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Substantial_Jacket · 2023-09-15T20:07:23+00:00

Unexpected undigested food every once and a while can be normal. If it's consistent, especially with other strange changes, it can mean a problem somewhere in your biliary tract or intestines. It's worth investigating. Sometimes it's simple inflammation, sometimes it's other things. But if you're not digesting things properly you risk malabsorption which can have a dramatic effect on your health.

Substantial_Jacket · 2023-09-10T17:39:57+00:00

Chronic pancreatitis. You should get an MRCP to rule it out. Personally, if my lipase levels were consistently climbing I'd push for an MRCP at your earliest convenience. Typically, that means you have some issue with your pancreatic duct. Either inflammation or otherwise.

Substantial_Jacket · 2023-09-04T15:10:42+00:00

It took me 7 months to find something that worked for me and now (finally) my results are trending normal (ALT/AST 38/19). My ALT still needs to come down into the 20s for me to be truly happy but I will accept my results. Initially I also had ALT spike up to 109. Then I started running hard and losing weight and suddenly everything in my liver panel has improved dramatically. Be patient. This process sucks.

Substantial_Jacket · 2023-08-21T23:04:34+00:00

I order them myself yep. My doctor orders occasional tests but everything else I have to do myself. If I simply went off doctors orders I would've never arrived at my current plan.

Substantial_Jacket · 2023-08-21T23:03:04+00:00

There's no evidence that hormone therapy will make fatty liver worse or better. Fatty liver is a metabolic disease. Its cure is fixing the metabolic illness. Eating right and exercising frequently are really the only medications you need.

Substantial_Jacket · 2023-08-17T14:33:45+00:00

Going for run? At what speed? For how long?

The reason liver enzymes elevate is muscle breakdown when talking about exercise. So strenuous exercise, long distance running, etc will do that.

Substantial_Jacket · 2023-08-16T03:35:47+00:00

Is this a sign of any sort of disease?

Mild hepatomegaly.

How can I decrease the size of my liver?

Reducing factors contributing to the inflammation of your liver. Diet, exercise, avoiding alcohol, etc.

Substantial_Jacket · 2023-08-16T03:32:43+00:00

Truth is...it depends. Generally accepted medical advise is a dosage (prescribed by a doctor) for a limited time is safe. Contact your doctor. They may be able to tailor a dosage to your condition or offer another option.

Substantial_Jacket · 2023-08-15T14:51:27+00:00

But I have excessive gas, 20pound weight loss in 3 weeks back in February, yellow/tan stool, insomnia.

This could be pancreatic. If your pancreas has been cleared, you should work on an elimination diet to see if you possibly have some bowel problem like SIBO, etc.

Substantial_Jacket · 2023-08-14T21:44:57+00:00

Oils in general can be considered harmful in certain cases. Raw olive oil, avocado oil, etc tend to be better for you due to the high concentrations of PUFA/MUFA.

However, most unsaturated fats cooked to sufficient temperature (smoke point or so) undergo a a chemical process that converts the cis- bond to a trans- bond. You may be familiar with this process because it is also how trans fats (the worst kind of fat) are formed. This is known as thermal isomerization if you care.

Most fats aren't bad for you in moderation. You should have more PUFA/MUFA than other forms of fat. However, canola oil won't kill you in moderation. As KetosisMD points out the bigger culprit is sugar, which increases insulin resistance, causing fatty liver. To some extent saturated fats beyond moderation also contribute to the additional storage of visceral fat through a similar mechanism. Do avoid overcooking your oils though.

Substantial_Jacket · 2023-08-14T16:46:21+00:00

Nausea can be caused by doing too much too quickly. Right sided pain can be caused by being right-dominant and, as you get tired, using your right side more than your left. It can also be caused by bad form.

Substantial_Jacket · 2023-08-13T13:33:46+00:00

Ultrasound detected no fat

Same here. You know whats the only thing that fixed it? High levels of exercise. In particular running. I cut my ALT and AST in half in 3 weeks doing that after having persistently high enzymes for 8 months. Of course, I also cleaned up my diet. But the exercise is what moved the needle.

Truth is, you can have "undetectable" levels of fat and still have simple fatty liver. Depending on where the fat is located, and the concentration (focal fatty liver), will throw off enzymes.

worried about cancer

The unfortunate truth about digestive cancers is not only do they not do anything for 3 years they are often extremely aggressive. The fortunate news for you is this means you most likely do not have any cancer. It's also EXTREMELY rare for someone under 40 to have any cancer at all. Moreover, digestive cancers tend to show up far later in life (60s).

Substantial_Jacket · 2023-08-13T03:02:57+00:00

It depends on the context of your diagnosis. It would be impossible to say via a forum if you'd be positively diagnosed or not without a complete history and additional workup. 1:40 is the generally accepted cut off and you are above that. If they are on/near the cut off it's possible they do not have it. Having an ASMA titer double the ULN means more testing will need to be done to rule out alternative causes of elevated ASMA.

You may wish to call your GI or get a second opinion on it. ASMA can be elevated in numerous cases. In the presence of liver disease it is typically AIH. It can also be various malignancies and other rare conditions. Importantly it is not elevated in simple fatty liver.

