This Spring my liver enzymes were double normal AST about 95 & ALT about 90 ??..........Got an ultrasound, came back as Fatty Liver, written up as "mild to moderate, normal liver size and texture".
Prior to this I was on an average of 11 beers per day on weeknights, about 18 on the weekends. (Bud Lite) - (Almost 90 beers a week) - Sheesh......(And I've drank over 20 years).......
Now, for the past 2 months I only drink 6 beers per night & 2 or 3 Non-Alcoholic O'douls. This has cut my drinking back by 50% - (About 45 less beers per week)
Since I've cut back to 50% does anyone here think my liver has somewhat thanked me a little? lol........ I mean, on my next blood test, do you think those enzymes will fall some, get back to sort of normal ??.......
I know alot of replies will say "Why not cut back to 0?". But for now I'd like to hear your thoughts on 6........(beats 12).......
Last edited by dstranger99; 06-11-2012 at 12:38 PM.
Well, 6 is definitely much better than 12... What caught my eye was your AST equal to or slightly higher than the ALT. AST is usually substantially lower than ALT (often about half) and a high AST relative to ALT is a red flag for alcoholic liver disease. When AST reaches double ALT with a long history of heavy drinking, this is a very strong sign for cirrhosis. With your AST about equal to ALT it's possible you're half way into serious trouble.
Other signs of alcoholic liver disease to look for are red areas on the palm of your hands near your wrist below your pinky or on the ball of your thumb (palmar erythema), small blood vessels that pop-up on your face (which you may only notice when shaving), small reddish spots on your chest, or swellings that come and go in your ankles or stomach.
I used to drink about as much as you did/do, and I tapered down to half for a while before going all the way to zero myself. It's a great way to get away from alcohol, as once you do get down near zero, if you relapse, you typically return to lower drinking levels that are easy to get back down to zero again.
What surprised the heck out of me was, my liver symptoms (red palms, spots on chest) actually increased for a while when I finally quit. I had developed a low-level iron overload (alcohol increases iron absorption from food and iron is stored in the liver!), and this iron was causing a lot of inflammation in my liver.
I had to donate blood about 6 times in a year and chelate iron with IP6 (inositol hexaphosphate) before I really started feeling better.
When you get your next labs done, ask your doc to include a "ferritin" (stored iron) study in your blood work. If it's near or over 100, and you want to keep drinking, you may want to lower your iron down to a ferritin level of 30 to 60 through blood donation. This will greatly reduce the inflammation in your liver and buy you some time.
Your doctor will say the normal range for ferritin is up to 300, but this is for people who do not drink! Alcoholic iron overload is how a lot of drinkers get into trouble in middle age, and keeping your iron at more youthful levels will help keep your liver young too.
Google around on: alcoholic liver disease & IRON, and learn more about this.
Liver enzymes can be misleading. They can go sky high (over 1000) in alcoholic or viral hepatitis, or acetaminophen poisoning; but they can also be within the normal range, even with advanced fibrosis if inflammation is low, as when an alcoholic with liver damage stops or reduces his drinking. They are a great indicator of how much damage was done the week before the blood draw for the test, but a poor indicator of how much total damage (fibrosis) is present from past injury.
The enzymes are produced when liver cells are damaged, and a healthy liver can spike very high enzymes when inflamed because it has a lot of cells giving off enzymes after inflammation occurs. A severely damaged liver may be 50% scar tissue (fibrosis), with only 50% of the healthy cells a normal liver might have. This damaged liver will produce elevated enzymes when inflamed too, but there may not be enough cells left to produce the really high enzyme levels a healthy liver can. Does this make sense?
Moderately high enzymes can mean a healthy liver that is mildly inflamed, or a severely damaged liver that is very inflamed and screaming as loud as it can. The damaged liver simply can't scream as loud as a healthy liver can because it doesn't have nearly the number of cells the healthy liver does.
Now lets look at those "normal" numbers... AST normal = 35, and ALT normal = 55. Notice the normal for AST is about a third lower than normal for ALT. As liver enzymes rise and fall depending on how inflamed the liver is, these ratios should remain about the same. If you've been on a real bender, both these would shoot up, but the ratio shouldn't change all that much. AST might be 350, and ALT 550. Sky high enzymes, but the AST still about a third lower than ALT.
