Elevated ALT and Bile Acid Test Results??

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is it time to- eat?!
Barked: Mon Jun 2, '08 7:30pm PST 
Hi there. Harry and I have not been on dogster in a really long time - work has been so busy. But we're in the middle of something confusing and...honestly...very scary. Hoping there will be some insight / info available here.

A few weeks ago, Harry had some basic blood work done, and the results came back with an elevated ALT. The level for that test was...I think...80 (not certain). Vet repeated the test about two and a half weeks ago. Again, the result was elevated. Vet said that elevated ALT was very ambiguous. Not possible to diagnose or suggest something specific.

Next step was to do a fasting/post-fast bile acid test. We did that last Thurs morning and got the results today. Vet said normal number for fasting was anything less than 10. Harry was 27. For post-fasting, vet said anything less than 20 would be considered normal. Harry was 26 post-fast. Vet said Harry’s numbers aren’t extremely elevated – said on a scale of concern, he still wouldn’t be panicking.

Harry is currently a bit overweight - about 9.5 pounds (for his frame, he should be closer to 8.5 lbs). He'll be turning three years old in Oct. He isn't lethargic. Is always ready and willing to eat, play, go for a walk, etc.

His diet for the past 12-14 months has been Nature's Variety raw medallions.

Our next steps per the vet are to stop his raw diet for 10 days - he's putting him on WD (yuck) with absolutely nothing else. Going to do a fasting ALT test on Friday, June 13. And at that time also do a liver ultrasound.

Does anyone have any experience with similar test results? I've been trying to search via google, but still getting a very broad range of info. And really freaking myself out.

Has anyone had issues with elevated liver enzymes related to a raw diet? If it were simply a matter of the diet, I would be more than thrilled to change it to ensure that he is and stays healthy.

I just want my little guy to be ok...

thanks for any info.
Telly Lam

Never met a- lampost I- couldn't pee on
Barked: Mon Jun 2, '08 7:43pm PST 
Hi, Harry. You're very handsome in your bow tie.

I'm sure the vet explained to you what the ALT and bile acids test for.

The ALT is an enzyme made within liver cells. When there is something - anything - that makes liver cells unhappy (e.g. inflammation, injury, hypoxia, etc.) some of this enzyme can escape into the blood circulation and be elevated on a blood test. So ALT is non-specific for liver injury. Typically, we say that any result that is 2-3x the upper reference limit is considered significant (since there is some individual variation).

Bile acids indirectly tests for liver function - elevations indicate that the liver is having trouble "re-couping" bile acids, especially after a meal. This could indicate reduced liver function (which could reflect liver injury, inflammation, reduced total number of functional liver cells) or abnormal circulation to the liver (e.g. portosystemic shunts). Again, this test indicates liver function issues, but is not specific as to what type of functional problems the liver may be having.

A lot of the disease processes that could cause such elevations may manifest clinical signs - but some disease processes, e.g. portosystemic shunts - may be relatively silent or manifest signs that are hard to pick up. So, if the repeat tests STILL come back abnormal, then it might be time to do some further diagnostics, for example, your vet may order an abdominal ultrasound to visualize what's going on better (don't worry - it doesn't hurt!), or may order liver biopsy if something in the ultrasound indicates it.

The other possibility is that you are unique - the "reference intervals" established for "normal population" is based on mean +/- 2 standard deviations, and you could just be one of those lucky individuals who is normal, and whose normal values for ALT and bile acids are outside of that statistical cut-off for what is deemed "normal."

In any case, I have a few dog friends who are on raw diets, and I have never heard of this directly causing elevations in ALT activity or bile acids.

Wishing you all the best.
Viper- *ADOPTED!!!!- *

can you throw- that plz?
Barked: Mon Jun 2, '08 7:47pm PST 
Viper here is having that same test done to quell any fears his new adopters may have... this is the only reason I know anything about the bile acid tests. I found out that the new adopters lost there 2 yr old labradoodle to liver cancer. The only way they found it was because of the bile acid test coming back high. So... I would say something is up with the liver... perhaps just the diet... lets hope.

Gabe the Dog

It's Gabe. Gabe- the Dog
Barked: Mon Jun 2, '08 7:47pm PST 
Elevated alt indicates some sort of damage or overload to the liver.(it is the enzyme I believe that it is measuring) the bile acid can indicate diminished liver function if it is very high. But your vet is not concerned? they do not sound too out of range.

