Fatty Liver

[Osidge]

I believe early signs of fatty liver is raised enzymes in a cheap blood test. If elevated an ultrascan can show the fatty liver. Hence fatty liver disease.
The blood test is used to monitor it. Further increases induce further investigation or high level of enzymes cause concern.
My 220 to 22 assured me of a healthy liver, gp too.

You can have a fatty liver without abnormal LFTs.

 

[Osidge]

These tests are all included in my liver function tests that I have records of going back 10 years (thanks to on-line test results) None of these has ever been anywhere other than well within the quoted standards. (Bilirubin, ALT, albumin, Alk Phos )

I must conclude I have never had a fatty liver. Unless anyone can dispute this for me.

Not necessarily. You can have a degree of fatty liver without it affecting the function of the liver to a degree that your LFTs would be abnormal.

 

[ickihun]

You can have a fatty liver without abnormal LFTs.

I know but a scan confirmed mine, twice. Only when specialist sees raised enzymes for me does he order a scan. Maybe same of most specialists?

 

[Osidge]

A new study: Comparison of efficacy of low-carbohydrate and low-fat diet education program in non-alcoholic fatty liver disease; Randomized controlled study:

http://onlinelibrary.wiley.com/doi/10.1111/hepr.12918/full

Helpful for our Korean members.

 

[Osidge]

I know but a scan confirmed mine, twice. Only when specialist sees raised enzymes for me does he order a scan. Maybe same of most specialists?

If your LFTs are raised you will be sent for a scan. I was having a kidney ultrasound and they did my liver and prostate at the same time. I had a degree of fatty liver but normal LFTs.

 

[ickihun]

If your LFTs are raised you will be sent for a scan. I was having a kidney ultrasound and they did my liver and prostate at the same time. I had a degree of fatty liver but normal LFTs.

Maybe raised LFTs are a sign of a chance fatty liver could be changing to cirrhosis so needs investigating?

 

[Liam1955]

Been to the Hospital today for my 4 monthly review with the Liver Specialist. My ALT is up to 89 (was 69 in May) and my Gamma GT is down to 48 (was 65 in May). He is arranging the 'long overdue' Fibroscan and also arranging for me to have a Endoscopy procedure - (he is concerned with my Iron Deficiency Aneamia). To be seen again in Clinic in 4 months time.

 

[serenity648]

Been to the Hospital today for my 4 monthly review with the Liver Specialist. My ALT is up to 89 (was 69 in May) and my Gamma GT is down to 48 (was 65 in May). He is arranging the 'long overdue' Fibroscan and also arranging for me to have a Endoscopy procedure - (he is concerned with my Iron Deficiency Aneamia). To be seen again in Clinic in 4 months time.

are you on any anti inflammatory? they gave my husband iron deficiency anemia.

 

[Liam1955]

are you on any anti inflammatory? they gave my husband iron deficiency anemia.

No, don't take any Anti-inflammatory drugs/NSAID's.
Been taking daily Iron Supplements on prescription for 5 years now. My last Ferritin count (iron stores) was 13 and I am told today it needs investigating further with Blood Coagulation and Iron Binding Tests too, plus the Endoscopy.

 

[Oldvatr]

No, don't take any Anti-inflammatory drugs/NSAID's.
Been taking daily Iron Supplements on prescription for 5 years now. My last Ferritin count (iron stores) was 13 and I am told today it needs investigating further with Blood Coagulation and Iron Binding Tests too, plus the Endoscopy.

I have IDA too. When taking iron tabs or tonic like Floradix , did you increase Vit C intake, Iron needs Vit C for metabolism and also an acid stomach. so my PPI med interferred with mine, and any antacid remedies for settling the tum will work against absorption. Old age is sometimes a factor. Funnily enough it seems spinach us actually bad for IDA due to the phytochemicals in it reacting so you do not actually absorb the iron even though it is a greenleaf veg,

 

[Liam1955]

@Oldvatr - I take Sodium Ferederate 190mg/5ml (Sugar Free) 3 times a day and take Vitamin C daily.
Don't take Antacids unless I am really desperate, don't like Spinach - but eat loads of Brocolli, Lettuce and Capsicum Peppers.
The Liver Specialist checked my list of medications today and was satisfied with what I am taking.
When I took Iron Tablets for a couple of years (2 different types) I had to take Antacids as the tablets gave me indigestion.
What I find odd is why not do investigations 5 years ago when I was diagnosed with Iron Deficiency Aneamia.
(My Mother was Type 2 for 20 years and 2 years before she died she developed Iron Deficiency Aneamia - but, it was not investigated).

 

[Indy51]

@Liam1955 - are you taking metformin extended/sustained release and/or a proton pump inhibitor like Nexium? Both can cause issues with iron absorption. Metformin SR gave me a bleeding stomach and subsequent low ferritin. Good that they're giving you an endoscopy - that's how mine was diagnosed.

 

[Indy51]

Another question - have you ever been tested for coeliac?

 

[Liam1955]

@Indy51 - Hi, No I have not been tested for Coeliac. I take the Standard Metformin. The Liver Specialist went through my list of medications and daily supplements to see if there was anything that may be causing problems.
This is what I take on a daily basis:

38 units Humulin Insulin.
2000mg Standard Metformin.
5mg Dapagliflozin.
10mg Ramipril.
4mg Doxazosin.
50mg Sertraline.
20mg Atorvastatin.
4 Drops Cholecalciferol (Vitamin D3).
15 ml Sodium Ferederate (liquid Iron)

1 x 100mg Milk Thistle Tablet.
1 x Vitamin C tablet.
1 x Zinc tablet.
1 x Garlic Oil Capsule.
1 x Vitamin E Oil Capsule.
1 x Omega 3 Oil Capsule.