This rule isn't absolute, and one enzyme may rise faster than the other when an insult occurs, and one may return back to normal slower than the other once the inflammation stops, so this ratio may not follow in lock-step as enzymes rise and fall, BUT... Generally speaking, an AST equal to or above ALT over a series of tests done over many months time MAY mean something isn't quite right. The higher the AST is over ALT, the greater the indication of trouble, and when AST is double or more over ALT, this becomes a very strong indicator of alcoholic cirrhosis.
Now your ratio is only 1/1, and this is only one test so I wouldn't waste a perfectly good panic over this, but you do need to WATCH THIS in any further testing you have done. A stubbornly high AST floating over your ALT for any length of time, or a separation in this ratio from 1/1 towards 2/1 is a BAD SIGN!
Hopefully, with your moderation in drinking, all will be normal with your next test, and the AST will be back down below the ALT where it belongs.
Make sure they test for albumin, platelets and ferritin with your next test too... Albumin and platelets can rise and fall with hydration, so if you have a "fasting blood draw" in the morning when you may be a bit dehydrated, albumin and platelets should be in the middle of the normal rage with someone your age. If you're well hydrated, they may come out a bit below the middle of normal range, but they should not be "low normal", especially in a morning blood sample. Low, low normal, or falling albumin and platelets over a series of tests is another BAD SIGN.
Ferritin (stored iron) much over 100 is another BAD SIGN if you like to drink. Iron builds up in livers of long term drinkers over time, and when it reaches a certain point, inflammation can ramp up with remarkable swiftness and cause problems. Dumping excess iron is easy if you are eligible to donate blood and aren't afraid of needles. The ones they use at the blood bank are BIGGER than the ones they draw blood with at your doctors lab, but just one donation can drop your ferritin by 30 points.
If a blood donation simply ain't gonna happen, then avoid vitamins with iron, restrict your red meat consumption, and drink coffee with breakfast and ice tea with lunch. Coffee and tea inhibit iron absorption from food.
The ultrasound looks great! Alcoholic livers usually get very LARGE and fatty, sometimes doubling in size, so this is a good sign.
I'm not a doctor by the way... I'm a drinker! (an old and wise one) But I work in the medical profession, and have studied well up on alcoholic liver disease to be sure I wasn't getting into trouble myself.
I'm clean and sober now, but not so much by choice... I believe it was iron that got me in the end. Ferritin crept up and eventually started inflammation that had me on the wagon to avoid serious problems with my health. By the time I figured out what was going on, I was scared straight.
Liver disease is a long slow decline into a very bad end, and once it reaches a certain point, there's no stopping it or turning back. I wouldn't risk having my liver go over a cliff for anything in the world. Surprisingly, I found there was life after alcohol, and it's not all that bad. You might want to consider a "reality check" and see what you think from the other side of the bar.
Best of Luck to you!
Last edited by BillinSD; 06-12-2012 at 05:07 PM.
Hope your enzymes look a bit prettier when you check them next.
Doc's almost never check ferritin/iron in men during routine labs, as the upper limit is set sky-high @ ferritin 300, so almost no one ever shows a clinical iron overload. High/normal ferritin isn't so much of a problem as long as you don't drink, but:
Alcohol increases iron absorption, and excess iron is stored in the liver.
As the decades roll by you can wind up with a LOT of stored iron in the liver.
Alcohol is metabolized in the liver, and this metabolism creates a lot of oxidative stress.
Iron can act as a "catalyst" for some of the byproducts of alcohol oxidation and create a particularly nasty form of free radical called the "hydroxyl" which can start a chain-reaction of chronic inflammation going that is hard to stop once it gets started.
If you like to drink, always demand a ferritin test every time you get routine labs done. It's a very cheap and simple test (you don't need to be fasting) and the doctor shouldn't object. You need to ask for a copy of the result, as unless it's over 300, the doctor won't even notice it as it won't be flagged as high by the lab.
When ferritin gets near 100 or more, it's time to dump some iron, or strongly consider saying farewell to the frothy nectar. Alcohol and Iron do not mix!
I had to learn this the hard way.
Last edited by BillinSD; 06-12-2012 at 06:11 PM.
That stuff was a God-Send. It used to be when I came home from work, the first thing I did was pop open a brewski. When I decided to cut down, I would drink O'doul's after work and hold off on the beer till after dinner.
