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Old 09-22-2012, 04:20 PM   #1
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Does This Sound Like Alcohol-Related Liver Injury?

I'm a 38 year old guy, had gastric bypass surgery in 2004 with no complications. No other health problems. Also a light smoker for 20 years (2-6 cigs a day). I started drinking in college 20 years ago and in college definitely binge drank like your stereotypical frat guy. I'm pretty sure I had alcohol poisoning once. For the past 12 years my drinking has been more like once a week on a weekend night, but that one time could involve 5-15 drinks. I'm not worried about being an alcoholic - I don't crave alcohol daily. It's just all my friends drink and when I hang out I like to drink with them. And this has been going on for years. But I'm the only one that seems to be suffering. They have a headache the next morning, take a tylenol and go on with their life.

For the past 10 years, I'd say... the next morning after a night of drinking I feel HORRIBLE. It's not just a hangover. I feel like I'm bed-ridden. I never vomit or feel nauseous. What I do feel is a that my abdomen is bloated and my stomach feels sour / acidic. If I don't have a headache, my head feels FOGGY. My eyes hurt. I feel mentally slow. Physically I feel tired. Sometimes I feel short of breath and all I'm doing is laying on the couch. I feel unwell, sickly, malaise, and it's a waste of a day b/c I don't feel like doing anything or seeing anybody. These symptoms usually last at least 2 days and start to clear up around day 3. Lately it's been happening with less and less alcohol.

I've been getting lab testing for lots of things regularly b/c of my gastric bypass and so far i only have slightly elevated bilirubin (Gilbert's) which my doctor feels is harmless. My other liver enzymes have been in the normal range. I have never gotten an ultrasound or other kind of scan.

I guess I'm wondering if I have reason to be concerned, or if I'm over-worrying about something (I can be a little be of a hypochondriac sometimes). I'm hoping other people with similar reactions to alcohol could respond and let me know if they were worried too and what they did about it. Thanks.

 
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Old 09-23-2012, 09:49 AM   #2
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Re: Does This Sound Like Alcohol-Related Liver Injury?

Hi birddream, & welcome to HealthBoards! Alcoholic Liver Disease is really tricky to detect and measure in its early stages so it's really difficult to say if your symptoms might "sound like" ALD.

A couple of thoughts for you to ponder... Gastric bypass patients often develop difficulties absorbing a few important nutrients the body takes up in the acidic portion of the duodenum, before stomach acid is neutralized. If you're also on acid blockers (which many gastro patents are), this may contribute to or compound this problem.

THIAMINE (Vitamin B-1) is one of these nutrients that requires an acidic environment for absorption, and is absorbed only in small amounts (with any given meal) in a small portion of the duodenum. Thiamine is also VERY IMPORTANT in the metabolism of both carbohydrates and alcohol.

If you're low on thiamine, either from your bypass, from taking acid blockers, or both, alcohol will quickly burn through your thiamine reserves, creating a deficiency which may cause the symptoms you describe.

The general rule with alcohol is... If your liver enzymes are fine, and your feeling fine (after consuming alcohol), you're probably not being harmed all that much, but if you're having problems in either of these areas, you need to quit drinking entirely, or figure out what's going on and fix it.

An interesting experiment you might wish to try would be to pick up some low dose vitamin B-Complex (Balanced B-50) at the drug store, and perhaps some extra Thiamine (AKA vitamin B-1) tablets too. I recommend LOW DOSE formulas, as it's much more effective to take low doses a couple of times a day than a mega-dose once a day. Remember, no matter how much thiamine is in the vitamin (or food), your body won't absorb more than 1 or 2 milligrams of thiamine with each dose.

Next time you've got a drinking night planned, take your B-Complex with two meals that day, along with some extra thiamine with dinner before the party begins. If your morning after symptoms are greatly reduced, you've found your problem. If additional B-Complex with breakfast the morning after speeds your recovery, this is also an indication a thiamine deficiency (probably related to your bypass and/or acid blocker) is your problem.

If you're being treated by a doctor, you should discuss this (and any supplements you take) with him/her. He'll probably say "just don't drink", and that's good advice, but I doubt he/she would have problems with you taking low dose B-Vitamins if you are going to drink.

B Vitamins need magnesium to work, and I don't know if bypass patients are prone to low mag absorption or not, but if they are, a LOW DOSE Magnesium Citrate supplement might boost the effectiveness of your B-Complex. Too much mag can cause diarrhea, so a single low dose (200mg) with lunch or dinner would be plenty to insure you've got enough mag without causing GI issues the morning after. Mag Citrate is the only form of mag that is well absorbed if you're on acid blockers, so don't substitute this with another form of mag. If all you can find is the 400mg dose (which is common), a pill cutter may be a wise investment.

Potassium is another vital mineral that gets depleted with alcohol consumption and is associated with morning after symptoms. Potassium supplements are NOT RECOMMENDED by most doctors or me, but tomato juice is rich in potassium, and a V8 or tomato juice the morning after really will fix you up in a jiffy if low potassium is your issue.

