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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."

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 soluble fiber 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). Puritan's Pride and Vitacost have the best prices I've found; 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, you should 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.

Note that many liver supplements contain similar ingredients, so if you give more than one at a time, you may be overdosing some things. For example, Liver Support Factors contains 100 mg of l-methionine per tablet, which is part of the s-adenosyl-methionine (SAM-e) found in Denosyl and SAM-e supplements. Liver Support Factors also contains milk thistle (silybum marianum, which is included in Denamarin (a combination of SAM-e and the milk thistle extract silybin) and other liver support supplements. It would be better to rotate between different supplements rather than doubling up on some of these ingredients.

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 are several email lists at Yahoo Groups related to liver disease in dogs:
Canine Liver Support
DogLiverDisease
CanineLiver-d
Liver_Shunt_And_MVD_Support
LiverShuntChat

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."

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)
The ALP is elevated. What now? (scroll down)
Tests for Liver Disease in Dogs and Bloodwork differentials for dogs and Bloodwork- Alkaline Phosphatase
Bile Acids Overview
Urine Bile Acids Testing
Urine Bile Acids Testing
Leptospirosis in Dogs (lepto can cause liver disease as well as kidney disease)

• Taurine is an amino acid that is good for the heart. Taurine deficiency may be linked to feeding certain lamb and rice diets, and to feeding very low-protein diets. Studies suggest that taurine supplementation may be helpful for dogs with heart failure even when no deficiency exists. Certain breeds of dogs have been found to develop dilated cardiomyopathy (DCM) that is linked to taurine deficiency. Affected breeds include the American Cocker Spaniel, Porguguese Water Dog, Newfoundland and Golden Retriever. Other breeds that may be affected include the Scottish Terrier, Border Collie, Doberman Pinscher, and potentially other large and giant breeds as well. It is less likely that DCM in the Doberman Pinscher and Boxer is related to taurine deficiency, though supplementation will not hurt. Give as much as 250 mg to a small dog, 500 mg to a medium dog and 750 mg to a large dog, twice a day. Taurine is 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. Lamb and rice diets may contribute to taurine deficiency, either due to the effect of rice or a lower availability of taurine in lamb.
• Carnitine is another amino acid that helps to keep the heart strong. Certain breeds, particularly Boxers, as well as Cocker Spaniels, Springer Spaniels, and Doberman Pinschers, may be affected by dilated cardiomyopathy (DCM) that is linked to carnitine deficiency, and improves when supplements are given. Even when there is sufficient carnitine in the diet and blood levels are normal, providing additional carnitine may improve cardiac function. For Boxers and Cocker Spaniels who have DCM, you can give as much as 20 to 45 mg per pound of body weight daily. For other breeds, or dogs who do not have DCM, 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 OK (this supplement is expensive). 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.
• Arginine is another amino acid that may provide beneficial effects for dogs with CHF (congestive heart failure) by improving endothelial function and cardiac output, and may result in improved exercise tolerance and decreased dyspnea (shortness of breath).
• Fish oil such as salmon oil or EPA oil (not cod liver oil) provides the omega-3 fatty acids EPA and DHA that can be beneficial for heart disease. These omega-3 fatty acids reduce inflammation and improve cardiac cachexia (lean muscle loss/muscle wasting), and may help with anorexia (loss of appetite) and arrythmias. Dogs with heart failure have lower concentrations of EPA and DHA in their blood. Give one 1,000 mg fish oil that contains 300 mg combined DHA and EPA per 10 pounds of body weight daily, preferably split into two doses, for dogs that are symptomatic (you can give half that amount to dogs before they show any symptoms, i.e. one gelcap per 20 lbs of body weight). If you are using more concentrated supplements that contain 500 mg combined EPA and DHA per gelcap, then give one gelcap per 16 pounds of body weight daily. Flax seed oil is not recommended, as the omega-3 fatty acid ALA it contains must be converted to EPA, which happens at a very low rate in dogs, if at all. Be sure to also give vitamin E whenever you supplement with oils: 100-400 mg per day, depending on the size of the dog. Vitamin E it is also good for the heart.
• CoQ10 (Coenzyme Q10) is an antioxidant that may be beneficial for dogs with heart disease, particularly DCM. Give up to 1 mg per pound of body weight daily, divided into two doses. Q-Gel or a comparable oil form should be used, it is much more bioavailable than the dry form.
• 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 (100 to 400 IU daily), and Garlic (one minced clove for a large dog, half for a medium dog and 1/4 for a small dog). Other antioxidants may also be helpful.

