Liver function test abnormalities

[.Chris.]

Hi everyone, new user here.

I wondered if others with ME/CFS have abnormal liver function test results?

Ever since I went down with this illness I've had a slightly elevated ALT, and shorty after it started (I had an acute onset) I began to get upper right quadrant pain, which has persisted for over 4 years now. The LFTs have been repeated numerous times (though not particularly recently) and they've all come back with an ALT of between 64 and 98, with one or two showing slightly elevated AST and Gamma GT as well. A while ago I saw a hepatologist who did all the usual tests and ordered an ultrasound - this showed some fat in my liver, which he was at a bit of a loss to explain, since I don't really have any of the risk factors. Anyway, he thought it was nothing untoward and did not explain my fatigue and headaches, although several years later I still have pain in the liver area.

Does anyone else have this problem? I'm curious if this is a one-off, or if it's a known thing in people with ME? Particularly intriguing is the thought this might be due to a persistent viral infection, or the after-effects thereof.

 

[rosamary]

It's not something I've heard of. Sorry, I can't be of more help.

 

[Cheesus]

I had elevated ALT for a long while that no one could explain. I had an ultrasound which didn't show anything. I couldn't get to a hepatologist by the time by GP referred me as I was too sick, but my GP had ruled out all known causes of elevated ALT and was at a complete loss as to what it could be.

I personally believe the elevate ALT is caused by abnormalities in the gut microbiome. There is a lot of evidence linking liver disease to gut flora, so it is definitely plausible. Ultimately I started taking taking milk thistle - somewhere around 500mg per day - and my ALT dropped instantly, after being elevated for about 2 years. I tried to come off it a few times over a 6 month period but my ALT went back up each time I tried. I am finally off it now and my ALT stays at around 40.

 

[Kati]

Hi everyone, new user here.

I wondered if others with ME/CFS have abnormal liver function test results?

Ever since I went down with this illness I've had a slightly elevated ALT, and shorty after it started (I had an acute onset) I began to get upper right quadrant pain, which has persisted for over 4 years now. The LFTs have been repeated numerous times (though not particularly recently) and they've all come back with an ALT of between 64 and 98, with one or two showing slightly elevated AST and Gamma GT as well. A while ago I saw a hepatologist who did all the usual tests and ordered an ultrasound - this showed some fat in my liver, which he was at a bit of a loss to explain, since I don't really have any of the risk factors. Anyway, he thought it was nothing untoward and did not explain my fatigue and headaches, although several years later I still have pain in the liver area.

Does anyone else have this problem? I'm curious if this is a one-off, or if it's a known thing in people with ME? Particularly intriguing is the thought this might be due to a persistent viral infection, or the after-effects thereof.

Hi @.Chris. i can relate to what you said.

I got sick with mono, this was my acute onset. There was liver involvement- so my liver enzymes were elevated for a while. The ultrasound showed sludge in the gallbladder. i got 2 gallbladder attacks in the following weeks, with the "mother of all gallbladder attacks" 5 months after onset. The gallbladder was necrotic. There was never actual stones to the gallbladder.

8 years following the disease onset, my liver enzymes are still closer to the upper normal limit, but thankfully no more pain.

Many doctors tell me that the gallbladder issue is not related to my disease onset, and I don't believe them. But what is there to do now that my gallbladder is out?

Personally getting it out was the best and only solution. The gallbladder pain is piercing. I remember it very well.

I am not saying this is what you have- a wonky gallbladder but if you still have yours, it may be worthy of investigating.

While the liver enzymes are out of range, for the doctors your numbers would be considered acceptable. Someone really sick would have AST up to 5 and even 10 times the upper limit of normal. This is when the specialists get excited.

What you can do is notice when you have the pain, and whether it relates to when you had a particularily fatty meal - the pain in that effect would appear usually in the middle of the night, typical gallbladder time and it is usually when the gallbladder is trying to squeeze some juice to emulsify the fats. And oftentime if you eat less fats, you have less pain. Also being jaundiced and having light grey stools should be reported, this would mean you have a blockage in the gallbladder duct.

I would suspect your hepatologist checked you out for Hep B and C and that kind of stuff, right?


Sending my best wishes. I hope it helps.

 

[Skippa]

Yeah always got "slightly raised" "livers" but even though it makes it go red on the doctor's screen they say it is nothing to worry about every time "sometimes if we've just had a mild cold it can do this, nothing to worry about". Every time.

Are you taking any meds regularly that could slightly raise them? For example chronic paracetamol/acetaminophen?

 

[Eastman]

A liver problem as a causal factor in ME/CFS was suggested a few years back in the thread, CFS/ME as a Liver issue.

It was also suggested as a reason methylation helps with ME/CFS in the thread, Putting methylation into perspective: the liver.

Finally, there is an ongoing thread that started off discussing unfolded protein and has morphed into one discussing liver-related treatments as a possible treatment for CFS, Unfolded Protein Response and A Possible Treatment for CFS.

 

[Cohen2]

I'll chime in as someone with M E whose always had normal liver function. Although my globulin is always at the lowest limit of normal and albumin always high limit of normal.

 

[.Chris.]

Thanks for the replies everyone. The hepatologist said much the same as you, @Kati – that my ALT was 90, he worries when it's 900. I'm not sure if they checked my gallbladder but I imagine they did and found nothing – I had a total of 3 ultrasound scans and an MRI, on which they found nothing other than fatty infiltration of the liver. I'll have to have another look at their letters. I was tested for hepatitis B and C, as well as other stuff like haemochromotosis – all negative. I'm not taking any medication that could cause liver problems, in fact when the enzymes were at their highest I wasn't taking anything at all.


