Liver function tests abnormal

[DianaCox]

OK, this is strange - I had my LFTs redrawn two days ago when I had some missing tests from my annual labs done (Vit K, ferritin and CRP were missed). And look at my numbers now! I have bought but not started taking the Vit E and Coromega (I'm redoing my 4 weeks of pills tomorrow, when I will add them):

Date ..... AST (0-40) ... ALT (0-32) Comments
1/9/17 .. 136 ............... 162 ........... Initial appointment

1/27/17 . 126 .............. 274 ........... Recheck

2/20/17 .. 74 ............... 145 ........... After stopping Vit A, D, K1, K2

5/18/17 .. 48 ............... 184 ........... After resuming ½ dose of Vit A, D, K1, K2

8/10/17 . 237 ............. 249 .......... Still taking 1/2 doses of vites.

9/13/17 .. 28 ................ 59 .......... I didn't change ANYTHING - AST NORMAL! ALT barely above normal!

And my ferritin was 152 - top of the range is 150 - I haven't had an infusion for 2.5 years. My CRP was very normal too.

I'm not complaining - just confused!

 

[hilary1617]

@DianaCox What!?! Well, that's just awesome!

 

[DianaCox]

Latest updated levels - the liver doc said they were good enough that he canceled my upcoming appointment. I added vitamin E but never took any of the Coromega.


Date ..... AST (0-40) ... ALT (0-32) Comments
1/9/17 .. 136 ............... 162 ........... Initial appointment

1/27/17 . 126 .............. 274 ........... Recheck

2/20/17 .. 74 ............... 145 ........... After stopping Vit A, D, K1, K2

5/18/17 .. 48 ............... 184 ........... After resuming ½ dose of Vit A, D, K1, K2

8/10/17 . 237 ............. 249 .......... Still taking 1/2 doses of vites.

9/13/17 .. 28 ................ 59 .......... I didn't change ANYTHING - AST NORMAL! ALT barely above normal!

11/28/17 . 75 ................ 96 ......... High, but not alarmingly so



These are the numbers overall (including additional tests) which I copied from the annoyingly graphic-intense LabCorp site:
Albumin, Serum
4.1 NORMAL
Reference Range: 3.6-4.8 g/dL

Alkaline Phosphatase, S
105 NORMAL
Reference Range: 39-117 IU/L

AST (SGOT)
75 HIGH
Reference Range: 0-40 IU/L

Bilirubin, Total/Direct, Serum
0.9 NORMAL
Reference Range: 0.0-1.2 mg/dL

Bilirubin, Direct
0.24 NORMAL
Reference Range: 0.00-0.40 mg/dL

Bilirubin, Indirect
0.66 NORMAL
Reference Range: 0.10-0.80 mg/dL

ALT (SGPT)
96 HIGH
Reference Range: 0-32 IU/L

Vitamin A, Serum
71 NORMAL
Reference Range: 26-82 ug/dL

Vitamin D, 25-Hydroxy, Total
Vitamin D, 25-Hydroxy, Serum
76 NORMAL
Reference Range: All Ages: Target levels 30 - 100

 

[DianaCox]

Another update. Five or so months ago, when my numbers were high, my liver doc suggested a consult with Banner Hospital in Phoenix, which is running clinical trials on drugs for liver fibrosis, which I presumably have due to NAFLD. The appointment finally occurred today. I had a fibroscan, and the number came back in the "not-that-bad-but-something-to-keep-an-eye-on" category of stage 2. https://www.racgp.org.au/afp/2013/july/fibroscan/ My fibroscan score was 7.8.

So the interesting thing was that there were 2 clinical trials for drugs for fibrosis, but one you had to have a score of stage 3, and the other took stage 2 but no history of bariatric surgery allowed. So I didn't qualify for either.

The doctor suggested that I could have a liver biopsy for a definitive answer (more likely than not, the biopsy would show LESS fibrosis than the fibroscan, because it tends to overestimate in older people and heavier people - I'm not that heavy now, but ...) - so the bottom line was, if I had a biopsy, which is a painful procedure, NOTHING about my treatment would likely change. So, no thanks.

Interesting that these drugs are in phase 3 though - note to @DSRIGGS .

 

[Clematis]

After elevated liver tests and fat blobs visible on a scan (NAFLD), my doc just had me start taking OTC Silymarin (Milk Thistle) 200mg twice a day. She said one of her med school mentors ran studies on it and found it to be beneficial for those with NAFLD. She says she has had great success with her own patients and it works fast - one can see if it's working with a liver panel 6 weeks later. I'll get blood work in 4 weeks and let you know.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612568/

Not scientific but the first place I've seen reference rapid weight loss as cause for NAFLD. https://www.drweil.com/health-wellness/body-mind-spirit/liver-kidney/fighting-fatty-liver/

 

[DSRIGGS]

Another update. Five or so months ago, when my numbers were high, my liver doc suggested a consult with Banner Hospital in Phoenix, which is running clinical trials on drugs for liver fibrosis, which I presumably have due to NAFLD. The appointment finally occurred today. I had a fibroscan, and the number came back in the "not-that-bad-but-something-to-keep-an-eye-on" category of stage 2. https://www.racgp.org.au/afp/2013/july/fibroscan/ My fibroscan score was 7.8.

