Cold Turkey

I am a 38 yo relatively healthy male, 6'2'', 215 lbs.  Last April I had a blood test for insurance and got back slightly elevated liver enzymes: AST-32; ALT-46; GGT-172.  ALso high colesterol.

In June I went to the hospital with severe pain in left flank.  Tests revealed a loss of blood flow to one kidney but they could not determine cause.  MRA also revealed "mild, difuse fatty infiltration of the liver and pancreas" and enzymes were raised: AST-77; ALT-99.  Also, this was a week after my mother passed away of lung cancer, so it was a very stressful time.  Also, my father has a fatty liver.

I was released next day but told to abstain from drinking for three weeks leading up to another liver panel.  Prior to all of this I probably averaged 20 drinks a week (2-3 glasses of wine a night with extra on weekends).  I was able to quit, but I did have some strong cravings after a week or so and was pretty irritable, though no physical symptoms.  I also really enjoy wine.

My liver panel in July was back down to normal after abstaining for three weeks: AST-29; ALT-42.

I had a GI doc scheduled for November (earliest he could see me lol).  In the meantime, I ate better, exercised more, and cut alcohol consumption in half (without difficulty), again just a glass or two of wine at dinner.  Lost 15 lbs, etc.

Now the GI tells me he wants me to quit drinking completely for 6 months, during which he will do three more liver panels, conclude with another MRA and possibly a liver biopsy!!!  I tell him this is a pretty tall order, and he basically tells me I am an alcoholic because I don't like the idea of giving up wine entirely.

The liver panel taken yesterday remains normal despite the fact that I have still been drinking approx 10 drinks a week: AST-33; ALT-42.  All else remains normal on comprehensive metabolic panel and lipid profile except cholesterol but that is coming down too (CHOL-217; HDL-C=50; LDL-C=143).

So my questions are - 1) based on the lowered liver enzymes after I quit drinking for three weeks, is that conclusive that my fatty liver is caused by drinking as opposed to NASH? 2) If I quit for six months and levels stay down, is he going to tell me to quit drinking for good?  I feel that I have always been a "responsible drinker", ie don't miss work or show up hung over, don't drink in morning, don't binge drink, don't go to bars, spend lots of time with large family (4 children, including 5 year old triplets), etc. but I tell this doctor that I would be put out giving up wine for good, and I am treated like a pariah.  He never once asked me if I improved my diet, lost weight, exercised more, etc, he just wanted to know why I did not want to quit drinking.  "The human body only needs food and water"  What kind of advice is that??  Is he over-reacting or do I really need to seriously consider giving up something that has become a quite pleasurable part of my life because I have a mild diffuse fatty infiltration of the liver?

[Kevin Pho, MD]

To answer your questions:
1) It is most likely that the elevated liver enzymes is due to the moderately heavy alcohol intake.  If the liver enzymes do not normalize despite completely abstaining from alcohol, then you may want to investigate NASH as a possibility.

2) I cannot predict what the GI doc is going to say.  However, because the liver enzymes improved when you cut down, it would definitely be a good idea to cut back.  Unless something else comes up on the liver tests (i.e. hepatitis C etc.), I do not see a concrete reason from your description to completely abstain (although it is advisable).  

The elevated liver function tests is your body's warning that you were drinking too much.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[roxnsox]

If you haven't already, take a look at this website:  liverfoundation.org.  They have a lot of good information.  Click on the "Liver Health Information" part near the top of the page.  
  Even moderate social drinkers may risk liver damage.  I have been living with a damaged liver for years and it isn't much fun.  Doctors consider my disease mild.  I have been diagnosed with NASH.  
   Good luck.