless your dog has problems with hepatic encephalopathy, fat malabsorption, or has a liver shunt (more info below). Dogs with severe liver disease will benefit from dietary changes, supplements and medications, but dogs with mildly elevated liver enzymes do not require a change in diet. Liver-supportive supplements can be given at any stage if desired.

Hepatic Encephalopathy
Hepatic encephalopathy (HE) is the name given to neurological problems caused by the build-up of ammonia in the dog's system due to liver failure. Symptoms may include seizures, tremors, head pressing, blindness, and behavioral changes.

If your dog is showing signs of hepatic encephalopathy, it is important to reduce the amount of ammonia in the system. This is when protein restriction may become necessary. Red meat produces more ammonia and should only be used in very limited amounts or not at all. Cottage cheese (and other dairy products) and eggs are good sources of low ammonia-producing protein. Even in dogs with HE, you must be careful not to reduce protein too much, as protein malnutrition can result, leading to ascites and other problems.

Lactulose is a prescription supplement usually recommended to help reduce ammonia if signs of hepatic encephalopathy are present. Neomycin, an antibiotic that kills ammonia producing bacteria, lessening the amount of ammonia exposure, is also given to dogs with HE.

Liver Shunts
Dogs with portosystemic shunts (PSS) have specific dietary requirements that are different from dogs with other types of liver disease. While surgery is the treatment of choice, dogs with liver shunts can benefit from a low-purine diet, to prevent the formation of urate bladder stones (uroliths). Lowering purines does not require that you feed a low-protein diet, which would be contraindicated. It is important to feed proteins that are high-quality and low in purines. High-protein foods that are low in purines include dairy, such as cottage cheese (better to use low-sodium varieties), ricotta cheese and yogurt, as well as eggs. White fish and chicken are medium-purine foods that are still good to feed. Organ  meats, seafood and soy have a high purine content.

Dalmatians often have a metabolic condition that requires a low-purine diet. See the following for more information on feeding a low-purine diet to prevent urate stones, including several sites that show the level of purines in various foods:

Nutritional Management of Uroliths (see the section on Urate Urolithiasis)
The Prevention and Treatment of Urinary Stones
Fallacy of "Low Protein" vs. "High Protein"in Generalizing About Diets For Stone-Forming Dalmatians
Low-Purine Raw Diet Guidelines
Preventing Urate Stone Formation In Dalmatians Using A Basically BARF Diet
Purine-Yielding Foods
Food Sources of Purine
Instructions for a Low Purine Diet (human-oriented, includes details on the amount of purines in some foods)
Purines in foods

See the following for more information on dogs with liver shunts:

Apparent dietary protein requirement of dogs with portosystemic shunt (this study shows that dogs with liver shunts need normal amounts of protein, not low-protein diets)
Congenital Portosystemic Shunt
Recognition and Management of Portosystemic Shunts in Dogs
Portosystemic Shunts

You may want to join the Liver Shunt and MVD Support group for more information.

Supplements for dogs with liver disease
Current research indicates SAM-e (S-Adenosyl-L-Methionine) may be beneficial for liver problems -- give 200 mg twice a day to a large dog (recommended dosage is 10 mg per pound of body weight daily). SAMe is best given on an empty stomach, at least one hour before or two hours after eating (longer is better). Vitacost has the best price I've found (NSI brand), Costco also has good prices, as do iHerb and Sam-e Source. If you have a small dog, you may need to use the veterinary drug Denosyl, which is just SAMe but comes in a 90 mg size, see VetAmerica for better prices (they also now offer a generic 100 mg version which would be fine for small dogs), though these are not in blister packs and may be affected by moisture. Now Foods also offers 100 mg size. When giving SAM-e, it is best to also give a B-vitamin supplement, which is good for the liver as well.

There are several herbal products that are recommended for dogs with liver disease. One that has worked for several dogs is Country Life BioChem Liver Support Factors, which contains milk thistle and a variety of other herbs, and seems to work better than milk thistle alone. See Liver Support Factors for a couple of reliable first-person accounts of how this supplement helped their dogs. Another  is an herbal tincture called Skin and Liv-A-Plex, which also contains milk thistle. Recommended dosages of milk thistle alone range from 50 to 200 mg two or three times a day. I have also seen Alpha-Lipoic Acid and LiverCare recommended, as well as the general immune system booster Vetri-DMG. Picrorhiza, an Ayurvedic (Indian) herb, has been shown to be even more effective than milk thistle for treating liver problems.

Dietary guidelines
If your dog is showing symptoms of liver disease, it may make sense to make some dietary adjustments. It is better to feed several small meals a day rather than one or even two, if possible. I would recommend feeding moderate amounts of both high quality protein and fat. Dairy products, including cottage cheese, ricotta cheese and yogurt, may be easier to digest and produce less ammonia than meat products -- you may want to look for low salt varieties if you feed a lot of cottage cheese, or if your dog develops ascites (fluid retention). Eggs are an excellent protein source for dogs with liver disease. White fish can also be used.

