nutrition for liver disease

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montydon

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:confused:Hi everybody

I have a 20 yr old Welsh D with liver disease. I think I am feeding him the best diet but I have one area of concern. Protein is mentioned which should be low - I understand that - but 'of the highest quality'. The last bit I am confused about. Can anyone please explain what this means and give me an example of a feedstuff with low but high quality protein. Thanks very much
 
Box of Frogs is the person for liver advice. My yard had a mystery problem last winter and searching old threads brought up lots of good advice from her.
 
Montydon, sorry to hear your horse is unwell but here is the low down on feeding to support a sick or damaged liver, straight from Prof Knottenbelt, a world expert on liver disease in horses:

1. Feed a very low protein diet
2. What protein your horse does have (he will need SOME protein!) should be the very highest quality you can afford as this will mean less work for the liver
3. Feed little and often as this is less work for the liver than big blasts
4. Add Milk Thistle to his feeds to support the liver - D&H do a good quality dried tub
5. Add Yea Sac to his feeds to stimulate a flagging appetite and aid hind gut digestion
6. No conditioning feeds or oils EVER as the liver won't be able to break them down
7. Use starches and sugars for energy but with the obvious precautions
8. If ragwort poisoning is suspected, the condition may be permanent
9. If ragwort poisoning is suspected, keep the horse out of the sun during spring, summer, autumn
10. Be aware that a poorly functioning liver can bring other problems such as blood not clotting properly, distended abdomen, blood in urine etc etc

Let me know if I can help further. I took on a desperately sick rescue gipsy cob - she had terrible ragwort poisoning. With the Prof's helpd + D&H + my own wonderful vets I pulled her back from the brink but it's always a balancing act and any tiny thing can tip such a horse over the edge. Good luck x
 
My understanding of the "quality" of protein is the ratio of branch chain amino acids to aromatic amino acids.

This article by Bryan Waldridge at Kentucky explains some of it quite well, I think:

http://www.ker.com/library/proceedings/12/2012 Conference Proceedings_1268.pdf

Maybe it's worth having a word with a few nutritionists and seeing if any of their products have a better ratio of bcaa's than others?

Sarah
 
Thank you everyone for your support. I have probably read every article I can get my hands on and I have avoided a forum so as not to get any more confused but it is a very difficult situation. Without telling the whole story (as we all have very varying issues with this complaint) I have had a biopsy and it is implicating ragwort although they are also saying that it could be a result of ascending infection etc. He has been on steroids now for the past four months and results have been up and down but my vet says the steroids are keeping things in check and would like me to continue for several more months. I respect vet advice but they do not have to manage the situation.

As there is a real risk of laminitis with the use of steroids ( he is also arthritic with all that that entails) I am treating him as if he is prone, in other words, muzzle soaked hay etc.. However with the risk of laminitis with these steroids (prednisolone) and coming into the winter when the weather may restrict me from exercing him I have decided to wean him off the steroids, with vet advice of course. Vet has advised me that the disease may or may not progress, months or years. As with everything there is no guarantee but there is also no guarantee that the steroids will stop the fibrosis.

This is breaking my heart and I just want to make sure that everything is as good as possible for him in the future.

Sorry to ramble but as you will appreciate this is very difficult for me to comprehend.

So back to the diet -
I will post details later to see if you have any more advice.

Thanks for listening.
 
What I forgot to say - I don't want people thinking I am uncaring - is that long term use of steroids poses other risks and my decision has been one of fine balancing and taken with a lot of heart searching. I feel that the risks outweigh the benefits in my case and I would love to know how you all feel in your own situations.
 
Box_Of_Frogs said:
Montydon, sorry to hear your horse is unwell but here is the low down on feeding to support a sick or damaged liver, straight from Prof Knottenbelt, a world expert on liver disease in horses:

1. Feed a very low protein diet
2. What protein your horse does have (he will need SOME protein!) should be the very highest quality you can afford as this will mean less work for the liver
3. Feed little and often as this is less work for the liver than big blasts
4. Add Milk Thistle to his feeds to support the liver - D&H do a good quality dried tub
5. Add Yea Sac to his feeds to stimulate a flagging appetite and aid hind gut digestion
6. No conditioning feeds or oils EVER as the liver won't be able to break them down
7. Use starches and sugars for energy but with the obvious precautions
8. If ragwort poisoning is suspected, the condition may be permanent
9. If ragwort poisoning is suspected, keep the horse out of the sun during spring, summer, autumn
10. Be aware that a poorly functioning liver can bring other problems such as blood not clotting properly, distended abdomen, blood in urine etc etc

Let me know if I can help further. I took on a desperately sick rescue gipsy cob - she had terrible ragwort poisoning. With the Prof's helpd + D&H + my own wonderful vets I pulled her back from the brink but it's always a balancing act and any tiny thing can tip such a horse over the edge. Good luck x
Click to expand...


