GGT Coming Down Slowly

Thanks for your response, billinSD.

One more data point: Had new labs done last week, at the 13-week abstinence mark.  GGT and ALT went up.  So data points at 0-day, 1 month, 2 months, and 3 months abstention for GGT/ALT are:

231/58 (I incorrectly said 221 in the OP); 164/48; 137/48; and now 155/89.

I am pretty disappointed.  I have increased my running this past month, running 3.5 to 5 miles 3x week, no alcohol, lost a couple pounds.  I was sure the numbers would be down, and was shocked to see them go up.

To answer your questions, I doubt I have solvent exposures, and I'm not taking iron supplements.  I'm a lawyer, so in an office or in court most days.  Nothing unusual about my diet.  Try to go moderate on the carbs, but not on a true low-carb diet.

My internist referred me to a liver specialist, who I'll see in 2 weeks.  Hopefully that can get me some answers...

I do not see ferritin and TSAT on any of my labs, so that's something I can ask the liver specialist about.  

Thanks for your input

Strenuous exercise shouldn't affect GGT much, but it can bump ALT and AST briefly higher.  

Try going easy on the workouts for 5-7 days before your next labs and see if you get a substantial improvement.  

Glad you're getting to see a liver doc.  I'm sure he'll order kitchen sink labs, which should include iron (ferritin & TSAT), but definitely ask if these will be included in your labs.  

Legal eagles often have a lot of dry cleaned clothes hanging in their bedroom closet, & the dry cleaning fluid (perchloroethylene) will outgass from these clothes for a couple of weeks after they come home from the cleaners.  If your widows are closed, you may be exposed to significant levels of perc (which is highly liver toxic) all night long as you sleep.  

Don't know if you've got a spare bedroom you can keep your dry cleaned clothes in for a little experiment.  If you can crack the window overnight this might also help.  

Some dry cleaners also advertise a non-toxic solvent, which would be interesting to try.  

Hopefully your liver doc will provide some additional diagnostics and uncover some clues.  

Best of Luck!  

Just an update.

I saw the hepatologist yesterday. He had blood drawn (lots - 11 vials) to test for many liver diseases, as well as the usual panel.

Enzymes continued to rise, still with no alcohol consumption (now at 16 weeks). GGT to 210, ALT to 126, and AST to 62.

Ferritin was high, at 346.5.

We're awaiting the rest of the liver disease test results before I see him again. He did tell me to begin on 800-1,000mg of Vitamin E daily.

Sorry your labs aren't improving, but glad you're seeing a specialist and getting a good workup. This really doesn't look like alcoholic liver disease (to me).

Hopefully you're getting transferrin saturation (aka TSAT or iron saturation) included in your labs. When ferritin is elevated TSAT can indicate if iron is truly high, or your ferritin elevation is simply due to increased cell turnover in the liver. Ideally, you want to see TSAT in the middle third of the normal range, and not up into the high end of normal. If TSAT is above normal, then BINGO, iron may be what's causing or contributing to your inflammation. When both ferritin and TSAT are out of range, a referral to hematology would be wise for an opinion on whether therapeutic phlebotomy to lower iron might be helpful.

Glad your doc is prescribing Vitamin-E. There has been some promising research with this. Hope he told you to look for "Natural" form Vitamin-E with "mixed tocopherols". It should say natural on the label and if you look at the ingredients, natural form is "d-alpha tocopherol"; the synthetic form is "dl" alpha tocopherol.

Formulas that also include mixed tocopherols (d-beta, d-delta & d-gamma) in addition to the d-alpha (primary form) are best. I would avoid the "High-Gamma" E formulations as these taste (& smell) awful. Simple & cheap natural E with mixed toco's is best. Look also at the expiration date. Most supps are rated at a 2 year shelf life, but fresher is better in my book, & I always look for at least 12, and preferably closer to 18 months before the expiration date for optimal freshness.

Hope you find out what's going on and there is a good fix for it soon! I'm interested in hearing what your liver doc has to say.