Liver disease is one condition  where it makes sense to add grains, as soluble  fiber helps remove ammonia from the system so the liver does not have to process it. Oatmeal is particularly high in soluble fiber and would be good to use, as long as your dog doesn't have any problems with it (use whole rolled or quick oats, which have more soluble fiber than instant). Boiled white rice and, to a lesser degree, pasta are useful due to their high digestibility. I prefer feeding at least half meat and other animal products, and no more than half grains and other carbohydrates, unless less protein is needed to control symptoms of hepatic encephalopathy. For those who use a spreadsheet, you should feed a minimum of 1 gram of protein per pound of body weight daily, and carbohydrates should not provide more than 45% of calories.

Avoid supplements with copper and foods that are high in copper, including most organ meats, especially beef liver -- see Vitamin & Mineral Content of Various Organ Meats for more information; also see the Copper Nutrient List but be aware that you can't compare these foods directly as they use different measurement sizes for different foods. Copper can accumulate in the liver when bile excretion is reduced and cause further damage. Lamb, pork, duck and salmon are high in copper;  turkey chicken and other fish have moderate amounts of copper; and beef, cheese and eggs are low in copper. In advanced stages of liver disease, both copper and sodium (salt) must be severely restricted; salt is restricted to help prevent ascites (fluid build-up in the abdomen) related to low albumin levels, which are caused by poor liver function. You can use the USDA Nutrient Database to check for amounts of these nutrients in specific foods. You can also give a zinc supplement to help bind copper, especially if you suspect copper accumulation. See this article on Copper Toxicity/Chronic Active Hepatitis for more information.

The amino acid l-carnitine can help with fat metabolism and thereby be beneficial for liver disease, and l-arginine may be helpful in reducing ammonia that can accumulate with liver disease. Dogs with problems absorbing fat may benefit from a low fat diet using medium-chain triglycerides (MCTs), a form of fat found in dairy products and coconut oil. Use virgin (unrefined) coconut oil sold in glass jars and give up to 1 tsp per 10 lbs of body weight (start with less and increase gradually).

Good supplements to give would also include Vitamin B complex and vitamin E. Zinc should be increased above normal levels to help bind copper, and because its antioxidant properties help to protect the liver. Vitamin A should be limited with liver disease -- normal amounts are fine, but don't give higher amounts. Cod liver oil, which is high in vitamin A, should be used sparingly, if at all, and liver should also be limited (liver is also high in copper). Vitamin C should not be given to dogs with copper retention, but otherwise is beneficial. Fish oil (body oil, not liver oil) can be given in moderate amounts, maybe 1000 mg per 20-30 lbs of body weight, it's not known whether it's helpful for liver disease or not but can help with inflammation.

Dr. Jean Dodds recommends her Liver Cleansing Diet for dogs with liver disease, but it is very important to understand that this type of diet is only needed for dogs with very severe liver disease that is causing hepatic encephalopathy (neurological problems caused by too much ammonia in the system). It is definitely not indicated simply because your dog has elevated liver enzymes, which may not even indicate liver disease (see above). Although I feel it is unnecessary, I see no problem using this diet short-term (two or three months) for dogs that may have liver disease, if it makes you feel better and your dog does not object, but I do not recommend feeding such a restricted diet with so little variety long-term unless absolutely necessary. If your dog is suffering from hepatic encephalopathy and needs a severely restricted diet for this reason, this diet would be appropriate, though more variety would still be preferable. See a more complicated, but more complete, version of the diet here. It's fine to use the simple version in the short term, but if you need to feed a restricted diet for more than two or three months, you should use the more complete version. Again, you should also use variety rather than always feeding the same exact foods (for example, Dr. Dodds mentions substituting chicken for fish, and adding eggs to the diet).

See Sunny's Miracle Diet for information on a cooked diet and treatment protocol that one person used successfully to treat their Cairn Terrier with terminal cirrhosis of the liver. Others have also reported success using this diet, and it is not as low in protein as the Dodds diet above, so it would be a better choice for most dogs. Liver Disease and Diet has additional information on this subject, and I have also seen Donald Strombeck's book, Home Prepared Dog and Cat Diets recommended for liver disease recipes (these are cooked diets without bone). All of these are low in protein and so would not be appropriate except for dogs with advanced liver disease.

As always, I recommend that a variety of different foods be fed, rather than just a single, unvarying diet.

There is a possibility that certain fruits are liver protective, including watermelon, grapefruit, lychee, fig, kiwi, cherry, Japanese plum, and papaya.

Links to more info
There is an email list at Yahoo Groups related to liver disease in dogs: CanineLiver-d.

