Abnormal liver counts

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Hello,

Has any had any expiernce with elevated liver enzymes over a period of time and a high GGt? 

Thanks 

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  • Posted

    GGT is the most sensitive marker for liver inflammation, but it is fairly non-specific, & not a particularly good indicator of disease.  Those with fatty liver often have a chronic/moderate GGT elevation without substantial disease and many prescription (and OTC meds) can bump enzymes high.  GGT, as well as ALT/AST stubbornly in triple digits (over 100) is concerning, and should be followed and the liver evaluated with ultrasound.  

    Alcohol consumption can bump GGT high, but it should fall to normal with abstinence in a month or so.  A stubborn and substantial GGT elevation can indicate alcoholic disease.  In evaluating alcoholic disease, I like to look at the "De Ritis" (ALT/AST) ratio for additional clues.  When AST floats substantially over ALT in drinking populations, this can indicate alcoholic disease, particularly when combined with a stubbornly elevated (triple digit) GGT.  

    The De Ritis inversion can have false positives, as exercise & exertion can pop AST high, and B-Vitamin deficiency (due to drinking) can cause an abnormally low ALT.  This is why I also look at GGT.  I consider the combination of a substantial De Ritis inversion with a stubborn triple digit GGT a red flag for alcoholic liver disease.  Without BOTH of these occurring at the same time, the risk of alcoholic disease is much lower. 

    Alcohol aside, mild to moderate elevations in liver enzymes are quite common and not particularly ominous unless they stubbornly hang double or more normal over several labs over time.  Even if this is occurring, time is probably on your side, though this isn't something you want to see going on indefinitely.  

    Hope you get to the bottom of this soon!  

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    • Posted

      Thanks for your response! I have never consumed alcohol so that isn’t the problem. I have had every lab test scan and unltrasound done and nothing was found but my numbers have stayed about the same.
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    • Posted

      Has your doc ordered an iron lab in your bloods?  Males tend to accumulate iron which can contribute to liver inflammation.  Transferrin saturation (aka iron saturation) is particularly telling.  You want this in the middle third of the normal range for optimal liver health.  Ferritin (blood lab) also important.  The upper limit for ferritin is set quite high by most labs and is the threshold for clinical iron overload.  Optimal ferritin is much lower (50 to 150 max).  
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    • Posted

      A "normal" result in your iron lab can sometimes be misleading, as these labs are designed to flag clinical iron overload typically related to genetic hemochromatosis.  Often serum iron is the only test done, & serum iron isn't particularly good at flagging sub-optimal iron homeostasis.  

      Transferrin saturation (aka iron saturation or TSAT) and ferritin are both much better indicators of iron homeostasis.  You want to see TSAT in the middle third of its normal range, and ferritin below 150.  

      If you're running out of suspects, a wise man named Sherlock Holmes once said: Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth! 

      Do some research into Dysmetabolic Iron Overload Syndrome (DIOS) and see what you think.  

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    • Posted

      Great; well scratch that of the list then.  

      Don't know if you're on any prescription meds or take a lot of over the counter pain meds.  A substantial percentage of prescriptions can cause liver issues.  A single course of antibiotics can cause cholestasis (thick/muddy bile) that can last for several months.   

      PPI acid blockers have come under a lot of fire lately for side effects not previously known (malabsorption of minerals & small bowel bacterial growth).  Aspirin, ibuprofen & naproxen have their own issues, as does paracetamol.  Even blood pressure meds can bump liver numbers.  

      Toxic exposures in the workplace or even at home are another possibility,  If you have a lot of dry cleaned clothes hanging in your bedroom closet, these can outgas "perchloroethylene" for weeks, exposing you as you sleep.  

      The liver also prefers saturated fat to polyunsaturated oils.  Fish oil supplements in particular can have oxidation issues in the liver.  "Lecithin" found in eggs is the liver's favorite nutrient, & this isn't found in substantial amounts in most other foods.  Adding some eggs to your diet (if you haven't already been eating them) or a lecithin supplement (if eggs aren't going to happen) might help.  A 30 day trial before your next bloods might be interesting.  

