I'm an alcoholic who has drank 2 bottles of wine a night for about a year and a half. I've had my liver investigated this year, and found out a lot. I had a high ALT (124) which then went down to (112) with a normal GGT. I also had an ultrasound which showed a fatty liver.
Throughout all of this, both my GP and my sonographer said they do not suspect cirrhosis and that the damage could be reversed. I also cut back on the alcohol, but admittedly frequently relapse into a 2 bottle binge, probably explaining why the ALT remained high.
I've just had my latest liver function to find my ALT is higher than ever at 150. I do drink well over what I should, but much less than I used to, yet my ALT is the highest it's been. My rheumtatologist has referred me to a fibroscan. She seems very concerned about how high my ALT is and does not seem to think it tends to be this high with fatty liver. Could fatty liver alone cause an ALT of 150?
My other question is this: would fibrosis have appeared in the ultrasound or not? And, if I might have fibrosis (the ultrasound guy seemed very confident he was not looking at cirrhosis) is fibrosis reversible, or does it always ultimately and eventually progress to cirrhosis?
I am now abstaining from alcohol. This ALT is too much for me to deal with and keep drinking. So I'm stopping altogether.
Thanks.
Written by
KR95
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Give up alcohol for good. If you aren't prepared to do that then none of the following advice will be of any value.
Neither fibrosis nor cirrhosis would necessarily show up on an ultrasound scan unless the damage was gross. A FibroScan is worth doing to check for fibrosis. You probably don't have cirrhosis drinking the way that you have for a year & a half.
Your liver is more than just fatty with an ALT of 150. The normal GGT but high ALT may mean that you have a serious case of NASH. Whatever the reason your liver is quite inflamed & you need to do everything you can to help it recover. Lose weight if you are overweight but do it steadily without drastic dieting. If you have metabolic syndrome or type 2 diabetes stopping the inflammation will be a lot harder. Exercise regularly. Cut down on saturated fat & sugar. Avoid anything that might stress your liver other than prescribed medication.
Fibrosis can repair itself if you do everything right but it's not as simple as stopping drinking alcohol if you have a fatty liver & NASH.
I've been getting blood tests every 3 months & to my surprise my latest blood test showed that my own NASH is getting worse despite not drinking alcohol for almost 3 years (I was never a heavy drinker) & not taking a painkiller for 13 months (overuse of painkillers, stimulants & supplements led to my liver problems).
I'm not overweight but I have some belly fat that I need to lose. I exercise quite strenuously daily. I don't have metabolic syndrome or type 2 diabetes & my diet is healthy yet my latest blood test result shows that my liver is getting worse. My ALT is nowhere near as high as yours but rose from 43 to 54 & my platelet count has dropped from 181 six months ago to 135 (15 below normal). It's the last thing I expected given what I've been doing to improve my health & that I felt like I was getting healthier. NASH killed my mother & may eventually kill me if I can't stop it.
If losing my belly (visceral) fat doesn't work the only remaining option I'll have is trying a diet like the one in the following link which may be anti-inflammatory & liver friendly. If that doesn't work then NASH will likely get me although it may take years.
The GP I see is useless other than for referring me to a specialist to cover his arse. He prescribed the painkillers that caused my problems & he downplayed the importance of various abnormal blood test values over the last 5 years (like for example a low platelet count) instead of warning me that they were a sign that my liver was starting to struggle. Even when my ALT rose above normal for the first time he made light of it as if it was nothing. My GP has no concept of preventative medicine! I only realised that something was wrong when I started to feel very ill & on checking my symptoms the penny dropped that it was my liver.
The specialist that I've just been referred back to at my request after my latest disappointing blood test result probably won't be able to do much other than agree with the measures I'm taking & perhaps order another ultrasound scan & FibroScan to compare the results with the previous scans I had when I last saw him.
My point is that you need to be proactive in dealing with your liver problem like I am trying to be with mine.
Hi edward, when you said you fell very ill what are the symptoms you’re experiencing that led you to think it was your liver? And how did they diagnosed you with NASH? Via ultrasound?
The symptoms I had were symptoms of acute hepatitis:
• Impaired brain function (encephalopathy)—I felt ‘foggy headed’ and like I had a hangover on a daily basis for several months.
I experienced instances of losing orientation at shopping centres and while driving and not knowing where I was until I got my bearings. I also looked for objects and my brain didn’t register their presence despite what I was looking for being in front of me.
I also experienced great difficulty posting on a computer forum that I often post on because I could no longer express myself in words coherently and articulately. This was due to my liver not being able to clear my brain of toxins.
Encephalopathy can be subtle as well as gross. I gave up alcohol almost 3 years ago because I blamed it for things like memory lapses but I now believe that the memory lapses were mild encephalopathy.
• Unpleasant Flushes Rising from the Stomach to the Top of my Head
• Excessive Frequent Yawning
• Daily Bouts of Extreme Fatigue—I often felt extremely tired typically in the late morning and late afternoon. On a few occasions I had to nap after only being up for a few hours.
• Disturbed Sleep Pattern—I started going to bed much earlier than normal around 7:00 p.m. instead of my usual 10 or 11 p.m. My sleep was fitful and I typically woke multiple times through the night sometimes sweating abnormally.
• Itchy Skin (Pruritus)—I'm not sure about this one. My itchy skin is mainly my scalp, neck & upper body.
• Outbreaks of scaly skin on my face & illnesses like tonsillitis lasting 6 weeks due to my immune system becoming compromised.
I had an ultrasound & FibroScan. The ultrasound showed a normal sized liver with no apparent abnormalities or signs of fatty liver. My FibroScan score was 4.3 but I don't trust it because the technician only took 3 shots & it was done after I'd lived clean for 6 months.
I haven't had a drink of alcohol for almost 3 years or a painkiller for around 14 months yet my last blood test indicated that my liver is more inflamed than ever which is the last thing I expected.
I exercise on a treadmill for up to an hour daily & do some strength training as well. My belly fat is slowly dropping so I'm hoping that my next blood test shows that my liver is settling down.
My GP gives out painkillers to his patients & makes light of abnormal blood tests & then when his patients develop cirrhosis he makes light of that too. He doesn't know that FibroScans exist.
I'm now doing everything I can to help my liver settle down & repair itself. I feel healthy & the symptoms I listed have largely disappeared however my last blood test showed that you can feel healthy while your liver gets worse. I have an appointment with my hepatologist in 5 weeks to discuss why my liver is more inflamed than ever after the steps I've taken to help it.
Thank you for a very detailed response Edward. Nothing showed up on your last ultrasound even a fatty liver? They’’ve diagnosed NASH only on your blood results alone?
I don't have a diagnosis. My liver is inflamed for unknown reasons. The painkillers I took for many years appear to have caused inflammation that has become chronic.
Just come across your post and wondered how you are getting on?
I have read that any form of alcohol including the non alcoholic beers which have a tiny amount of ethanol can inflame your liver, this might be the reason for your continued high ALT. Strenuous exercise can also raise ALT as can many over forms of Liver disease.
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