The book Hope for Healing Liver Disease in Your Dog has been highly recommended by people I trust (though I have not seen it myself) as a great, practical, non-technical source of information to help you immediately start caring for your dog. You can check out a Free Preview.

Following are websites with general information on liver disease in dogs:

The Liver and Diet for Liver Needs
New Approaches to Liver Disease
Liver Disease: Signs, Symptoms, and Diagnosis
Canine and Feline Liver Disease: An Overview
Prevention is Key in Avoiding Canine Liver Disease
Liver Disease in Dogs
Liver Disease Summary
Management of Chronic Liver Disease in Dogs
Liver Disease and the Ideal Diet
Nutritional Management of Liver Failure and Hepatic Encephalopathy
Nutritional Support for Dogs and Cats with Hepatobiliary Disease from the Journal of Nutrition Vol. 128 No. 12 December 1998, pp. 2733S-2746S (highly technical but lots of good info). For a simple flow chart on "Nutritional Management in Hepatobilliary Disorders", go to page 5. The very first entry says "If NOT encephalopathic: normal maintenance" -- no dietary changes needed. The second section starts out "Avoid protein restricted diets unless HE [hepatic encephalopathy]."
Liver Diseases -- highly technical but has some good information on a variety of different causes of liver problems
Nutrition of Dogs with Liver Disease see chapters 4 and 5 in particular. Excerpt: "Provision of adequate high-quality proteins as well as calories is essential to ensure a positive protein balance and enable hepatic regeneration. Protein levels are often inappropriately restricted in dogs with liver disease in order to manage possible hyperammonemia. In fact, protein requirements are at least normal or even increased, and many dogs with liver disease do not have hyperammonemia. . . .
In general, diets for dogs with liver disease should be highly digestible with a high energy density provided by fat and carbohydrates. Moderate protein restriction may be necessary in dogs with clinically evident HE, but protein quality should be very high. In addition, the diet should contain high normal to increased levels of water-soluble vitamins, enhanced zinc (>43 mg/1000 kcal), restricted copper, restricted sodium (<0.5 g Na/1000 kcal) in case of ascites, and a moderate amount of mostly soluble fiber. Protein restriction should be avoided as much as possible, especially in dogs with acute inflammatory hepatic disease or necrosis."
Links to tests used to diagnose liver disease:
Common Laboratory Tests in Liver Disease (human oriented)
Diagnosing Liver Disease in Dogs: What do the Tests Really Mean?
When Your Dog Has Abnormal Liver Enzymes (scroll down)
Tests for Liver Disease in Dogs and Bloodwork differentials for dogs and Bloodwork- Alkaline Phosphatase
Bile Acids Overview
Urine Bile Acids Testing
Leptospirosis in Dogs (lepto can cause liver disease as well as kidney disease)

Heart Disease

As mentioned above, for heart problems, feed heart, such as beef heart and chicken heart, as often as four or five times a week, preferably raw. Supplements for heart problems include:
  • L-carnitine -- an amino acid that helps to keep the heart strong. Certain breeds, particularly Boxers, as well as Cocker Spaniels and Springer Spaniels, may be affected by dilated cardiomyopathy (DCM) that is linked to carnitine deficiency, and improves when supplements are given. L-carnitine may provide other benefits to dogs with heart problems as well. You can give as much as 500 mg to a small dog, 1,000 mg to a medium dog and 2,000 mg to a large dog, twice a day, though less is probably fine for dogs not suffering from breed-related deficienies. The free form type is best; never use synthetic forms (D-Carnitine or DL-Carnitine). Note that carnitine is also abundant in red meat (especially beef) and dairy. For senior dogs, a combination of L-Carnitine and Acetyl-L-Carnitine may work best; use together at the rate of 2-3 mg each per pound of body weight. All amino acid supplements are best given on an empty stomach.
  • Taurine -- another amino acid that is good for the heart. As with carnitine, certain breeds of dogs have been found to develop heart disease that is linked to taurine deficiency. Affected breeds include the American cocker spaniel and Newfoundland. Other breeds that may be affected include the Portuguese water dog, Doberman Pinscher, and potentially other large and giant breeds as well. Give as much as 500mg to a small dog, 1,000mg to a medium dog and 1,500mg to a large dog. Best given on an empty stomach. Note that taurine is abundant in raw meat, particularly heart, but much is lost when the meat is cooked. You may want to add some raw meat to the diet if your dog suffers from heart disease.
  • CoQ10--Give 1 mg per pound of body weight, divided into two doses. The Q-Gel (oil) form should be used, it is much more bioavailable than pills.
  • Fish oil (body oil, not liver oil) and flax seed oil provide omega-3 fatty acids that can be helpful with heart conditions. Give 1,000mg fish oil (containing 300mg combined DHA and EPA) per 10 to 20 pounds of body weight, split into two doses per day. Fish oil is better utilized by dogs than flax seed oil. The omega-3 fatty acids may help with muscle wasting and with arrythmias. Be sure to also give vitamin E whenever you supplement oils, 200-400mg per day, and it is also good for the heart.
  • Other supplements that may be helpful include B-Complex vitamins (B-50 or B-100, depending on size of the dog), Selenium (about 1/2 mcg per pound of body weight daily), Vitamin C (250 to 500 mg twice a day), Vitamin E (200 to 400 IU daily), and Garlic (one clove chopped to a large dog, half to a medium dog and 1/4 to a small dog).
    • Also see the following for more info:
    Nutritional Therapy in the Treatment of Heart Disease in Dogs
    Dilated Cardiomyopathy (DCM) Treatment for Rapid Heart Beat
    CHF Supplements
    Natural Support for Heart Problems in Dogs & Cats
    New treatments for congestive heart failure
    Nutritional Therapy of Heart Disease
    What Supplements Should I Give My Dog with Heart Disease
    Cardiovascular Disorders and Heart Healthy Diet