So the interesting thing was that there were 2 clinical trials for drugs for fibrosis, but one you had to have a score of stage 3, and the other took stage 2 but no history of bariatric surgery allowed. So I didn't qualify for either.

The doctor suggested that I could have a liver biopsy for a definitive answer (more likely than not, the biopsy would show LESS fibrosis than the fibroscan, because it tends to overestimate in older people and heavier people - I'm not that heavy now, but ...) - so the bottom line was, if I had a biopsy, which is a painful procedure, NOTHING about my treatment would likely change. So, no thanks.

Interesting that these drugs are in phase 3 though - note to @DSRIGGS .

Thanks Diana. My GI who is a liver specialist as well ran numerous tests on me and since my liver function is very good he said that I should just watch how much I drink (okay he actually said I shouldn't drink at all but I have a glass of with dinner maybe once a week). As he said I am lucky in that although I am in stage 3 which is irreversible, but it hasn't hurt my function to this point. Basically he would have told me to lose weight and get my Diabetes under control. My one big positive from my DS struggles is that I am no long a T2DM patient and I have a normal BMI. That being said I will keep an eye on these drug trials as I might be needing them someday.

 

[DianaCox]

So, I got back from our extended RV trip on Monday, and I got a bill from a lab company associated with Banner Hospital, where I had my specialist appointment/clinical trial screening in January, reminding me I hadn’t seen those results. Here are the updated numbers - GO FIGURE!

Date ..... AST (0-40) ... ALT (0-32) Comments
1/9/17 .. 136 ............... 162 ........... Initial appointment

1/27/17 . 126 .............. 274 ........... Recheck

2/20/17 .. 74 ............... 145 ........... After stopping Vit A, D, K1, K2

5/18/17 .. 48 ............... 184 ........... After resuming ½ dose of Vit A, D, K1, K2

8/10/17 . 237 ............. 249 .......... Still taking 1/2 doses of vites.

9/13/17 .. 28 ................ 59 .......... I didn't change ANYTHING - AST NORMAL! ALT barely above normal!

11/28/17 . 75 ................ 96 ......... High, but not alarmingly so

1/12/18 .. 23 ............... 41 ......... Both totally NORMAL!? Note reference ranges from this lab: AST 10-41, ALT 5-46

 

[2000DuodenalSwitch]

So do you have a clue what caused the crazy numbers? My D is 99 (30-100) after I increased from 150,000iu to 200,000iu to try to lower my 38 PTH (15-65) a bit. Scheduled for abdominal ultrasound next week to check liver. I had liver biopsy in 2006, nothing found (wishing I’d gotten copy of report) for same reason. Numbers went back down after but gone up again last couple of years (see screenshot).
DS 10/11/2000

 

[DianaCox]

My doctor thought my D and A were too high for my liver, which already has the insults (non-alcoholic steatohepatitis or NASH) from years of obesity. I cut all my fat solubles (including K1 and K2) in half and added E and my numbers went down. But that might be coincidental.

 

[2000DuodenalSwitch]

My doctor thought my D and A were too high for my liver, which already has the insults (non-alcoholic steatohepatitis or NASH) from years of obesity. I cut all my fat solubles (including K1 and K2) in half and added E and my numbers went down. But that might be coincidental.

Interesting. My A is only midrange (I take 50,000iu); 200,000iu D (going to reduce to 150,000iu since my D is near top edge); I don’t take E (was your E lowish?); but I take a crapload of K1 and level still near low edge (5/day Biotech K-1000 Plus Superior Source Triple K sublingual). I’m afraid to reduce the K because it’s so low as is. I start having gum bleeding each time it drops. I will be in a pickle if it’s the K that’s causing my liver issues, arghhh!
But wait...if my K lab is low, it’s not absorbing in digestive system and going through liver, right? My B12 is the only thing that’s high other than the D. I only take 1/week B12. Should I add E if my E lab is good without any? Does E help liver?

 

[DianaCox]

Update - in case you don't want to read through this whole thread: because I've had some bad liver function test numbers, I not only have my PCP on it, and a GI/Liver doc on it, I also have been seeing a research MD at Banner Hospital who is doing clinical trials on new drugs for fibrosis/NASH. Although my numbers were better recently, she wants me to test every three months and if my numbers go up, to go in for a liver biopsy, assuming there may be some intermittent inflammatory process going on. So I had a new draw on Tuesday.