Personally speaking Box of Frogs has a lot to answer for.:mad::):) ty BOF
I took her advice and called D&H who put my mare on
sugarbeet /speady beet
high fibre cubes and alfa.

she was doing well but thurs her laminitis blew up bad.


She just could not take the beet. The idea was to give her protein , just enough the sustain her but not upset the laminitis.

It was working , call D&H Teresa is the one to ask for,

I was feeding my mare 10 small feeds a day ie split into that 700grms per feed.

I am using

Legaphyton ( from vets)
milk thistle
yea sac
nettles

other things good for the liver is

dandelion root
licorice
lemon juice

One mistake i did was to use a detox BIG MISTAKE liver disease needs help not a detox.l


NO FAST FIBRE
hifi or anything with straw, this causes amonia to build up and give the horse brain fog

Do not:

use a detox with disease:
nothing with straw in it

http://equinecare-and-control.weebly.com/l.html

usefull facts and links
 
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My Shetland has untreatable liver damage, apart from a slightly pot-belly you would never know. My vet advised me to only give him high fibre feeds, no alfalfa, low protein, no oils etc. He will not eat milk thistle or yea-sacc any more having had it every day for months so he just has Badminton high fibre nuggets twice a day with carrots along with haylage. I was offered steroids but decided against it, I didn't want him getting laminitis on top of his liver problems and he is doing well so far. I do know that there is no more help for him though, and as soon as he shows any signs of illness he'll be PTS.
 
5 horses with liver disease, loads of biopsies, 24k in vets bills- what do you want to know!

Only biopsy will show treatment needed, otherwise it's guess work. Fast fibre and straw fine, trinity consultants for liver support and quality protein, don't bother using food. Get all weight off of using steroids. Been through the lot with top Vets
 
Louis,

please could you expand on what the biopsies showed and how that informed the treatment.

The reason I ask is because I have 5 ponies with liver disease at present (highest GGT being 2,300), and when I had another pony post mortem'd a few months ago, even a thorough look at relatively large sections of liver could not give us enough information to be able to inform treatment of the others.

So I've held off from biopsies so far, but if I hear anything particularly persuasive then I'd reconsider.

Thanks.

Sarah
 
Hi

What do you mean by 'get all weight off using steroids'. The steroids are to slow down the progress of the fibrosis, surely they have nothing to do with weight loss do they? My horse is not overweight. It is the side effects of the steroids (laminitis) that worries me most.
 
If anything, steroids will incrrease weight! Personal experience of this with a neutered male cat with chronic bladder problems. On steroids for 7 years, bless him and he ended up looking like Jabba the Hutt. Didn't help much either.
 
flintfootfilly, previous to my pony being diagnosed, I had another Shetland die from liver damage in 2010. As this was all new to me I had him biopsied after the blood test to determine if there was any treatment available. The biopsy revealed that he was not suffering from any type of poisoning, ragwort or otherwise, but from hepatitis which had been symptomless and had damaged his liver beyond repair. I bought him at weaning from a breeder I had bought from before, in fact the 2 ponies I have now are from her.
I turned down a biopsy on the second pony as vet felt it would be unlikely to be another cause and said pony hates vets and would be stressed at going into the clinic.
 
Louis said:
Fast fibre and straw fine, trinity consultants for liver support and quality protein, don't bother using food. Get all weight off of using steroids. Been through the lot with top Vets
Click to expand...


Straw products caused ammonia build up in the blood and can give brain fog.


Liver disease don't give straw products.

Trinity consultants L94 no good for liver disease IMH caused odema and a behaviour problem. It is a detox too strong for the disease, her liver needs to repair before it could be detoxed, was a waste of money now sits on the shelf along with the setback salts
 
Get weight off because of steroid use! - misstyped!

Sarah - have pm'd you - give me a call pronto!

Get your horses biopsied straight away - without a biopsy you are shooting in the dark big time and just wasting money. Biopsies in my case showed a huge iron deposit in several ponies - this would not have been found any other way. Also the amount of damage. One with the best bloods, had by far the worst liver!! There is a scoring system after boiopsy, this one was given a 90% chance of dying within 6 months if untreated.