    Foods that are natural diuretics include celery, parsley, watermelon and dandelion leaf. You can also get dandelion leaf tinctures (using the leaf, rather than the root). Dandelion helps replace the potassium that is lost with diuretics. You can feed bananas and apples to help with potassium loss if you are giving diuretics, such as lasix, or you can get potassium pills if your dog develops hypokalemia (low potassium). Side effects of lack of potassium are nausea, vomiting, muscle weakness, listlessness and rapid heart beat.

    Hawthorne berry is also sometimes recommended, but it may potentiate (increase the effects of) digitalis and other positive inotropic drugs and cardiotonic glycosides, so be sure to ask your vet before using it. When supplementing with herbs, I prefer to use tinctures that are made specifically for dogs, so that the dosage will be correct. Brands that I trust include Animal Apawthecary (see Hawthorn Plus and Senior Blend), Azmira Holistic Animal Care, and Tasha's Herbs for Dogs and Cats.

    Another supplement I've seen recommended for heart problems in humans, including cardiac failure, hypertension, angina, endocarditis, pericarditis and edema, is the Aryuvedic herb Terminalia Arjuna. Arjuna seems to work by improving cardiac muscle function and the pumping activity of the heart. Arjuna also benefits cardiomyopathy, or weakening of the lower muscles of the heart. The commonly recommended human dosage is 500mg three times a day, adjust accordingly for the size of your dog (large dog would get adult human dosage, medium dog half the adult dosage, small dog 1/4 the dosage). This article on Congestive Heart Failure mentions this herb, along with other alternative treatments. It is also one of the ingredients in Bio-Cardio from Thorne Research, which contains all of the above recommended herbal supplements along with a few others. Thorne Research products are often recommended by veterinarians.

    Note: A specific type of heart problem called Dilated Cardiomyopathy can occur in both dogs and cats if the diet is deficient in taurine . This problem has been discovered in a number of dogs being fed commercial dog foods. Studies are being conducted at UC Davis to determine the extent of the problem. See Nutrition and Congestive Heart Failure for more information. Adding fresh, raw meat to the diet would help counteract the potential for deficiency. See Commercial Dog Foods and Foods Used to Supplement a Commercial Diet.for more information on a good diet for your dog. Also see Taurine for a chart of the taurine content in different foods (note how much it decreases when the foods are cooked). Doberman Pinschers, Cocker Spaniels, Golden Retrievers, Newfoundlands and Boxers are some of the breeds that are prone to Dilated Cardiomyopathy, see the following sites for more specific information:
    Dilated Cardiomyopathy in Dogs (see page 2)
    Dilated Cardiomyopathy: What Can Be Done Now?
    Dilated Cardiomyopathy (DCM) in Dobermanns
    Dilated Cardiomyopathy: a daunting disease of the heart
    General Information About Dilated Cardiomyopathy in Doberman Pinschers
    Dietary Taurine Deficiency and Dilated Cardiomyopathy in Dogs

    Note that Digoxin is among the drugs that Collies and related breeds (Australian Shepherds (including miniatures), English Shepherds, German Shepherds, McNabs, Old English Sheepdogs, Shetland Sheepdogs, Longhaired Whippets and Silken Windhounds) may react to. Also see MDR1 Problem Drugs List with North American Brand & Trade Names for a more extensive list of drugs and their brand names that should be avoided if your dog carries this gene.

    There is a new blood test available for detecting heart disease in dogs. It is called the Canine CardioCare test. It detects the results of early heart disease from various causes, so it can be used as a screening test, or to help differentiate whether symptoms such as coughing might be caused by heart problems, and to help determine the severity of existing heart disease. This test is also available in the UK. The same methodology has been used for humans as well, see Blood Test for Heart Disease (click on Natriuretic Peptides) and Hormone May be New Marker of Heart Disease for more info.

