Demystifying the BILE ACID TEST using Shaili’s results
January 17, 2009
Ming
Providing the explanation took much longer than expected. I did numerous rewrites, checked my facts, had my sister who is a microbiologist proof it, and read it to various people to see if it was easily understood.
The sister who proofed it is the one who has the 1.5 year-old son with no functional small intestine and a liver that was failing. The link about baby Bo is in the side bar under “My Nephew’s Rare Disease“
I have not done the ALT or bilirubin write-ups yet, but they’re coming. Please note that the BAT is usually one of several tests in a panel of tests for liver disease.
Back to the BILE ACID TEST (BAT). First, if you haven’t seen Shaili, the athletic Pug, she is featured two posts down. Her recent blood work came back with some high Bile Acid Test numbers:
- Fasting Bile Acid Test (BAT):
Shaili’s result: 13.4 µmol/L **HIGH**
Normal range: (0.0-12.0) µmol/L
- 2HRS Bile Acid Test (BAT):
Shaili’s result: 44 µmol/L **HIGH**
Normal range: 5.0-25.0 µmol/L
“But what does this all mean?!” you ask?
Most dogs are given the BAT to determine if there is a problem with their liver, or if another test they had done for liver disease was inconclusive.
For instance, as in Shaili’s case, if liver disease is suspected, but the biliruben test shows normal levels, the BAT is run because it is a more sensitive test for liver damage.
The BAT result numbers show how much bile acid is in the blood stream at the time each blood sample was taken.
- 1) On an empty stomach (no food for 12 hours)
2) Two hours after a (high-fat) meal is eaten
A high amount of bile acids in either blood sample means the liver is not adequately doing it’s job of pulling bile acids out of the bloodstream, which indicates liver damage.
The bile acid level in the blood sample two hours after the meal should only be slightly higher than the bile acid level before the meal because a healthy liver is able to remove most of the bile acids after two hours.
When a dog eats, food going into his body is in part “digested” by the bile acids that break down fats. Those bile acids are initially released from the gall bladder into the intestine to help with digestion.
After the food is digested, the bile acids go into the blood stream where the liver retrieves them and returns them to the gall bladder for storage until the next meal. This is why some articles state that the liver “recycles” bile acids.
Here is a simplified progression of the events upon feeding the dog:
- 1) The dog eats, triggering bile acids to be released from the gall bladder into the intestines2) While in the intestines, the bile acids help digest the food and break down fats from the meal
3) After the food has been digested, the bile acids in the intestines move into the bloodstream
4a) At this point, a properly and fully functioning liver would efficiently take the bile acids out of the bloodstream and return them to the gall bladder to be released and used again at the next meal.
4b) If the liver is damaged and not functioning properly, it will not be able to remove the bile acids at a normal rate, so the blood sample taken will show a high level of bile acids in it.
Upon eating, the body triggers the release of BA from the gallbladder into the intestine, where it helps break down fats ingested. Once the food is digested, the BA goes back into the bloodstream where it is recaptured by the liver.
Even though this test is a good indicator of liver disease, the results do not provide information on how severe the damage is, what caused the damage, whether the liver can recover and what the expected outcome would be.
Shaili’s “Fasting” Bile Acid Test is a bit higher than the normal range, and her “2-Hour” BAT level was double or more than levels in the normal range. Look at these results again along with the BAT results for a Pug Puppy that likely has a liver shunt:
- Fasting Bile Acid Test (BAT):
Normal range: (0.0-12.0) µmol/L
Shaili’s result: 13.4 µmol/L **HIGH**
Pug Pup with suspected liver shunt: 287 **VERY HIGH** This is 21 times Shaili’s BAT level
- 2HRS Bile Acid Test (BAT):
Normal range: 5.0-25.0 µmol/L
Shaili’s result: 44 µmol/L **HIGH**
Pug Pup with suspected liver shunt: 1877 **VERY HIGH** This is over 42 times Shaili’s BAT level
- UNITS DEMYSTIFIED:
• “µmol/L” is “micromoles per Liter”
• A mole (mol) is an amount of a substance that contains a large number (6 followed by 23 zeros) of molecules or atoms.