First I would move your horses!
 
Interesting to hear your experience of liver biopsies, Louis.

A friend of mine has also found that despite relatively good blood results, a liver biopsy is showing a worse picture, so I do understand that there can be quite a difference in the picture painted by each of these tests. And then of course my own experience of having one pony pm'd and the liver looked at through that actually showed very little problem, and that was with looking at a large area of the liver rather than just a few little needle biopsies. So either way, it can only ever show part of the picture.

I keep reading that clinical signs give the best indication of prognosis.

Interesting too that you think blood tests are a waste of money in this context (I think that's what you were saying). I find them very helpful as it allows me to look not only at changes in liver enzymes with time, but specifically to see whether there are any indications of decline in liver function as well as giving an indication of whether the white blood cells are having to cope with infection.

You mention a huge iron deposit in the liver of several of your ponies. Was there anything you were able to do in the light of that knowledge? My (little) understanding of iron in liver is that it's quite commonly found, and that the horse has no way of getting rid of it. A friend tried bleeding her horse in the hope of reducing iron in the blood (and gradually over time in the liver) but it did not prove helpful.

What is the reference for the 90% chance of dying within 6 months if untreated. I know Liphook have looked at biopsy scores and blood indicators and come up with %ages of survivors/nonsurvivors at 6 months, but as far as I know that was not linked to treatment or nontreatment. This is the file I mean: http://liphookequinehospital.co.uk/wp-content/uploads/2012/03/LiverDiseaseandLiverBiopsy.pdf and it seems to be Andy Durham's papers of 2003 and 2010 in the EVJ that provided this data. So I'm guessing there is a different paper that you are referring to?

You mentioned considering moving the horses. Is that something you did? How did you monitor any changes following the move? What was the outcome? How soon did you see any changes? Were you able to pin down what you felt was the cause?

Sorry for all the questions!

Sarah
 
There is a biopsy score at the bottom of the report. In my case 3/14 (Durham et al 2003 EVJ 53 (6) 534). I don't think it is particularly good but the histology comment is 'prognosis for return to normal hepatic function is fair to guarded'

I think that comment covers all bases so I am in two minds. My cynical side says that with litigation a big factor in medical cases they have to give you the worse case scenario.
 
Andy Durham is my vet, haven't read reports, just go by what he says as one of top specialists in the country for this. My 5 varied from 6/14 to 11/14. I think my highest ggt was 420, had another tested this week with a ggt of 190. Ggt has a max of 40, bile acids also relevant with a max of 12. Mine mainly had fairly normal bloods with minor inflammatory response apart from liver readings, ended up just doing liver tests as much cheaper. Horses on azothiaprine, prednidale and trental, up to 200 tablets a day. Most had two biopsies, the ones who had been on land longest had high iron and had 24 or36 litres of blood removed over several weeks to induce anaemia, but this was not necessarily the cause as more recent arrivals had liver problem but no iron.
All horses looked and acted normal apart from the above signs. They were all on very low diet to reduce weight due to lami risk. Low but quality protein, no oil, Alfa etc. apparently milk thistle supplements no use as need buckets daily to help at this level. Though improved after 6 months and 2 nd biopsies , the worst one was moved three months ago and now has clear bloods. He is more forward and back in gentle work.
You can quote all you like about different theories and papers but I have the 24k t shirt on this one!
 
Yes does look like you have the t shirt on this one! All my bloods have been very varied but basically the liver specific enzymes have been up and now bile acids. My horse is on the same meds as yours but am weaning him off as no significant improvement. Same diet as well. Interested to know what you mean by the 'ones who have been on land longest have higher iron' Is the iron a specific test or does it come within the haemotology readings?
 
But what do your biopsies show. Liver disease treatment is a shot in the dark without a biopsy! I would have lost one without a biopsy!
 
I think I posted that my biopsy score was 3/14 on the Histology Report from the lab. It is non specific with possible ragwort connection or 'other toxic hepatic injury'. Andy Durham and David Rendle (who did the biopsy) prescribed me same meds as you 'in order to prevent any further fibrosis) but no mention of an iron disorder.
 
Iron was a specific problem to me, as was a possible toxin to you. But the biopsy is to show possible cause and amount of damage as liver regenerates. The more fibrosis the less generation. Think drugs were to protect and heal liver. Mine all improved but I think other things also helped and moving was obviously vital as worst horse now has normal bloods after 3 months
 
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