Liver / Gastro question!

[BlessedNYC]

Hi Docs,
Great work you do here. I have a question regarding someone i know - here are his lab work results on the liver. I wanted to ask if this is any indication of something serious? the doctor gave him liver cleansers - milk thistle and giseng something - instead of a liver medication.
The cleasers are working well and he is improving. These are the tests after one week of cleansing the system.

Total Protein - 79 g/l
Albumin - 39
Globulin - 40
A/G Ratio - 1.0
Bilrubin Total - 72 pmol/l
Bilrubin Direct - 54.0
Bilrubin Indirect - 18.0
Aspartare Aminotransferase - 692 lu/l
Alanine Aminotransferase - 1176
Alkaline Phosphatase - 259
Gamma - Gluamyl Transferase - 303
Creatine Kinase - 57
Prothrombin Time - 14 seconds
Hepatitis B - Negative


The doctor had suspected hepatis B and that came up negative.
whats your take with these results. He doesnot have a stomach problem or pain. He has jaundice which is clearing after he started taking the cleansers. The color in his feases is coming back to normal. He has regained his appetite since he started cleansing the leaver
- there tests were taken before the improvements.


Additionally, he took a sonogram which showed a normal stomach but they could not rule out hepatitis. The spleen was slighly enlarged.

whats your take?

[Kevin Pho, MD]

Those liver tests are markedly elevated, with an ALT of above 1000 and total bilirubin above 50.

Possible causes can include acute hepatotoxicity due to a medication, ischemic hepatitis (shock liver), acute viral hepatitis, or alcoholic hepatitis.

There is no role for liver cleansers at this time - as there is very little data supporting its use.  

In addition to the ultrasound, you may want to consider a liver biopsy if the diagnosis is non-revealing.  A complete hepatitis panel should be done in addition to hepatitis B.

Discussion of these options should be done 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.
http://www.straightfromthedoc.com

[surgeon]

first of all, liver "cleansers" are as bogus as any fraud there is. It's completely fake, unproven, and a rip-off. Whatever caused the jaundice would have cleared if the person had taken eye of newt, or danced naked under the moon. That said, jaundice which is associated with pale stools, and which clears on its own is suggestive of a gallstone in the bile duct which passed on through; or pancreatitis. Hepatitis is a possibility, as are other viral illnesses such as mono.

[BlessedNYC]

so what are the list of diseases he should be testing for?  also are you saying that if he had a gall stone stuck he could have had jaundice without any stomach pain?  are you saying that since he is seeing an improvement he should consider the stone was expelled from the system?

[astros18]

Oh here we go again, surgeon, with your bogus claims. Liver cleanses are absolutely NOT bogus, only to most in the medical profession like surgeon. I think the proof is in the pudding. If your friend is getting better he should continue what he's doing. It certainly is possible he has gallstones or a stone stuck, but if he is losing his jaundice and his bowel movements are going back to normal, then something is obviously working. Continue reading this forum about the TONS of problems people have after getting their gallbladder removed. I speak from personal experience, you are never the same. I think it's wonderful that your friend has found a doctor who is not closeminded about the wonderful healing of nature. A friend of mine was told she had a nonfunctioning gallbladder over a year ago. Thanks to chiropractic, herbs, and other natural protocals, she is living happily with her now functioning gallbladder. Good luck to your friend.

[mmfd]

The surgeon is always right on the money, from my view as an RN.  The reason the medical profession thinks the liver cleanser  type claims are bogus, is because they ARE bogus!  We are very lucky to have someone with his experience and tell it like it is approach.

[BlessedNYC]

I still wonder how he got better from what was a serious illness as you can see the test results.  He is okay now as of today but told me he started feeling better when he started taking the herbs. He said before then he was very sick.
If its not the cleansers - what do you think happened medically?  I want to know so that if it returns god forbid - we can treat it right.

[surgeon]

Try this little experiment: tomorrow, just before dawn, remove your clothes, stand in your yard, and chant to the moon-god. The sun will come up. It works every time.

Or this: wait til you get a cold. Take echinacea. The cold will be gone within a few days.