Diet
Diets for dogs with heart disease should be high in protein, particularly meat, which supplies amino acids that are good for the heart and helps to preserve lean body mass. Beef heart and other heart meats may be particularly beneficial.  The amount of fat in the diet may need to be increased for dogs with cardiac cachexia (muscle wasting), or decreased for dogs that are overweight, but should remain moderate rather than low. Carbohydrates should also be reduced for dogs that need to lose weight. See the section on Senior and Overweight Dogs for more information on how best to achieve weight loss.

Sodium should be moderately restricted in early stages of heart disease, and more severely restricted in late stages (severe restriction may actually be harmful in early stages). The use of ACE inhibitors such as Enalapril or Benazepril reduce the need for severe sodium restriction. With early stage heart disease, avoid feeding diets that have over 100 mg of sodium per100 kcals. With mild to moderate heart disease, sodium should be restricted to 50-80 mg/100 kcals in the main diet, and with advanced heart disease, sodium should be less than 50 mg/100 kcals. At all stages, avoid treats and table scraps that are high in sodium, such as baby food, pickled foods, bread, pizza, condiments (e.g., ketchup, soy sauce), lunch meats and cold cuts (e.g., ham, corned beef, salami, sausages, bacon, hot dogs), most cheeses, processed foods (e.g., potato mixes, rice mixes, macaroni and cheese), canned vegetables (unless "no salt added"), and snack foods (e.g., potato chips, packaged popcorn, crackers).

Pills can be given in pieces of fresh fruit, "no salt added" peanut butter, raw or cooked meat (without salt), or low-sodium canned food. You could also use Pill Pockets -- the smell is very enticing, and you can pinch off just enough to cover the pill, making each one last a long time (I used to think they were too expensive because I thought you had to use a whole pill pocket each time you gave pills). I'm not sure how much sodium they contain, but you can use very small pieces to lessen that concern.

Potassium needs may be increased, if you are giving digoxin or diuretics, or decreased, if you are treating with ACE inhibitors such as Enalapril, or with spironolactone. Monitor blood potassium levels and make adjustments as needed.

Note that many prescription cardiac diets are high in potassium, which may be inappropriate depending on the medications being used.  Some prescription diets are also low in protein, which is always inappropriate for dogs with heart disease. If you are feeding a prescription diet for heart disease, you can improve the quality of the diet by adding high-protein animal-source foods such as meat, eggs and dairy, but be careful not to add foods that are high in sodium, such as cottage cheese and canned fish. Note that prescription diets are not usually necessary unless needed to reduce sodium in later stages of heart disease. This can also be done by feeding a homemade diet. See Balancing a Homemade Diet for more information. You can look up the amount of sodium in various foods on the USDA Nutrient Database.

If your dog does not want to eat, try feeding multiple small meals, and offer different foods. It's more important that your dog eat something than that he eat the best foods for his condition. Foods that are higher in protein and fat are likely to be the most palatable.

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 herb is 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.

Dilated Cardiomyopathy (DCM) 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. 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). Cocker Spaniels, Golden Retrievers and Newfoundlands are some of the breeds that are prone to Dilated Cardiomyopathy that may be related to taurine deficiency. See the following sites for more specific information:
Dilated Cardiomyopathy in Dogs (see page 2)
Dilated Cardiomyopathy
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 (see page 6)
Taurine status in normal dogs fed a commercial diet associated with taurine deficiency and dilated cardiomyopathy

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. The Cardiopet proBNP Test from IDEXX Labs 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. 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.

There is a new DNA test available for detecting the mutation that causes cardiomyopathy in Boxers. It's done with a cheek swab and costs around $70. See the following for more info:
New genetic test is a breakthrough for Boxers — and people, too
Vet cardiologist discovers gene for heart disease
Have Your Dog Tested for the Arrhythmogenic Right Ventricular Cardiomyopathy Mutation

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

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

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.

 

I've used the following solution with success: Mix 1 ounce witch hazel with 1 ounce aloe vera gel, then add a few drops of lavendar oil. Use this mixture to clean the ears daily for three days, then weekly after that. Witch hazel is drying, which is good.

