Liver enzyme levels

[Irish73]

A few weeks ago my doctor prescribed Lamisil for a toenail fungus, but she suggested I have a liver function test before starting the cycle.  I went back this morning to discuss the results and she said my enzyme levels were high.  She recommended that I throw away the Lamisil prescription, she wrote me a new one for topical Penlac, and scheduled a second round of blood tests.

Now I’m very concerned.  Like most visits to the doctor, I was shuffled in and out very quickly and barely had any time to think or ask questions.  She rhymed off a few numbers related to enzyme levels… AST, ALT and GGT I believe… somewhere in the 70-80 range.  I have no idea what this means.  She asked me about alcohol use and admittedly I down-played it out of embarrassment.  In hindsight, I should have been more honest.  I estimated that I have 15 drinks per week, on average, which she thought was in the normal range.  In truth that number should be much higher, maybe somewhere around 50.  She also asked me about a history of hepatitis, of which there is none.

My upcoming blood test is looking to check creatinine, uric acid, sodium, posassium, chloride, AST, ALT, GGT, alk. phosphatise, bilirubin, chronic hepatitis and hemoglobin.  Would the doctor be pursuing a second test if I’d been honest about my alcohol consumption?  How serious are my enzyme levels?  And if I’m dry and sober for 3 days prior to my next liver function test, will those numbers go down?

I’m having trouble finding quality information online, and it’s near impossible to book enough time with the doctor to discuss a topic at length.  Any insight and/or advice would be really appreciated.  Thanks.    

[Kevin Pho, MD]

I agree with the workup thus far.  Liver enzymes in the 70-80 range are moderately high.  Alcohol certainly can play a role into this.  

An ultrasound should be considered to image the liver for any anatomical abnormalities.

Reducing or abstaining alcohol use should be done as well.  Repeating the liver enzymes periodically should be done to ensure they are not rising.

These options 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.
www.kevinmd.com

[Irish73]

Thank you Dr. Pho.  I understand that an ultrasound would be the next logical step, and that alcohol consumption should be reduced or cut off completely.  But my specific questions remain unanswered:

Would the doctor be pursuing a second test if I’d been honest about my alcohol consumption?  How serious are my enzyme levels?  And if I’m dry and sober for 3 days prior to my next liver function test, will those numbers go down?

Basically I'm wondering if my numbers indicate a serious problem and whether those enzyme levels can be pushed up following a drinking binge.  Meaning, do the numbers go up and down depending on recent alcohol intake.

Thanks again.

[chico1]

IRISH,
MY LIVER ENZYMES WERE AROUND 130 AND 90 FOR AST ALT. IT TOOK A COUPLE OF MONTHS FOR MY TO COME DOWN. THEY ARE NORMAL NOW WITH 4 MONTHS OF NOT DRINKING; HOWEVER, MY FERRITIN (IRON) NUMBER IS 480. I TO WAS A HEAVY DRINKER, NOT BECAUSE I WAS A ALCOHOLIC, BUT BECAUSE I LIKE SPORTS, BAR-B-Q AND BEER. PLEASE DO NOT HOLD ANYTHING BACK FROM YOUR DOCTORS. THEY CANNOT FIX IT IF THEY DO NOT KNOW EVERYTHING.THE ENZYMES CAN GO UP FROM A NUMBER OF THINGS. FROM WHAT MY DOC TOLD ME "IT IS NOT JUST ONE OR TWO NUMBERS THAT ARE TESTED BUT THE WHOLE TEST COMBINED. READ THROUGH THESE POST AND YOU WILL
LEARN ALOT. IF I WERE YOU I WOULD A LEAST STOP THE ALCOHOL UNTILL YOUR DOCTOR FINDS THE REASON FOR ELEVATION. KEEP IN MIND THE LIVER IS THE ONE ORGAN THAT
CAN HEAL ITSELF. GOOD LUCK

[onebluecat]

50 drinks per week indicates substantial intake and physical dependency is likely and withdrawal symptoms may not allow you to just stop drinking without some side effects. Many people believe they can just stop drinking anytime so they do not consider immediate action. Its denial and the primary symptom of Alcoholism, our nations number one health problem.

I am sure Dr. Pho would agree that alcohol is not GI friendly in extremes.

Consider professional help and nutritional therapy to heal that ailing liver while being honest with your doctor as other vital functions suffering under excessive alcohol consumption too.

