Elevated ALT, don't know why

05-18-2017, 10:52 PM

I have posted on the gallbladder board, but wanted a liver opinion as well. I'm a 38 y/o male. I've had two elevated ALT levels since December 2016. Routine bloodwork showed ALT of 122 in December, then at the end of January, dropped to 34. As of May 15th, back to 100. All other enzyme levels normal. My ALT levels have always been normal until the December 2016 test (I get tested once a year for a physical) I also have been having RUQ pain when I eat over the last few months, so I'm thinking it's probably a gallbladder problem. I had an ultrasound which only showed a 5mm polyp on the gallbladder, liver normal. HIDA scan of 88%. Upper endoscopy normal. Been blood tested for: Hep A-C, AIH, EBV, CMV, Wilsons, hemochromatosis, immunoglobulin, all negative. I don't take any prescription meds. Only supplements are a multivitamin, turmeric, and milk thistle (one per day). All of these I have only taken since the December test. Alcohol wise, I drank my fair share in my 20's, but have cut back a lot in my 30's and only have a couple of drinks a month now. My docs have said it could be gallbladder problems causing this, but normally the ALP enzyme would be elevated as well, which it's not. Is there anything I could be missing in regards to the liver? Seems like I've had a full work up, and I'm considering just going ahead with the gallbladder removal at this point.
Thanks

05-19-2017, 08:21 PM

I wouldn't be too eager to get my gallbladder yanked with no stones and a good ejection fraction and normal ALP. Lots of folks say they experience nothing but relief after gallbladder surgery, but others report digestion issues.

I would look to possible workplace or household toxins for your mystery elevation. Triclosan in antibacterial soaps is a known liver toxin. Probably not a problem to wash your hand with, but I wouldn't want to rub it all over my body.

Dry cleaning fluid is also highly liver toxic, and this out-gasses from clothes for up to a month after you bring them home from the cleaner. If you've got a closet full of dry cleaned clothes, you either need more ventilation, or perhaps store them in a closet outside the bedroom.

Volatile (oil/plug-in) air fresheners are also bad news for the liver, as are dryer sheet fabric softeners if your dryer vents to room air. Same if you have occupational exposure to solvents, glycols etc.

Lecithin from egg yolks or supplements can help thin bile and stimulate flow, purging the liver of evil humors. Thick, muddy bile can cause problems and thinning bile can often be helpful.

I'd exhaust all possibilities and try any remedies before I'd opt for surgery.

Hope you get this mystery solved soon!

05-19-2017, 08:43 PM

Quote:

Originally Posted by BillinSD

I wouldn't be too eager to get my gallbladder yanked with no stones and a good ejection fraction and normal ALP. Lots of folks say they experience nothing but relief after gallbladder surgery, but others report digestion issues.

I would look to possible workplace or household toxins for your mystery elevation. Triclosan in antibacterial soaps is a known liver toxin. Probably not a problem to wash your hand with, but I wouldn't want to rub it all over my body.

Dry cleaning fluid is also highly liver toxic, and this out-gasses from clothes for up to a month after you bring them home from the cleaner. If you've got a closet full of dry cleaned clothes, you either need more ventilation, or perhaps store them in a closet outside the bedroom.

Volatile (oil/plug-in) air fresheners are also bad news for the liver, as are dryer sheet fabric softeners if your dryer vents to room air. Same if you have occupational exposure to solvents, glycols etc.

Lecithin from egg yolks or supplements can help thin bile and stimulate flow, purging the liver of evil humors. Thick, muddy bile can cause problems and thinning bile can often be helpful.

I'd exhaust all possibilities and try any remedies before I'd opt for surgery.

Hope you get this mystery solved soon!

Hi, thanks for the response. I definitely don't have any of those evnironmental issues. I don't dry clean, use any weird soaps, and don't use any air fresheners. I've tried all the home remedies for stones, with supplements, egg yolks, lemons, etc. I still have pain after most meals with any fat. Including just coconut oil. I actually eat pretty healthy. One surgeon said he would remove it based on the polyp. He said if this grows I would need the gallbladder removed anyway, and he also said a lot of times what look like polyps on ultrasound are actually gallstones. There is a lot of controversy on HIDA scans. Most docs will tell you the higher % the better, but there is a newer school of though that anything over 75% is "hyperactive" and can cause problems as well and should be removed. I wouldn't mind waiting a bit longer, but unfortunately I need to do this while I have my health insurance (will be covered at 100%), as I will likely be quitting my job soon. So I need to make this decision ASAP. I can't think of why else my ALT could go from normal, to high, back to normal, back to high. One surgeon told me passing a gallstone could theoretically cause this. However my GP said the ALP is also usually high in this case, which mine never has been. And yes, I am concerned about the chance of long term digestive problems. My doc said about a 5% chance of this happening.

05-19-2017, 11:38 PM

A tough call, and a very personal decision. With toxic exposures ruled out and alternate remedies exhausted, tincture of time is about all that's left. Sometimes these things do just pass.

Acute gallbladder attacks, typical with a stone passing are usually acutely painful. I guess it's possible a polyp might intermittently restrict flow causing the symptoms you are getting. This could either pass or get worse.

I really can't advise what I would do without being in your shoes.

Best of Luck whichever way you go!

Elevated ALT, don't know why

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