      Keep digging, & you're bound to get to the bottom of this sooner or later.  

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    • Posted

      Liver labs are fairly fluid and can change from month to month.  90 days is typical to have "second look" labs done when they are out of range.  Over shorter periods of time you probably won't see a substantial move, though it's certainly possible.  

      ALP (alk-phos) often pertains to bile flow & when bile isn't flowing well ALP, ALT & GGT will all come up high.  The biliary system is like a sewer the liver dumps its metabolic waste for disposal down the GI tract.  If this gets gummed up, the liver has trouble disposing of waste.  

      "Sluggish Liver" used to be a common diagnosis, but it has fallen out of favor as it lacks specificity.  I like this term as it states the obvious quite well.  Bile gets thick & muddy from a choline poor diet or medications, & the liver begins having trouble doing its job efficiently.  

      Besides the lecithin I mentioned above, Curcumin is also known to stimulate bile flow.  Dilute the sludge, clear the pipes and get bile flowing well, & recheck your labs in 90 days.  

      It's nice when you can get a specific diagnosis, but if you can't, trial and error may eventually pay off.  

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    • Posted

      Oh yes, the liver can take quite a beating over many years time without suffering extensive damage.  

      When enzymes are high though, you want to keep working on what might be causing this.  If you want to live to 100, you've got to get labs back into range for the long haul before too long.  

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    • Posted

      Viral hepatitis A can pop enzymes into the thousands and most patients have a full recovery.  

      Mild elevations (less than double norm) over a year or two shouldn't produce advanced disease.  This said, you don't want to live the rest of your life like this.  Keep digging, and you're bound to find the cause.  

      Coffee & tea are both well known liver tonics.  Dietary or supplemental lecithin too.  The "PIVENS trial" showed Vitamin-E may be the best medicine for NASH.  A 30 day trial of all these before your next labs might be interesting.  

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    • Posted

      "If mine are under 100 more then the normal limit is that still bad?"

      This is a gray area.  I've read doctors don't sweat moderate elevations up to double norm over more than one test.  If you're just under 100 more than normal, this shouldn't be alarming short term, particularly with normal imaging (ultrasound).  

      I'd keep working on a possible cause, as this isn't the sort of thing you want going on indefinitely.  There simply has to be a reason.  Time is on your side for now, but this isn't the kind of thing I'd ignore completely.  

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    • Posted

      Less than 2 grams/day (4, 500mg tabs) shouldn't bump your numbers too much provided you are eating well.  I'm really not sure how long any effect should persist, but provided you haven't gone over 3 grams per day (6, 500mg tabs) I expect a week should be plenty of time for any effect to wear off. 

      Heavy dosing (4+ grams per day) might bump enzymes high for up to a month.  

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    • Posted

      I've never heard of moderate/intermittent use of Tylenol popping enzymes high.  Tylenol is so widely used, I expect a spike in enzymes from moderate use would be both noticed & well documented by doctors and patients.  

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    • Posted

      Alk phos is often related to bile flow.  Bile can become thick & muddy if dietary choline is low or diet is low in fat. Anorexia or dieting can also cause cholestasis (thick/muddy bile).  When bile doesn't flow well, ALP can spike high.  Get bile moving again & ALP should fall.  

      Fatty foods stimulate bile flow, & good choline/lecithin consumption helps thin bile so it flows easier.  Has your diet changed recently?  What ever you're doing, keep up the good work.  

      Hope this means your enzymes will start looking better!  

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    • Posted

      From what I've read, the liver's preferred form of choline is phosphatidylcholine aka Lecithin.  Eggs are the richest source of this.  Other sources can be found online. 

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    • Posted

      If the copper stain is from a biopsy, this may mean Wilson's disease.  Your doc's should be on top of this if Wilson's is suspected.  Wilson's is something that MUST be treated (usually with zinc).  

      If you have copper plumbing in your building/home, it's best to run the water for 30 seconds or so before filling a glass for drinking.  Copper tubing feeding an ice maker can also add a lot of copper to the ice, as the water tends to sit in the tubing for extended periods between use.  

