High GGT&GPT, Nafld? Aih?

[daLefty]

Hi all, found this forum lately, I'm from Germany, and I hope you can help me a bit out.

All started December 2020, when I did a regular check up at age 35. Being 1,70m and 90kilos at that time. I'm male.

Drank no alcohol at all for more than 5 years, and before that drank no more than 1 or 2 beers per month (!).

I do lots of sports (running, crossfit). Nutrition has been protein focused, but with lots of crap carb and sugar.

No drugs, no medication, nothing. I'm smoking ever since, ~10 cigs a day. While I'm doing sports all my life, with 4-5 sessions a week (45minutes each).

With Lockdowns I gained few kilos and couldn't hit the gym for several months, working just from home. So that was increasing my weight from midrange body fat area to chubby.

So end of 2020 the results looked bad, with GGT at ~300 (upper limit 60), GPT ~120 (upper limit 50), GOT normal. My Triglycerides had been elevated at 300 (upper limit 200) and Cholesterines elevated a lot as well.

GOT has been around 40 (upperl limit 50) ever since.

Doc sent me to MRI scan (early 2021), where everything looked super good.

Doc sent me to liver specialist (April 2021), doing a FibroScan, where everything looked good, except liver looking white = fatty.

Liver Doc recommended to change diet and lose weight.

So I did, lost 5 kilos over 2 months, blood results improved, bringing GGT down to 120, GPT down to 60, Trigylcerides back to 200, Cholesterines still mildly elevated.

I kept relaxing, eating bit more unhealthy again, and Triglycerides and GGT increased together in the absolute same % ratio.

So I did proper diet again and lost another 5 kilos, and again GGT and Triglycerides dropped significantly (GGT ~120, Triglycerides 150) within 6 weeks.

So my Doc and me got confident, that my liver results indeed came from bad diet and sugar, fatty liver. So I shall keep focusing on clean diet, which I did and improved.

But unfortunately since 3 months, liver results are increasing slightly, while Triglycerides are now below 100, and Cholesterines are about to just hit normal range.GGT is back at 200 and GPT at 90.

I kept my diet clean, even improved with more veggies, water only. So I can't improve diet anymore honestly speaking.

I'm highly confused and anxious, as liver de-coupled from the positive improvement of all other items in the blood tests.

Here is some questions that I'm asking myself or where I'm getting confused:

1. They couldn't rule out AIH last year, but recommended to try diet before doing biopsy to rule out AiH.

But: if I had AiH, how can GGT and GPT drop at that significant rate with only proper diet? Wouldn't liver be under attack constantly independent from diet and therefore GGT and GPT remain high all the time?

2. What else might this cause? It's not alcohol. Obviously it neither sugar nor bad diet, or why would liver worsen when everyting else improves. For metabolic disorder my Cholesterines would need to be much higher says my Doc. All Hepatitis tests has been negativ.

3. In case it's NAFLD: could it just take many months time for the liver the get rid of the fat and recovering, while still going up and down in GGT levels?

I feel super good, have no symptoms at all, only minimal yellow eyes due to Billirubin slightly elevated. No fatigue, doing 4-5 sessions of sport per week, feel super fresh with 6 hours of sleep. And feel even better since losing 10kilos.

Any ideas?

I got another appointment in 2 weeks at the liver specialist to further discuss. But until then I'm trying not to go crazy and figure out where this comes from.

Thanks for help!

Edit: Added picture of historical blood results.

[AyrshireK]

Definitely sounds more fatty liver related when your numbers have only gone up with poor diet, less exercise and drop again when you are eating better etc.

GGT also tends to be more a fatty liver indicator than AIH where when things arn't going so good it's usually the inflammation markers like ALT which rises.

When you say they couldn't rule out Auto Immune Hepatitis did they actually run tests for the auto immune antibodies that could point more to AIH. (It's possible of course to have both AIH and fatty liver).

Keep the good lifestyle changes going, maintain a healthy weight and diet and maybe look at whether you can stop the smoking too (don't switch to vaping as it has been proven to actually contribute to fatty liver in both animal tests and humans).

