Does anyone know something about bile acids?

[Pyrrhus]

Since you mention fat malabsorption, you might be interested in this discussion:

Pancreas Damage, Exocrine Pancreatic Insufficiency (EPI) and Chronic Fatigue Syndrome (CFS)
https://forums.phoenixrising.me/thr...y-epi-and-chronic-fatigue-syndrome-cfs.62997/

 

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What does "weird" ultrasound exactly mean?

I went back to this thread to go through all the comments I got again since I’m still trying to perform some detective work to figure this thing out once and for all (thank you so much everyone for providing your insight!) and I realized my answer to your question @mariovitali was far too vague.

I previously said my ultrasound showed “an enlargement of my liver and ‘something with my bile ducts’” which wasn’t very specific and not very accurate (which is the downside of trying to recall medical terms from memory as a layman). I found my doctor's notes from the ultrasound and what it actually said (translated from my native language) was:

Increased echogenicity of the left lobe and slightly dilated intrahepatic bile ducts.

As far as I’ve understood, after researching the ultrasound findings, echogenicity of the liver generally points to steatosis (fatty liver) and dilation of the intrahepatic bile ducts to some type of blockage due to gallstones, a tumor, PSC, other.

But then I’m back to the fact that my liver tests consistently have been on the lower spectrum of the reference range; that I don’t have elevated bilirubin or total bile acids and that those findings would be expected if there was an actual blockage hindering the bile flow + that my CT scan presumably didn’t back up the ultrasound findings since I never heard anything about it again (can’t seem to find those notes).

So yeah, what I have to support the cholestasis hypothesis is still hypercholesterolemia, elevated serum secondary bile acids and a decreased bile acid synthesis (i.e. low 7aC4) …

… and yet nothing that explains it.

I just thought I’d update the thread with the specifics on my ultrasound to clarify - and in case some liver/bile genius would happen to see it and be able to come up with a theory!

 

[vision blue]

To rule out that taurine deciciency is involved, a urine anino acid is helpful. Either high or low taurine relative to other amino acids would be a red flag (its how i found my taurine deciciency, Does t sound like is your issue but as tou said you were trying to figure out which factors relwvent to bile acid issues are relevent to you. Might be useful to scratch that off the list

Also, you mentiion doing microbiome testing, but you didnt say anything a lut “compgrensive stool analysis”. The carb i tolerance you mentioned may be illuminated by the test as well

When was your ultrasound? It really would not be crazy to repeat that unless it was like a month ago. You also might want to grab some screenshots of the bile duct from the current ultrasound. You might be able to find somebody that can read that if you can’t yourself to see if there really is some dilation of the bile duct

I would also suggest that you shouldn’t assume that you don’t have any of the bile duct or liver diseases that you mention just because your liver enzymes are not elevated. Those are crude d tests and normal values do not have to rule out disease. The supposed principal is that when there is liver damage those enzymes spill out into the blood and that’s why they measured as elevations. But you can have liver damage and not have them slikk out into the blood. I don’t remember as much what causes bilirubib elecation (meaning What is the mechanism Which bile duct issues and gallbladder issues raise them). Anywat the blood tesrs are not a perfect marker for liver abd gallbladder problens

There’s also another ultrasound test that can be done to assess for cirrhosis its a a test that I refused because I am very sensitive to ultrasounds but it’s an advancement in technology were previously when we need a biopsy. Called fivrosure or something like tgat I can also look to see if there’s any damage from fatty liver and I believe can help diagnose fatty liver.

Itheres also a blood test for fibrinogen- wait i think thats the wrong word/test. I think my memory on this is fading.

if you can bear going for another test I would vote for repeating the ordinary ultrasound

 

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Forgot to also add if you have not had a blood tezt for GGT its worth getting. Ita a very sensitive test for liver, so sensitive many no longer use it. But in your case with alt a d ast and bili nirmal, would be heloful to see iftbis more sensitive test is normal

Note Also alt and ast affected by time of day and neal consumotion, so higest cues woukd be erarly am and before eating anything

 

[mariovitali]

A good test to assess liver condition would be a Fibroscan.

 

[vision blue]

A good test to assess liver condition would be a Fibroscan.