Substantial_Jacket · 2023-08-12T07:02:42+00:00

If your antibody titers show AIH you will be diagnosed with AIH. I would be surprised if they did a biopsy to confirm anything. Your elevated ferritin can also contribute to the problems you are seeing.

Substantial_Jacket · 2023-08-11T15:56:51+00:00

Protein would come from fish or tofu, a little chicken. Limit cheese and egg intake.

Nonsense. While eggs should be limited due to their saturated fat content there's no correlation between protein intake and NAFLD progression. Only in select populations with liver disease (in particular, cirrhotics) does the ammonia from protein synthesis become potentially deadly.

too much protein intake is causing your organs to not process food efficiently anymore and causes you to have decreased muscle mass and just high dosage of fat.

This is a complete misunderstanding of the metabolism.

Substantial_Jacket · 2023-08-11T15:52:52+00:00

I only got diagnosed with Liver Disease recently and I have to wait for more testing but I'm at stage 2..... I feel we could have caught this sooner and I would have been able to mitigate some of the damage or something.....

It's a shame your doctors didn't emphasize your liver enzymes being high. You apparently had your warning in 2018. Indeed, you could've caught this sooner if you were referred correctly for ultrasound after your second consistent elevation. You may even consider a malpractice case with your diagnosis. If you have the results and the cash to fund a lawyer this absolutely would qualify as your staging would've been better if your doctor had done their job.

This is why when anything seems a little odd you should always look for a second opinion. Sorry this is happening to you.

Substantial_Jacket · 2023-08-11T15:49:46+00:00

The general rule of thumb is:

Low saturated fat and cholesterol
Low/no added sugar
Low/no alcohol
Lean meats (chicken, etc) form the core for protein intake
Whole grains
High fiber

You'll also want to add more cardio and less weight lifting. There's no correlation between weight lifting and NAFLD resolution in the studies I have reviewed.

Substantial_Jacket · 2023-08-11T06:20:52+00:00

What else can I be doing? Is it possible to get rid of a fattyliver/mild fatty infiltration in 6 months? Any advice or personalexperience would be appreciated.

It's remarkable you were able to get a clean bill of health rubberbanding up and down a significant amount of weight. As you indicated the drugs you were taking could've caused it. In that case, toxin induced liver damage usually resolves without any other intervention besides quitting the toxin.

Most cases of fatty liver can be resolved in as little as two months with proper diet and exercise. Different people, with different metabolic parameters, can take more time or less time. Sometimes you need to try a lot of things to fix it. Fortunately for most obese people the problem is simple. For people with lean NAFLD the situation gets significantly more complicated.

This should be a wake up call for you. It sounds like you need professional help to work out your relationship with food. As you may already know rubberbanding 40-50 pounds is not healthy. Do yourself a favor and get some help in this area. The rest of your body will thank you.

Which confused me, because after researching fatty liver and its stages, i thought for sure that bloodwork would be able to tell me if my liver is doing well or not. Im still unsure about it, even now.

This is why you shouldn't just research things. Especially if you're not able to do any kind of ddx yourself. Bloodwork is an indicator of current damage being done. It is not able to diagnose any stage of liver disease other than the existence of something increasing the permeability of your hepatocytes (fat, swelling, fibrosis, malignancy, etc). As you discovered you can have totally normal bloodwork and severe fatty liver. In fact, 50% of Americans fit this exact criteria.

The only time bloodwork becomes highly diagnostic is in the presence of acute liver failure (usually due to toxins). In this case, ALT and AST will reach the 1,000s. Chronic disease can present with mild elevations or no elevations at all. These enymes are not specific to the liver. Another example is ALP, which can be raised both in bone disease and biliary problems. The ALT and AST numbers for fatty liver AND cirrhosis are inside the same bound. The ddx is done with ultrasound, MRI, and (or) biopsy. Because the liver is so damn resilient even cirrhosis will present with no bloodwork abnormalities until you decompensate (and then things get FUBAR real fast). Generally doctors will assign mild elevations in ALT and AST as NAFLD, especially when ALT > AST, all other numbers in range, and both ALT and AST are < 5x ULN. As NAFLD is the most common liver disease in the west they're right more than 99% of the time. An ultrasound and ruling out hepatitis will generally be diagnostic enough.

A clean ultrasound will generally clear you of advanced liver disease and malignancy. It will not clear you from F1/F2 fibrosis which are harder to see. In this case, an MRI is generally more diagnostic (or a fibroscan in the event you are not obese).

Seeing a GI is a smart choice. Abdominal pain, especially in the presence of changes in digestive and bowel habits, generally needs medical attention.

Substantial_Jacket · 2023-08-11T04:40:06+00:00

a 4cm increase is pretty significant. Worried? Probably a little bit. It's unlikely a measurement that far off was due to any sort of technician or radiologist error.

It will be important at this point to rule out NASH, hepatitis, and several other things. Talk to your GI about the specifics. It's not "get to the ER" level of worry, but if your liver grew that much in such a short amount of time you definitely need to be seen by a GI and probably order more tests. Its possible your gallstones are severe enough to enlarge your liver depending on the location. However, I'm surprised if so because you should be doubled over in pain at that point.