Or this: try liver cleansers. (the good news is you have lots of choices: search the term and you'll find all sorts of potions.) You will FEEL better (and, if you have a condition that doesn't require treatment, you may actually GET better.) The same is true of any placebo you can name, for a significant percentage of people.

As to the individual in question, it's impossible to say for sure what happened. I've mentioned some possibilities earlier. And if it does happen again, he ought to see a doctor who believes in actual diagnosis and treatment.

And, to be real: I'm sorry to be so cynical. As a surgeon with a few decades of experience, I've seen people truly and deeply harmed by relying on quackery. Which is not to say that no one has been harmed by mainstream medicine. But what we do is based on studies, testing, and scientific comparisons. Liver cleansing, and the like, is based on someone making a statement with no effort at proof. Humans are complex: no treatment is perfectly predictable for all people. No disease proceeds in exactly the same manner in all victims; nor does everyone respond to treatment in the same way. We fail to cure many things; but we continually strive to improve, and do so by adhering to principles of scientific testing -- while acknowledging that it's still imperfect. Such things as liver cleansing have NO basis in physiology (it has, in fact, no meaning at all: there's no such thing), have NEVER been tested in a meaninigful way, and are promoted by people who are either willfully deceitful or sadly gullible. Sorry. But that's the way it is.

[lizziecee]

Thank you for telling it how it is! I have had Crohn's for some 35 years and well meaning friends are always suggesting I try snake oil or other rather ridiculous preoccupations. I have total and utter trust in my gastro, who used to work in a leper colony in Africa, and with Aids patients in London, UK. He reads the research, understands it and tries to explain it to me when prescribing allopathic drugs such as  methotrexate, prednisolone and shortly, Thalidomide, as he is one of the few gastros in the UK licensed by the German mnfr of that drug. I just don't get those folks who go to specialist doctors then refuse to take their advice and appropriate medications, all scientificlly tested by their peers.
Thank you for your common sense.
Liz.

[BlessedNYC]

Thanks surgeon.  This doctor is a hepatologist and using the test results above made some determinations not to give him any conventional medication.  You mention viral diseases like hepatits and mono.  the doctor ruled out mono.  do you have any idea what else it could be? I want him to be able to check for everything.  HIV was ruled out as well as herpes etc.
Please advise.  I like your jokes but i want some serious information here because i worry about him and want another opinion.  I gave you the test results, whats your take?

[BlessedNYC]

please read through my question and advise.  thanks

[astros18]

To each his own. I think a surgeon has no reason to believe in natural medicine. After all he takes out body parts for a living. I had all documented serious medical problems for well over 2 years. Prescription medications made it worse and taking out my gallbladder was the worst decision I ever made. The reason surgeon cannot tell you what has made your friend better is exactly what he stated- he has absolutely no idea. Your liver is your detoxification organ. Let's hope it can be cleansed thru good nutrition or other means. I recommend you read Dr. Jordan Rubin's book, Patient, Heal Thyself. He is also the author of The Makers Diet. He was at deaths door with Crohn's disease and healed himself. I quote," Modern medicine is based on a science that sees the world in closed and mechanistic terms, leading to a limited belief system. This approach says that if something is wrong, all that's needed is to either take out the part causing the problem or dispense a drug. But this approach often screws up the dynamics of the body and ends up leading to more problems." A snake charmer is no more natural medicine than is an appendectomy. There are definitely charlatans out there in both the natural and allopathic world, but just because something cannot be explained in scientific terms does not mean it has no benefits.

[JackieG]

Thanks, Surgeon, for putting things in their proper perspective.  There are some who advocate liver cleansing and other potions as a cure all for everything.  I am not sure that all of these people are blissfully ignorant. I think some have sinister motives. I am glad you put things in perspective in a very open and honest way for us.

Best regards,
Chicken Soup

[BlessedNYC]

I think i have failed to understand why i paid $16 donation.  It seems my question was brushed off.  I provided test results but did not get a clear answer apart from herbal criticism.  
Surgeon tried to respond but was not clear.  Is there a doctor on this web who can help me out?