Zymox Otic has been recommended by several people as helping when nothing else seemed to work. It is supposed to be effective for both yeast and bacterial infections. You can get it with or without hydrocortisone (which helps control itching). Click here for more information. There is also an Ear Solution for regular cleaning. Both are available thru Amazon and VetAmerica

Blue Power Ear Treatment is a mixture of alcohol, boric acid powder and gentian violet. I have used this solution in combination with the witch hazel/aloe vera mixture above with success in treating a long-term yeast infection, but I still hesitate to recommend it. Both alcohol and gentian violet are ototoxic (can cause deafness) if the eardrum is ruptured. The solution dries the ear out (probably due to the alcohol), which really seems to help stop the yeast from multiplying. It can be irritating to the ear, though, so I don't use it as frequently as recommended. It can also be very painful if ears are inflamed. Some people have used witch hazel or a combination of witch hazel and aloe in place of the alcohol in the recipe for a dog with very sensitive ears, or for long term use with a dog prone to yeast infections.  K9 Ear Solutions from Liquid Health uses alcohol, boric acid and gentian violet, along with colloidal silver. Gentian Ear Treatment from Urban Carnivore is a combination of witch hazel, boric acid and gentian violet. Gential violet "has the potential for severe damage" according to this article on ototoxicity.

Another recipe that is somewhat similar to the Blue Power Ear Treatment above combines 6 oz alcohol with 1/2 tablespoon boric acid powder, 2 oz white vinegar, and one teaspoon betadine. Boric acid is commonly used in ear medications. Vinegar is a source of acetic acid, which is often used in ear cleaning solutions to combat yeast. The combination of boric acid and acetic acid can also be effective against pseudomonas. Both of these ingredients appear to be safe even if the eardrum is ruptured (many other ingredients can cause ototoxicity/deafness if used when the eardrum is not intact). Betadine is an iodine solution that is antibacterial and may help to soften wax and loosen other debris. Alcohol is drying, but can be irritating if the ears are inflamed, and may be harmful if the eardrum is ruptured. It shouldn't be used frequently, or if the ears are inflamed or the eardrum is not intact. You could replace some or all of the alcohol with either sterile saline (which is not drying, so would leave the ear more moist, which could be a problem with yeast) or witch hazel, which is an astringent and has some drying properties. Another astringent is Burow's Solution/Domeboro, which contain aluminum acetate. See the following web sites for more information: http://www.zimfamilycockers.com/EarCleaner.html MalAcetic Otic Burow's Solution Bur-Otic HC Ear Cleanser

Pellitol ointment was recommended by a vet in an article in the Whole Dog Journal (June 2004). She says to completely fill the ear canal with Pellitol, massage the ear, especially around the base, then leave it undisturbed for a week (this is one case where filling the ear is appropriate). The ointment will dry up and flake off, taking the ear's debris with it. You can then use cotton balls or Q-tips to remove whatever is left. If the ear is not ulcerated, bleeding or painful, you can put a pinch or two of boric acid powder in the ear first, using your finger or a Q-tip to work it in, before applying the Pellitol. Remember that boric acid is toxic, it is important to be sure that none gets in they eyes, mouth or nose if you use it. Sometimes a second treatment with Pellitol is necessary, or you may need to flush the ear to complete the therapy. Cleaning with a regular cleaning solution on an ongoing basis should be done to prevent problems from recurring. Pellitol is also available at VetAmerica.

Vinegar (acetic acid) in various combinations is often recommended. Vinegar helps to control yeast and fungus. Note that alcohol is drying, which can help with yeast, but it can also be painful if the ear is inflamed, so use with caution. I have seen a variety of recipes, including:  Mix 2 tablespoons apple cider vinegar (acetic acid) with one cup of (warm) water.  Mix equal parts of alcohol and white vinegar. Mix 3/4 white vinegar with 1/4 water. Mix 3/4 apple cider vinegar with 1/4 witch hazel. White vinegar may be the better choice for yeast.

Probiotic Powder or Acidophilus can be used both orally and in the ears to help clear up yeast infections.

For yeast infections, you can also use Monistat or Massengill Vinegar & Water Douche or other over-the-counter treatments for vaginal yeast infections in women. Apply creams gently using a Q-tip.

DermaPet® Ear/Skin Cleanser , which contains both Acetic Acid (vinegar) and Boric Acid, has been recommended for treating both yeast and bacterial infections of the ear.

Vodka/Boric Acid: Use an 8 oz bottle and fill with about 6-1/2 oz of vodka. Into the vodka put about a tablespoon of boric acid powder and shake vigorously. Make a saturated solution so keep adding the powder until it no longer dissolves. Squirt into the ear and massage, let them shake their heads, then wipe out with cotton pads. If there's a lot of gunk, do this twice a day. Works for sore ears and infection. Vodka is supposed to be less harsh than rubbing alcohol.

