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Elevated liver enzymes
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Good to see a post from you, Wayne. 
I believe I'd say "no way" next time they tried to put me on Xifaxan.
Also, I don't understand why your Dr. wasn't more concerned about the elevated liver enzymes. At least it seems like he should have scheduled another test within a few weeks to see about any changes.
However, I know little about it........... I just know what has happened when my Mom's were elevated. Both times her's went back down but they did check to make sure they did.
Glad everything else looked good.
Love, Shirley
I believe I'd say "no way" next time they tried to put me on Xifaxan.
Also, I don't understand why your Dr. wasn't more concerned about the elevated liver enzymes. At least it seems like he should have scheduled another test within a few weeks to see about any changes.
However, I know little about it........... I just know what has happened when my Mom's were elevated. Both times her's went back down but they did check to make sure they did.
Glad everything else looked good.
Love, Shirley
When the eagles are silent, the parrots begin to jabber"
-- Winston Churchill
-- Winston Churchill
Hi Wayne,
Oh no, not another problem!
Here is my best guess...... Whenever I see elevated liver enzymes, I think they're due to medications until proven otherwise. Since most drugs are metabolized by the liver, it makes sense. My advice, FWIW, is NO MORE Xifaxan, wait a few weeks, and repeat the liver enzymes. They should be coming down. Be sure to avoid taking Tylenol or drinking any alcohol until the enzymes come back to normal. And keep us posted.
Love,
Polly
Oh no, not another problem!
Here is my best guess...... Whenever I see elevated liver enzymes, I think they're due to medications until proven otherwise. Since most drugs are metabolized by the liver, it makes sense. My advice, FWIW, is NO MORE Xifaxan, wait a few weeks, and repeat the liver enzymes. They should be coming down. Be sure to avoid taking Tylenol or drinking any alcohol until the enzymes come back to normal. And keep us posted.
Love,
Polly
Blessed are they who can laugh at themselves, for they shall never cease to be amused.
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Hi Wayne,
As Rosanne Rosanadana would say, "It's always something", isn't it.
I totally agree with Polly. Until proven otherwise, I would assume that the elevated liver enzymes are due to meds.
If they don't come down in the future, here are a couple of things to consider, (among quite a few possibilities). I'm guessing that the first one probably doesn't apply to you, but the second one definitely might.
1. An AST/ALT ratio over 1.5 is considered to be highly suggestive of liver damage due to alcohol. I only mention that because your ratio is almost 3. Since you probably don't even use alcohol, that just goes to show how misleading enzyme test levels can be.
2. Gluten sensitive enteropathy can be a cause of elevated liver enzymes.
http://www.ncbi.nlm.nih.gov/pubmed/17969053
Consider this quote, from the website link below:
http://robbwolf.com/?p=113
Surely your doc understands the implications, so if he's not particularly concerned about the test levels, then you probably don't need to be worrying, either. Polly's right on the money, of course, in suggesting that you should avoid the use of acetaminophen and/or alcohol, until the enzymes come back down, since they're both prime contributors to elevated liver enzymes.
Hopefully, they'll come down on their own. If they don't, though, you might want to consider giving the paleo diet a try for a few months, and then check them again.
Tex
As Rosanne Rosanadana would say, "It's always something", isn't it.
I totally agree with Polly. Until proven otherwise, I would assume that the elevated liver enzymes are due to meds.
If they don't come down in the future, here are a couple of things to consider, (among quite a few possibilities). I'm guessing that the first one probably doesn't apply to you, but the second one definitely might.
1. An AST/ALT ratio over 1.5 is considered to be highly suggestive of liver damage due to alcohol. I only mention that because your ratio is almost 3. Since you probably don't even use alcohol, that just goes to show how misleading enzyme test levels can be.
