Fatty Liver on a thin (low BMI) person?

[jwilcox]

I am a 29 year old male, healthy, non-smoker.  I am a very light casual drinker (few beers when out w/ friends every ~4 weeks or so).  Routine (~5yr) blood work showed elevated liver enzymes (ALT/AST).  ALT was ~110, AST was ~50.  No pain, nothing out of the ordinary (maybe a bit of exhaustion, but not an overwhelming amount).

For 3 months, I reduced fat somewhat (no fast food, no fatty foods, etc, but I didn't get too crazy with diet), which incidentally dropped my weight from ~160lbs to ~155lbs (I'm 6' 2", so my BMI is very low at 19.6).  Going in for a follow-up test, my ALT rose to ~180, AST was still around ~50.

Hepatitis tests were all negative, as were iron/copper tests and chronic hepatitis/Wilsons tests.  However, when they took those tests (1 week later), my ALT had dropped back to ~130.

Went in for a sonagram, and they found no issues with the liver or gall bladder, but did report steatosis (fatty liver).  Doctor suggests I lose 5-10 lbs, limit my fat even further, then retake bloodwork in 3 months.

I'm only 155lbs, and dropping 10 more lbs would put me into the official "underweight" category according to BMI.  I have very low body fat, and certainly no stomach fat.  Additionally, earlier attempts to reduce fat (causing lost weight) only caused my ALT to rise.  This time around though, I'm cutting out ALL alchohol, just to remove that as a cause.

Should I have cause for concern?  The biggest "cure" for fatty liver I've read is diet and exercise, however I've already got a good diet, good BMI, and run frequently.  Any urgency to speak to a hepatologist (and/or get a liver biopsy), or should I just continue working on my diet for another 3 months and retake the bloodwork?  Any other suggestions for lowering that ALT, or other suggestions for what to look for?  I just am nervous that I'm too thin, and eat too well, to have a fatty liver.  Thanks!

[Kevin Pho, MD]

There are two major causes of fatty liver - alcohol and NASH (non-alcoholic steatohepatitis).  If you are drinking alcohol, I agree with abstaining.  NASH is less likely in someone as thin as you.

With negative testing thus far, I would consider a liver biopsy for a more comprensive evaluation.  An ALT above 3 times the normal limit may warrent this test.  

This option should be discussed with your personal physician.

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.

Kevin, M.D.
kevinmd_

[Kalio1]

Thin people can get fatty liver too, I know it doesn't seem ogical with a name llike "fatty liver", but it is true. I'd stick to a strict liver friendly diet, continue exercise, cut the alcohol out and retest periodically to keep an eye on it. Your LFT's are up so any alcohol is a bad idea. Be careful of what supplements or medications you take also.

If the LFT's remain high, I'd see a iver specialist for further analysis.

[Kalio1]

Thin people can get fatty liver too, I know it doesn't seem ogical with a name llike "fatty liver", but it is true. I'd stick to a strict liver friendly diet, continue exercise, cut the alcohol out and retest periodically to keep an eye on it. Your LFT's are up so any alcohol is a bad idea. Be careful of what supplements or medications you take also.

If you do that for severa months and the LFT's remain high, I'd see a liver specialist for further analysis.

[steve333]

I suggest taking silymarin, which is an herb called milk thistle and helps regenerate the liver and increase bile flow. From what i have read there is a supplement called Pantethine which is supposed to be good for fatty liver.
Please research these before deciding to take them to see if they will be good for you.
Also, eat beets! Beets are very good for the liver.