    For more information on heart problems in dogs, see the Veterinary Heart Institute and Veterinary Clinical Cardiology. Two email lists that may be helpful are CanineHeartHealth and CanineCongestiveHeartFailure

    Ear Problems

    See the article on Ear Care and Disease (starting on page 11) for in depth information about various causes of ear problems, both chronic and acute. Also see Treating Ear Problems in Cats, Dogs, and Other Pets for an easy to read overview. Note that most chronic ear problems are related to allergies, so in order to control the ear problems, the allergies must also be controlled. Antihistamines can help with environmental allergies (and sometimes with food allergies) -- see this page for dosage info. Natural anti-inflammatories, such as salmon oil (fish body oil), vitamin E, bromelain (given away from meals), quercetin (bioflavonoid) and yucca tincture can sometimes help. Frequent bathing with a gentle shampoo can remove allergens from the body and help many dogs, as can frequent vacuuming and the use of a HEPA air filter. Dogs should be kept flea-free as well. See Food Allergies Part I: Ear problems for more information on the relationship between allergies and ear problems.

    Hypothyroid dogs "often have ear infections and show ear pain, redness, and odor," and Cushing's Disease can also be associated with chronic ear problems, particularly in middle-aged dogs.

    Yeast Infections

    Many dogs suffer from chronic ear infections that are caused by a yeast overgrowth. Sometimes removing grains, yeast, and all sugary/starchy foods from the diet (including most fruit, potatoes, sweet potatoes, yams, corn, peas, and winter squashes) will help. See Malassezia Infections and Yeast Infections of the Skin for information on a specific yeast organism called Malassezia. Also see Feeding Grains to Dogs? for a good article on why grains are not necessary and some of the problems they can cause. It is helpful to give something to kill yeast as well, once you have switched to a yeast-free diet. One such product would be Azmira's Yeast & Fungal D'Tox. Olive leaf extract is also good for controlling yeast, such as Animals' Apawthecary's Ol-Immune.

    Other supplements that may help with yeast include Probiotics, Vitamin C with bioflavonoids, fresh crushed garlic, olive leaf extract, and salmon oil. Other things that can set off a yeast infection are vaccinations, anethesia, topical flea killers, and autoimmune disorders. Allergies (environmental/inhalant/atopy, flea or food) and bacterial skin infections (pyoderma, folliculitis) may also be interrelated with yeast problems. In fact, recurrent yeast infections are usually related to allergies.

    Two people have reported that their dog their dogs had terribly yeasty ears, and one began to lose his hearing. Both ended up discovering that the dogs were hypothyroid. Treating the hypothyroidism resolved the ear problems. Neither had other symptoms of hypothyroidism except a little lack of energy. See below for more info on hypothyroidism.

    There are many topical treatments for yeast and other ear problems. Please keep in mind that almost anything other than sterile saline can cause ototoxicity (deafness) if used when the ear drum (tympanic membrane) is ruptured, which is not uncommon when a dog is having ear problems, but the ear drum will grow back when the infection is removed. These treatments may be useful for keeping a chronic problem under control, but it may be best to have your vet take a look first, to determine what is going on with the ear, and whether the ear drum is intact, before proceeding with home treatments -- it will not help to treat the ears for yeast infection if the real problem is bacteria or mites, for example. If the ear is very infected, it may also be necessary for your vet to flush it out before you will be able to use one of these methods for helping to keep the ear clean.

    Rather than filling the ear with fluids, in most cases it's better to put the treatment on a cotton ball or swab and use that to clean out the ear. Moisture encourages the growth of yeast, so you want the ears to be dry.

    You should warm any solution you use to body temperature by immersing the bottle in a bowl of warm water. This makes ear cleaning much less aversive to the dog. Put the solution on a  cotton ball, then use that to wipe the ear. You can also use a Q-Tip, but be careful not to go any further into the ear than you can see or you may cause damage. Clean daily for three days, then every other day for a week, then weekly after that.

    Other things that have worked for some people include:

    See the following articles for a number of other natural suggestions for ear problems:
    Ear Problems
    Herbal Help for Ear Infections under Health/Herbal Info
    Otitis Externa Good conventional overview of causes of ear problems

    Products I've seen recommended by people who have used them with success:
    Surolan Ear Drops -- this is a medicinal product that contains Miconazole nitrate for yeast (malassezia), polymyxin B sulfate for bacteria, and prednisolone for inflammation. Click here for a little more info. One person whose dog had a long term problem with her dog's ears was able to clear them us using this product combined with flushing the ears.
    Canyon Meadow Natural Ear Wash -- contains tea tree oil, so use with caution
    Herbal Ear Rinse from Animals' Apawthecary
    Halo Herbal Ear Wash
    Ear Fresh Medicated Ear Powder
    Animal Dermatology Laboratories Foaming Ear Cleaner and Ear Flushing Drying Lotion (available only from your vet)
    Ear Wash with Tea Tree Oil (do not use tea tree oil for cats or toy breed dogs)
    DermaPet Ear/Skin Cleanser for Pets
    Epi-Otic Ear Cleanser
    Natural Ear Comfort
    Pooch Calming Ear Remedy
    Zymox Otic (see above)