Fibroscan, that's the name, thanks. Was trying to think of it when i mentioned the special scan above; it uses very high power ultrasound repeatedly to get the scan. Coudn't remember the name though - i wrote fibrosure (actually i wrote fivrosure but that was a typo)- got the name confused with the blood test that looks for cirrohisis and fibrosis- that's the "fibrosure".

 

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Thank you so much for providing your thoughts on my situation! That’s super appreciated and helpful.

Also, you mentiion doing microbiome testing, but you didnt say anything a lut “compgrensive stool analysis”. The carb i tolerance you mentioned may be illuminated by the test as well

The Comprehensive SA indicated dysbiosis. I had a very low Firmicutes/Bacteroidetes ratio (often seen in Inflammatory Bowel disease, which I nevertheless don’t have as I’ve had multiple endoscopies), no growth of Lactobacillus or Bifidobacterium and generally a very low diversity of bacteria.

It also showed low SCFA and increased fecal fat (which makes sense considering my bile situation. It was chiefly phospholipids). And too high amounts of “protein products: valerate, isobutyrate, isovalerate” (which I don’t know what it means).

When was your ultrasound? It really would not be crazy to repeat that unless it was like a month ago. You also might want to grab some screenshots of the bile duct from the current ultrasound. You might be able to find somebody that can read that if you can’t yourself to see if there really is some dilation of the bile duct.

Thank you! That has been my thought process too. I’m going to request it the next time I see my doctor. The ultrasound results somehow sound more plausible than the CT, considering something is obviously going on with my liver in one way or the other. I also never got to see the CT results and just took my doctor's word for it being alright (i.e. there might have been findings, yet not what he at the time considered to be significant ones. I can't see the CT results anywhere in my medical records). But I want to retake the ultrasound.

I will ask about the Fibroscan as well. Thank you to both of you for bringing it to my attention!

I would also suggest that you shouldn’t assume that you don’t have any of the bile duct or liver diseases that you mention just because your liver enzymes are not elevated. Those are crude d tests and normal values do not have to rule out disease. [...] I don’t remember as much what causes bilirubib elecation (meaning What is the mechanism Which bile duct issues and gallbladder issues raise them).

I’ve also read that the liver enzymes can be normal even when there’s damage, but I’ve taken so many, not only the ALT, AST and ALP several times spanning over years, but also the GGT:

The GGT results were: First time 0,19, Second time 0,21 (Ref range <0,76)

And even PT/INR (blood clotting test similar to the Fibrinogen one) which was 1,0 (Ref range <1,2)

That’s why I felt it’s perhaps safe to trust that there isn’t any damage to my liver? At least not the type of damage that would show on these types of tests. But of course, there might be something there after all …

Two of my closest relatives recently found out that they have PBC and PSC and both are classic cases with elevated liver enzymes/bilirubin/jaundice. PSC (scarring of the bile ducts which causes narrowing and reduced bile flow often causes bilirubin to be elevated).

I think my first step, as you say, must be to request another ultrasound as the last one I got was years ago. I have been considering if something “not purely liver related” could cause my issues. I e.g. asked about Growth Hormone Deficiency in another thread (having come up very low on a single – not very reliable but anyways – GH test). GHD apparently often lead to liver issues and elevated cholesterol. But that explanation is probably quite unlikely. I’m just trying to pinpoint where the issue is stemming from – directly from the liver or from some other mechanism messing with my liver/bile function ... This one is tricky.

The amino acid/Taurine thing could also be well worth considering! I was for some reason supplementing with Taurine at one point and didn't see much relief (I tried about every supplement out there during a time when I was feeling my worst health wise).

Thank you again for everything!

 

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Thanks for the answers. But now that I see them its changing tbought direction
Your comp stool anysis seens rather noteworthy
Can thid all be “just” pancreatic insufficiency? I think someone posted on tgat earlier w/o even knowing your results.
MYbe im misremembering, but dont tbose results suggezt you are not metabolizing fats or proteins? What was your value on that test for Elastqce? Was it on the low side if not outright low?
If you have normal elastace but not breaking down fat or protein, that shoukd greatly narrow down what it is I can generate hypothesis but so can you after googling. I think you hsve enough for a symptom checker:

One thing that you may be running into but slowing down progress in the sorely close minded MD world is that the comprehensive stool analysis is not used by many MDs except for alternative infringe doctors even though it is a wonderful test. So the approach to that is to just ask the MD know rather say to the MD that you think you have increased fat in the store and they can do a test for that that is excepted by the MD world. Ditto for protein.