Acidic foods and beverages (tomato juice, tomato sauce, orange juice etc) will greatly increase absorption of thiamine from both food and supplements if you take them together either before or after drinking. This is important if you are on acid blockers. Without some form of acid, either stomach acid or acidic food, thiamine is very poorly absorbed!

Avoiding alcohol may be the wisest choice for you, and probably what your doctor will recommend, but if a little alcohol once in a while is important to you, adequate B Vitamins and magnesium are what your body needs to metabolize alcohol safely, and potassium from tomato juice (and more B-Complex) the morning after may help you bounce back quickly.

Best of Luck to you, and stay healthy!

Last edited by BillinSD; 09-23-2012 at 11:16 AM. Reason: Addition

 
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Old 09-23-2012, 06:25 PM   #3
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Re: Does This Sound Like Alcohol-Related Liver Injury?

Thank you for your reply!

I should have mentioned that I'm very good at taking all of my required vitamins / supplements, and have never been deficient in anything in my lab work (except for a time when my iron was a little low). I've taken the following daily since the surgery:

Vitamin B-50 complex (1 in morning)
Sublingual B-12 (1 every other day)
Multivitamin (double dose in the afternoon)
Calcium Citrate + Magnesium (double dose in the morning)
Zinc (1 in morning)
Benfotiamine B1 (3 times a day)
Lechithin (3 times a day)

I also exercise at least 3 times a week, which consists of 30 minutes on the treadmill.

My labwork has always good (except for the elevated bilirubin of 1.6) - I go in for my latest labwork this coming Wed.

I just feel sick to the point of not wanting to leave my house the day after a night of drinking and don't know why :/ (aside from the obvious which is I probably shouldn't be drinking so much)

 
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Old 09-23-2012, 07:16 PM   #4
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Re: Does This Sound Like Alcohol-Related Liver Injury?

When you see your Dr Wed for labs, ask him to order a GGT liver enzyme. It is the most sensitive one related to alcohol. I think anyone would feel bad the next day or two after 5-15 drinks. If you can't stop after 2, you probably shouldn't drink at all. The fact that you continue to drink even though it makes you so sick is one sign of alcoholism. Daily craving isn't necessary. Many alcoholics are binge drinkers, which is what your pattern sounds like. Depending on what you drink, there could be another issue causing the bloating. You may have gluten intolerance, and beer contains LOTS of gluten from the barley and wheat used to ferment it. Coupled with the snacks that typically go with drinking, you may be getting a gluten overload every weekend, as well as alcohol overload. I would read up on the symptoms of alcoholism. You must have built up a tolerance to alcohol, which is another symptom, to be able to drink that much and still be conscious. Hate to put a damper on your fun, but better that than to dismiss some big red flags in your health picture.

 
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Old 09-30-2012, 07:40 AM   #5
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Re: Does This Sound Like Alcohol-Related Liver Injury?

I'm happy to update that my labs from last week came back very normal. My liver enzymes were:

AST 26
ALT 27
LDH 158
GGT 30
A/G Ratio 2.2 (one point high)
Total Bilirubin 1.6 (it's already established that I have Gilbert's Syndrome)

I think I'm ok. Last night I limited myself to one beer every 45 minutes and I feel ok today.

 
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Old 09-30-2012, 08:02 AM   #6
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Re: Does This Sound Like Alcohol-Related Liver Injury?

Glad your enzymes came back good. Attempts to limit your alcohol intake and watching the clock to curtail your drinking (waiting til you can have your next one) are also signs of an alcohol problem. It helps to try to think of it as an "allergy" to alcohol. Please don't dismiss the idea that you may have alcoholic tendencies, and most deny that possibility for a long time before they realize it is true. By then, damage may be irreversible. Please at least learn all you can about it, and see where you fit into the picture of this insidious disease. It may save your life in the long run.

 
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Old 09-30-2012, 08:03 AM   #7
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Re: Does This Sound Like Alcohol-Related Liver Injury?

Great news birddream... Looks like you've found your sweet spot!

Wish my numbers looked like yours.

 
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Old 09-30-2012, 10:12 AM   #8
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Re: Does This Sound Like Alcohol-Related Liver Injury?

I never going to understand liver problem and liver enzyme lab results.

I don't drink but I have fatty liver (discovered on an ultrasound searching for possible kidney stones on 2010) I dont have any pain on my left stomach side or anything suppodsely related to liver disease symptom.

I have had a few liver enzyme lab test after I saw that I have fatty liver, and all of those lab test always came with AST and ALT in range 10-18 (normal range) but I still have fatty liver according to any ultrasound, CT I have, even if blood work for liver enzyme are normal. The last ultrasound I had was in August of this year, a CT scan with contrast, that show that I have the left side of my liver with fat and the right side of my liver without fat??? also that same day a blood lab work showed:

AST - 10
ALT - 13

So, this is a mistery for me...

 
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