    DIARRHEA

    See your vet if your dog has diarrhea accompanied by black, tarry stools or stools with a lot of fresh blood, loss of appetite, frequent vomiting, lethargy, bloating, signs of pain, or if the diarrhea lasts for more than two days. For occasional diarrhea with no other symptoms, try these remedies:

    If diarrhea continues for more than a couple of days, or if it is accompanied by other symptoms, such as vomiting, see your vet for more help. Diarrhea can cause dehydration and may be a symptom of a more serious problem. Your vet also has access to more potent anti-diarrhea medication, if needed. See the following articles for more information:
    Diarrhea & Vomiting: When to See Your Veterinarian
    Diarrhea
    Diarrhea in Dogs and Cats

    The suggestions above are meant to help with occasional problems, not severe or chronic diarrhea. For those, see the section on IBD, IBS and Colitis below.

    IBD, IBS, Colitis and other GastroIntestinal Disorders (including information on SIBO, EPI and Addison's Disease)

    IBD (Inflammatory Bowel Disease), IBS (Irritable Bowel Syndrome, which is caused by stress) and Colitis (inflammation of the lower bowel) can cause frequent diarrhea and be quite dehabilitating, even to the point of being life-threatening. These conditions can be difficult to manage and get under control.

    IBD cannot be accurately diagnosed without a biopsy, but there are certain symptoms that will help you determine whether your dog is suffering from large bowel (colitis) or small bowel diarrhea, which can help you decide what the most likely cause may be and what treatments are apt to work. For example, small bowel diarrhea is more likely to be caused by bacterial infection or EPI (see below). See The Pet Center's web page on colitis for a table with the different symptoms between the two, and an overview of the possible causes. Note that it's a good idea to treat presumptively for parasites to rule them out as a cause, as some can be very difficult to detect on a fecal exam (whipworms in particular are hard to find). Panacur (Fenbendazole) is a very safe drug to use that is effective against most intestinal worms, including whipworms, as well as giardia. Iit will not work for coccidia, unfortunately, but the drugs needed to treat that are stronger and I wouldn't encourage using them without a definite diagnosis. I know of people who have spent months trying different diets and supplements to try to help their dogs with chronic diarrhea, only to find out that the cause is parasites and treatment with either Panacur or Albon (for coccidia) clears the problem up quickly.

    Although there are many causes of chronic diarrhea, one factor that I've seen come up over and over again is an intolerance for grains in the diet. Many dogs that are switched to a grain-free raw diet do very well, often better than they have in their entire lives. In general, you want to stay away from all grains and other starchy foods that take a long time to digest, such as potatoes and corn, limit the amount of fiber (from vegetables), and avoid dairy, to see if that helps.

    Problems with grains may be related to food allergies, or to difficulty digesting carbohydrates, or to gluten intolerance. Sources of gluten include wheat (including Kamut and spelt), barley, rye, and triticale; oats are considered questionable (oats are gluten-free but processed oats can be contaminated with gluten), while buckwheat, corn/maize, and rice are gluten-free. Dogs with gluten intolerance may also react to dairy products and to soy. Grains can contain molds or storage mites that can cause an allergic reaction as well.

    Many dogs with IBD and other gastrointestinal problems have difficulty digesting fat and may need a low fat diet. In those cases, you may be able to supply additional fat and calories with coconut oil, which contains a form of fat called medium-chain triglycerides (MCTs) that are easier to digest. Use virgin (unrefined) coconut oil stored in glass jars and give up to 1 teaspoon per 10 lbs of body weight daily, but start with much less and increase only gradually as you see your dog can tolerate it. Dairy fat also contains MCTs. See the following for more information on MCTs:

    Use of Medium Chain Triglycerides in Clinical Nutrtion
    Medium Chain Triglycerides
    For IBD, colitis, and other forms of gastric irritation, here are some supplements that may help: See the human-oriented article on Gastrointestinal Repair Nutrients for some additional information on supplements used to help heal the digestive tract.

    See my post on Inflammatory Bowel Disease that discusses a recent veterinary conference Update on Inflammatory Bowel Disease, which talks about diagnosis and treatment for some additional information, including mention of using Budesonide (Entocort® EC) in place of prednisone when immunosuppressive drugs are needed, as it has fewer side effects and may be more effective.

