Copper deficiency, iron overload & severe fatty liver

[Crsonic10]

Hi everyone, new here. 17 year old son had high liver enzymes, iron overload and now low copper levels. Ultrasound done showed fatty infiltration or other hepatocellular disease. Doctor wants a biopsy. I did a friboscan as a second opinion and shows severe fatty liver no fibrosis. He has lost 15 lbs and is doing good. No symptoms. My concern is iron overload and copper deficiency. We really prefer to avoid biopsy. We thought maybe get another blood test when he loses more weight. Anyone else in the same boat?

[Hidden]

For your son to be deficient in copper after having iron overload seems odd unless perhaps the copper deficiency resulted from attempts to lower his iron levels in which case in time his copper & iron levels should normalise. Has he been tested for haemochromatosis? If he's copper deficient then giving blood to control his iron level could make him more copper deficient. The same goes for avoiding iron rich foods to keep his iron levels normal. You should discuss this with a specialist.

The most important thing is to get your son's enzymes into the normal range through him gradually losing more weight until his BMI index is in the normal range (preferably the lower end) by following a healthy liver friendly diet (no junk food, avoid saturated fats & too many carbs) doing regular exercise & avoiding liver stressors. It ought to be achievable for someone as young as your son.

Your son having fatty liver & high liver enzymes means that he has both NAFLD (non-alcoholic fatty liver disease) and NASH (non-alcoholic steatohepatitis). Fatty liver on its own is considered benign but when accompanied by raised enzymes (inflammation), as in your son's case, if left unchecked it can lead to progressive liver scarring (fibrosis).

If the FibroScan showed no fibrosis putting your son through a biopsy may be unnecessary unless his problems continue in which case a biopsy might help to resolve any uncertainty as to the true state of his liver.

[Crsonic10 in reply to Hidden]

His Naturopath said that Iron overload depletes copper, he said if we get his iron taken care of his copper should be good. My son is trying, this is so difficult and worrisome.

[Hidden in reply to Crsonic10]

The naturopath appears to be correct. Iron overload can lead to a slight copper deficiency. If your son's iron levels come down his copper level could normalise. That won't fix his NAFLD & NASH though which are his biggest problems.

[Crsonic10 in reply to Hidden]

How do we bring iron levels down? He has already changed his diet and started walking. He has lost 15 lbs so far. I give him juices in the morning (beets, celery, carrot, broccoli stem, kale, radishes etc) I also told him to begin warm lemon water as soon as he wakes up. Also taking liver rescue supplements (dandelion, milk thisle, curcumin) what else can I do??

[Hidden in reply to Crsonic10]

He should be tested for haemochromatosis. There are different types of iron. My ferritin level has always been above normal but my iron & transferrin levels are in the middle of the normal range. My gastroenterologist suggested I give blood but I dismissed the idea because if I gave blood to get my ferritin level down my iron & transferrin level would drop possibly below normal causing problems.

In your son's case giving blood might lower his iron level quickly & then his copper deficiency should fix itself. That option should be discussed with a liver specialist.

You should stop giving your son the concoction of liver supplements. There is no evidence that they work and in all likelihood they are making his NASH worse. I also don't see much benefit from giving him juices. Weight loss through careful dieting plus exercise are his biggest hope. If his weight drops into the normal BMI range his fatty liver should reduce & his enzymes may normalise.

[Crsonic10 in reply to Hidden]

I have another story, 10 years ago I also had high liver enzymes and high iron. An ultrasound detected fatty liver and I never went back to the doctor. I did lose 45 lbs and I had a blood test (probably not a liver test) and doctor said everything looked good. I am concern about my liver also. I was not tested for hemocromotosis either. The iron seems to be hereditary. I have an appointment to check my liver soon

[Crsonic10 in reply to Crsonic10]

Why would the supplements make his NASH worse? I give him juices to make sure he is getting good nutrients because he spends alot of time at school and work. He is a senior, in colorguard and works. He is never really home and eats alot of salads only. I try to give him leafy greens and stuff by juicing

[AyrshireK in reply to Crsonic10]

It's the stuff you are calling the liver rescue supplements (dandelion, milk thistle, curcumin) that Edward is probably referring too. There is no proper evidence that these do anything positive for the liver at all and we have had members on here who have been told by their hepatologist to stop milk thistle in particular as it might actually do more harm than good.

Hope you get some answers as to what is going on with your boy.

If doctor wants to do a liver biopsy to see what is going on it is really a good test to see the liver at a cellular level and see if there is a particular part of the liver system that is inflamed (this can identify auto-immune conditions too). Generally a quick and relatively painless procedure. My hubby has had two without issue - one through his side and one transjugular.

All the best,

Katie

[Hidden in reply to Crsonic10]

Dr. Melissa Palmer's Guide To Hepatitis and Liver Disease:

"Vegetables may be consumed freely. However, the practice of daily juicing of large quantities of fruits and/or vegetables should be avoided in people with severe liver disease."

One obvious reason for the above is that juicing removes the fibre.

None of the supplements you give your son have been proven to be beneficial to the liver. Giving him several of them every day is if anything more likely to add to the load on his liver than help.

"... it is important to be aware that some preparations of milk thistle may contain iron; therefore, milk thistle should be avoided by people with liver diseases associated with iron overload ..."

"... some herbs commonly taken to treat liver disease (milk thistle, dandelion, and licorice) may contain iron. Therefore, people with hemochromatosis should avoid all herbs."

"Anecdotally, it has been claimed that dandelion (Taraxacum officinale) possesses liver-healing properties. In fact, dandelion has been purported to enhance bile flow and to improve both hepatitis and jaundice. However, actual studies involving dandelion are difficult to locate. Dandelion has an extremely high vitamin A content, higher than that of carrots. Since high levels of vitamin A can lead to serious liver damage it is not advisable to use any herbal preparation that contains dandelion. (Please note: Dandelion may contain iron and therefore should be avoided by people with iron overload diseases.)"

"Turmeric (Curcuma domestica) is the main ingredient in Indian curry powder. For thousands of years, this herb has been used by India's practitioners of traditional Ayurvedic medicine as a cure for liver disease. It might, therefore, be concluded that the Indian population has a lower incidence of liver disease than the rest of the world, but this has not been demonstrated."

[AyrshireK in reply to Hidden]

Well researched answer Edward

[Grank]

A special test is required to diagnose hereditary haemachromatosis and your GP must organise it asap if that is what is suspected. Testing for raised ferritin levels is not enough.

If diagnosed with haemachromatosis then venesection (removal of a pint of blood) will reduce his ferritin (iron) levels and he will feel much better. Abstinence from alcohol is essential, as is a sensible and healthy diet, because haemachromatosis will eventually damage the liver if care isn’t taken. I’m sorry to be so blunt, however I have hereditary haemachromatosis, as do other male members of my large Celtic family. It is perfectly manageable and it is possible to live a long and healthy life by making alterations to diet and living a healthy lifestyle. No alcohol is perhaps difficult to take on board for one so young, however I’m afraid it is essential. My brother refused to cut out alcohol, he only consumed 6-7 units a week, however he died aged 44 of haemachromatosis and decompensated cirrhosis.

[Crsonic10 in reply to Grank]

Is there symptoms of hemocromotosis?

[Grank in reply to Crsonic10]

General symptoms are weakness, joint pain (mine feels like flu symptoms when my ferritin is too high) and tiredness. However it differs for everyone.

[Crsonic10 in reply to Grank]

How is your copper when iron levels are high?

[Grank in reply to Crsonic10]

They’ve never mentioned measuring my copper levels.