2. Gluten sensitive enteropathy can be a cause of elevated liver enzymes.
http://www.ncbi.nlm.nih.gov/pubmed/17969053
Consider this quote, from the website link below:
Note the comments by one of the patients doctors, (which I have highlighted in red).I’ve had a slew of questions regarding elevated Liver enzymes, the Zone, Paleo, CrossFit etc. We have two clients, both pharmacists, who had stunningly high liver enzymes, particularly ALK (alkaline phosphatase). Frequently AST and ALT are also elevated, occasionally even bilirubin. Both clients have seen a dramatic reduction in liver enzyme levels with the adoption of a Paleo diet…for one individual he also had a con-founder of hyperinsulinism. The doctor of one client said: “It is preposterous… dietary manipulation cannot change liver enzyme status…the decrease must be due to another factor…” This person has had high liver enzymes for over 20 years…the only change was dietary, that mainly being the adoption of a gluten free Paleo diet. What a mis-informed IDIOT.
http://robbwolf.com/?p=113
Surely your doc understands the implications, so if he's not particularly concerned about the test levels, then you probably don't need to be worrying, either. Polly's right on the money, of course, in suggesting that you should avoid the use of acetaminophen and/or alcohol, until the enzymes come back down, since they're both prime contributors to elevated liver enzymes.
Hopefully, they'll come down on their own. If they don't, though, you might want to consider giving the paleo diet a try for a few months, and then check them again.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Wayne,
FWIW, that link worked just fine for me - it just happens to be a print file, rather than the regular HTML file.
Okay, lets look at that analytically. Even if the findings of that study are 100% accurate, the odds don't look all that grim, if you analyze it properly. Using the Life Tables from the CDC statistical database, (and guessing at your age, according to my memory), the probability that an American male will survive from the age of 46 to 56, is 95%. (IOW, you have a 5% chance of dying within the next 10 years). If the odds were to actually be shifted by 78%, then your chance of dying within the next 10 years would be 8.9%, so your probably of survival would be 91.1%. That's not so bad, is it?
The real issue, of course, is the reliability of statistics, as derived from research projects of that sort. That ratio is an arbitrary parameter, that someone chose to analyze, based on the data available from that cohort database. It may be significant, but on the other hand, without corroborating evidence, it may simply be an irrelevant coincidence. As we all know, most research projects these days, result in predictable outcomes, relative to the goals of the researchers. IOW, you can prove pretty much anything you want to prove, if you're a "good" researcher, or a "creative" report writer. Look at the wave of opinion reversals that the medical researchers continue to throw at us, these days. First alcohol is bad for us - then it's good for us. Red meat causes colon cancer - well what do you know, it turns out that it doesn't cause colon cancer. I'm not sure that we can afford to put much credibility in any research claims, the way things are going. The bottom line is, I wouldn't let that article worry me. There are more important things in life.
On the other hand, IMO, you really should give some thought to trying to find a doctor or two who might be more responsive to your needs and wishes. Doctors who don't return calls, (or who don't have someone in their office return your call), don't seem to me to be very concerned about their patients' welfare.
Tex
FWIW, that link worked just fine for me - it just happens to be a print file, rather than the regular HTML file.
Okay, lets look at that analytically. Even if the findings of that study are 100% accurate, the odds don't look all that grim, if you analyze it properly. Using the Life Tables from the CDC statistical database, (and guessing at your age, according to my memory), the probability that an American male will survive from the age of 46 to 56, is 95%. (IOW, you have a 5% chance of dying within the next 10 years). If the odds were to actually be shifted by 78%, then your chance of dying within the next 10 years would be 8.9%, so your probably of survival would be 91.1%. That's not so bad, is it?
The real issue, of course, is the reliability of statistics, as derived from research projects of that sort. That ratio is an arbitrary parameter, that someone chose to analyze, based on the data available from that cohort database. It may be significant, but on the other hand, without corroborating evidence, it may simply be an irrelevant coincidence. As we all know, most research projects these days, result in predictable outcomes, relative to the goals of the researchers. IOW, you can prove pretty much anything you want to prove, if you're a "good" researcher, or a "creative" report writer. Look at the wave of opinion reversals that the medical researchers continue to throw at us, these days. First alcohol is bad for us - then it's good for us. Red meat causes colon cancer - well what do you know, it turns out that it doesn't cause colon cancer. I'm not sure that we can afford to put much credibility in any research claims, the way things are going. The bottom line is, I wouldn't let that article worry me. There are more important things in life.