Mix Betadine and (warm) water half and half. Betadine, like alcohol, is drying but can be irritating, so use with caution.

Other things that have worked for some people include:

• adding organic apple cider vinegar to their food (anywhere from 1/2 teaspoon to 1 tablespoon, depending on the size of the dog)
• cleaning with olive oil (just on the cotton ball, not instilled in the ear)
• supplementing with Noni Juice
• treating the ear with acidopholus powder (just break open the capsule and sprinkle the powder in the ear after cleaning),
• treating the ear with whole milk yogurt
• acupuncture/acupressure.
• Lavender essential oil can be effective against yeast, but should not be used straight, it is better to mix it with witch hazel or a carrier oil, and should not be used at all on cats, toy breed dogs, or very young puppies.
• A fellow Shar-Pei owner was successful using Colloidal Silver to treat yeasty ears.
• Another person added Ascorbic Acid (a form of vitamin C) to acidify the body and it helped clear up a yeast problem in the ears. If you try this, be sure to use Ascorbic Acid, and not one of the ascorbate forms of vitamin C, which are not acidifying. Also, increase vitamin C slowly, as too much will cause loose stools.

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 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)
Hy-Otic Ear Rinse contains hyaluronic acid to help with healing if the eardrum is injured (common with severe infections)

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:

• Fast the dog for 12 to 24 hours (liquids only) to give the gut time to heal. It will heal quickly if given the opportunity, but if food keeps irritating the digestive tract, the diarrhea may continue and your dog runs the risk of dehydration and possible other problems. For puppies and very small dogs, you may need to limit the fast to 12 hours or less to avoid problems like hypoglycemia. Make sure your dog drinks enough liquid during this time to avoid dehydration. Broth made from vegetables, rice, and meat and bone is good for providing electrolyes; serve only the liquid at room temperature several times a day. Rice congee (see below) can also be used. Do not continue to fast your dog after the initial 24 hours. If diarrhea continues without improvement, you should then see your vet.
• Rice congee is made by boiling one cup of white rice (not minute rice) in four cups of water for 20 to 30 minutes. The liquid is soothing and can help stop both vomiting and diarrhea. Mix in a little chicken baby food or honey for flavor, if needed. Start by feeding the liquid alone, then try mixing the rice as well with cooked chicken breast or boiled ground beef.
• Probiotics (beneficial bacteria) help to keep harmful bacteria in check and restore intestinal balance. They can be added to rice water or other food. There are two strains that may be particularly good for dogs: Lactobacillus sporogenes (available at Amazon) and Enterococcus faecium, a strain that is native to dogs. Several canine probiotic supplements, such as Jarrow Formula's Pet Dophilus Powder, contain Enterococcus faecium. You can also use products made for people, available from your health food store or department. Continue to add probiotics for several days up to six months, to help repopulate the beneficial bacteria in the gut.
• Feed small, frequent meals after fasting, if possible. Feed boiled chicken or hamburger (boiling will remove the fat), baby food or cottage cheese, along with white rice (overcooked with extra water) or other bland foods, such as white bread.
• Add pumpkin to the food. Pumpkin helps by absorbing the liquid in the system and adds fiber to help firm the stool. Canned pumpkin (not pumpkin pie mix) works fine. Use small amounts only, as too much can actually lead to loose stools. Sweet potatoes are also supposed to help.
• Cabbage juice is also recommended for soothing and helping to stop diarrhea.
• Enteric coated peppermint, which you can find in a health store. Peppermint helps with the lower bowels, but must be coated to make sure they reach there intact. This is given 15 minutes before a meal. You can also try peppermint tea. Do not use peppermint in any form if your dog has problems with reflux.
• Ginger is also good for both nausea and diarrhea. You can use ginger capsules or ginger tea.
• I've seen several products recommended from people who have used them successfully with their dogs. Note these products are not meant to be used for more than three days at a time (numbers in parentheses are posts where these products are mentioned):
• Diarsanyl for dogs with periodic colitis or occasional acute diarrhea. It contains Montmorillonite clay, which should be safe to use as directed (twice daily for three days). This product is also safe for cats and is available in other countries as well as the US. Also available at Amazon. (133305, 133355)
• Bene-Bac Pet Gel beneficial bacteria (probiotics), also available at Petsmart and Amazon
• Forco (164229)
• Dia Bac Diarrhea Control (134279)
• Fast Balance-G.I. also called Immediacare G.I. and Quick Relief all made by a company I like and trust. Also available at Amazon: Fast Balance, Immediacare, Quick Relief. (149706)
• Endosorb (124057)
• MediBulk from Thorne Veterinary
• Certain over-the-counter human anti-diarrhetic products can be used for up to three to five days. There are several things to be aware of when using these products:
• Pepto-Bismol and now Kaopectate (which was recently reformulated) contain salicylates, which are related to aspirin and may cause gastric problems, although these products are used for dogs. Warning: Do not use any product that contains salicylates if your dog is also getting aspirin or any NSAID drug (Rimadyl, Deramaxx, Metacam, Etogesic, etc.) without your veterinarian's direct advice, and never use them at all with cats. There are other  kaolin-pectin products such as Pet Pectillin, Durvet Kaolin-Pectin, Proviable KP and Priority Care Kaolin-Pectin that do not contain salicylates and would be a safer choice, or you can use plain Pectin.
• Imodium (loperamide) can be used for severe diarrhea to help reduce fluid loss, but it may cause problems for certain breeds of dogs, notably Collies and also Australian Shepherds (including miniatures), Shetland Sheepdogs, and Old English Sheepdogs, plus English Shepherds, German Shepherds, McNabs, Long Haired Whippets and Silken Windhounds, Imodium is contraindicated for dogs with intestinal infections, as it slows GI transit time which increases absorption of toxins from bacteria (see Drugs Used in Treatment of Diarrhea). A single dose is probably OK, but if your dog needs more than that, you should see your vet. See Loperamide (Imodium AD) for more info. Also see Multidrug Sensitivity for an article about other drugs the breeds above may be sensitive to, which include Ivermectin, certain chemotherapy drugs, digoxin, and possibly morphine. 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.
• One vet recommended Metamucil. Although Metamucil is commonly used as a laxative, apparently the fiber can help absorb water in the colon and thus control diarrhea. It is important that your dog drink lots of water when taking a supplement like this.
Dosage for most of these products is given in the links above. For others, adjust the dose according to the size of your dog (large dog would get an adult human dose, medium dog half the dosage for an adult human, small dog one quarter the dosage). None of these should be used long-term, just on occasion as needed. If diarrhea continues for more than a day or two, or if your dog is showing other symptoms such as vomiting, fever, lethargy, etc., see your vet rather than trying to treat at home.
• There are several natural remedies that will help soothe and heal the gastrointestinal tract. These include slippery elm bark, l-glutamine (an amino acid supplement), and marshmallow root (herb). Phytomucil (also available in 4 oz size) from Animal's Apawthecary contains two of these. I have also seen a Chinese Herbal remedy recommended called Huang Lian Su that can be used for dogs, but I personally am somewhat leery of using these types of remedies without the specific advice of a holistic vet trained in Traditional Chinese Medicine..
• Carob powder can also be used to treat diarrhea, as well as vomiting and lack of appetite, just add 1/2 to 2 teaspoons to food, honey, water or yogurt three times a day for three days.
• Here is Dr. Pitcairn's recipe for using slippery elm bark for diarrhea, from his book, Dr. Pitcairn's New Complete Guide to Natural Health for Dogs & Cats:

Thoroughly mix 1 slightly rounded teaspoon of slippery elm powder with 1 cup of cold water. Bring to a boil while stirring constantly. Then turn the heat down to simmer and continue to stir for another 2 to 3 minutes while the mixture thickens slightly. Remove from the heat, add 1 tablespoon of honey (for dogs only -- cats don't like sweets, so leave it out), and stir well. Cool to room temperature and give 1/2 to 1 teaspoon to cats and small dogs (under 20 lbs), 2 teaspoons to 2 tablespoons for medium dogs (20 - 40 lbs), and 3 to 4 tablespoons for large dogs (over 40lbs). Give this dose 4 times a day, or about every 4 hours. Cover the mixture and store at room temperature. It will keep for a couple of days.
Slippery elm capsules are available at health food stores. Urban Carnivore offers a convenient powder form. Powder form is also available at Amazon.
• Digestive enzymes can help dogs who have a problem digesting fat, which often results in a mucousy stool.
• For dogs prone to diarrhea, the following supplements given on an ongoing basis may help:
• L-glutamine, at the rate of 500 mg per 20-25 pounds of body weight (more is OK)
• Gastriplex (Thorne Veterinary), also available from HolisticPetInfo
• Total Digest also called Acetylator and Digest Discovery
• Enhance Digestive Aid
• Perfect Form, from The Honest Kitchen
• Berte's Digestion Blend
• Perma-Clear (Thorne Veterinary), also available from Naturamart.
• Diarrhea can be caused by worms and other parasites. If it continues for more than a couple of days, see your vet to determine the cause and to make sure your dog is not getting dehydrated. Keep in mind that some parasites, including whipworms and coccidia, may be difficult to spot on a fecal exam. Sometimes it makes sense to treat with Panacur to see if it helps, even if the fecal is negative.
• There are many other causes of diarrhea. Too much food can lead to loose stool. Certain supplements, foods or additives can cause a reaction in some dogs. Too much vitamin C (the amount varies by dog) causes loose stools. Too much fat in the diet can lead to loose or mucousy stools.