 

[Oldvatr]

@Liam1955 - are you taking metformin extended/sustained release and/or a proton pump inhibitor like Nexium? Both can cause issues with iron absorption. Metformin SR gave me a bleeding stomach and subsequent low ferritin. Good that they're giving you an endoscopy - that's how mine was diagnosed.

Not sure about this assertion you make here
As regards a PPI contraindication:
http://www.medscape.com/viewarticle/804146_2
My iron tablets patients info does contraindicate one PPI (Omeprazole) but not Lansoprazole. The FDA does issue a warning on Omeprazole, but not in connection with iron adsorption.

The effect of Metformin is also not proven, There is plenty of blog activity and forum discussion but I cannot find any studies that Metformin affects serum ferritin levels. It is known to affect B12 absorbtion. It seems to be anecdotal evidence and folk law rather than a scientific fact.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371989/

I can believe a possible link to the PPIs due to their action on stomach acid, and my own observations did show that a SR Metformin was not working as efficiently as it had been before the PPI was added to my scrip. I have as a result retimed my PPI dose to the night time to move it clear of when I take my other meds.

But do you have a study report that shows a connection to either PPI or Metformin?

I have an interest in this topic since I too have iron deficiency anemia, and I too queried if it was due to either meds or diet, but drew a blank so far. My B12 is fine, and that can affect iron intake, and my vit C should be ok due to LC diet.

The treatment for stomach bleeding such as ulcers is actually a PPI. A check for Helicobacter Pylori may also show/ eliminate another possible cause of IDA. My GP cannot give me this screening due to cost constraints in the practice, and it seems that my ferritin levels have recovered so not a panic issue at the moment. There used to be a diagnostic test for intestinal blood in the faeces, but the local lab has discontinued doing this since they went private, It used to be an optional test that was performed when elderly gents like me had the prostate examinations, and I asked my GP to add it last month, but since the lab cannot do the screening test, this opportunity was missed. As it happens my prostate checks all passed, and the urine retention I had must have been due to the UTI I had on the day of the ultrasound scan.

PS My blood tests showed a higher level of white blood cells and also leukocytes, which indicated an infection going on somewhere in my body. My urine was full of leucoctes too, and I was confirmed with having a UTI. A prolonged infection can also upset ferritin levels and the haematocrit value. But I have always been borderline anemic. Seems I am still there,

 

[serenity648]

My husband problem was caused by Naproxen, a pain killer, not by the Omeprazole.

 

[Indy51]

@Oldvatr - Omeprazole/Nexium are the same thing as far as I know.

I don't have studies, but then I haven't really researched it since the cause of mine was found by endoscopy quite easily and as soon as I stopped taking the metformin XR the stomach pain and presumably the bleeding (I think I've still got the pics somewhere) ceased. I was given a series of 5 injections and when my ferritin levels were next tested, I had normal levels again. I've been tested for h pylori on several occasions due to a series of endoscopies over the years and have always been negative.

@Liam1955 - I think coeliac is a very common cause of anaemia. I had a friend who ended up in hospital in her 60s (so much for it being a childhood disease) literally at death's door. She had pernicious anaemia and Vitamin K deficiency - the root cause of which turned out to be coeliac disease. It's the first thing I'd ask to be tested in any case of micronutrient malabsorption.

 

[Indy51]

An addendum. I was recently researching a drug that my respiratory specialist wants to prescribe, the major side effects of which are digestive/gastric issues. The drug is metabolised via the CYP1A2 gene/enzyme. I discovered that Nexium which I - rightly or wrongly - blame for almost all the digestive issues I have, turns out to be a CYP1A2 inducer. It is also contraindicated for use with the drug he wants me to take.

When I had my 23andme genetic results, it turns out I have a SNP in that gene that makes me a slow metaboliser of caffeine and some drugs. Given my reaction to Nexium, I suspect I should avoid all drugs that are metabolised via that pathway like the plague.

 

[Oldvatr]

@Oldvatr - Omeprazole/Nexium are the same thing as far as I know.

I don't have studies, but then I haven't really researched it since the cause of mine was found by endoscopy quite easily and as soon as I stopped taking the metformin XR the stomach pain and presumably the bleeding (I think I've still got the pics somewhere) ceased. I was given a series of 5 injections and when my ferritin levels were next tested, I had normal levels again. I've been tested for h pylori on several occasions due to a series of endoscopies over the years and have always been negative.

@Liam1955 - I think coeliac is a very common cause of anemia. I had a friend who ended up in hospital in her 60s (so much for it being a childhood disease) literally at death's door. She had pernic anaemia and Vitamin K deficiency - the root cause of which turned out to be coeliac disease. It's the first thing I'd ask to be tested in any case of micronutrient malabsorption.

Nexium is Esomeprazole which is probably the weakest in the family. Omeprazole is the strongest and has the FDA warnings.

Coeliac iron deficiency: Wikki says:
https://www.google.co.uk/search?sit...-ab..0.16.1460...0j0i131k1j0i10k1.w256dheeW6o

 

[Liam1955]

Thank You @Indy51 for all the interesting information you have given me.
My GP checks my Ferritin Levels on a monthly basis.
I am having my Hospital Diabetic Review on the 21st August and have the Blood request form and I see that I am being tested for:
LFT, U&E, GGT, Cholesterol/HDL-C, Ferritin, B12, HBA1C, TSH only and FBC.
(All Blood Requests done for Hospital Appointments copies are always sent to my GP).