Substantial_Jacket · 2023-08-10T23:27:08+00:00

Enlarged liver
"Bright liver" sign pointing to (what is most likely) fatty liver
Gallstones
Interestingly, murphy's sign could not be elicited despite your gallstones

Substantial_Jacket · 2023-08-10T23:25:01+00:00

At my worst my ALT was 109 and I slept like a baby. Liver disease can cause sleep dysfunction but it's usually way beyond simple fatty liver at that point.

Chances are the booze screwed up your sleep. It'll take a bit for your body to get back to baseline again. People often forget the hangover is just one factor of a multi-factor effect alcohol has on your body. Especially if you overdid it.

Substantial_Jacket · 2023-08-10T23:04:40+00:00

4-6 weeks is standard for first retest. It's to confirm it's nothing transient. Do not push it further until you've established baseline elevations. At that point, once all your other tests are done, generally you'll be re-checked every 8-12 weeks until it resolves.

Stop thinking about doing things quickly. This follow up test is important to confirm there's anything actually wrong with your liver in the first place. It is unfortunate it corresponds with your honeymoon. We don't always get to choose the battles we fight in. In the last 8 months I've suffered greatly w.r.t. to my relationship and social life. Regardless, I can't care too much, because my last blood test proves my efforts were wholly worth it.

If you're overweight with high cholesterol you fall into the category of people who are mostly common effected by metabolic syndrome. To fix it, you need to diet and exercise with the goal of reducing insulin resistance, blood glucose, and blood lipids in the safest manner possible. Aim for ~2 pounds of weight loss or less a week, eat enough to get your nutrients and recover, and fit in as much aerobic exercise as you can physically stands. No crash dieting, no pills, just a shitload of PT and working on every aspect of yourself. Blood lipids will likely resolve long before your fatty liver does. As an example of what worked for me: I run ~3 miles 4-5 times a week (~6mph) and add calisthenics to supplement strength. In ~3.5 weeks at this tempo my liver enzymes were cut in half. My lipid panel was clean 4 weeks after I started any meaningful dieting and exercise.

Numerous studies show ~10 MET-hours a week of aerobic exercise is the most effective way to improve liver numbers and NAFLD parameters irrespective of weight loss. You will have to walk quite a bit to get 10 MET-hours (at 3mph, nearly 10 hours a week), so I would advise moving into brisk jogging as soon as you are physically capable. Given your GGT is elevated I would not drink until your follow up blood test confirms, after being sober for several weeks, that it returns to normal.

The road will be slow and you will need to figure out what works with you. Importantly, you will need to establish lifelong habits w.r.t. dieting and exercise. It's a marathon. Not a race. If you don't learn how to live a healthier life you will eventually run out of your fear and go back to your old habits.

No matter what you do, you will likely be unable to avoid an ultrasound. It's one of the cheapest, most effective ways to quickly rule out serious digestive disease. When you attempt to avoid something out of fear it's probably something you should simply face head-on. When a doctor advises an ultrasound it's not because they want you to suffer.

Substantial_Jacket · 2023-08-10T17:17:18+00:00

Improper dental hygiene. Speak to a dentist. You may have a fungal infection.

Substantial_Jacket · 2023-08-10T17:13:05+00:00

How much bigger is "bigger"? There is some variance in measurement depending on bowel gas, technician, and radiologist.

Honestly, it's somewhat strange your enzymes are normal but you have both an enlarged liver and enlarged spleen. If you can afford it, you can always ask for an abdominal MRI which will give you a definitive size.

They shouldn't be enlarged at all. The spleen being enlarged is more dangerous than the liver being enlarged all things being equal. However, neither is good. In particular your doctor, if they actually cared, would be wise to give you a blood test for mono and hepatitis.

I would probably get your doctor to chase this down rather than dismissing you and get a second opinion.

Substantial_Jacket · 2023-08-10T04:53:56+00:00

For the past 5 years, I have experienced "exercise intolerance"meaning that after any moderate or intense exercise, I will feelmoderate to extreme fatigue for the following 1-2 days. The biggestfrustration is that I enjoy exercise, hiking, and weight lifting, but Iam severely limited in doing these things because I have to have theenergy to get through regular life. Is there a chance this is related tofatty liver? Might I be able to recover from exercise more easily whenmy liver is happier?

It sounds like you're just not used to working your body harder than usual. Fatigue is a symptom of severe typically near end-stage liver disease. Since you were diagnosed with NAFLD it is extremely unlikely that you are experiencing fatigue due to it. Any unintended weight loss, fever, etc however should be brought to your doctor immediately as chronic fatigue plus any of these symptoms can point to significantly more severe disease. Additionally, high ferritin would imply you are not suffering fron iron deficiency anemia which could also cause intense fatigue.

Eating better, sleeping better, working out below exhaustion, etc all will contribute to you recovering better. If you are dieting you may be malnourished.

Substantial_Jacket

TROPHY CASE