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Elevated Enzymes
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Elevated Enzymes

I am a 39 year old female with elevated liver enzymes of 113 AST(SGOT) and 179 ALT (SGPT). I have no idea what this means. I don't drink and I don't have hepatitis. My diet consist of mostly organic fruits and vegetables and oatmeal and whole wheat bread (soy fortified)I rarely eat junk food and drink only water and green tea.  My died is restricted not by choice but because everything else makes me very sick. I also have irritable bowel disease and can retain up to 4 or 5 pounds of water in one day.  I just found out about the enzyme elevation after going to several doctors over a period of five years with complaints of extreme fatigue,nasuea,body aches and pains and inability to get out of bed and go to work for short periods of time.  Finally after being unable to go to work for a few weeks because of bladder infection symptoms(but no bladder infection)the elevated enzymes were found. I still feel horrible and am barely able to work.  My question is what does this all mean and where do I go from here?
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Elevated liver enzymes means that your liver is inflamed.  The trick is to figure out what is making it inflamed.  I assume that the doctor's checked you for Viral hepatitis and that is what you mean by your comment "I don't have hepatitis".  It may be possible that you have a non-viral type of hepatitis.  Have the doctors sent you for an ultrasound of your abdomen?  They should do this to check to see if you have "fatty liver".  You may have fatty infiltration of the liver.  
   If you would like to do some research on your own there was an article in the April issue of the New England Journal of Medicine about Fatty liver.  Sometimes they call it Non-Alcoholic Steatohepatitis (NASH).  Sometimes they call it Non-alcoholic Fatty Liver Disease (NAFLD).  
   I had symptoms like you described and it took me years and years to find a doctor willing to believe that there was someting wrong with me.  Now I am being treated and I feel so much better.  Please post again and I will be glad to answer any other questions you might have.
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I'm so glad I read this Post. The last 2 years i've been having the same problem. i'm 22 years old. and i have all the same syptoms (symptoms) as you. I just had an appointment yesterday and felt horrible when i left. I didn't feel like they believed me. I've had an ultrasound and everything done. but seems like i'm getting a run around. I'm glad to hear i'm not alone in this. I just wish they didn't make me feel worse about what i'm feeling.
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Hi, roxnsox, that info was helpful to me also!  Have you been diagnosed with fatty liver?  Did you have a biposy?  My doctor said the biopsy wasn't really necessary since he knew what the diagnosis would be, I have mildly elevated liver enzymes, and a sonogram that showed diffuse fatty infiltration.  I had all the other blood tests, which have come out normal.  I actually had a HepC test come out positive at first, but the subsequent tests came out negative, and he says that first one must have been a false positive.  Many weeks of anguish though!!  Anyway, can fatty liver cause as many symptoms as you describe?  I get a mild aching feeling on my right side, high up, especially if I have eaten badly, or more likely, if I have not eaten anything at all.  I have a child who is sick at home right now and didn't have time to eat much today, and found that I was having the pain worse.  I get very tired easily, and sometimes feel itchy.  Also, can this affect your moods?  I am still sort of going through menopause, I thought I was done with it, but I still keep getting periods sometimes, so I must be having crazy hormones, which I guess could add to the bad moods.  Sorry to keep asking all these questions, but just one more thing, what is the basic treatment for fatty liver?  Are you on any meds for it?  I am just trying to eat right (not very successfully) and taking 400 IU of vitamin E per day.  Thanks in advance for any advice, and your posts here have been so helpful!!  Oh, I know I just said I would only ask one more question, but here comes another one!  When I thought I had HepC for a while, the posts on the Hep board made me feel reassured that HepC is very slow progressing, and that you would probably die with it than of it, do you know if the same is true for fatty liver, which can progress to NASH?  Do you know if it's also a slow progressing thing?  I was happy to find out that I most likely didn't have HepC, and fatty liver instead, but I am wondering if it's just as serious.  Thanks again in advance and thanks for all the other posts that have been so helpful!!  Val
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Avatar_n_tn
I will try to answer some of your questions in this posting ans will post again later.  Yes, I had a biopsy.  After my biopsy the doctors said that I had Non-Alcoholic Steatohepatitis (NASH).  The only approved treatment for NASH at the moment is to go on a low fat diet and lose one pound per week. If you lose weight too quickly you run the risk of damaging your liver.  I am participating in a Clinical Trial at the National Institute for Health in Bethesda, MD.  I go there every month and they examine me and check my blood.  I have the opportunity to talk to a doctor once a month about this disease.  I was so happy when I finally had a diagnosis for my condition.  I was fatigued for years and years.  Itching and Irratibility are symptoms of liver problems, yes.  
   There are three types of Fatty liver.  If a biopsy shows liver inflammation and scar tissue, or if fibrosis has occurred, then steatohepatitis is diagnosed.  Steato means fatty and hepatitis means inflamed.  Fatty liver can occur without inflammation and is simply called steatosis.  Steatohepatitis may be associated with alcohol use, BUT if the liver damage is unrelated to alcohol use then the condition is called Non-Alcoholic Steatohepatitis.