On the other hand, IMO, you really should give some thought to trying to find a doctor or two who might be more responsive to your needs and wishes. Doctors who don't return calls, (or who don't have someone in their office return your call), don't seem to me to be very concerned about their patients' welfare.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
My liver scores were high and gallstone present (nothing new) so my doc insisted that I go to see a surgeon. I had consulted with him informally some years ago when DH had surgery. He said I didn't have to do a thing then and he said it again at my appointment. The liver scores they sent him (my last) were normal.........
Regular doc also wanted to raise my Pravachol and I just said NO.
Regular doc also wanted to raise my Pravachol and I just said NO.
DISCLAIMER: I am not a doctor and don't play one on TV.
LDN July 18, 2014
Joan
LDN July 18, 2014
Joan
There isn't much info about that ratio out there. I suspect that the claim that high AST/ALT ratios are an indication of advanced liver disease due to alcohol consumption, was merely a fortuitous observation, that some researcher just happened to notice. Since they couldn't see any other indications in that relationship, the alcohol connection is the default finding, whenever you do a search. IOW, no one really knows why the ratio would be high, except that in the case of heavy alcohol consumption, it indicates advanced liver damage. If alcohol consumption is not involved, then no "practical" information about the ratio exists. I say "practical", because there does seem to be some connection between AST/ALT ratio and primary biliary cirrhosis, (PBC), but the ratio is usually much lower, in that situation.Wayne wrote:I also wanted more info about the AST/ALT ratio ... since I'm not a consumer of alcohol, what does it mean?
I doubt that PBC is the problem, because you should be itching, at this stage, if it is developing. Your doc can run some additional tests, to rule it out.
http://www.cumc.columbia.edu/dept/gi/PBC.html
Acetaminophen can cause some pretty wild liver enzyme excursions in a fairly high percentage of the general population. Here is some info on that:
http://www.medicinenet.com/tylenol_live ... /page2.htm
Here's some info on drug interactions that can affect ALT and AST levels. As you can see, there are a lot of possibilities:
http://www.medicinenet.com/liver_blood_tests/page3.htm
I doubt that the Xifaxan caused the problem, but that doesn't mean that it would have been impossible.
You mentioned that you're taking omeprazxole. Prilosec, (Omeprazole), inhibits one of the key liver enzymes, (cytochrome P450 2C19), involved in eliminating drugs from our systems. That mode of action means that it can lead to increased blood concentrations of certain drugs, and it's certainly possible that it might cause unintended consequences which could lead to elevated liver enzymes, or who-knows-what.
On the link - yes, it took me to a Medscape log-in page. Since I'm a member, and my browser automatically filled in the blanks, I just automatically hit the log-in button, without even thinking. The way that works is, the first time you visit one of their sites, you go straight to the site. When you do, their server sets a cookie on your computer, so that the next time you visit, you get a log-in screen. A few other sites do that, also, and when that happens, I usually just move along, and look for another source, but I use Medscape so often, that I registered there.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
WAYNE!!!
Take a deep breath and let it out slowly, please. Now say "OMMMMMM".
I can so relate to what you are doing. I've been there, done that! Can you imagine going through medical school and thinking that you have every single disease that you are learning about? As if the stress levels in med. school weren't already high enough, we had to worry about having all of the diseases too. Of course, as we learned about the psychiatric diseases, we were always diagnosing our friends and family members, not ourselves! LOL!
Seriously, though, it's time to sit back, relax, and stop surfing for liver disease on the net.
First of all, it is not unusual for anyone to have elevated liver enzymes at some time in their lives. You should not draw any conclusions whatsoever from a one-time test. (Remember, the lab could have given you someone else's values - mixups do happen). What is important is what happens over time, and there is no reason to believe that the values will stay elevated.
I am guessing that the Tylenol may have been the culprit. It IS possible to get elevated liver enzymes, even from taking the maximum recommended dose. In the study Tex cited above, subjects took 2, 500 mg tabs 4 times a day (which is the highest recommended dose) for 2 weeks. Of that group, up to 44% had ALT values more than 3 times the upper limit of normal. (your ALT value was only 2 times the upper limit of normal). One person's value was 10 times greater. (Folks in the placebo group had no elevations). So, even occasional doses could potentially cause problems, especially if one is super sensitive to the effects of Tylenol.