Thanks very much for your response, billinSD. No, the doctor didn't tell me about natural v. synthetic Vitamin-E/d-alpha v. dl-alpha. I bought synthetic, but will buy a bottle of the natural asap.

I got some more iron-related labs back today:

Total Iron Binding Capacity: 308 (reference range showed as 250-450)

UIBC: 207 (reference range showed as 111-343)

Iron: 101 (reference range showed as 38-169)

Iron Saturation: 33% (reference range showed as 15-55%).

So all of the above appear normal. Not sure what this means in combination with the high ferritin, and haven't talked to the doctor about the results yet.

Iron labs (other than ferritin) look great. Iron Saturation in middle third of normal range means your ferritin elevation is most likely due to inflammation or increased liver cell turnover.

Ferritin will most likely fall as inflammation is reduced.

Very interested to hear of the Vitamin-E has a substantial effect. I expect you should see some improvement within 30 days or so if this is going to be a good fix.

Best of Luck!

All the liver disease tests came back negative.

An interesting test called NASH FibroSure was done. As I understand it, it takes the measure of 10 biochemicals, and analyzes them by an algorithm as a surrogate to predict various liver conditions. My results on this test were:

F0 (No Fibrosis)

N0 (No NASH)

S3 (Marked or Severe Steatosis)

The doctor's web notes say fatty liver is my most likely condition, and that we should re-take labs in a month after I have been on Vitamin E for 5 weeks. The notes say that if enzymes have not come down then, a biopsy may be appropriate.

I am glad the more serious liver disease tests came back negative. But I am confused as to why, if I have fatty liver, my enzymes have not come down (but have actually gone up in the case of ALT & AST) in the past 16 weeks of alcohol abstention and increased physical activity (gone from jogging about 2 miles 3x/week to about 4 miles 3x/week).

Also, the doctor's web notes say alcohol is a likely contributor to fatty liver, since my cholesterol and weight are normal. I am confused by that since my history has been to drink an average of 15 drinks/week, which is moderate, and since abstinence hasn't normalized my numbers.

Congratulations on the clean FibroSure report. NASH is very difficult to get quieted down once it gets started, so I'm betting you won't have too much trouble resolving simple fatty liver.

Strenuous exercise can bump both ALT and AST higher, so let's assume this might be what's going on with your labs. Try taking a week off (or at least 5 days) before your next blood draw, & I bet you'll see a significant drop.

Fatty liver is aggravated far more by sugar (particularly High Fructose Corn Syrup) than by dietary fats, so try to focus like a laser on sugars rather than trying to go fat free. A lot of specialty coffees now days have almost as much sugar as sodas, so you'll need to look carefully for hidden sources of fructose (corn syrup).

Sometimes keeping a diary of everything you eat and drink over a typical week can be helpful. Your doc might be interested in seeing this, and if you're referred to a nutritionist, this is the first thing he/she will want to see.

A fellow named Chris Masterjohn (PhD) has done a lot of research into fatty liver, and has a website/blog called "The Daily Lipid". Seek this out, and read what he has to say. Look for "Fatty Liver and Choline" and click "Start Here for Fatty Liver Disease" on the page that opens from the Choline link.

I like his paper: "The Sweet Truth About Liver and Egg Yolks — Choline Matters More to Fatty Liver Than Sugar, Alcohol, or Fat"

Give this a google and see what you think. If you wish to increase choline, a "Lecithin" supplement (phosphatidylcholine) is the best form to take (avoid Choline Bitartrate). Always best to run anything you are considering past your doc before you buy or try, but Lecithin is a pretty benign supplement.

I'm betting you're going to have this under control in time for the holidays, and hopefully can enjoy a little of the holiday cheers.

Best Wishes for Better Health!

Thanks so much for your input, billinSD. I am reading Dr. Masterjohn's blog, and will post an update once I get my next check in about 4 weeks.

Dear Adam,

Do you have a follow up? My wife has almost exactly the same blood markers mentioned, and also even less alcohol consumption.