   Fat in the liver does not produce symptoms in some patients because it is deposited slowly and few side effects are felt.  When the fat content increases rapidly, the liver expands and the membrane stretches, resulting in abdominal pain.  
   I have gotten some of these statements from a website called California Pacific Medical Center.   I used some of their sentences because I think they explain it clearly.  The website address is www.cpmc.org/advanced/liver/patients/topics/fatty_liver.html

I'm glad you found my information useful.
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Avatar_n_tn
Thanks to everyone for being so helpful, the comments you posted were extremely helpful.  I have not not had a biopsy yet only a lab test and I was tested for hepatitis B and C.I have been feeling pretty bad for about the last five years and have been getting the runaround, also I have had doctors telling me I was depressed and giving me all sorts of antidepressants,which only made me feel worse. I had some doctors telling me it was all in my head (men doctors,the women were more helpful) I really can remember not feeling well for at least three years before that. I guess if you have an hmo you have to be more persistent than I was.  The only way I was able to have a renal panel done was because of the sympoms of bladder infection. Also, can you have fatty liver if  you are not overweight?
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Avatar_n_tn
Yes, it is possible to have fatty liver and not be overweight.
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What is nonalcoholic steatohepatitis?
Nonalcoholic steatohepatitis (NASH) is described as inflammation of the liver associated with the accumulation of fat in the liver. It differs from the simple accumulation of fat in the liver (fatty liver, or hepatic steatosis) in that the inflammation causes damage to the liver cells while simple fatty liver probably does not. NASH is not connected with other causes of chronic liver disease, including hepatitis B and C viruses, autoimmune disorders, alcohol, drug toxicity, and the accumulation of copper (Wilson
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Hi, and thanks so much for the info!!  I apologize if I have two postings on here, I clicked once, and then my computer froze up, so I don't know if that one posted or not, so I am writing again here.  I was wondering about NASH.  I have mildly elevated enzymes, and a sonogram that read "There is diffuse increased echogenicity of the liver with a liver span of 13 cm.  The findings are consistent with diffuse fatty infiltration." My question is if I have mildly increased enzymes, does that mean it's NASH as opposed to just fatty liver??  This is so scary to think that I could have cirrosis (cirrhosis) and I thought I was pretty healthy.  I am overweight and carry alot of weight in my abdomen, but don't drink or smoke.  Could it just be fatty liver and have elevated enzymes?  I know I need to loose weight either way, but how are you being treated for NASH?  Just losing weight?  Can you stop the progression?  I am taking 400 IU of vitamin E each day, do you think that's ok?  Sorry for all of the questions!  I guess I need to go back to my doctor to ask about a biopsy, he didn't think one was necessary since he seemed certain my diagnosis was fatty liver.  Anyway, thanks again, and I wish I could be helping you!  Val
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Avatar_n_tn
Yes, you could have NASH with mildly elevated enzymes.  I do.  That is why it was so hard for me to get any doctor to believe that there was anything serious wrong with me.  If you have only mild or vague symptoms they have a tendency not to believe you. The only way to verify the diagnosis is with a biopsy.  I have some scarring and moderate fibrosis.  The only APPROVED treatment is to lose the weight.  I am participating in a clinical trial.  That is how I got the biopsy and diagnosis.  I am on a medication.  It is being tested for the treatment of NASH.  After the clinical trial is completed then you might see a report in the news. Many, mnay, many people has NASH but don't know it yet.  People that have NASH usually carry the extra pounds around their middle.  They also tend to be pre-diabetic.  Is there any diabetes in your family?  You can go to the ClinicalTrials.gov website and do a search on Fatty liver.  You will find some information there.  Scroll all the way down to the end of the page and click on "Detailed page" (or something like that, I can't remember exactly)
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Hi roxnsox, thanks again so much for the info!!  You know, I was so happy when I found out that I didn't have HepC, I had a postive test that later turned out to be a false-positive, and fatty liver seemed so benign at the time.  Now, as I am looking through different links with info about NASH, it seems to have a bad prognosis also, that is if I'm reading things right.  The difference seems to be that with HepC, it's really very hard to get rid of, and I guess you have a better chance of reversing NASH or at least stopping the progression.  It's just that when I would read about HepC, it seems like it said it's very slow progressing, and takes like 20-40 years to do any damage at all.  I was reading something about NASH, however, that said that something like 30% of people go on to cirrosis (cirrhosis) in only 7 years.  I know sometimes you have to get your info at reliable places, and I'm trying to not get too upset here!  So, it wouldn't be simple fatty liver with elevated enzymes, right?  Plus, I figure I've had it for over ten years already cause that is the time that I started gaining weight.  I just noticed I would say in the last couple of years how I have been gaining a lot of weight around my middle, I think I look like I'm pregnant.  And, yes, diabetes is in my family.  I don't think I have it yet, though.  Do you have it?  I am going to get a book on a diabetic diet, and start following it, do you have any good suggestions?  I just can't believe I have something that could take me away from my kids in only a few years.  I have a daughter that's only 8.  I don't drink or smoke, and I'm trying to loose weight now.  Lots of incentive!  Do you think it's ok to take vitamin E?  I am taking 400 I.U. twice a day, I hope that's safe.  Well, thanks again for the info, I really appreciate the help!  One more thing, the only treatment you're on is losing weight, and you're taking a medication, right?  Well, good luck, and thanks again!  Val
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Yes, I think the vitamin E is okay.  My doctors have given me a multivitamin to take.  