Katie

[daLefty in reply to AyrshireK]

Thanks Katie!

They found Antibodies, so they "couldn't rule out AIH" back then, but assumed more that it's coming from fatty liver. +being male, where AIH is rather uncommon.

And of course, I was happy to try diet first, "hoping" for fatty liver and not have to do biopsy.

I started a mix of smoking and vaping 3 months prior to that odysee in 2020, and yeah, stopped vaping now completely as this was one of the few things I could consider to be the cause.

[daLefty in reply to AyrshireK]

Do you have any idea/explanation why liver worsens over the past 3 months, although diet got even better and everything else improved? It does simply not make sense to me, but maybe there is an explanation

[AyrshireK in reply to daLefty]

It can take the liver a little while to catch up with blood improvements so keep up the good work on diet and fitness and hopefully .

Whilst AIH is rarer in males it is still possible - my husband has cirrhosis due to Auto Immune Hepatitis though his may have been triggered by long term use of prescription acne antibiotics.

The liver biopsy is usually a very quick and relatively painless test - hubby has had two - one via the conventional through the side route and one transjugular and neither gave him any trouble. If that is what it takes to get you a firm diagnosis then consider it. With AIH once they get you on the treatment it can stave off any future damage so if it is that then you want to get to grips with is as soon as possible.

However, you do have a few indicators that fatty liver is in some part going on here.

All the best, Katie

[daLefty in reply to AyrshireK]

So having AIH does not necessarily mean that liver enzymes are highly elevated all the time at a more or less constant level?

Just started scheduling biopsy, unless the specialist in 2 weeks doesn't recommend anything else, I'll have to get this done I guess

[AyrshireK in reply to daLefty]

AIH tends to 'flare' sending liver inflammation markers massively high - some of the members of the AIH facebook group see their ALT into the 1000's and this doesn't tend to come down on it's own but requires treatment.

If your dietary changes have been too severe that can also actually put liver numbers up with fatty liver.

It sounds like you've been doing a bit of roller coaster - good eating and exercise brings numbers down, a little slip and into unhealthy ways and numbers go up again then latterly despite good eating etc. the numbers have climbed a little. Maybe it's a result of too severe a diet change and what you need is a good healthy plan rather than being good, bad, good, bad etc. Every time your liver becomes inflamed it can exacerbate any damage and whilst the liver is good at repairing itself it can't do so forever, eventually scarring will begin.

A good healthy and well balanced diet (not too severe as yours sounds) and good exercise regime and maintained long term. The BLT has shared details of a study into the benefits of a Mediterranean style diet for NAFLD.

Details on NAFLD and this diet at:-

britishlivertrust.org.uk/in...

britishlivertrust.org.uk/ea...

[daLefty in reply to AyrshireK]

Thanks Katie!

I've cut weight often due to my fitness/weightlifiting hobby, so I learned early to never go hardcore cutting.

My max is 500-1000 calories deficit, protein focused. With this approach, things dropped sharply those two times.

But since 3 months as I'm maintaining my weight at 78 kilo, but only improving my macros and clean-level of food as good as one can, things are different.

And of course, only diagnosis will help. I'm just trying to understand what it might mean when things look like they do in my case.

Thank you!!

[MINTVCX]

Hi, of course below is not professional advice.

1. They could not have ruled out AIH so I assemu you had some small level of antibodies towards AIH. There is something like smpotanic remision. But I think is a long shot considering you are male (AIH is less likely). Only biopsy can clear it up but it is doctors' call.

2. Well there is something like lean NASH. You can have some genetic predisposition for fatty liver regarding your tests. But your metabolic tests were pretty high which have decreased. I think you have been checked for other possible diseases by your doctors (PBC, hemochromatosis, Alpha-1 antitrypsin deficiency, Wilson's etc.). But it seems all look like fatty liver only with no fibrosis (according to your fibroscan result).

3. Yes I think it is possible. I think even if you test healthy person, LFT can be different when testing often not because of liver issue.