    Here are links to more information on IBD, IBS and Colitis, as well as some other causes of chronic diarrhea:

    Colitis in the Dog and Cat good list of possible causes, plus how to differentiate between small- and large-bowel diarrhea
    Colitis in Dogs and Diarrhea and Loose stool from VetInfo, always a good source
    Diarrhea information from WSU College of Veterinary Medicine
    Inflammatory Bowel Disease information from Veterinary Partner, another good source
    Inflammatory Bowel Disease in Dogs and Cats information from PetEducation, another good source
    Canine Colitis
    Dietary Management of Chronic Diarrhoea good information on diagnosis as well from SpeedyVet
    Dietary Fibre and Gastrointestinal Disease more from SpeedyVet
    Treating Acute Diarrhea And Chronic Diarrhea in Dogs commercial site, but one I trust, written by a vet
    Beja anecdotal information from one dog owner who has been thru this
    Inflammatory Bowel Disease Update (human oriented)
    IBD/IBS Archive from Holisticat (cat oriented)
    Parasites:
    Parasites of the Digestive System
    All about intestinal parasites
    More technical:
    Diet and Large Intestinal Disease in Dogs and Cats
    Update on Inflammatory Bowel Disease
    Inflammatory Bowel Disease in Dogs
    Clinical and Nutritional Aspects of Managing Gastrointestinal Health, Diabetes, and Obesity
    Intestinal Disorders in Dogs and Cats
    Diagnosis and Management of Refractory Diarrhea
    Histocytic Colitis in Boxers and other Large Bowel Diseases
    Advances in Dietary Management of Gastrointestinal Disease
    The Most Common Digestive Diseases: The Role of Nutrition see particularly Chapter 6: Chronic diseases of the intestinal tract causing diarrhea
    Holistic Approaches to Inflammatory Bowel Disease
    There is an email group often recommended for people whose dogs have IBD: IBDogs

    SIBO and EPI

    Diarrhea and other stool problems can also be caused by diseases such as SIBO (Small Intestine Bacterial Overgrowth) and EPI (Exocrine Pancreatic Insufficiency). SIBO can be related to IBD.

    Symptoms of SIBO include loud stomach noises, lots of gas, increase in stools, often mushy, and many times, DECREASED appetite and loss of weight. SIBO may be linked to a Vitamin B12 (Cobalamin) deficiency, which occurs due to problems absorbing this vitamin, not due to dietary deficiency. It is treated with B12 injections, and usually with Tylan (tylosin), an antibiotic powder, or Oxytetracycline. Antibiotics must be given for 4 to 6 weeks to be effective. Tylan is very bitter, so is best given in capsule form. It is expensive, but you can find it cheaper in bulk and just put it into capsules yourself using an inexpensive capsule maker (apparently the 00 size capsule holds 1/4 teaspoon). Additional treatment should include probiotics, and may involve feeding a low fat diet and/or a novel protein diet, if food sensitivities are suspected. L-glutamine might also be helpful in repairing the intestinal mucosa (give 500 mg per 25 lbs of body weight). In German Shepherd Dogs, SIBO may be a primary condition, but in other breeds, it is considered secondary to other gastrointestinal conditions, such as IBD, EPI, delayed intestinal transit due to partial obstruction or other causes, food sensitivities, etc., so it is important to find and treat the primary condition, and not just the SIBO. The most common test for SIBO is a blood test sent to the GI Lab at Texas A&M. It is a Cobalamin (B12) & Folate test (dogs with SIBO usually, though not always, have low Cobalamin and/or high Folate). If you run these tests, it makes sense to also run a TLI (for EPI) because if the results of the B12 or folate are off they are going to tell you to first rule out EPI (see below for more info on EPI). Go to http://www.cvm.tamu.edu/gilab/assays.asp to read about these tests (they are the first two listed).  Dogs are required to be fasted 12 to 18 hours before the test. Note that B12 injections are colored red and may cause the urine to be a reddish color. See Bacterial Overgrowth in Dogs-More Common Than You Think for more info.

    Symptoms of EPI include INCREASED appetite; huge fluffy, smelly, gray or yellowish stools (often described as "cow patty stools"); frequent defecation; weight loss; gas; and loud stomach noises (called borborygmus). The dog's pancreas doesn't produce enough digestive enzymes to break the food down and therefore no matter how much they eat, they can't digest their food and therefore they are literally starving. Loss of weight can be rapid. EPI is most common in German Shepherd Dogs, but occurs in other breeds as well. Dogs with chronic pancreatitis have an increased risk of developing EPI. A blood test called TLI (trypsin-like immunoreactivity) is used in combination with tests for Folate and Cobalamin to confirm a diagnosis of EPI.

    This condition is treated with prescription powder enzymes, such as Viokase. Viokase is hundreds of times more potent than the standard digestive enzymes you would find in a health food store. Viokase is very expensive, but there are generic equivalents such as Biokase that are a little cheaper (see below). Once your dog is stabilized, you can also try reducing the dose to see if the improvement can be maintained with less, as dosage needs often decrease over time.