Dr. James R. Milam has prety much written the book on this subject for laymen and information can be found from his book "Under the Influence" http://www.lakesidemilam.com/UnderTheInfluence.htm

Alcohol and the Liver:
In general, for healthy people, one drink per day for women and no more than two drinks per day for men would be considered the maximum amount of alcohol consumption to be considered moderate use.  (By “healthy” people, we are referring to non-pregnant women, individuals not addicted to alcohol, and people without pre-existing medical conditions, among others).  However, the amount of alcohol that a person can drink safely is highly individual, depending on genetics, age, sex, weight and family history, etc.  A “drink” is considered to be:

4-5 ounces of wine

10 ounces of wine cooler

12 ounces of beer

1-1/4 ounces of distilled liquor (80 proof whiskey, vodka, scotch, or rum)

How Alcohol Travels Through the Body
Alcohol is metabolized extremely quickly by the body.  Unlike foods, which require time for digestion, alcohol needs no digestion and is quickly absorbed.   Alcohol gets “VIP” treatment in the body – absorbing and metabolizing before most other nutrients.  About 20 percent is absorbed directly across the walls of an empty stomach and can reach the brain within one minute.

Once alcohol reaches the stomach, it begins to break down with the alcohol dehydrogenase enzyme.  This process reduces the amount of alcohol entering the blood by approximately 20%.  (Women produce less of this enzyme, which may help to partially explain why women become more intoxicated on less alcohol than men.). In addition, about 10% of the alcohol is expelled in the breath and urine.

Alcohol is rapidly absorbed in the upper portion of the small intestine. The alcohol-laden blood then travels to the liver via the veins and capillaries of the digestive tract, which affects nearly every liver cell.  The liver cells are the only cells in our body that can produce enough of the enzyme alcohol dehydrogenase to oxidize alcohol at an appreciable rate.  

Though alcohol affects every organ of the body, it’s most dramatic impact is upon the liver.  The liver cells normally prefer fatty acids as fuel, and package excess fatty acids as triglycerides, which they then route to other tissues of the body.  However, when alcohol is present, the liver cells are forced to first metabolize the alcohol, letting the fatty acids accumulate, sometimes in huge amounts.  Alcohol metabolism permanently changes liver cell structure, which impairs the liver’s ability to metabolize fats.  This explains why heavy drinkers tend to develop fatty livers.

The liver is able to metabolize about ½ ounce of ethanol per hour (approximately one drink, depending on a person’s body size, food intake, etc.).  If more alcohol arrives in the liver than the enzymes can handle, the excess alcohol travels to all parts of the body, circulating until the liver enzymes are finally able to process it. (Which is another good reason not to consume more than one drink per hour.).

How the Liver Breaks Down Alcohol
The alcohol dehydrogenase enzyme breaks down alcohol by removing hydrogen in two steps:

1.      Alcohol dehydrogenase oxidizes alcohol to acetaldehyde

2.      Acetaldehyde dehydrogenase oxidizes the acetaldehyde to acetyl CoA. These reactions produce hydrogen ions (acid). The B vitamin niacin (in its role as the coenzyme NAD) picks up these hydrogen ions (becoming NADH).  Thus when alcohol is metabolized, NAD diminishes and NADH increases.

During alcohol metabolism, NAD becomes unavailable for the many other vital body processes for which it is needed, including glycolysis, the TCA cycle and the electron transport chain.   Without NAD, the energy pathway is blocked, and alternative routes are taken, with serious physical consequences:

The accumulation of hydrogen atoms shifts the body’s balance toward acid.

The accumulation of NADH slows the TCA cycle, resulting in a build up of pyruvate and acetyl CoA.  Excess acetyl CoA results in fatty acid synthesis and fat begins to clog the liver.   (An accumulation of fat in the liver can be observed after only a single night of heavy drinking).

Fatty Liver and Liver Disease

With moderate drinking, the liver can process alcohol fairly safely.  However, heavy drinking overtaxes the liver resulting in serious consequences.  A liver clogged with fat causes liver cells to become less efficient at performing their necessary tasks, resulting in impairment of a person’s nutritional health.  Fatty liver is the first stage of liver deterioration in heavy drinkers, and interferes with the distribution of oxygen and nutrients to the liver’s cells.  If the condition persists long enough, the liver cells will die, forming fibrous scar tissue (the second stage of liver deterioration, or fibrosis).  Some liver cells can regenerate with good nutrition and abstinence, however in the last stage of deterioration, or cirrhosis, the damage to the liver cells is the least reversible.

Alcohol and Malnutrition
For moderate drinkers, alcohol does not suppress food intake, and may actually increase appetite.  Chronic alcohol consumption appears to have the opposite effect.  Alcohol causes euphoria, which depresses appetite, so that heavy drinkers tend to eat poorly and become malnourished.

