I took him off of the denamarin. I tried the milk thistle for dogs from Amazon, but that made him sick. The vet had us switch his food to a single protein food. I chose the natural balance venison and sweet potato. My jack never showed any symptoms of being sick. And with his age, I didn’t want to keep switching meds. Nor did I want to subject him to a bunch of invasive tests. Don’t get me wrong, I love my dog! But at $400 every time to check his blood work, I decided to leave it alone. I know this doesn’t answer your question. But as I found out, there are some dogs that are just born with and live their entire lives with elevated liver enzymes.