Funny thing was, when I tried to cut back further, I found I couldn't really stomach alcohol free beer after dinner. What I did then was delay my dinner. I'd go out after work and hike around the woods or the mall for a couple hours and eat around 8. European dinner hours!
When I did this, I found I could get by with only a couple of light beers before bed. After about a month or so like this, and a real brutal day at work, I just hit the sack after dinner one day. I was alcohol free without even trying that hard.
I still felt pretty lousy for a couple months until I started donating blood. I have a theory that as you detox off alcohol and your fatty liver returns to normal size, the relative concentrations of iron in your liver INCREASE as fat leaves your liver cells, but the iron does not. All that stored iron doesn't go anywhere until you experience a sudden iron loss through blood donation and your body calls up the reserves to make new blood cells.
I've read that liver inflammation (and enzymes) often actually increase when long term drinkers quit, and this is exactly what happened to me. I initially quit because I had a few pink splotches (vascular nevi) pop out on my chest and a few blood vessels visible on my face. I felt fine, but I didn't like these warning signs of alcoholic liver disease showing up so I decided to do a reality check, more to see if I actually could stop if I needed to.
As I tapered down slowly, I just started feeling worse and worse. Palmar Erythema popped up on both my palms, and I developed a rather nasty ache in my right side where my liver is that spread all the way across my lower chest. I thought I must have waited too long to quit and started frantically researching alcoholic liver disease and cirrhosis.
It was at this time I stumbled across how much of a factor iron plays in liver disease when I started reading things like: The "Role of Iron in Alcoholic Liver Disease" and "Liver Iron Predictive of Death in Alcoholic Cirrhosis". I had donated blood in the past, so I figured what the heck and gave it a try.
I was very impressed with how swiftly "my malaise" lifted like a fog, starting with the first donation. By the time I had dropped 3 pints in 6 months (the fastest the blood bank would allow), I was feeling back to my old self.
I'm a born again believer now... The fix for (early stage) alcoholic liver disease is to DUMP THAT EXCESS IRON that's been building up in your liver all these years. It has made all the difference in the world to me.
Last edited by BillinSD; 06-12-2012 at 09:27 PM.
Bill, Thanks for the responses, and I will post my enzymes after my next Dr Visit (Sept).
In the meantime, I'm gonna hang with a few O'douls, and a new limit of 4 Bud lites nightly...I figured 6 was still a little much.....
And as far as Iron goes, my reserves may be different, I've had long term bleeding due to hemorrhoids (several years), (Gonna probably end up having to get them banded!!). The blood loss eventually gave me mild anemia on that last CBC, and I was on Iron pills for a month to build up my hemacrit count. Until I get them fixed I'll probably end up on Iron pills again temporarily. They gave me suppositories recently, 1 a night for 10 nights to see if that will fix them, if not, banding is my next step....Always something.. lol
Interesting thought... Were you on the iron pills when you pulled the high enzyme test?
No, but that was when they noticed my iron was low. Called it "iron deficiency anemia", then gave me an Rx for these red pills for 30 days, I took them and all went back to normal. (for now)...
Note: They drew blood at a gastro office where my doc referred me to schedule a colonoscopy that later confirmed hemorrhoids, they called me a few days after taking the blood, said my iron was now normal, stop the pills.......
Well Bill, I blew it ! lol.......After my last test I went back to old habits after awhile, 8 or 9 beers daily. New #'s
Dr. Told me to go back to 4 or less or stop completely, and do a recheck in June. He also said it's like this; told me a comparative story. "So, theres an old russian who drinks 2 bottles of vodka daily and nothings wrong with him, where someone else drinks 2 glasses of wine and gets cirrosis"......Everyone is different I guess....
So, I've went back to just 4, guess I'll have to keep it that way permanantly now........Damn....I do love a good beer.......
4 a day ain't as bad as "nevermore" as a famous poet (Poe) once said. Drink in moderation and you may enjoy a wee nip before bed for the rest of your life. Once your liver is damaged though... Nevermore!
When I was younger, old drinkers used to tell me "you just can't party like you used to once you get old"... I never understood what they meant then, but I do now!
Moderation in all things, and to thine own self be true!
Best of luck to you, and keep tabs on your liver's health. Once it's gone, nothing can fix it again.