Alcohol is very rich in energy, packing 7 calories per gram.  But like pure sugar or fat, the calories are void of nutrients.  The more calories an individual consumes in alcohol, the less likely it is that they will eat enough food to obtain adequate nutrients.  To make matters worse, chronic alcohol abuse not only displaces calories from needed nutrients, but also interferes with the body’s metabolism of nutrients, leading to damage of the liver, digestive system, and nearly every bodily organ.  

[Irish73]

chico1:

Thanks for your reply and input.  I'm glad to hear that your enzyme numbers came back down to normal levels again.  That gives me some hope.

It sounds like we're kind of in the same boat.  But I won't kid myself by saying that "I'm not an alcoholic," because I recognize that I am.  But I don't have many of the typical symptoms of your average alcoholic: insomnia, injuries, blackouts, depression, decreased appetite, weight loss, tardiness or absence from work, loss of employment, divorce, financial problems, etc.  In fact, in many of those categories I'm completely the opposite.  I never have trouble sleeping, I eat well, I'm happily married, I have a well-paying and steady job and I don't have any financial problems to speak of.  For these reasons it's been somewhat difficult to accept the fact that I do have an alcohol problem.  And much like you, my drinking seems to coincide with sporting events, BBQs and other social gatherings.  I don't drink every day, but once I start, it seems to be a slippery slope.  I'm a fairly big guy, so it takes quite a bit of alcohol before I even notice that I'm buzzed.  But these are sorry excuses for my consumption levels.

I will take your advice and keep surfing around this forum.  I've already found some useful information.  Thanks again.

____________________

onebluecat:

Thank you for your input.  Trust me, I'm not in denial regarding my alcoholism.  I realize that 50 drinks per week is substantial intake and I'm working to fix the problem.  I will definitely look into picking up the book you recommended.

I'm still hoping Dr. Pho will answer my questions.  I'm hoping I don't have to pay again to re-submit them.  I was really looking for answers and advice specific to my situation.

[HPierce]

Unfortunately, you WILL need to pay again in order to get the doctor to answer your question.  I had to submit a question three times, three different ways to get the exact answer I was looking for.  A pain, yes........but probably worth the $ 48 to me.  Try submitting again and be VERY specific to the ONLY question you want answered and he will answer you again.  But you have to pay again.  He will not reply to more than one post for $ 16.  I tried. You can check all the back-posts to see that this is true.  Good luck to you.

[Irish73]

Thanks for the advice HPierce.  I might submit again, and if I do I'll be sure to be very clear about my questions (even more clear than I was the first time, which was pretty damn clear).

But first, I'll get the new results from my latest liver function test.  I'm supposed to get them back this week.  

[Rheinau]

Irish73 - I was a drinker for 20 years. I thought I would always be a drinker but I stopped when I thought it might be affecting my health.  I thought I needed it to be happy but I realized I didn't need it.  I feel better now, it's better for my health and I concentrate on the things that really matter to me -my kids.  It may be hard but if I can do it you can too.  I decided on my own that I didn't want it anymore.  You'll have to get the alcohol out of the house and stop participating in the fun drinking activities like hanging out at bars.  I am 18+ months now without alcohol.  I miss drinking but I never plan to go back to it again like I did before.  I may drink a few good german beers in the future but at this point I don't see a need.  

I need a healthy liver more than ever now.  This summer I tested positive for TB exposure.  I will probably start the meds soon which are harsh on the liver.  I am really nervous cause I know the meds damage the liver but I will give it a try.  

Good luck with stopping with drinking.  You can do it.

[bennie1]

I have been having problems with my cholestrol , about 7 yrs ago my Dr. put me on lipator, well a couple of years ago he had to take me off the lipator because of my liver count going up to over 300, its taken a long time to bring my liver count down to 73, between all this his has done a liver scan , came out normal, had a kidney scan, came out normal, had a pancreas scan done all normal, all because I have been complaining about pain in below the right rib cage and along the back side. last week I had my cholestrol checked and my liver count , ofcourse my cholestrol is really high 335 to be exact, and my liver when up to 75 so he wants to put me back on cholestrol  medicine, because he thinks that the high cholestrol is causing my liver count to go up again, I hate to do this feel like a rock and a hard place, and so I  also mention the pain again and he says oh well that so like your gallbladder, not to be disrespectful but did he just now figure it out. any I am to have a hidascan for the gallbladder, I  don't if that is the way you say. I do drink my wine at night with my dinner and then some. I don't know if taking the medication for cholestrol is a good idea , HELP.  THANKS B.