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 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.

Chronic pancreatitis may be a cause of diarrhea, particularly if vomiting, anorexia (loss of appetite), or abdominal pain is also present, but symptoms may be as subtle as not wanting to play or skipping meals occasionally. There's a blood test your vet can do to find out whether pancreatitis is contributing to your dog's problems called the Spec cPL.

Many dogs with IBD, chronic pancreatitis, or 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

• N-Acetyl Glucosamine (NAG) is a form of glucosamine that helps to repair the intestinal lining. It may be especiallyl helpful for dogs with IBD. It is found in many digestive supplements, or can be purchased separately at a health food store. Products that contain NAG include:
• Acetylator made by Vetri-Science, also called Total Digest by Mountain Naturals, and Digest Discovery, by US Animal Nutritionals
• Gastriplex by Thorne Veterinary, also available from HolisticPetInfo
• Berte's Digestion Blend
• L-glutamine and Slippery Elm Bark can also help soothe the digestive tract and relieve inflammation. L-glutamine in particular helps to repair the mucosal lining of the digestive tract. L-glutamine is a single amino acid that should not provoke an allergic reaction, even in dogs with severe food allergies.
• Phytomucil is an herbal supplement that can help with IBD and other digestive problems. It contains slippery elm along with marshmallow root, licorice root; and plantain leaf, which are herbs that are beneficial for the digestive tract.
• Seacure is hydrolyzed fish protein shown to help with leaky gut syndrome and malnutrition. Because it is hydrolyzed, it should not provoke an allergic reaction even in dogs with severe food allergies. It is at least 40% l-glutamine, so I don't know whether it's more effective than plain l-glutamine (which is much less expensive) or not.
• Probiotics can help replenish the friendly bacteria and eliminate the pathogenic bacteria in the intestines. There are two strains that may be particularly good for dogs: Lactobacillus sporogenes (available at Amazon) and Enterococcus faecium, a strain that is native to dogs. Several canine probiotic supplements, such as Jarrow Formula's Pet Dophilus Powder, contain Enterococcus faecium. You can also use products made for people, available from your health food store or department.
• Prebiotics help support the beneficial bacteria in the intestines, which may help with digestive disorders. Larch arabinogalactan is a form of soluble fiber that is frequently used as a prebiotic, found in supplements such as Arabinogalactan Powder from Vetri-Science/Food Science and Arabinogalactin. Fructooligosaccharides (FOS) are another form of soluble fiber used as a prebiotic that is often included in  probiotic supplements.
• Fish Oil (such as salmon oil or EPA oil, not cod liver oil), which contains the vital omega-3 polyunsaturated fatty acid EPA, can help break the inflammatory cycle in colitis as it does in rheumatoid arthritis and psoriasis. Some studies have been done that indicate supplementing with omega-3 fatty acids can help with intestinal inflammation. Fish oil is the best source of these and has been found beneficial in human patients with IBD. Give a maximum of 1 gram (1,000 mg, which generally includes a combined total of 300 mg EPA and DHA fatty acids -- you can use fewer gelcaps if the fish oil has more EPA and DHA) per 10 pounds of bodyweight. Be sure to also give vitamin E whenever you supplement oils, 200-400 mg daily or every other day for a large dog. Evening Primrose Oil or Borage Oil may also be helpful, due to a high content of gamma-linolenic acid (GLA). Be sure to also give vitamin E whenever you supplement oils. Note that fish oil may be contra-indicated in dogs with fat intolerance.
• Coconut Oil contains medium-chain triglycerides (MCTs) that are a form of fat that does not require the same type of digestion as other types of fat, and so can be used for dogs with pancreas problems or fat intolerances. Be sure to use only virgin (unrefined) oil in glass jars. Dosage is 1 teaspoon per 10 lbs of body weight daily, but start with less and build up.
• Enteric coated peppermint, which you can find in a health store, can be helpful for dogs with colitis. Peppermint helps with the lower bowels, but must be coated to make sure they reach there intact. This is given 15 minutes before a meal. Do not use peppermint in any form if your dog has problems with reflux.
• Other herbs that may help with colitis and gastrointestinal inflammation include yucca herbal tincture or glycerite (such as Yucca Intensive), quercetin (bioflavonoid, available at Amazon), bromelain (an enzyme that may work synergistically with quercetin, available at Amazon), boswellia (herb, available at Amazon) and curcumin (a spice, also called turmeric).
• Digestive enzymes are helpful to some dogs. Most dogs with colitis need help with digestion of the nutrients for best assimilation, but occasionally enzymes may make diarrhea worse, so discontinue or try a different brand or type (plant-based, animal-based/pancreatin, or soil-based) if you don't see improvement.
• There is also anecdotal evidence of Bovine Colostrum being helpful, available at Amazon.

