Hello,
Has any had any expiernce with elevated liver enzymes over a period of time and a high GGt?
Thanks
GGT is the most sensitive marker for liver inflammation, but it is fairly non-specific, & not a particularly good indicator of disease. Those with fatty liver often have a chronic/moderate GGT elevation without substantial disease and many prescription (and OTC meds) can bump enzymes high. GGT, as well as ALT/AST stubbornly in triple digits (over 100) is concerning, and should be followed and the liver evaluated with ultrasound.
Alcohol consumption can bump GGT high, but it should fall to normal with abstinence in a month or so. A stubborn and substantial GGT elevation can indicate alcoholic disease. In evaluating alcoholic disease, I like to look at the "De Ritis" (ALT/AST) ratio for additional clues. When AST floats substantially over ALT in drinking populations, this can indicate alcoholic disease, particularly when combined with a stubbornly elevated (triple digit) GGT.
The De Ritis inversion can have false positives, as exercise & exertion can pop AST high, and B-Vitamin deficiency (due to drinking) can cause an abnormally low ALT. This is why I also look at GGT. I consider the combination of a substantial De Ritis inversion with a stubborn triple digit GGT a red flag for alcoholic liver disease. Without BOTH of these occurring at the same time, the risk of alcoholic disease is much lower.
Alcohol aside, mild to moderate elevations in liver enzymes are quite common and not particularly ominous unless they stubbornly hang double or more normal over several labs over time. Even if this is occurring, time is probably on your side, though this isn't something you want to see going on indefinitely.
Hope you get to the bottom of this soon!
Thanks for your response! I have never consumed alcohol so that isn’t the problem. I have had every lab test scan and unltrasound done and nothing was found but my numbers have stayed about the same.
Has your doc ordered an iron lab in your bloods? Males tend to accumulate iron which can contribute to liver inflammation. Transferrin saturation (aka iron saturation) is particularly telling. You want this in the middle third of the normal range for optimal liver health. Ferritin (blood lab) also important. The upper limit for ferritin is set quite high by most labs and is the threshold for clinical iron overload. Optimal ferritin is much lower (50 to 150 max).
I think my iron level came back normal
A "normal" result in your iron lab can sometimes be misleading, as these labs are designed to flag clinical iron overload typically related to genetic hemochromatosis. Often serum iron is the only test done, & serum iron isn't particularly good at flagging sub-optimal iron homeostasis.
Transferrin saturation (aka iron saturation or TSAT) and ferritin are both much better indicators of iron homeostasis. You want to see TSAT in the middle third of its normal range, and ferritin below 150.
If you're running out of suspects, a wise man named Sherlock Holmes once said: Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth!
Do some research into Dysmetabolic Iron Overload Syndrome (DIOS) and see what you think.
That is two tests that I don’t think I was tested for. Weird
I had a TIBC checked, iron sat, and Ferittin actually
Was Iron Sat in the middle third of normal range? Ferritin below 150 or so?
Yes it was along those numbers
Great; well scratch that of the list then.
Don't know if you're on any prescription meds or take a lot of over the counter pain meds. A substantial percentage of prescriptions can cause liver issues. A single course of antibiotics can cause cholestasis (thick/muddy bile) that can last for several months.
PPI acid blockers have come under a lot of fire lately for side effects not previously known (malabsorption of minerals & small bowel bacterial growth). Aspirin, ibuprofen & naproxen have their own issues, as does paracetamol. Even blood pressure meds can bump liver numbers.
Toxic exposures in the workplace or even at home are another possibility, If you have a lot of dry cleaned clothes hanging in your bedroom closet, these can outgas "perchloroethylene" for weeks, exposing you as you sleep.
The liver also prefers saturated fat to polyunsaturated oils. Fish oil supplements in particular can have oxidation issues in the liver. "Lecithin" found in eggs is the liver's favorite nutrient, & this isn't found in substantial amounts in most other foods. Adding some eggs to your diet (if you haven't already been eating them) or a lecithin supplement (if eggs aren't going to happen) might help. A 30 day trial before your next bloods might be interesting.
Keep digging, & you're bound to get to the bottom of this sooner or later.
I hope so! I have them rechecked next month so I’ll have to wait and see!
Do you know if these counts can go up and down or do they basically stay the same?? ( alkaline phosphate and ALT)
Liver labs are fairly fluid and can change from month to month. 90 days is typical to have "second look" labs done when they are out of range. Over shorter periods of time you probably won't see a substantial move, though it's certainly possible.
ALP (alk-phos) often pertains to bile flow & when bile isn't flowing well ALP, ALT & GGT will all come up high. The biliary system is like a sewer the liver dumps its metabolic waste for disposal down the GI tract. If this gets gummed up, the liver has trouble disposing of waste.
"Sluggish Liver" used to be a common diagnosis, but it has fallen out of favor as it lacks specificity. I like this term as it states the obvious quite well. Bile gets thick & muddy from a choline poor diet or medications, & the liver begins having trouble doing its job efficiently.
Besides the lecithin I mentioned above, Curcumin is also known to stimulate bile flow. Dilute the sludge, clear the pipes and get bile flowing well, & recheck your labs in 90 days.
It's nice when you can get a specific diagnosis, but if you can't, trial and error may eventually pay off.
I don’t have a diagnosis, but my liver is still working perfect!
Oh yes, the liver can take quite a beating over many years time without suffering extensive damage.
When enzymes are high though, you want to keep working on what might be causing this. If you want to live to 100, you've got to get labs back into range for the long haul before too long.
Mine have been over the normal range for over a year already
So I hope there not causing damage over all that time
Viral hepatitis A can pop enzymes into the thousands and most patients have a full recovery.
Mild elevations (less than double norm) over a year or two shouldn't produce advanced disease. This said, you don't want to live the rest of your life like this. Keep digging, and you're bound to find the cause.
Coffee & tea are both well known liver tonics. Dietary or supplemental lecithin too. The "PIVENS trial" showed Vitamin-E may be the best medicine for NASH. A 30 day trial of all these before your next labs might be interesting.
Yeah mine aren’t that high, maybe I’ll have to try that.