Elevated liver enzymes?

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Elevated liver enzymes?

Postby britdoc » Mon Dec 20, 2010 1:32 pm

Hey now,

So I have been vegan for almost a year at this point, and told my doc at a routine health visit. Because of my 'radical decision' we did some labs - retested lipid panel, metabolic panel, hemogram, etc. Everything was fine (cholesterol excellent - LDL dropped from 105 to 60!) with the exception of a mild increase in the liver labs (AST, ALT) one of which tripled (from 20 to 60, normal 10-40).

I'm a doc myself, and am not sure why this happened - I think that this might be supplement or medication related, but a quick google search found this to be not an isolated case (http://www.thekindlife.com/forum/thread ... er-enzymes). I have looked through pubmed and have not really found anything helpful linking a vegan diet to increased liver enzymes, but this is the only thing that has really changed in my lifestyle over the last year or so.

Has anyone else experienced anything like this, and if so, what happened?

Thanks,

BD
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Re: Elevated liver enzymes?

Postby hardcore iv » Mon Dec 20, 2010 1:47 pm

Years ago I had a slightly high AST level. My doctor wasn't very concerned. It went back down to the normal range at my next blood test. I didn't change anything about my lifestyle or diet between those tests.
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Re: Elevated liver enzymes?

Postby beforewisdom » Mon Dec 20, 2010 3:49 pm

I got correctly diagnosed with NASH after having been a vegan for about 10 years and a vegetarian for over 20. A few years ago I lost 48 lbs, on purpose, for other reasons and the NASH completely disappeared.

NASH isn't always caused by being overweight, sometimes people within a normal range get it and have elevated liver enzyme counts.

"The plural of anecdote is not data." (Roger Brinner)
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Re: Elevated liver enzymes?

Postby britdoc » Mon Dec 20, 2010 3:52 pm

Yeah, I have heard about the whole NASH thing - I am not overweight, and my liver enzymes were normal a year ago...we'll see what happens.
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Re: Elevated liver enzymes?

Postby hardcore iv » Tue Dec 21, 2010 1:07 pm

I just got some results back today. It was actually only my ALT levels that were high. AST was always normal. Jumped from 36 to 52 U/L in 7 months. Normal range according to the pathology lab is 5-40. I've also dropped a few kg since the last test. Will see how things change when i am a ripped 100kg in mid 2011.
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Re: Elevated liver enzymes?

Postby Gelert » Tue Dec 21, 2010 1:35 pm

You'd expect the ratio to be the other way round in case of viral hepatitis, but given your line of work, I assume all is tickety boo on the Hep B vaccination front?

This is something that happens every so often by the way and it's understandable - the thought process that since being vegan is the major apparent change in lifestyle and is not that common in the general population, that changes in blood chemistry or whatever *must* be due to it, whereas the aetiology could be any one of a dozen things which Jo Bloggs may or may not get.
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Re: Elevated liver enzymes?

Postby beforewisdom » Tue Dec 21, 2010 1:56 pm

I'm a programmer. At my last job a team of us maintained a very complex, poorly (not) documented system which was constantly being modified.

It was a bit like being a medical doctor

We had to ferret out what the problem was out of that complex system and do it in a brief amount of time to keep people happy.

It was common for a lot of the programmers in the face of that uncertainty to jump on the first superficial item out of the ordinary.........understandable, but they would stick with it as a theory even though it was proven not to be the issue.

I noticed doctors doing the same thing.

I don't tell them anything about my diet unless they ask me a direct question and then I answer their question directly without volunteering any more information about my diet than giving them exactly the information they asked for.

It saves so much time and BS

"The plural of anecdote is not data." (Roger Brinner)
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Re: Elevated liver enzymes?

Postby slodki » Tue Dec 21, 2010 10:04 pm

@beforewisdom, I do the same. Though doctors often have little to no nutritional education they as if they do.
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Re: Elevated liver enzymes?

Postby britdoc » Wed Dec 22, 2010 4:15 am

@beforewisdom and gelert - you are right. I do think he is kind of obliged, in a sense, to follow up on the labs...they are slightly out of wack and if I developed a raging hepatitis, he could be liable (dumb litigious society that we live in...) He did ask me to quit all meds, alcohol (Ha! I wish...) and supplements for a week before re-testing them. He didn't blame anything on veganism...he is quite supportive, and I only told him because he asked me about the 20lb weight loss and the fact that my LDL went from 110 to 50 (!).