I would bet that, with time, your values will return to normal. If not, then I would echo what Tex recommended - trying the paleo diet or at least a strict gluten-free diet. I have been absolutely humbled to learn about all of the ways that gluten sensitivity can negatively affect the body.....from abnormal liver enzymes to neurological problems to full-blown psychiatric problems to symptoms/findings consistent with lupus, autism in children, multiple sclerosis, thyroid disease, etc., etc., etc. And most of the traditional medical community doesn't have a clue, unfortunately.
Please feel free to ask me any questions. And I encourage you to "express yourself" to your GI doc. Tee Hee. You probably won't gain any wisdom, but maybre he will, and at least you might feel better. He should certainly have discussed a plan for following the elevated liver enzymes - IMHO it is unethical and poor medicine not to do so, to leave a patient "hanging" in thin air.
Love,
Polly
Take a deep breath and let it out slowly, please. Now say "OMMMMMM".
I can so relate to what you are doing. I've been there, done that! Can you imagine going through medical school and thinking that you have every single disease that you are learning about? As if the stress levels in med. school weren't already high enough, we had to worry about having all of the diseases too. Of course, as we learned about the psychiatric diseases, we were always diagnosing our friends and family members, not ourselves! LOL!
Seriously, though, it's time to sit back, relax, and stop surfing for liver disease on the net.
First of all, it is not unusual for anyone to have elevated liver enzymes at some time in their lives. You should not draw any conclusions whatsoever from a one-time test. (Remember, the lab could have given you someone else's values - mixups do happen). What is important is what happens over time, and there is no reason to believe that the values will stay elevated.
I am guessing that the Tylenol may have been the culprit. It IS possible to get elevated liver enzymes, even from taking the maximum recommended dose. In the study Tex cited above, subjects took 2, 500 mg tabs 4 times a day (which is the highest recommended dose) for 2 weeks. Of that group, up to 44% had ALT values more than 3 times the upper limit of normal. (your ALT value was only 2 times the upper limit of normal). One person's value was 10 times greater. (Folks in the placebo group had no elevations). So, even occasional doses could potentially cause problems, especially if one is super sensitive to the effects of Tylenol.
I would bet that, with time, your values will return to normal. If not, then I would echo what Tex recommended - trying the paleo diet or at least a strict gluten-free diet. I have been absolutely humbled to learn about all of the ways that gluten sensitivity can negatively affect the body.....from abnormal liver enzymes to neurological problems to full-blown psychiatric problems to symptoms/findings consistent with lupus, autism in children, multiple sclerosis, thyroid disease, etc., etc., etc. And most of the traditional medical community doesn't have a clue, unfortunately.
Please feel free to ask me any questions. And I encourage you to "express yourself" to your GI doc. Tee Hee. You probably won't gain any wisdom, but maybre he will, and at least you might feel better. He should certainly have discussed a plan for following the elevated liver enzymes - IMHO it is unethical and poor medicine not to do so, to leave a patient "hanging" in thin air.
Love,
Polly
Blessed are they who can laugh at themselves, for they shall never cease to be amused.
Wayne,
I suspect that Enterolab has yet to see a normal BM. Send them what you've got - it'll tell them how bad it is.
I wouldn't wait to see your GI before you change your diet. He/she will most likely not support you in your endeavor. My attitude was that it can't hurt and will likely help. There's a bit of a learning curve, but we're here to help you and there is a lot of information on the home page. If you're lucky, you'll find a big difference just by eliminating gluten.
You aren't alone in feeling tired and depressed with this disease. Those feelings can go away once you're feeling better.
I hope you post some pictures of your garden again. I really enjoyed them last year.
Gloria
I suspect that Enterolab has yet to see a normal BM. Send them what you've got - it'll tell them how bad it is.
I wouldn't wait to see your GI before you change your diet. He/she will most likely not support you in your endeavor. My attitude was that it can't hurt and will likely help. There's a bit of a learning curve, but we're here to help you and there is a lot of information on the home page. If you're lucky, you'll find a big difference just by eliminating gluten.
You aren't alone in feeling tired and depressed with this disease. Those feelings can go away once you're feeling better.
I hope you post some pictures of your garden again. I really enjoyed them last year.
Gloria
You never know what you can do until you have to do it.