   I think I have had this disease for about 30 years.  I have one grandson and I am trying very hard to stay healthy so I can be here for more of my grandchildren.  They are such a joy.  
   After my biopsy my doctor said my prognosis was good.  The information I have seen and what my doctors have told me is that only 10 per cent of NASH patients would progress to cirrohsis.
   When I started being tested for the clinical trial they did a lot of testing of my glucose levels.  They told me I am insulin resistant.  I think that means that I am "pre-diabetic".  So I have put myself on a diabetic style diet.  I quit drinking sugar sweetened drinks and try to eat low-glycemic foods.  Low glycemic foods are whole grains, among other things.  So basically if you eat fresh natural foods that is best.
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Thanks for the reply!  That's good news about the 10%, and I would like that 10% would be people who maybe didn't get diagnosed in time, and didn't make the necessry lifestyle changes, but that's just a guess.  It is non-alcoholic, so most people that would advance on to cirrosis (cirrhosis) wouldn't be drinkers in the first place I guess.  I keep thinking that I might be in ok shape since I don't drink, and never have really been much of a drinker, but maybe that dosen't matter with this.  I do need to go back for more testing, my problem is just that I don't know what's going on.  And, then once I find out, I want to go to a nutritionist to help me with a diet plan.  Did you say you follow a diabetic diet right now?  I need to find out what that is exactly.  And, what did you say your symptoms were when you were first trying to get diagnosed?  Thanks again for the help, it's been so useful!!  Val
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Hey, I just read my comment above, and I meant to write that I would think that the 10% of people who progrss to cirossis.... and I accidentally wrote "like" instead of "think", and I just wanted to clear that up, it sounds stupid that way!  I am tired, it's late at night and I'm not typing very well.  I was upset when I read it back, cause it sounds like I'm saying I would "like" for the 10% to be ...blah blah blah, and I didn't mean that, sorry, it's just a typing error!!!  Thanks, Val
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Book recommendation:  My doctor had told me to get the book "Eat, drink, and be healthy" by Dr. Walter Willett.  I started following the recommendations in his book and I lost twenty pounds very easily.  I have been on a diet plateau for about two months now and have decided that the only way I am going to lose more weight is to increase my exercise.  So I have started walking on a treadmill three times per week.  I think diabetics need to control the number of carbs they intake.  My mom is diabetic so I have been learning more about the disease.  There is a website that I like for dieting called CalorieKing.com.  It is a wonderful website.
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Thanks so much!  I will definitely look for that book, I've been needing a recommendation.  You have NASH, but not Hep, right?  I was just wondering about this, you can probably tell I worry way too much, BUT... I don't know if I mentioned before that I had a HepC test (The HCV-RNA by PCR) that actually came out positive, but the doc I went to said they had been having some problems with that lab and the way they did the test, so he said it was a questionable positive.  I just still read everywhere how accurate and sensitive this test is, it still scares me that somehow there could be a mistake and I could have it.  Since that first test, I went to a GI, and his quantatative and qualatative came out negative, and then he sent me for one more very sensitive test, called the Heptimax, and that also was negative, so he seemed sure that my enzymes were elevated because of fatty liver.  It just seems weird cause I just read on this board how fatty liver and NASH is assoicated with HepC also.  It all seems so coincedental!  I guess I should just start believing my doctor and not worrying so much, it's good to get alot of info on what you have, but sometimes it can be scary to read too much.  I don't really know if they tested me for diabetes, is that the glucose test?  I had a glucose test in the grocery store in January and my glucose was 106 with a range
of 76-110, so that seems kinda close.  The higher it is, the more likely you're a diabetic, right?  So, you don't have diabetes?  Do you know why you would have NASH?  Thanks again for all the info, and sorry I'm blabbing on and on here!!  I appreciate it!!  Thanks, Val
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Right, I have NASH, not Hepatitis C.  Hepatitis C is a viral hepatitis.  NASH is a non-viral type of Hepatitis.  
The paper that the doctors gave me says that they do not know what causes NASH.  They used to think that middle aged obese women were the only ones that would have NASH.  But during a study some children between the ages of 9 and 16 were diagnosed with NASH.  So anyone can have it.  
  My doctors gave me two Glucose Tolerance tests.  They are three hours long.  You would remember if you ever had one.  They take blood every thirty minutes during the three hour period.  The blood sugar test you mentioned in your last posting is the blood sugar test that diabetics use to test their blood sugar every day.  If the number is around 100, that is a good blood sugar level.  Above 140 is too high if I remember correctly.  The doctors told me that I have insulin resistance which is a precurser to diabetes.  
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