Interesting that liver inflammation is possibly linked to gut bacteria – I've had bowel problems of one form or another for over 10 years on and off (including long before I got ME).

 

[erin]

My recent blood tests showed slightly elevated ALT, AST, GGT and the bad cholesterol. Also my thyroid gland is not working recently. My internist thinks they are related somehow. Whole endocrine system is messed up a bit.

 

[Tammy]

Particularly intriguing is the thought this might be due to a persistent viral infection

Yes...........this is what I think.

 

[me/cfs 27931]

Particularly intriguing is the thought this might be due to a persistent viral infection, or the after-effects thereof.

For 15 years, elevated liver enzymes and high LDL ("bad") cholesterol were the only abnormalities which showed up on standard lab tests.

About 3 years ago, my AST and GGT spiked, and I finally got to see a liver specialist. After an ultrasound, he diagnosed non-alcoholic fatty liver disease, likely due to a viral infection.

Since that time, my liver enzymes have come down to almost normal range. Perhaps due to learning how to pace. Or perhaps decreasing alcohol consumption to just 1 drink per week. Or perhaps just the cyclical nature of my ME/CFS. Maybe all three.

 

[ryan31337]

About 3 years ago, my AST and GGT spiked, and I finally got to see a liver specialist. After an ultrasound, he diagnosed non-alcoholic fatty liver disease, likely due to a viral infection.

That's interesting, my endocrinologist raised suspicions of NAFLD too, he's hoping it'll resolve itself now i've stablised blood glucose/insulin with diet - I get the feeling he thinks a ketogenic diet will fix anything though

As others have echoed, gastro/liver specialist wasn't the least bit concerned with bilirubin & ALT regularly 2-3 times above normal range. Was hoping for a full screen and ultrasound but no chance

 

[Little Bluestem]

Several years ago I had raised ALT, along with declining iron and zinc levels. At that time, a short-lived and controversial member here suggested that I had an accumulation of iron in the liver caused by a shortage of an enzyme needed to utilized it. She said this was due to a B2 deficiency. I did the B2 protocol she suggested and my ALT came down. Of course that does not prove causation.

 

[.Chris.]

Thanks for the further replies. Interestingly, @erin, I also had a few slightly off thyroid tests (overactive) and high cholesterol, though the endocrinologist thought it was not significant. I’ve no doubt she’s right, but it’s interesting to wonder if these might be pointing to whatever the underlying problem is.

@Webdog, it’s interesting that your liver specialist said that. I didn’t know that viruses could cause fatty liver, and I can’t find anything about it on the internet.

 

[erin]

@.Chris. My recent thyroid test after using Levothyroxine for 6 weeks came even worse! I am hypo and taking the thyroid hormon replacement mad it more hypo. My liver pane looks much better now though, AST, ALT, GGT all within normal range, previously higher cholesterol 224 and LDL 134 are I believe negligible.

 

[cfs6691]

Thanks for the further replies. Interestingly, @erin, I also had a few slightly off thyroid tests (overactive) and high cholesterol, though the endocrinologist thought it was not significant. I’ve no doubt she’s right, but it’s interesting to wonder if these might be pointing to whatever the underlying problem is.

@Webdog, it’s interesting that your liver specialist said that. I didn’t know that viruses could cause fatty liver, and I can’t find anything about it on the internet.

I have been arguing that there are CFSsufferers with undiagnosed liver disease(blood tests are unreliable in order to eliminate liver disease/damage-I can provide quotes from medical journals on the subject).It seems that even those who should be getting the attention of hepatologists are not getting the help and the attention they need.
On the subject of fatigue and liver disease I have this quote:E Anthony Jones Fatigue associated with chronic liver disease:A riddle wrapped in a mystery inside an enigma ''There is a strong clinical impression that many patients with compensated chronic liver disease develop fatigue of a severity that seems to be out of proportion to the patients'general medical condition...fatigue can be the dominant,and may be the only symptom in patients with chronic cholestasis'' Hepatology 1995 Nov22(5)p1606
There are articles on the subject of long term fatigue after viral liver disease ,I haven't looked into that because I suspect that my condition was caused by medication known to be toxic to the liver(most medications can be toxic to the liver).You may want to look into that yourself,the ignorance and indifference of hepatologists never ceases to amaze me.
Out of traditional remedies for the liver licorice root infusion and aloe vera have provided a little bit of relief for some of my symptoms,while milkthistle hasn't been of any help.
I find it so frustrating that there is scientific knowledge such as the interaction of bile acids with the endocannabinoid system(that regulates among others appetite,pain sensation and other functions)that is not being used to explain the symptoms of patients and provide relief.And that is just one example of scientific knowledge,The liver has many functions such as breaking down hormones and xenobiotic chemicals,while it also produces chemicals that take part in immune response.

 

[barbc56]

Simple fatigue is not the same as the "fatigue" of me/cfs.

I'm not questioning if some with me/cfs may have liver conditions which might exacerbate me/cfs symptoms but I would question liver problems as the cause unless possibly a "hit and run" causative factor.

Is this what you're saying or did I misread your post? Major fall here!

 

[Little Bluestem]

I am concerned about my liver phase 1 and phase 2 function, but cannot seem to get a test from my usually competent doctor.

 

[Prefect]

I came down with "ME" 20 years ago after my AST shot up to 1200 and ALT shot up to 800. Bilirubin was normal. Creatine Kinase was also high. Tested negative for all hep viruses. Enzymes resolved after a few months. To this day don't quite know what happened that month. Still symptomatic (mainly brainfog, lightheadedness and psychiatric stuff) and my stool has remained yellow. But can exercise with no PEM and drink alcohol. Bit of a mystery.