One more thing if your bilirubin is slightly high maybe you have Gilbert’s Syndrome? But even if yes it is irrelevant to your liver status. But elevated bilirubin is usually common with advanced fibrosis (F3-F4) which you seem not to have. What is your INR level? And what state of fatty liver? S1, S2, S3? But Liver diagnosis is very difficult sometimes so I would leave it for hepatologists. Good luck.

[daLefty in reply to MINTVCX]

Thanks!

Bilirubin came in elevated only with the very initial blood test in 2020, prior to FibroScan and with the most recent blood test, in between no elevation.

I learned that there could be much more reasons out there, which haven't been discussed actively by the liver specialist last year.

I haven't received any rating as well, as there was no Fibrosis, and she basically commented to Scan with "wow, tissues looks like a baby's. Take care of your diet".

Made me happy back then, but now I feel have been sent to the wrong expert...

Nevertheless: Everything one could see from the MRT screening was not there. No gallstones or any other sort of inflammation in the whole upper abdomen.

I visit a new liver expert in 2 weeks - looking back a year ago the former liver specialist didn't tell me much about any other potential causes (those you mentioned and what I learned by research over the past months).

So there wasn't too much ruled out besides what I mentioned. And I have a long list of things to discuss and questions to the new expert. Hopefully with more insights, explanation and such.

[daLefty in reply to MINTVCX]

The more often I review the picture, the more i get to the conclusion that whenever there is deficit (no matter small or big), liver improves. Once I change to maintain without deficit, things worsens.

Might there be still too much fat with me? My body fat index is ~18/19.

78 kilos seem bit too much for 1,70m, but I own some muscle mass, higher than average untrained person.

[MINTVCX in reply to daLefty]

Yep BMI is not so accurate when muscle mass is higher than avarage. I would calm down if I were you.

Although I had recent year similar to you I mean I looked for possible diseases, analysing my results, trying to find some pattern close to my case. You can see my profile to read details. Anyway it is not going to help.

[daLefty in reply to MINTVCX]

Thanks!

My goal is to have a big list of potential reasons to work through with the expert. Don't want to have uncertainty any longer.

[daLefty]

Just added a picture with "historic" blood results, so you can better see how things developed.

GGT and Triglycerides (and probably Cholesterines, not measured in some test) did go hand in hand, up and down.

Since 3 months at least Triglycerides have de-coupled from GGT, while GGT seems still going hand in hand with Cholesterines.

[TemoDubai]

I think u had Fatty liver and you should not to be so worry and I think you have to lose some Kilos to reach 70kg and not more. U mad FibroScan and the result was good, so relax and keep your lifestyle and no surge at all. Greetings from MAINZ

[Kakey]

If there's doubt I would have a biopsy. That is based on my own experience, I lost 4 years when I could have been taking the medicine I need. I have fibrosis because of that.

[daLefty in reply to Kakey]

Absolutely, scheduled for early May unless Doc has another plan in 1,5 weeks.

[daLefty]

Hi all,

quick update, been at the Biopsy yesterday, just returned today.

Well, it was kind of pain in the a*** to be honest, and not that "easy peasy" as one can often read.

Sharing my honest experience: it hurts kind a bit while it's done, at least getting the local anaesthesia isn't fun. Laying down for several hours and pressuring the injection site is bit crappy as well.

Nevertheless I survived and am back to normal the day after.

While prepping this they used ultrasound and my liver turn back to full baby mode, no fat at all. Means -15kilos helped in first place.

Nevertheless this means that AIH gets even more plausible in my case.

Will have results and follow up meeting in 2 weeks.

Cheers!

[Kakey in reply to daLefty]

Glad it went OKish. Good luck, waiting for results is one of the hardest bits i think.

[daLefty in reply to Kakey]

Thanks!

Actually it's quite ok, had several months to get comfortable with that worst case AIH scenario. We'll see, no damage delt yet and one can treat it, so could be worse I guess.

[Kakey in reply to daLefty]

Definitely. I had suspected AIH too, but biopsy showed PBC, another autoimmune liver disease. You'll be OK.