Non-Alcoholic Fatty Liver Disease (NAFLD) & PPIs

[Clematis]

During blood work a week ago I had elevated liver function readings:

Amylase 116 U/L (range 30-104)
Alkaline Phosphatase 137 U/L (range 32-117)
AST 80 U/L (range 13-35)
BUN 24 mg/dL (range 7-21)
CO2 31 mmd/L (range 22-30)
ALT 93 U/L 7-38

I didn't think anything of it as I hadn't had high readings before. I wrote it off to a minor infection.

On Monday I had a gastric MRI and the report said:

Mild hepatic steatosis. Scattered too small to characterize T2 hyperintensities.

and later in the report:

Fat observed in liver indicative of non-alcoholic fatty liver disease.

(Really weird but this last sentence was in the online report on Monday afternoon but when I looked at it again online Friday morning, it was GONE. The radiologist must have edited it but there is no notation that it was indeed deleted. I'll talk to the gastro about it all when I see him on Wednesday for an endoscopy.)

Assuming I have indeed developed NAFLD virtually overnight, what do I do about it?? It looks like the recommendations are:

1. Lose weight. (If I lost 10# I'd have a BMI of 19, a bit too scrawny for my likes.)

2. Control insulin sensitivity. (I have no evidence that I have insulin sensitivity. Glucose readings are normal -- fasting is 84.)

There is no data to show efficacy of any pharmacological treatment.

But then I got to wondering what I have been doing differently between when labs were run in July and the labs run last week.

I WENT BACK ON A PROTON PUMP INHIBITOR AT THE END OF JULY. Yeah. PPIs can promote liver disease. https://www.eurekalert.org/pub_releases/2017-10/uoc--car100517.php

Several years ago the "miracle" statins nearly killed me. Now the "miracle" PPIs may do the same.

I thought I'd share this as I know someone was concerned recently about their elevated liver readings (@DianaCox maybe?).

 

[DSRIGGS]

Although dr. K found stage 3 bridging fibrosis of my liver last year when he did a biopsy during my surgery because it looked so nasty, my function is excellent. So I've been told just to try to limit alcohol consumption and obviously the couple of the best remedies for stopping the progression of non-alcoholic fatty liver is to get rid of diabetes and not be obese, so the DS took care of that for me.

I do take Protonix and I have been on a PPI for probably 10 years now so thanks for that information I'll have to look at it when I'm not in a loopy IV Dilaudid mode

 

[DianaCox]

Hmm, I've had funky liver levels all year, and I take a double dose of Protonix (40 mg x 2/day). But I'm horrified at the idea of quitting them (I still have some occasional break-through nausea/heartburn and middle-of-the-night puking). And yes, mild steatohepatitis, and the doctor wants me to lose more weight (which I have plenty of room to lose - like 30 lbs). Meh.

 

[DSRIGGS]

Hmm, I've had funky liver levels all year, and I take a double dose of Protonix (40 mg x 2/day). But I'm horrified at the idea of quitting them (I still have some occasional break-through nausea/heartburn and middle-of-the-night puking). And yes, mild steatohepatitis, and the doctor wants me to lose more weight (which I have plenty of room to lose - like 30 lbs). Meh.

I dropped my Protonix to once daily of 40 because of all the bad press about it, but I left it ordered as 2 per day because I wanted it if I needed it.

 

[Settledownnow]

Is this the first time set of labs with elevated liver enzymes? I have elevated level enzymes - much higher than those numbers. I scheduled an appointment with a gastroenterologist then decided to cancel and wait for the next set up labs in Dec.

I know elevated liver enzymes have been associated with rapid and significant weight loss, but I also wonder if the DS diet of liberal fat intake also contributes. I cannot find any information on the topic. Obviously, many DSers eat a high-fat diet and do not have a problem with their liver, but I have been wondering if there is already a predisposed condition for liver disease does the dietary fat overwhelm our liver? The literature I've read seems to point to malabsorption of a consequence of liver disease and not a causative factor.

At any rate, I've been experimenting with reducing my saturated fat intake and increasing unsaturated fats, increasing intake of fish, limiting the use of protein drinks, and keeping my protein 100 grams per day for the next set of labs. I have weaned myself off PPIs but I still need to take Pepcid 10 mg daily. I'm working on getting off the stuff but it is a slow process. I have never taken statins, don't drink, and do not take Tylenol or any other OTC/or RX meds on a regular basis.

 

[KathrynK]

This article outlines practical steps for treating NAFLD, including reducing sugar, exercise and taking vitamin E in addition to the steps you have identified.

http://pmj.bmj.com/content/91/1072/92

 

[Jbandmmomma]

I dropped my Protonix to once daily of 40 because of all the bad press about it, but I left it ordered as 2 per day because I wanted it if I needed it.

Gah. I've been without my protonix for just over 3 weeks. Pharmacy and physician's office can't seem to coordinate themselves to get it pre-authorized for this year. I'm dying. Twice daily zantac 150 and pepcid in the middle of the day. This keeps it barely at bay. I know I had a fatty liver when I had the DS, and this information does not make me happy. For now, I'm going to keep taking my protonix, living with the horrid reflux is not what I want.

 

[Webmommy]

So I know this is old but is this revealing itself to be true or just suspected? Because my liver enzymes started increasing after I started taking it and are not going down like expected.