@slodki - too right. I knew a lot about nutrition prior to and during medical school due to my own interests and was stunned and amazed at how ignorant many M.D.s were...even disparaging educated nutritionists because they were 'less qualified' (i.e. did not have an M.D.) than them.

One of my favorite quotes from a fellow medical student, in her fourth year - 'Richie, did you know that oil and vinegar...the supposed 'healthy' salad dressing...is nothing but fat?'

Oil = fat? Shocking.
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Re: Elevated liver enzymes?

Postby Gelert » Wed Dec 22, 2010 11:20 pm

Out of interest, if you feel like sharing, what supplements etc. are you on?

As you'll know the liver is the metabolic hotbox of the ooman bodee - if you're on something complex or a bit strong it might be forcing it onto turbo and that's what's showing up. Alternatively, there are lots of toxins (not in the "Gillian McKeith" sense, more aromatic compounds) that partition into adipose tissues and sit there for the rest of your life but if you've had a fairly sudden and not insubstantial weight loss these can become mobilized and your poor ol' liver has to sort it all out.

It's all fascinating stuff. I love the cytochromes P450 stuff. There's a practical class I'd love to run on the ratio of caffeine to xanthine-something-or-other in students wee as a marker of whether the P450 that metabolises caffeine is induced. Sadly the ethics committee all think its a bit too much like watersports to extract stuff from wee to bung on the HPLC.
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Re: Elevated liver enzymes?

Postby britdoc » Thu Dec 23, 2010 12:00 am

I don't mind sharing at all...

Currently 800mg ibuprofen ~1x day for a tendon issue, when it bothers me...
Nitroglycerin patch 0.2mg/day (cut into 1/4) for said tendon
Niacin
Vitamin B complex
Multivitamin

Oh, then the workout supplements - nothing more fancy than creatine (NOW sports), brown rice protein and soy protein.

Complicated stuff, eh? Since you mentioned caffeine, I would also mention that I have been hitting the caffeine pretty hard of late...I hate that, but residency, a second job and 2 kids certainly take the toll on me...
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Re: Elevated liver enzymes?

Postby britdoc » Sat Apr 16, 2011 8:18 pm

OK, doubt anyone is following this anymore, but this has practically been finalized so if anyone is interested -

After an extended workup, which annoyingly led to the discovery of a couple of weird potentially autoimmune antibodies being positive (ANA and Anti-smooth muscle, both quite weak titers) and a negative liver ultrasound, my PCP recommended I see a hepatologist, which led to the greatest doctor's visit ever.

After an extended history - supplements, diet, lifestyle, etc, we got talking about working out - she was very curious as to how much I lifted, etc, and she finally decided that she thought that the AST/ALT elevations were due to my working out - AST/ALT is also in muscle, so after a hard workout, they can be mildly elevated. Anyway, kicked the door in when I got home, yelling 'guess who was officially diagnosed with being muscular.' Always wanted to reach a level of buffness that gave spurious laboratory results. (Last two sentences said in a sarcastic goofy way, lest anyone think I am being egotistical. Not sure which smilie would be most appropriate for this. :mrgreen:)
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Re: Elevated liver enzymes?

Postby beforewisdom » Sat Apr 16, 2011 10:50 pm

Good news. Are those elevated levels of liver enzymes unhealthful in itself or is it just a false indicator?

"The plural of anecdote is not data." (Roger Brinner)
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Re: Elevated liver enzymes?

Postby thestoatyone » Sun Apr 17, 2011 1:57 pm

britdoc wrote:Always wanted to reach a level of buffness that gave spurious laboratory results.


LOL!

So you're in the clear then?

Good news I guess.
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Re: Elevated liver enzymes?

Postby britdoc » Sun Apr 17, 2011 4:58 pm

@ before wisdom...no, not unhealthy - just in the same way as if you exercised heavily, you would have waste products in your system (CK, creatine kinase is a big one from muscle breakdown) AST and ALT can be transiently elevated. Mostly in the clear - just want me to follow up in 6 months to check that things are the same.

And yeah, good news - always good to hear that a) I can still drink on occasion and b) won't need a liver transplant anytime soon...still an annoying and slightly expensive (with copays, and unexpected $500 bill for the ultrasound) wild goose chase. Bloody US healthcare system.
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