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
Natural Aids For Treating IBD Talks about the use of herbs and supplements
Beja anecdotal information from one dog owner who has been thru this
Inflammatory Bowel Disease Update (human oriented)
Inflammatory Bowel Disease from Holisticat (cat oriented)

Parasites of the Digestive System
All about intestinal parasites

Food trials and tribulations for allergic pets
Allergy testing for pets: Beyond the food trials and tribulations and onto the big guns

Diet and Large Intestinal Disease in Dogs and Cats
Update on Inflammatory Bowel Disease
Inflammatory Bowel Disease in Dogs
Laboratory diagnosis of intestinal disease in dogs and cats
Dietary allergy/intolerance
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

SIBO and EPI

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

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 (Hypoadrenocorticism) Updated
Addison's Disease (includes links to more info)
Addison Dogs

There are two email groups for people whose dogs have Addison's Disease: K9Addisons and AddisonDogs

• List of symptoms that may mean your dog is hypothyroid by Jean Dodds, DVM
• Diagnosis and Management of Canine Thyroid Disease by Jean Dodds, DVM
• General overview of hypothyroidism in dogs by Wendy C. Brooks, DVM, DipABVP
• Immune System and Disease Resistance by Jean Dodds, DVM
• Thyroid Can Alter Behavior by Jean Dodds, DVM
• Thyroid Dysfunction as a Cause of Aggression in Dogs and Cats by Linda. Aronson DVM & N.H. Dodman RVMS
• Thyroid Testing In Dogs: A Reference by Karen J. Wolfsheimer D.V.M. Ph.D.
• MSU FAQ on Thyroid Function in Dogs
• MSU FAQ on Thyroid Medication and Monitoring
• Autoimmune Disease by Linda Aronson, DVM
• More on AutoImmune Thyroiditis (be sure to read all three pages)
• Information on Thyroid Disorders
• Thyroid Study in Welsh Springer Spaniels by Colleen M O'Keefe, DVM, MS

Thyroid supplements should be given to dogs twice a day, rather than once a day, as is done with humans, as dogs metabolize it faster. When testing thyroid levels after your dog is on thyroid supplementation, it is important to draw blood 4-6 hours after the supplement is given.

The article A Diagnostic Dilemma points out that low thyroid can be a symptom of other problems, not just thyroid disease, and contains a lot of information about thyroid testing and about the need to stop the supplement to see if symptoms return, even if your dog shows improvement with supplementation.

Note that thyroid disease can precipitate or aggravate existing seizure disorders. Also see Thyroid and Seizures. There's also a good general article on hypothyroidism at http://members.aol.com/Tedenbert/bhealth.html. Vaccinations may also contribute to auto-immune disorders, including hypothyroidism.

Adding a small amount of kelp to the diet can be good for the thyroid because of the iodine it contains, but if your dog has thyroid disease, he will need to be treated with a prescription thyroid replacement, adding kelp is not going to cure a thyroid problem unless it was caused by an iodine deficiency, which is unlikely. Selenium deficiency may also contribute to hypothyroidism, so it may be worthwhile to try supplementing with small amounts (no more than about 75 mcg per day for a large dog, proportionately less for smaller dogs). However, supplementing with kelp, and feeding a raw diet, may reduce the amount of thyroid supplementation needed. If you do make such a change to your dog's diet, be sure to monitor his thyroid to see if the dosage needs to be adjusted. Also, be aware that too much iodine (from oversupplementing kelp) can actually lead to hypothyroidism.