Gabe had a big scare about a year ago, nausea vomiting, stomach tenderness. Later that night at the ER vet his ALT values were off the chart (over 900) which the vet said was indicative of poisoning. He pulled through with fluids, milk thistle, and antibiotics. We have since had bile acids run to check for residual damage and Gabe's results have been mildly elevated, but not too far out of range. Milk thistle (Silymarin) is available for dogs if there is an issue with liver function, we used Marin. Sometimes the bile acid test can indicate a problem with the structure of the liver.

But stay calm! I am just telling you the info I have from my experience. It does not mean you have any of these problems. Let your vet know your concerns and ask questions. If you repeat the lab work everything may come back in range. Like a human's chemistry, sometimes a dog's normal lab work is not in the "normal" range.
We'll be thinking of you and hoping that you continue to be healthy and that this is nothing to worry about! Take care.
As a side note, our vet who knows Gabe's history said it would be perfectly fine for us to try a raw diet. So I don't think that is the cause, though sometimes a moderately lower protein diet is recommended by some vets if there is a liver disfunction.

Edited by author Mon Jun 2, '08 7:50pm PST


is it time to- eat?!
Barked: Mon Jun 2, '08 7:53pm PST 
Hi, Telly.

thanks for the great info. you seem really knowledgeable, so I hope you don't mind a few follow-up questions...

In 2006 & 2007, Harry's ALT was within normal range and the exact same number both times. And now this year...it was high.

So...that kind of shoots the theory of Harry's normal being a little higher than the standard normal, right?

I really wish that could be the case.

As for shunts, I was under the impression that if a dog was already going on three, the chance of there being a shunt issue that hadn't already been detected was slim... would you agree with this?

The vet is saying that it could be something as benign as inflammatory bowel; however, Harry exhibits no signs of having any issues. No diarrhea. No sensitivities. He is willing to eat anything and everything and it never appears to affect him.

So... just crossing all our legs and arms that there is a simple and non-serious reason for what is going on.

thanks again...

is it time to- eat?!
Barked: Mon Jun 2, '08 7:57pm PST 
Thanks, Viper and Gabe.

Harry's numbers for the ALT and the Bile Acid are, according to the vet, not terribly high. But high nonetheless, requiring further examination. I just am so anxious and wishing we could get this figured out now...immediately.

is it time to- eat?!
Barked: Tue Jun 3, '08 7:18pm PST 
bumping with hopes of soliciting any additional relevant experience or ideas


Member Since
Barked: Fri Apr 11, '14 8:24pm PST 
Would love to know how things turned out with Harry. I have a labradoodle cross with the same elevated ALT and am now wondering about the raw diet
Kali earned- her wings- 10/21/14

She's game for- anything that's- fun.
Barked: Sun Apr 13, '14 5:21pm PST 
Vance CGC

You kids g'off- my lawn!
Barked: Mon Apr 14, '14 4:51pm PST 
This topic is from 2008.

But, as to the new question re: elevated liver enzymes and raw...

It can be done, but with the awareness that once you get into health issues like liver problems you're looking at a highly customized diet. The typical advice and generalized PMR/BARF diets no longer apply. I firmly believe a custom, homemade diet is the best thing you can feed a dog with organ disease, so I do encourage looking into it.

First you need to figure out exactly what the problem is, at least to the best of your ability.

As a "for instance," and maybe you'll get something useful out of this:

Overproduction of bile was Vance's biggest problem. For a long time, he ate a pretty general PMR diet, but I had to buy items as low fat as possible (and I still often trimmed them). Fat spikes bile production. Fats found in fish are easier to digest than fats found in other meats, so I fed as much of a fish-based diet as I could afford. After a certain point I did have to start cooking all the meat so I could further drain fat away.

I also had to cook any greens he ate. Again, raw greens will spike bile production. I added large amounts of fiber to his diet, like mashed chick peas, pureed lentils, sweet potatoes, and pumpkin. This helps absorb what bile is overproduced. It also helped him hold weight, because his digestive system was functioning pretty poorly overall. You have to be aware in doing this that adding fiber can falsely lower an ALT, as it's absorbing what would otherwise end up in the bloodstream. The liver is still sick, but the symptom is lessened. In many cases lessening symptoms is all you can do, and is worth it to keep them from snowballing.

And he ate many small meals a day. Always at least three, but up to five if I could fit them in my schedule. This decreases the load on the digestive system - it fires up, and then gets to rest, rather than firing up and working at a huge meal for hours, then getting nothing at all and filling with unused bile for hours.
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