Elevated ALT + GGT caused by Keto / Low Carb ?

[coxsox]

For the past few years my LFT readings for ALT+GGT have been slightly raised with no obvious reasons. I’ve had ultrasounds, CT scan, Fibrosis score, detailed blood test etc and the doctor doesn’t know why this is going on.

I decided to review my diet and take action to reduce my BMI (30+) following my ALT reading at Xmas of 80 and GGT reading of 128. I started a low carb diet/keto healthy version, i.e. plenty of veg, clean eating and managed to get the readings down to ALT 21 and GGT 68, within 1-2 weeks, and thought great at least ALT is ok now, actually the best its been in 3 years, and GGT going in the right direction. I had dropped about 8 pounds in those two weeks. As I have a good 20 pounds more to go I’ve kept on the Keto diet and continued to lose weight, slightly slower. I am in Ketosis all the time at varying levels, measured with Ketostix.

My latest blood tests came back this week (41 days later) and I was surprised/disappointed to see the ALT up to 114 and GGT 125, quite worrying. I’m due to speak to my doctor and ask for specialist referral. I’ve spent a long time trying to think what could be causing these issues. Firstly I thought a poor diet/overweight was causing the original high readings at Xmas and this seemed to be proven with how quickly the levels came down when I started the Keto diet. But I’m struggling to understand why the levels have now risen considerably, even though I’ve eaten clean Keto. I’ve done the usual google and can see quite a few people say Keto can raise liver enzymes and will speak with the doc about this. In the meantime I’ve stopped Keto in prep for more blood tests.

Has anyone had experience of raised liver enzymes whilst on Keto, it sounds like different people get different results and for me they were great for the first 1-2 weeks, but now not great. All of my aches and pains disappeared with Keto and I felt 10 years younger and was expecting great blood test results this time. Now I find myself wondering what is going on.....

[Nettekin]

Hi coxsox. Your post is very interesting to me as I too have had a sharp rise in ALT and ALP readings. Last August my ALT reading was a pretty normal 34. By November it was up to 140 and December to 168. The only change in my lifestyle was a loss of 2 stone after following the Fast 800 diet for several months in order to try and reverse a recent diagnosis of diabetes. It definitely worked for that - out of the diabetic range completely, but left now with this new problem! I was not strictly keto, but very low carb and calorie. I am awaiting results of a liver ultrasound and the doctor seems confused. Will be interested to see if you see any changes when you stop keto.

[OmShantix in reply to Nettekin]

I have cirrhosis with normal bloods for last 2 years. Have started Keto, after a lot of research. I saw in some places Keto raises ALT levels, but on other pages Keto is very good cirrhosis. Certainly a lot of the foods - oily fish, leafy greens, berries MCT oils etc are very good for liver. I have a 6 month check on 24 March so will talk to my gastroenterologist about it. Maybe it is the additional fats, processing glycogen - or ketones ?? I’d be very interested to see how you go if you didn’t mind to message me and update me. There has been very little research done on long term Keto diet as it is too new .... but even at my worst ie Hep C with cirrhosis (now cured) ALT was never above 90. I have no side effects from cirrhosis. I have a very sick liver that is functioning beautifully. Go figure. I hope it’s not Keto!!! Good luck

[Limalama]

Hi coxsox, thanks for raising this. I have AIH/PBC and when I was diagnosed last year I'd lost 20kg on a healthy lowish carb/highish fat diet - think dietdoctor.com with more veg and less cream. I'm not strong willed enough to go full keto, but a sort of 90/10 approach was working well. I was worried about the impact of Pred on my weight loss and my hep recommended the Fast 800 diet which is lowish carb/Mediterranean. Despite my best efforts I've put back 10kg over 10 months but have now gone back onto my old diet and lost 2kg so far. The big thing for me is I'm not so hungry which makes willpower stretch a lot further! I'm due a blood test next week so will be interested to see what if any impact the change in diet has had. Let's compare notes after our next tests?

[coxsox in reply to Limalama]

Thanks for all the prompt replies to my post. I’m due to see a specialist tomorrow to hear their thoughts on the problem. There is a lot of contradicting information out there on the benefits of LCHF/keto diets for fixing NAFLD and it may be that different people with genetic makeups react differently to keto. If I hadn’t been having blood tests I would have been none the wiser and stayed on a moderate keto diet as I feel great from it, quite ironic really. To me it seems the keto in the short term fixed my ALT, dropping it to 20 (lowest it’s ever been) then as I persisted with it the build up of ketones has caused the liver enzymes to rise. Anyway will see what tomorrow’s discussion brings, thanks.

[coxsox]

Quick follow up from todays specialist appointment.....

He didn't seem that concerned at the moment, in his opinion based on information he has, its still looking like NAFLD caused by BMI. I did ask him about the effects of Keto diets on liver enzymes, but he'd never heard of that, but did recommend a healthy eating approach to losing weight. So the plan is to have more blood tests in 2 weeks time to see how they fluctuate and hopefully come down by stopping the Keto. He also asked for another ultrasound and fibrosis scan, so will see how long those scans take to come through on the NHS. So will know more in a couple of weeks and report back....

[OmShantix in reply to coxsox]

Thanks for getting back coxsox. Look forward to hearing more 🙂

[barneuboy2k in reply to coxsox]

Wow, thats great! Your dr's and gastro sound amazing, ive been fobbed off from ultrasounds and blood tests from mine for over 18 months! Even though I showed a shadow and my bloods were up the wall. OK I dont really care about myself but im glad to see some people are getting well deserved care. x

[coxsox]

So the latest update on this topic....

Just got blood test results back 17 days after previous test. Wasn't really looking forward to these as any increase would have really worried me. The docs asked for lots of tests, including FBC, glucose, LFT's, NAFLD Fribrosis, Renal profile, Ferritin, eGFR, Hep B,C, AFP. For some reason the LFT didn't include GGT, which had previously been high. Anyway to cut a long story short, everything came back normal. My ALT levels had gone down from 114 to 29 in just 2 weeks and all other readings well within range.

I had done some more research and what I think has happened is to do with a combination of the Keto diet and or rapid fat loss. I'm no expert but what I read was that the released fat goes into your liver which raises the enzymes, and too much too quickly has a negative effect on the liver. So the strategy going forward is no Keto, but a steady weight loss diet which still seems to be working ok. I still have an appointment with a specialist to confirm things but hopefully things are getting back to normal as I continue my journey to a healthier lifestyle. Everyones genetics are different and this finding may not be the case for all, but I'm happy I seemed to have resolved things now....

Hope this helps anyone else in the same situation.

[Hidden]

This is certainly good news. Thank you for the update.

regards