    Alternatively, raw cow or pig pancreas can be used to supply digestive enzymes; see this article on Exocrine Pancreatic Insufficiency for more information. See the sections on Frozen Raw Food Products and Raw Food Co-ops and Local Groups for help finding a supplier in your area (companies that supply parts may be able to get you pancreas even if it is not in their product list). You can also talk to butchers, ranchers and livestock processors in your area to see if they can supply you with raw pancreas.

    See Gastrointestinal Function Tests  in Dogs and Cats for more info on interpreting the results of TLI, folate and cobalamin tests. See Chapter 1, Exocrine Pancreatic Insufficiency, for detailed, technical information on EPI diagnosis and treatment.

    Note that Medium Chain Triglycerides (MCTs) may be easier for a dog with EPI to digest. Studies show that digestions of MCT fats in dogs with EPI is reduced only by about 25%, while digestion of long chain triglycerides (LCTs) is reduced by about 95%. MCTs are found in milk fat and in coconut oil. See Use of Medium Chain Triglycerides in Clinical Nutrtion for more information on this topic. Note that when supplementing with coconut oil, you should use virgin (unrefined) oil in glass jars. You can give as much as 1 teaspoon per 10 lbs of body weight daily, but start with less and build up.

    Low-fat diets are traditionally recommended for dogs with EPI, but surprisingly diets with 43% calories from fat have been shown to promote better protein, fat and carbohydrate digestibility compared to diets containing 18% and 27% calories from fat in dogs with experimental EPI. Another study failed to show any significant benefit of severe fat restriction (13% of calories). These observations suggest that feeding a higher fat and thus more energy dense diet could promote a rapid restoration of optimal body weight without recourse to medium chain triglyceride oil. However, I would exercise caution when increasing the amount of fat in the diet, as dogs with EPI may also have fat intolerance, so increased levels of fat may lead to diarrhea in some dogs. See Exocrine Pancreatic Insufficiency, pages 170-72 (11-13 of 32) and 189 for more information.

    Dogs with EPI will benefit from a low-fiber diet, regardless of the amount of fat in the diet.

    Also note that there are studies, including one in the publication above on MCTs,  showing the bacterial lipase works better for dogs with EPI than pancreatic lipase, and is supposed to be less expensive. Unfortunately, all I can find on this are studies, not products. If anyone knows of any bacterial lipase products, I would appreciate it if you would let me know.

    Links to more info on EPI, SIBO, and their treatment:
    Tylan
    Viokase-V (this site also carries BioKase and Pancreved)
    Viokase-V (this site also carries Pancrezyme and generic alternative Epizyme)
    BioCase V from Thomas Labs
    Exocrine pancreatic insufficiency
    Pancreatic Insufficiency
    Exocrine Pancreatic Insufficiency (EPI) (search for EPI)
    What is exocrine pancreatic insufficiency?
    Pancreatic Insufficiency (Maldigestion Disorder)

    There is an email group for people with dogs that have EPI: k9-EPIGLOBAL

    Addison's Disease

    Non-specific gastrointestinal signs are a common indication of Addison's Disease, even if electrolytes (sodium and potassium) are normal. These signs may include vomiting, diarrhea, inappetance, dark tarry stools (melena -- approximately 15-20% of dogs with Addison's will have this symptom) or blood in the vomit, especially if symptoms improve when the dog is given fluids and Prednisone, then later worsen again. 5% of dogs with Addison's may have acute gastroenteritis resembling Parvo or HGE (Hemorrhagic Gastroenteritis). Dogs that appear to be in acute renal failure (high creatinine and BUN, with low urine specific gravity) may also have Addison's Disease. Low cholestereol, low protein (globulin and albumin), and elevated liver enzymes may point to Addison's Disease. Hypoglycemia (low blood glucose), or Hypercalcemia (high blood calcium)  may also be signs of Addison's. A sick dog with a normal lymphocyte count may have Addison's. Signs of weakness and even collapse that come and go point strongly toward Addison's Disease.

    The test for Addison's Disease is called an ACTH Stimulation test, it involves taking blood, then injecting the dog with a specific stimulant, waiting one hour, then taking blood again. It is safe and relatively inexpensive (I paid around $100 in 2003 to have my dog tested, and my vet is quite expensive).

    One of the medications used to treat Addison's Disease is called Florinef. It is expensive when purchased from your vet, but you can get it for much less form compounding pharmacies. Compounding pharmacies can also provide a liquid version which may be easier to get the proper dosage, especially for small dogs. Here are some compounding pharmacies that offer Florinef:
    Tiffany Natural Pharmacy (recommended by people on the K9Addisons list)
    Florinef for less lists a number of pharmacies that offer compounding for Florinef

    Please see the following sites for more information on Addison's Disease in dogs:

    Addison's Disease: Uncommon or Underdiagnosed?
    Canine Addison's Info
    Addison's Disease (Hypoadrenocorticism)
    Addison's Disease (Hypoa