So google your whoke set of findings if your elastace is normal and tell us what the short list is. I

Out of chriousity, what is your sIGA? (Curious cause most ha e too low a value and mine is 5 times the upper limit of normal)

(Tge dyabiisis seems secondary, not causal, eap given not finding a oathogenic bacteria. Unless theres something in history i dont know about)

Might as wekl also look at all the ways PBC is diagnosed, hust in case. And do t forget ykyr relatives may have been misdiagnosed; even if you all have the same or simikar issues or causes

 

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Pa. Your markers for IBD were ok?

How about a bullet list of what you have so far

- Increased fecal fat

Etc

 

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How about a bullet list of what you have so far

Thank you so much again for helping! I will try to answer as well as I can!

My Pancreatic Elastase was surprisingly high. It was > 500 (ref. > 200 mcg/g).

My Secretory IgA was also at a good(?) level 123 (ref. <=885 mcg/g).

I think that makes pancreatic insufficiency less likely. Is that right? Even though I did seem to have some difficulties digesting fats and proteins for some reason (lack of bile/bad gut flora possibly). I don't have any other signs of IBD. Every endoscopy has been clear. My relatives (the ones with PBC/PSC also both have IBD as liver disease and IBD are comorbidities but I don't have the types of gastro issues they experience such as seeing blood etc.)

I’ve tried to use a symptom checker, but the more specific tests can’t be used on most of them, which leaves the broader symptoms such as fatigue/malaise, muscle twitching and diarrhea (much less frequently these days after receiving FMT’s as a part of clinical study; thus, my microbiota is probably much better these days. It has however not improved my bile related issues).

They never checked for fat or protein malabsorption. They asked me about it – if I thought I had fat malabsorption to which I said yes. But they never offered testing so there might not be any accepted tests for that?

May I ask what you mean by the dysbiosis being secondary? It seems likely, I just don’t know secondary to what!

Here’s a bullet list of my findings (only things that are off):

Liver/bile related:

• Low bile acid synthesis: 7α-Hydroxy-4-cholesten-3-one (On average my values range from 0.5-2.9*) (ref. range 2.5-25.0)
• Total cholesterol 7.0-8.3* (ref. range 3.0-6.0)
• LDL 4.8* (ref. range 1.2-4-3)
• Elevated serum secondary bile acids* (I can’t access these results due to having them done at a special lab).
• Liver: Increased echogenicity of the left lobe and slightly dilated intrahepatic bile ducts.

According to my doctor I have secondary (not hereditary) dyslipidemia due to whatever's wrong with my bile acid synthesis. I'm 30 (F), My BMI is 19.

Comprehensive stool analysis (though outdated since I’ve since then had FMT’s which should have improved my microbiota somewhat):

• Low Firmicutes/Bacteroidetes ratio: 7* (ref. range 12-620)

• Fecal Fat (Total): 44.7* (ref. range 3.2-38-6)

Triglycerides: 0.6 (ref. range 0.3-2-8)

Long-Chain Fatty Acids: 29.3* (ref-range 1.2-29.1)

Cholesterol: 1.3 (ref. range 0.4-4.8)

Phospholipids: 13.5* (ref. range 0.2-6.9)

• Products of Protein Breakdown (Total) 9.1 (ref. range 1.8-9.9) (I saw this one was marked as yellow, so it’s a bit high but not off the charts)
• Short-Chain Fatty Acids (SCFA) 33.8 (was also marked as yellow) (ref. range > 23.3)

PCOS (Polycystic Ovary Syndrome) related:

• Testosterone 2.0* (< 1.7)
• LH/FSH ratio 3:1* (LH 17 – FSH 6)

Other:

• Some anemic tendencies (low erythrocytes, Hb and hematocrit but not super low).
• Have a persistent heart murmur (no structural issues)
• Episodes of fasting hypoglycemia of about 3.1 (ref. range 3.9-5.6) (Other than that normal serum glucose)
• Persistent low-grade fever between 99.5 °F-101.3 °F

Not sure how much these answers help. It feels really far off to find a solution to this unfortunately. I however really appreciate all the info and help you've offered hitherto!