• A micromole (µmol) is one-millionth of a mole. (definition from Healthwise web site)
A note about the Pug puppy above. If this puppy does have a liver shunt and it is operable, it actually has a chance of living a good quality of life as well as enjoying a longer or even normall life span given that it’s condition is managed by proper diet and supplements.
If you are looking for more information, a support group, and practical advice from experienced dog liver disease moderators, please visit the Dog Liver Disease (DLD) Yahoo Group. You are not alone if you have a dog with liver disease or suspected liver disease. There you will find hope and help for managing the condition, reducing the symptoms, and increasing the livespan of your dog..
Entry Filed under: Diet and Health, Guest Doggies
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1.
Cindy Overbey | March 27, 2009 at 10:19 pm
My Yorkie had liver shunt surgery in Aug.08. We had a liver panel/bile acid test done in Jan.09. We weaned our Yorkie off the UD diet and had a follow-up liver panel/bile acid test done a couple weeks ago. The first test came back great. I do not have the numbers though. The most recent test came back with good numbers on the liver panel but the bile acids were pre – 42.0 and post 22.0. The surgeon who did the surgery out of state said this was ok and not to put him back on a special diet. My Vet at home suggested putting him back on a special diet. I am torn as to what to do. Do you have any knowledge in this area? It could well be that these numbers are ok but I am very concerned after all we have been through. Thank you, Cindy
2.
Ming | March 28, 2009 at 10:52 pm
Hi Cindy,
I was a member of an outstanding dog liver disease support group: “Dog Liver Disease” support group on Yahoo (aka “DLD”).
The head moderator’s name is Olga. She and the other moderators have helped hundreds of Yorkies and other dogs with their post liver shunt health maintenance programs for the best quality of life and longevity.
If you go to the link below you will see a blue button (upper right) that says “Join Group”.
http://pets.groups.yahoo.com/group/DogLiverDisease/
You’ll fill out info about your Yorkie and its condition.
Ask this exact question on the group and I know you will get an informed response very soon.
If you have any trouble getting onto the group, let me know. Feel free to put my blog as the referral (Ming’s Dog Blog).
Best of luck with your Yorkie. I know that so many post liver shunt surgery dogs have done very well on the recommendations for diet and supplements on this group.
Also – please visit the blog’s new site at http://www.mingsdogblog.com
3.
Kristi | April 9, 2009 at 1:22 pm
Hello, I need some major help.
MI raise small rare breed Mi-Kis. I took 2 of them in to have their teeth cleaned on Monday. It didn’t happen because the blood work I had done on them Friday showed the alt was high.
My 7 year old 4 pound baby was 313. My 11 year old 5 1/2 pounder was 469. While there my vet tested the bile acids.
My 7 year olds bile acid is 71 1/2 and 41. The other babies was 61 and 42.
I have been crying for two days now. I am so worried. Am I pushing the panic button too early?
I gave my babies an Interceptor pill on the first. Their test was on the 3rd. I also got their parvo/distemper shots on March 25. They are on Innova dog food which is one of the best. On another group I was told that the shot and interceptor could have been an overload for their tiny bodies. Could this be possible? How long do those take to get through the system. I an new to this and have so many unanswered questions. Please help me. I am sick over this.
Thank you, Kristi
4.
Ming | April 12, 2009 at 4:32 pm
The recommended food is Royal Canin Hepatic. Feed the recommended amount, but split into 5 meals. That way the load on the liver is greatly reduced.
There are also supplements and other diet recommendations I could give you, but the moral support and advice on caring for your dogs that you will receive from DLD is life-saving.
I will be here for you if you need me, but I’m going cc this email to the moderator so that she may expect you.
The head moderator’s name is Olga. She and the other moderators have helped hundreds of Yorkies and other dogs with improving their health condition, quality of life and longevity.
If you go to the link below you will see a blue button (upper right) that says “Join Group”.
http://pets.groups.yahoo.com/group/DogLiverDisease/
You’ll fill out info about your dogs and their condition.