There are natural thyroid supplements that may help if the condition is not too bad. Armour Thyroid and Westhroid are natural thyroid supplements that may be used in place of synthetic supplements. These natural supplements contain T3 (as well as small amounts of T4) and may help dogs that cannot convert T4 to T3. Thyrolar and Cytomel are two other supplements that contain T3, for those dogs that continue to have problems despite normal T4 and TSH values. See the following articles for more information on Armour Thyroid vs. Synthroid:
Synthroid: Not FDA Approved!  (click on Synthroid under Articles)
Why Do You Insist on Synthroid Instead of Armour? -- A Patient's Letter
How To Switch From Synthroid To Armour Thyroid

There are also raw thyroid glandulars and glandular supplements that can help support the thyroid gland, but do not actually provide thyroid hormones. These are available from companies like Premier Labs, American Biologics and Nutri-Meds, as well as Thytrophin PMG from Standard Process (the version for dogs is Canine Thyroid Support available at Amazon) and Thymucin made by PhytoPharmica.

Addison's Disease:
K9Addisons
AddisonDogs

Allergies:
ALLERDOG
CanineAllergiesSolutions

Amputation: see Cancer and Orthopedic Problems

Blindness and Eye Problems:
GlindDogs

Cancer:
BoneCancerDogs (frequently recommended)
TriPawds web site and discussion forums on bone cancer and amputation
CanineCancer
CanineCancerAwareness
CanineCancerComfort
CaninesWithCancer
Amputee_Dogs
Artemisinin_and_Cancer
Canine_Cancer
Canines In Crisis (message board)
CircleofGrey (for Greyhounds and Whippets only)
EndlessLove
LymphomaHeartDogs
PetCancer Support Group
TheBlackSalveOpenForum

Collapsing Trachea
YAPCT Support

Cruciate Ligament (Knee) Injuries -- see Orthopedic Problems

Cushing's Disease, Hypothyroidism, and other Auto Immune Diseases:
Cushings
CanineCushings-AutoimmuneCare

Deafness:
DeafDogs

Degenerative Myelopathy
DegenerativeMyelopathyList (frequently recommended)
DMDogs (new in 2009)
DM (message board)

Diabetes Insipidus: (for what is typically called Diabetes, see Diabetes Mellitus below)
Diabetes_Insipidus_Dogs

Diabetes Mellitus:
PetDiabetes
PetDiabetes.com
DiabetesPet
Diabeticritters
MuffinPetDiabetes
Oscars_animaldiabetes_support
PetsWithDiabetes (message board)

Disc Disease: (also see Degenerative Myelopathy and Orthopedic Problems)
AbleDogs
Dodgerslist

Epilepsy:
Epil-K9 (frequently recommended)
Canine-Epilepsy-Guardian-Angels
Canine Epilepsy Network (message board)
K9Epilepsy
K9Epileptics
CHAFWU
Bull Terrier Neurological Disorders (not just for bull terriers)

Exocrine Pancreatic Insufficiency (EPI):
K9-EPIGLOBAL (frequently recommended)

Heart Disease:
CanineHeartHealth
CanineCongestiveHeartFailure
CanineHeartbeats

Hip Dysplasia -- see Orthopedic Problems

IBD and other Gastrointestinal problems:
IBDogs (frequently recommended, but recently started requiring a definitive diagnosis of IBD to join)

Kidney Disease:
K9KIDNEYS
K9KidneyDiet

Laryngeal Paralysis
LP
LPAlternatives

Liver Disease:
Canine Liver Support
DogLiverDisease
CanineLiver-d
Liver_Shunt_And_MVD_Support
LiverShuntChat

Megaesophagus:
Megaesophagus
Canine Megaesophagus

Meningitis:
AMBerners/ (Asceptic Meningitis)

Nail Problems -- see Symmetrical Lupoid Onychodystrophy

Neurological Disorders (also see Degenerative Myelopathy and Laryngeal Paralysis)
BullTerrier_neurological_disorders (open to other breeds as well)

Orthopedic Problems (also see Degenerative Myelopathy, Disc Disease and Wobbler's Syndrome)
Orthodogs (frequently recommended)
CanineHD
TPO
K9Orthopedics
WheelChairDogs
Amputee_Dogs
PetsDisability/ (message board)
HandicappedPets.net/ (message board)
ConservativeManagement

Pancreatitis: (also see Exocrine Pancreatic Insufficiency)
DogPancreatitis (formerly CaninePancreatitis)

Perianal Fistulas
PF-L

Symmetrical Lupoid Onychodystrophy
SLOdogs

Tick Disease:
Tick-L

Wobbler's Syndrome:
Wobblers