[astros18]

Silymarin selectively acts as an antioxidant and protects from free radical damage specifically in the intestines and stomach. It also increases the liver's content of GSH(glutathione) which is a substance in detoxifying many potentially damaging hormones, chemicals and drugs(including acetominophen). It has demonstrated a membrane stabilizing action which inhibits or prevents lipid peroxidation. It seems to alter the structures of outer wall membranes of heptocytes, preventing penetration of liver poisons and stimulates the action of nuclear polymerase A. It may increase ribosomal protein synthesis and stimulate the formation of new hepatocytes. i hope this explains how milk thistle may be helping your friend. Despite previous comments, there are numerous studies done on natural remedies and most can be found on the web. I would think you could talk to your friends doctor and find out why and how the specific remedies he has prescribed work. If your friend has some form of hepatitis, he must learn to support his liver thru excellent nutrition and healthy living, along with supplementation. I hope this helps some and that your friend continues to get better.

[surgeon]

"It seems to alter the structures of outer wall membranes of heptocytes, preventing penetration of liver poisons and stimulates the action of nuclear polymerase A. It may increase ribosomal protein synthesis and stimulate the formation of new hepatocytes."

Fascinating. Please provide links to the tests which have shown this.

[astros18]

I don't believe I was addressing you. I was providing Blessed NYC with some info he asked for. Obviously, his friends doctors must know what's best for him. I refuse to be drawn into a natural vs. allopathic medicine debate with you. I believe what I believe and you believe what you believe.

[JackieG]

I didn't think you could back your advice up with any facts.

[astros18]

I choose not to. As I said to surgeon I was not going to be drawn into this debate anymore. You believe what you believe and I believe what I believe. Your sarcasm, name calling, and superior attitude are not beneficial to my health. I will continue to post to whomever I feel like, advocating what works for me. If they choose to listen, fine, if not, that's fine, too. It doesn't matter what I show you or prove or disprove. You simply do not have the open mind that can admit there may be something out there besides prescription drugs and surgery that may actually help. It makes you feel so much better about yourself to think me sinister or gullible or whatever else you and surgeon like to laugh about. I am living proof as are my husband and children that natural medicine and supplementing and supporting the body works.

[JackieG]

That's fine.  But in fairness to those who you respond to you should at least tell them that your opinions cannot be supported by facts so they can take your recommendations for what they're worth.

[surgeon]

Look. Sniping aside, I think I've been fairly fair: I've said mainstream medicine doesn't have all the answers, and I've said no one can make perfect predictions of what will happen to all people under all circumstances. I admit to the imperfections of mainstream medicine. But look at the big picture, and see that in nearly all diseases, we have come a long way over time: and it's because of continual striving, questioning, a belief that we DON'T know everything, and we need to test new things. And we do. And by "test" I mean apply accepted scientific methods: research in labs. Double-blind prospective studies -- which means comparing various therapies in such a way that neither the patient nor the care-giver knows who's getting what therapy until data have been collected over time and analyzed; thereby eliminating bias and the placebo effect. When certain therapies --generally in the naturopathic or other categories -- are said to work, and when various explanations such as promoting production of certain enzymes are said to be in effect, but when there are no scientific studies to back it up, then we are in the realm of anecdotal medicine, of placebo effects (known to work in around 30% of cases in various instances). As a physician, I've never told my patients not to use whatever naturopathic or other therapy they want to try, as long as they simultaneously go with what has been studied and found -- within the parameters generally considered reproducible and effective -- to work in scientific terms. To say one "believes" is fine: as long as one recognizes that belief differs from proof. I don't practice based on belief. I do so based on reproducible, peer-reviewed, tested therapies. It's not about "belief."
          I think the US is heading down a sad path: science is becoming replaced by all sorts of belief systems, and when facts interfere with beliefs, then facts are ignored. It's happening in our schools, in our legislatures, and in the White House. Other countries, with whom we are competing in the long run for innovation, for solutions to the problems of energy, pollution, job creation -- those countries must be laughing in delight as they see their former number one competitor turning away from knowledge and facts, and choosing instead to go the path of "belief." We -- the US for anyone reading who's not in the US -- are happily and willingly committing suicide.