Weird - my numbers were practically perfect. And I've been drinking just a bit more than usual - like 5 drinks/week instead of 2-3, and occasionally two in one day.

Date ..... AST (0-40) ... ALT (0-32) Comments
1/9/17 .. 136 ............... 162 ........... Initial appointment

1/27/17 . 126 .............. 274 ........... Recheck

2/20/17 .. 74 ............... 145 ........... After stopping Vit A, D, K1, K2

5/18/17 .. 48 ............... 184 ........... After resuming ½ dose of Vit A, D, K1, K2

8/10/17 . 237 ............. 249 .......... Still taking 1/2 doses of vites.

9/13/17 .. 28 ................ 59 .......... I didn't change ANYTHING - AST NORMAL! ALT barely above normal!

11/28/17 . 75 ................ 96 ......... High, but not alarmingly so

1/12/18 .. 23 ............... 41 ......... Both totally NORMAL!? Note reference ranges from this lab: AST 10-41, ALT 5-46

3/27/18 .. 23 ............... 44 ......... Both essentially NORMAL!? Note reference ranges are the usual ones, so the 44 was a tad high.

I guess I'm not getting a liver biopsy any time soon.

My protein numbers were relatively good:
Protein, Total Reference Range: 6.0-8.5 g/dL
6.2 NORMAL
Albumin Reference Range: 3.6-4.8 g/dL
4.1 NORMAL

 

[2000DuodenalSwitch]

Update - in case you don't want to read through this whole thread: because I've had some bad liver function test numbers, I not only have my PCP on it, and a GI/Liver doc on it, I also have been seeing a research MD at Banner Hospital who is doing clinical trials on new drugs for fibrosis/NASH. Although my numbers were better recently, she wants me to test every three months and if my numbers go up, to go in for a liver biopsy, assuming there may be some intermittent inflammatory process going on. So I had a new draw on Tuesday.

Weird - my numbers were practically perfect. And I've been drinking just a bit more than usual - like 5 drinks/week instead of 2-3, and occasionally two in one day.

Date ..... AST (0-40) ... ALT (0-32) Comments
1/9/17 .. 136 ............... 162 ........... Initial appointment

1/27/17 . 126 .............. 274 ........... Recheck

2/20/17 .. 74 ............... 145 ........... After stopping Vit A, D, K1, K2

5/18/17 .. 48 ............... 184 ........... After resuming ½ dose of Vit A, D, K1, K2

8/10/17 . 237 ............. 249 .......... Still taking 1/2 doses of vites.

9/13/17 .. 28 ................ 59 .......... I didn't change ANYTHING - AST NORMAL! ALT barely above normal!

11/28/17 . 75 ................ 96 ......... High, but not alarmingly so

1/12/18 .. 23 ............... 41 ......... Both totally NORMAL!? Note reference ranges from this lab: AST 10-41, ALT 5-46

3/27/18 .. 23 ............... 44 ......... Both essentially NORMAL!? Note reference ranges are the usual ones, so the 44 was a tad high.

I guess I'm not getting a liver biopsy any time soon.

My protein numbers were relatively good:
Protein, Total Reference Range: 6.0-8.5 g/dL
6.2 NORMAL
Albumin Reference Range: 3.6-4.8 g/dL
4.1 NORMAL

Great news! It’s crazy that the numbers dropped into normal range with no clue why. I’m taking the Liver Therapy Supplement pills, reduced my D by 50k, so hoping it’s enough to make my liver numbers normalize soon too. Maybe I should start drinking too, hahaha? Will they continue rechecking a while to be sure your numbers stay down?

 

[DianaCox]

Yes, I have another recheck written for July, though it will probably slip into August because we’re going to be traveling.

My PCP also ordered another D3 level with my iron labs that were drawn yesterday, so we’ll see how the decrease in my supplementation from 10 pills/week to 5 has worked over the long term. It’s been over a year now.

 

[2000DuodenalSwitch]

Lo

Yes, I have another recheck written for July, though it will probably slip into August because we’re going to be traveling.

My PCP also ordered another D3 level with my iron labs that were drawn yesterday, so we’ll see how the decrease in my supplementation from 10 pills/week to 5 has worked over the long term. It’s been over a year now.

I decreased my D3-50 from 28/week to 21/week. I’m afraid to be more aggressive in D reduction without frequent D, PTH, calcium rechecks (which she will only do yearly unless I’m out of range at last test, grrr).

 

[2000DuodenalSwitch]

Yes, I have another recheck written for July, though it will probably slip into August because we’re going to be traveling.

My PCP also ordered another D3 level with my iron labs that were drawn yesterday, so we’ll see how the decrease in my supplementation from 10 pills/week to 5 has worked over the long term. It’s been over a year now.

Be sure to update us on your rechecks!!