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Hi M&C,

Your CBD dose was quite a bit higher than I assumed it would be. When I looked at the OTC options at my local store, as I recall a $100.00 bottle would have been enough to last 3 days at the 5 mg/kg/day dose. At the time, the prescription CBD was ~1200.00 a bottle. On a mg basis it was pretty comparable to the having to buy multiple OTC strength bottles.

As I understand it, CBD itself may cause a rise in ALP but an increase in ALT wouldn’t be expected, hard to know if it is related or not. Only way to know I think would be to discontinue and remeasure the blood levels.

Bile acids are produced from cholesterol, stored in the gallbladder, and shucked out into the intestines with gallbladder contraction, primarily in response to ingestion of food. They are reabsorbed in the ileum, the end portion of the small intestine. The blood flow from the intestines takes a tour through the liver and the liver picks out the bile acids and sticks them back into the gallbladder.

If the liver is not functioning well, the liver doesn’t do a good job picking the bile acids out of the blood, so the bile acids can be found circulating in the blood at higher than excepted levels. Bile acid levels in the blood can also be high when the blood flow to the liver is altered, like with a liver shunt. Gastric and Intestinal motility may also influence results. The bile acids have to be presented to the terminal intestine for absorption. Apparently, there can be day to day variation in test results due to this or other factors.

The test is usually done by measuring levels in the blood in a fasted state and again 2-3 hours after feeding, which is done to stimulate gall bladder contraction. If both pre and post eating samples are high, the problem is more likely one of liver function. If pre are normal and posts are high, it may be more likely to be a problem of blood flow. BUT these are very wide generalizations and dogs don’t read the books.

Apparently, there can be a lot of “grey” in interpreting the results. The specialist I took one of my dogs to said he rarely runs the test because the liver has a lot of functional reserve so local lesions that can increase liver enzyme levels in the blood may not alter test results at all and factors outside the liver can influence results. This could be why your vet recommended an ultrasound and not a bile acid test to further explore the liver enzyme increase.

On the other hand, if you are giving a dog something that is known to be able to alter liver function in some scenarios, doing repeated bile acids to monitor for change in function may be warranted. I believe an anti-seizure medication such as phenobarbital falls into that category.

Since so much about CBD use in dogs is unknown it makes sense perhaps to included bile acids in these initial studies to monitor for any toxic effects.

I’m not aware of any instance where MCT would increase liver enzymes.