160/520 AST ALT, high GGT please help!!!

[ill13632]

I am not a drinker and have NAFLD and after surgery had liver damage of about 160/520 AST ALT from anesthesia and low blood pressure (I'm diabetic).  I don't have a lot of money so what should I buy to repair my liver?  NAC, sam-E, lecithin choline GNC with phophitadylcholine, milk thistle, vitamin C, isomer vitamin E, vitamin B complex, folic acid?  after surgery I was vomiting, had itching, couldn't speak or remember, clay stools, all the signs of encepholapthy and choleostasis, I still feel weak and tired sometimes and have little appetite.  I feel nauseous after taking milk thistle.  these supplements play a role in methylation and brain function.

Thanks very much

[ill13632]

I found really significant cognitive improvement after taking these supplements.  maybe I am an undermethylator with liver damage from NASH?  sam-E may create melatonin and myelin as you know but is expensive to buy.  

[ill13632]

NAC may cause cardiac fibrosis, thickening of the walls and heart and lung hypertension, narrowing of the airways  
when I take the 1.4g of sam-E and metformin, 4 milk thistle pills, 2400mg of lecithin choline I feel nauseous sometimes for hours but without it I feel normal sometimes

[Thomas D Schiano, MD]

dont think that there is any one crucial element that is missing--I would recommend continuing the combinations that you are currently using.

[Thomas D Schiano, MD]

i dont think that there is any one crucial element that is missing--I would recommend continuing the combinations that you are currently using.

[ill13632]

I was given many antibiotics and I developed sleep disorders, NASH, brain fog, exhaustion, asthma.  is it true that my levels of s adenosyl methionine, glutathione or other chemicals were deficient and I was low in antioxidants like glutathione which caused the sleep disorders and brain fog (eg through neurotransmitter and melatonin deficiency)?

[ill13632]

hepatic homocysteine metabolism is a major focus in diabetes research

[ill13632]

regulating hepatic transsulfuration reactions may modify the recovery process after liver injury.  is sam-E the crucial chemical in my case or NAC or something else?  

[Thomas D Schiano, MD]

i think that it is OK to take the supplements that you mention

[ill13632]

I have been really sick after surgery and something injured my liver.  some of the randomized studies don't show any evidence that vitamin C or E can help liver disease, yet there seem to be some that show that sam-E or NAC can help.  it may help my damaged liver create these chemical compounds since it is handicapped by injury or it may cause more damage

yet I keep reading that choline deficient diets lead to liver disease and neurological problems.

[Thomas D Schiano, MD]

SAMe and NAC are available by mouth.  There are no studies documenting long term use of these supplements but i think that they are safe to use.  You could check a HOMA score blood test to assess if you have insulin resistance.  i dont think that you have cholestasis.

[ill13632]

I think I have cholestasis with itchiness, pale stools.  how long should I be on sam-e and at what dose?  are the studies conclusive on sam e?  sam-e is given IV and for 6 months, but I can't afford much- it seems to help NASH/NAFLD and increases glutathione levels.  glutathione is available OTC at GNC also

thanks!

[ill13632]

I am also taking metformin, there is an association between NASH and insulin resistance.  in studies in some subjects when the pancreas was removed and insulin administered the subjects still developed liver disease

I am hoping the choline will transport fat out of the liver and I take l-carnitine also

[ill13632]

I am reading a hepatology text, I feel that my liver disease caused some exhaustion and brain fog which are the symptoms of HE
I read 90% of people with OSA have NAFLD, 50% with NAFLD have OSA

[Thomas D Schiano, MD]

all possibilities

[ill13632]

thanks!  then it could be the sleep apnea, lack of neurotransmitters, or celiac disease/GERD

[Thomas D Schiano, MD]

NASH should not cause brain fog

[ill13632]

fasting is very bad for the liver and reduces glutathione levels, even though my appetite is gone I think I should eat a lot

[ill13632]

Thanks very much!  I took 72 g of NAC over about a week and now take 600-1800/day.  also started the s adenosyl methionine at 1.4g/day with vitamin B so as to not raise homocysteine levels.  there is also methyl b-12?

I'm curious what is the liver brain connection, does even a NAFLD liver cause brain fog and higher ammonia and so which supplements can cure that like choline?

NAC in mice studies causes lung/heart problems

[Thomas D Schiano, MD]

i think that you can continue to take the above.  your liver should regenerate.  other hepatoprotective herbs are schisandra, turmeric, licorice root and astragalus

[ill13632]

I'm not sure if I should continue taking 1600IU/day vitamin E with 1200 Sam-E, 1200 NAC, a lot of vitamin B, 600mg milk thistle, 1000mcg folic acid, 5g of choline?  I had echogenic liver on ultrasound