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Fatty liver - slightly elevated GGT & ALP
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Fatty liver - slightly elevated GGT & ALP

Hi there,

Before Christmas I went to my doctor complaining of fatigue. He did a full blood count and most came back normal except that I had very low vitamin D (33.3mol/L) and high Vitamin B12 (856ng/L). So he's prescribed me 20,000IU cholecalciferol capsules to take (twice a week for 6 weeks).

Liver function tests showed up the following:

High GGT - 89 iu/L (normal range 2-50);
High ALT - 66iu/L (normal range 0-40);
Normal AST - 37iu/L
Normal ALP - 36iu/L
Normal Albumin - 41/L
Normal Bilirubin - 12umol/L

On the basis of these results he sent me for an ultrasound scan of the liver, which showed up some fatty deposits. Due to this, he is referring me to a liver specialist.

I am only 29 years old and I overweight (BMI 30) but am losing weight (down from 250lb to 210lb in 12 months) by eating less unhealthy food and cutting portion sizes.

I also have a 5cm hiatus hernia, for which I have been taking 20mg omeprazole daily for almost 3 years (which I am unhappy about, as I didn't think PPI's were meant to be taken long term). Since the liver test results, I have stopped taking this since I read it can cause elevated liver enzymes, I am taking 75mg Zantac daily instead. I do get abdominal pain, but it's difficult to tell if it's being caused by the hernia or not.

I am changing my diet to suit. I've also started taking 360mg Milk Thistle, 500mg Choline, 1000mg Taurine supplements daily, in addition to my normal multivitamin and omega 3 fish oil.

My questions are -

1. How severe do you think the damage is, based on the above LFT figures?

2. Do you think the long term omeprazole use could have caused the elevated liver enzymes?

3. Do you think the low vitamin D & high B12 are related to liver function?

Many thanks, I look forward to your reply.

Gareth (Ireland)
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1. How severe do you think the damage is, based on the above LFT figures?

Liver enzymes aren't really considered to be liver function tests even though they're frequently referred to that way. I believe that your albumin and bilirubin are better indications of how well your liver is functioning and your test results are normal so that's a positive sign. Your elevated liver enzymes - ALT & GGT - suggest some inflammation and perhaps slightly increased liver cell death - the ALT primarily.

2. Do you think the long term omeprazole use could have caused the elevated liver enzymes?

I have no idea.

3. Do you think the low vitamin D & high B12 are related to liver function?


There seems to be an association between low vitamin d levels and liver disease. There is definitely an association with low vitamin d and hepatitis c. The cholecalciferol is to increase your vitamin d level.
Have you beeen screened for viral hepatitis?
If you are overweight fatty liver might be at play. Diet and exercise are the primary approaches to this disorder as there are no specific medications that are very helpful. There is evidence that vitamin e has a beneficial effect with fatty liver - if that is what you have.

I have no idea about your increased B12 level.

I would be careful with supplements. I have been researching milk thistle and though I am not convinced it is beneficial to the liver I haven't seen anything to suggest that it is harmful in any way. I have always stayed away from supplements since my hepatologists always discouraged using them.  

Good luck,
Mike
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