      Extended daily supplement use containing copper is another possibility.  Many multi-vitamins "with minerals" contain 2mg copper per dose, & this can add up over time, particularly when you are also consuming other sources of copper.  

      Some tattoo pigments also contain copper (green & blue) which can leach into systemic circulation over time.  Tattoo removal with laser can sometimes release a lot of copper all at once.  

      Dietary liver is also very high in copper if you eat this regularly.  

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    • Posted

      "Ceruloplasmin" is the blood test associated with copper and Wilson's Disease.  It's a cheap blood lab, & should be part of a Wilson's workup when ever unusual copper deposits are found in the liver on biopsy.  

      You might also look for a "Kayser–Fleischer" ring in the iris of your eyes.  Google images has some good photos of Kayser–Fleischer ring.  

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    • Posted

      I'm not well read in this area, but I believe stainable copper are deposits of copper outside of its normal protein carrier (Ceruloplasmin).  I believe theoretically you shouldn't have any stainable copper in liver tissue.  

      This is similar to iron staining.  Iron in the liver is supposed to be contained within ferritin proteins, and not show up on prussian blue tissue stain at all.  When it does, this indicates ferritin has degraded into hemosiderin, which is stainable.  

      I'm assuming the copper issue is the same, but I really don't know for sure.  Hope your doc can clear this up.  

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    • Posted

      Had a quick look around and found this regarding copper stain on biopsy...

      "The demonstration of copper-associated proteins suggests biliary disease in a noncirrhotic liver which also requires further investigation"

      The bile issue again.  From one of your posts above it appears your alk phosphate is running high, which is consistent with biliary issues, sluggish liver poor bile flow, and apparently iron staining on biopsy.  BINGO!  

      Lecithin, either from eggs or supplement may help thin bile and get it flowing better.  The lecithin is in the yolk of the egg so don't fool around with egg white omelettes or fake eggs (eggbeaters).  

      Turmeric and Curcumin are both also known to stimulate bile flow.  

      Always best to run anything you are considering past your doc before you buy or try, but I hope he wouldn't object to a few eggs per week and perhaps some curry/turmeric spiced meals.  

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    • Posted

      Yes, I noticed in the paper I found and quoted above they said "The demonstration of copper-associated proteins"...  Apparently a copper stain does show copper bound to proteins in the liver (Ceruloplasmin?). 

      I had assumed the copper stain was similar to the iron stain which does not show iron bound within its ferritin protein but only hemosiderin.  Looks like I was wrong there.  

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    • Posted

      I really don't know how that aspect works.  Like iron, copper is stored in the liver, & from what the paper said a high number in the copper stain may indicate biliary issues. 

      It may be that the liver dumps excess copper into bile for disposal down the GI tract, & if the biliary tree gets gummed up excess copper can accumulate in the liver.  I would expect to see ceruloplasmin elevated, but then I really don't know.  One way to find out.  Ceruloplasmin is a cheap lab, so really no reason not to look into this.  

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    • Posted

      Low platelets are associated with liver issues of many origins, but from what I've read occur due to enlarged spleen.  This would be visible on ultrasound.  

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    • Posted

      Hopefully time is on your side and you'll see improvement.  

      Livers Love Lecithin.  If you don't eat eggs, a supplement might help.  Check with your doc before you buy or try, but lecithin is a fairly benign supplement.  

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    • Posted

      Hello. I've read through a lot of your posts and you seem to be really knowledgeable so I wonder if you might give me some advice. I'm 48 year old female, not overweight and teetotal. My recent bloods showed normal liver profile but raised ALP on bone profile which my GP (I'm in the UK) says could be caused by either bone or liver. My ALP was 150 . He said that the elevation is minimal and he's not particularly concerned as all other tests were well within normal range. My mother has cholangitis and everything I've read on line says that ALP is to do with bile ducts. I'm terrified, my GP has been lovely but not very helpful. I would appreciate some advice if you can help.

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