Ask this exact question on the group and I know you will get an informed response very soon.
If you have any trouble getting onto the group, let me know. Feel free to put my blog as the referral (Ming’s Dog Blog).
Best of luck with your dog-children. Hang in there!
When I was an active member of the group I saw so many dog owners hanging by a thread on the verge of giving up. The DLD group was able to provide the necessary advice to start turning the situation around in a very short amount of time (days, usually, and even better in weeks).
There is hope! I’ve seen it with my own two eyes.
-Ming
5.
Ming | April 12, 2009 at 4:33 pm
Kristi,
I just realized I didn’t specify that the RC food requires a prescription. It is the one called “HEPATIC” for dogs with compromised livers.
The Dog Liver Disease group has found that dogs with less than healthy livers do much better not ingesting any animal meat protein. Goat yogurt is ok.
Feeding the 5 small meals has made a huge difference as well since the liver does not have to work as hard.
-Ming
6.
Kate | April 21, 2009 at 7:25 pm
Hello,
I am curious about the DLD group that you recommend. Is the group only for those othat have dogs with liver shunts, or is it for any dog liver disease? Just wanting to know before I join. My dog has a diagnosis of hepatitis, but this diagnosis is only being used because the vets have no idea what is wrong with his liver. I have been seeking solutions/help for over a year now, and thought the DLD group might have some advice. Thank you!
7.
Ming | April 21, 2009 at 7:40 pm
Hi Kate,
The Dog Liver Disease (DLD) Yahoo support group helps dogs with all forms of liver disease. The moderator is a super-woman of sorts who at times has as many as 11 liver-compromised dogs in her care since she also runs a rescue (Retro Doggy Rescue based out of Michigan).
I was on the group actively and daily for seven months. I saw so many frustrated, scared, upset, and desperate dog owners join and witnessed their quick transformation after getting practical advise that improved the quality of their dogs’ lives as well as theirs, sometimes in just days.
If I had not met people who were ready to say their final goodbyes to their dogs and joined DLD as a last ditch effort, I would not be recommending it so highly now, having seen so many dogs get a second chance at life.
When you join, you will have access to Olga, the head moderator who has been doing research on and keeps up with developments in the dog liver disease medical community.
Let me know if you have further questions. The group not only offers practical advise, but has information on resources for the recommended foods, supplements and medicine, and offers a caring and nurturing support system.
8.
Mary Conover | April 26, 2009 at 1:03 pm
Thank you! I have been trying to find information on the BAT for hours. My four-legged companion has the test tomorrow along with an ammonia test.
9.
CarolR | May 26, 2009 at 2:53 pm
My welsh terrier had elevated liver enzymes of 2,000. Normal is 213. Urine checked for Cushings, came back normal
Then bile acid done and liver functioning normal, low end of normal per results.
Repeated original blood test, same.
Told to wait 2 months, no medication and retest
Any thoughts????
10.
Ming | May 27, 2009 at 3:14 am
Hi Carol -
Good news that the bile acid test results were normal and no there was no sign of Cushings in the urine test.
I am mostly familiar with situations where the BAT came back abnormally high, indicating a liver shunt or microvascular dysplaysia (MVD) in the liver.
However, since the abnormal results were still liver-related and very elevated, I would seriously contact Olga (who is the head moderator on the Dog Liver Disease Yahoo support group) and/or join the group.
All the moderators (especially Olga) have helped innumerable dogs live a longer and better life through their care, nutrition and supplement recommendations. I have seen owners ready to say good-bye to their dogs turn the situation around in a short time with the advice and support of the DLD group.
I will forward your post to Olga, but you should contact her directly by email. Then, if you join the group, you will have regular access to ask her and any of the other moderators and members questions.
To go to the page to sign up for the DLD group, go to:
http://pets.groups.yahoo.com/group/DogLiverDisease/
If I find anything else out about the elevated liver enzymes, I’ll let you know.
Best Wishes for you and your terrier.
-Ming
11.