[Sarah Connors]

Hello Blessed NYC,

• I was going through your original post & their replies.
• Decided to post my personal experience of dealing with a patient with similar symptoms, a decade ago, when I worked in hepatobiliary medicine.
• It might be of some benefit.
• A lady aged 45 apparently healthy, suffering from no chronic ailment developed hepatitis. While performing her lab work it was found that she had Hep A & treatment commenced. In days her condition deteriorated & ultimately went in to hepatic encephalopathy/ coma.
• Was shifted to ICU, vitals were fine.
• But she developed Grade 4 hepatic coma, very high serum bilrubin & ALT levels which am forgetting at the moment.
• After passing about 8-10 days in ICU she expired. During these days what all we could do is just give her supportive therapy & lab work like LFTs, coagulation profile etc 4-6 hourly.
• What she suffered from is known in Fulminant Hepatic Failure, Acute Hepatitis, Toxic/ Shock liver.
• It has an incidence of approx. 1 in a million or so.
• The offending agents in most cases are the hepatitis viruses, certain drugs, anesthetic agents, ingestion of some fungi, toxins present in food.
• Basically what I am trying to advise you is that hepatitis occurring from any cause shouldn’t be taken lightly, because one of these patients can go into this condition, & when this does develop it is near impossible to treat it & bring the patient out of coma.
• The reason for it to develop in those few is still unknown.
• In all my med life have seen only 2 patients that have recovered from Fulminant hepatic failure Grade 4.
• Now coming to your friend, would like to advise you to keep an eye on his liver tests/ lab work & get them done at regular intervals at the same time keeping a very vigilant eye on his higher mental functions & GCS.
• It’s easier to get the patient back to normal from grade 1 or 2 but if he/ she passes to grade 4 it’s near impossible. At that stage no medical therapy is curative apart from supportive, according to my obsolete medical knowledge.
• You mentioned splenomegaly but are his platelets normal too?
• If some surgically curable cause like gall stones, obstruction, enlarged pancreas is not present & he is improving clinically & biochemically with what ever therapy given than continue with it, whether it’s allopathic or natural. Personally would ONLY like to see a patient cured. Don’t want to go into a debate regarding what is better & this is not the place for it or the answer to your question.
• Serum Bilrubin, ALT levels coagulation profile etc are very important & should be carried out regularly. So is supportive therapy.
• Get a complete viral profile performed. Ruling Hep B is not the end.
• Take a history about any intake of analgesics, food additives.
• To my knowledge we still fail to understand why some these apparently healthy individuals when exposed to certain non noxious agents like acetaminophen, halothane, Hep A etc, develop Fulminant hepatic failure.

Take care & hope this sharing of my experience helps.

PS: I apologize for any mistakes cause I just came back after 15 hrs of a stressful day!

[jasper97]

I have taken Milk thistle in the past for so called liver cleansing. I had pain from gallbladder. I agree with the surgeon here on herbal remedies they simple don't work. I think alot of times people have the ability to trigger a medical improvement upon themselves by thinking a pill might have helped. The the reason when studies on medicine is done placebo is given. Sometimes even lab results get better. Usually if it is a ailment such as a organ failing it is no better. However the person may feel better this is due to over psychological response.
For instance if you have a person who is on home oxygen almost everyone of these patients if their oxgen get disrupted within seconds they are short of breath. I mean I have seen people within 30 seconds think without it in about 45 seconds to a minute they are going to die. Their respiratory rate increases, nervousness and anxiety shoots through the roof. Look at the O2 sat monitor and they have an excellent 02 sat. Now leave it off for a few minutes and they will really have problems. I have seen physicians put them on airflow but it was room air and they were back to normal within a few seconds. This was done in order to obtain a blood gas on room air but a patient claim they could not tolerate the loss of their oxygen. After 15 mins on Room Air  and the blood gas was done. The physician would reconnect the tubing back to the oxygen and the patient never knew the difference, most did not, you would have a very few that would complain who indeed needed it.I witnessed this event everyweek on different patients. Patient knowledge of what he is taking, prescriber or adviser tells them what the outcome should be, and if their determination is to get better. With that combination your will see a mental improvement most of the time. Now whether the scientific test supports that is a different story. I read it's been proven that a person outlook can have an effect on his treatment. But it's usually his will to get better, it's not the herbal medicine or the placebo making him better. He did what he could have done all alone without any crutch he thought he needed to rely on.