Kim | August 4, 2009 at 12:29 am
My 9yr old toy poodle Shelby, was diagnosed 8.5 years ago with possible liver shunt and has been on Hills LD food since with no meds or treatment, with constent high bile acid levels. Now she is very sick, vomiting, wont eat or drink, urination accidents. Recently before she got sick, she was consuming major amounts of water. Now that she has been sick for 8 days, went to dr. today and she has fever, anemic, low potassium, and very diluted urine, which is odd, because she wont drink and we are having to force pedilite down with dropper. Dr. says possible Cushings or Diabetes Incipdus??? can these very rare disorders be linked?? She also has always been very, well, she gets excited with her stuffed animals 24/7, so could that be a hormonal inbalance, and if so, can it be related??? she is very lethargic now and still is refusing most foods and water :-( any suggestions or research sites would be greatly appreciated!!
12.
Ming | August 6, 2009 at 2:06 pm
Dear Kim,
I’m so sorry to hear about Shelby’s health troubles. I meant to respond right away, but was taking a friend to the city for a quad bypass, among other pressing personal issues
I would highly recommend that you get in touch with Olga. She is the head moderator and founder of the Dog Liver Disease (DLD) Yahoo support group. Not only is she an intelligent, well-informed person on dog liver-related issues (and other dog health issues), she is compassionate beyond reproach towards dogs with medical issues and is an amazing source of information on the type of care, nutrition, and supplements that have helped 100’s of dog owners improve the quality of their dogs’ lives as well as extend their life spans.
Some owners had all but given up hope before finding the DLD group and Olga.
Normally you would go to the DLD site, fill out the questionnaire about your dog in order to join the group, after which you will have access to Olga as well as many others who have experience and knowledge about how to best care for dogs with liver-related issues.
I can tell you that some of the initial recommendations will be to lighten the load on Shelby’s liver and system so that her body will have a better chance to recuperate.
1) Switch to Royal Canin Hepatic split into 5 meals a day. There is a formula for number of grams of protein per pound that your dog weighs.
A five or six pound dog would get about 120 kibbles a day, or 24 kibbles 5 times a day.
Small meals are much easier on the liver. The RC Hepatic will require a prescription.
You can supplement the kibbles with treats that the liver can process easily such as:
• diced apples
• slices of steamed carrots
• goat yogurt
• diced watermelon (no seeds)
***There will be a number of other recommendations, but I will let you get the accurate info directly from Olga or the DLD group.
The web address is: http://pets.groups.yahoo.com/group/DogLiverDisease/
Because Shelby is now showing other symptoms, please make sure you contact Olga and DLD ASAP. She may have insight on how to help Shelby.
After you get triage with Olga on Shelby’s condition, she will let you know how to proceed with getting onto the DLD group per the regular protocol.
I will forward her this email so that she will expect your contacting her.
All my best wishes for your Shelby!
13.
Ming | August 6, 2009 at 2:27 pm
Kim,
I wanted to include some info here that I forgot in my first reply.
The actual name of the Royal Canin Hepatic food I mentioned is called: “ROYAL CANIN Veterinary Diet canine HEPATIC LS 14″
Normally you would need a prescription for it, but you can order it without having to produce a prescription from Southern Agriculture’s web site.
The link is: http://www.southernagriculture.com/southag/product.asp?s_id=0&pf_id=PAAAAAHNAMKJFNCC
Also there are some powerful and effective supplements that Olga will most likely recommend to you, but it will be better to get that info from her.
Most likely it will include “Hepato Support” and “Vetri DMG”, both of which will help detox Shelby and strengthen her immune system without putting more load on her compromised liver and condition. Two sites I know of that carry these products are http://www.homevet.com and http://www.entirelypets.com.
There may be other sites. I have no affiliation with any of these sites. Just wanted to give you some leads. Once you get on the DLD group you can ask about specific feeding amounts, schedules, etc., and know what to look for in improvements as well as which tests to run, what results to look for, etc.
I hope I am not too late in responding. Shelby sounds like she needs immediate attention.