[MJS057]

I bought detox tea and liver cleanser supplements three weeks ago in hopes I could clean my liver that has suffered abuse from alcohol for the past 7 years while with the military.  After reading these postings I am convinved the products I purchsed are a bunch of @^#%&^@%#.  

As a side note, after taking the supplements I feel no different even though I barely drink and I continue to excercise.

I guess the only "natural remedy" is to take care of your body by eating healthy and excercising.

Good luck to you all.

[JackieG]

The liver is the only organ that can regenerate itself so long as a chronic, progressive disease is not present, so take comfort that a healthy lifestyle and no alcohol (or in moderation) will allow your body to repair any damage that you may have done to your liver. It sounds like you're on the right path, and time is actually your ally so far as your liver is concerned.

Good luck,
Chicken Soup

[sunnyo]

I've been reading this bickering back and forth since this post started. I just want to say I have a liver biopsy from 5 years ago that says I have liver cirrhosis from drinking.I started taking milk thistle 4 years ago.
I recently had a liver scan and liver ultrasound that shows no liver damage.Maybe it does help some people.

[Jennglen]

I was diagnosed with "chronic Hepatitis B w/cirrohsis of the liver" 10 years ago. I have been, and still am, being treated by GI doctors--professionals who specialize in liver diseases. I have the standard Liver Function and Ultra-Sound Tests done every six months. I am not on any medications because there are none that can improve my present medical condition. I am Surface Antigen Positive (not likely to ever change); E-Antigen Neg/E-antibody positive; my viral load is considered undetectable as indicated by a "DNA by PCR" test. And my ALT and AST are within normal range. That's about the best I can hope for. There are no medications that improve upon my medical condition. There are antivrals and interferon (I took the interferon treatment 10 years ago) for patients whose ALT/AST and DNA test results are NOT within normal range. These treatments (antiviral and/or interferon) are aimed at returning the liver function tests and chemistries to within normal ranges. That's where I am right now. And I can tell you that there are foods and dietary supplements that improve your overall health and, consequently, help your liver. But there are no alternatives or miracle cures. It's all ****. If you have a liver disease you would be foolish not to seek the care of a Gastroenterologist or Hepatologist.

[BlessedNYC]

Thanks everyone for the comments and ideas.  Guess what everyone? after taking herbs for a month-my friend's liver tests came back normal and astro18 was right - the protein level is the only count that is still high - all the 15 tests done indicate a normal and well functioning liver.  His doctor seems to be the best doctor on this subject because he was not closed to using herbs in order to make sure that his patient was healed.  He seems to have his patients health as his priority.  My friend feels even better than before he got sick- he said he has never felt better in his life.  So for those of you who live in the closed world - he will fax me his tests and i will post them as proof.  I guess an open mind goes a long way!!!  I am just happy that he is okay.  Actually after starting on the herbal medication, he started feeling better after a week and eating food - back in the gym etc and back at his office - has his own business.  His doctor still has him on a strick diet and no medication whatsoever without consulting him - he is off the herbs so that the doctor can monotor the liver progress - more like body now heal thyself.  I will keep you posted.  But everything is working well - he is back to normal!!

[Dev22]

I don't know whether I agree or disagree on this, but this is what I know.  I have a client who is now 80 years old.  She has Hep C, and was a candidate for liver transplant.  Her condition was terrible.  She did start taking Milk Thistle faithfully.  That was 18 years ago, and she is doing fine.  She has blood work ups regularly, but swears by the Milk Thistle.  I have read up on the herb and according to everything I've read, it has shown to improve liver health.  One of the sites I looked at was http://www.umm.edu/altmed/ConsHerbs/MilkThistlech.html
I guess its up for debate, but if it appears to help some, more power to them.  Kind of a "to each his own" thing.  I say, whatever works.