Fatty liver and Liver enzymes that go up and down??

[Lorelle09]

I was diagnosed with NAFLD or fatty liver in April of this year. Since April I have lost 20 lbs. I am now in normal weight female 5’2” now 127 lbs. My LFTs have always been normal. Usually AST 25 ALT 19 and normal is <40. I have been taking blood tests every three months since 2014 due to my Lupus and LFTs always perfect. Since April my LFTs have fluctuated monthly.

April- AST 53. ALT 83 high

May-AST 38 ALT 39. Normal

June-no testing

July- AST 55 ALT 85 high

August-AST 36 ALT 38 normal

September- AST 57 ALT 87 high

Does anyone with fatty liver experience fluctuating enzymes. Only reason I have been taking so many tests is because my doctor is trying to figure out why it is fluctuating from normal to above normal. I had ultrasound, CT and MRCP done. All showed fatty liver and mrcp showed some sludge in gallbladder too but nothing to worry about. I need to take a fibroscan next but due to COVID it has been postponed to most likely November maybe even next year. One doctor a gastro thinks it may be autoimmune hepatitis. Another gastro who specializes in liver thinks the fatty liver might be making it fluctuate and does not think autoimmune hepatitis. Anyways I’m just wondering if anyone with fatty liver has enzymes that go up and down. I would appreciate any and all information and advice. My symptoms are fatigue, headaches, brain fog, lightheadedness, memory loss although this happens with my Lupus as well

My husband seems to think that it might be from the covid vaccine since it took the first show in January the second in February and april enzymes were high I don’t know anymore I’m just frustrated and confused

Thank you!

[kensimmons]

AST and ALT can fluctuate by from one day to the next and even in the same day.

ALT

In healthy individuals, ALT levels can vary 10 to 30% from one day to the next. ALT levels can fluctuate 45% during a single day, with highest levels occurring in the afternoon and lowest levels at night. A high body mass index can increase ALT levels by 40 to 50%.

clinlabnavigator.com/alanin...

AST

Although day-to-day variation of serum ALT (10% to 30%) is comparable to that of serum AST, ALT also shows variability of approximately 45% during the day, with highest levels observed in the afternoon.

sciencedirect.com/topics/im...

Autoimmune Hepatitis can be diagnosed with a blood test that looks at several things. From memory I think those are ANA, SMA and some Hepatologists look at - IgG level (which, as your husband states, can be raised if you recently had the Covid shot).

news-medical.net/news/20210...

On the other hand, AIH is a disease that for some reason comes on to people with Lupus (and other autoimmune diseases but it seems to come on more often in Lupus, why that is, don't ask me).

Good luck, as long as it is not cirrhosis you can turn it around. Autoimmune - you can take pills for it.

[Lorelle09 in reply to kensimmons]

Thank you for replying and the information. I have a very positive ANA 2560 and negative SMA, and Norma IgG subclasses. Just positive ANA and recent liver enzymes going up and down.

[Lorelle09 in reply to Lorelle09]

Also I always take my blood tests first thing in the morning at 7am. So it should be at its lowest but still high??

[kensimmons in reply to Lorelle09]

I think what I linked says that alt and ast MAY go up and down, but doesn't always, so I certainly would not panic. Plus I'm sure the doctors know all this and keep it in mind.

Good luck!

[dave_tsda]

Hi Lorelle09, I had something similar happened to me when I was first diagnosed with Nafld. I had a few months of tests where my enzymes were going down and then out of the blue they shot back up one month. My hepatologist didn't really have an explanation, but eventually I stumbled across some articles that said when you start losing weight, your enzymes may go up (article and direct quote below)

After 3 more months, mine went back down and have been down every since. You'll want to continue working with your doctors on this, but hopefully this is the cause

"Background: Weight loss was shown to be associated with improvements in liver enzymes and improvements of nonalcoholic fatty liver disease. However, some evidence also shows that liver enzymes may transiently increase immediately after a dietary-induced weight loss."

pubmed.ncbi.nlm.nih.gov/184...

[Lorelle09 in reply to dave_tsda]

Thank you for the info. I will keep this in mind. Hopefully mines will eventually stay low. Been five months of highs and lows.

[mtk0925]

My cousins and myself and a few of my aunts all have up and down liver enzymes all of us only socially drink and all of us tested and scanned and never diagnosed with Fatty liver so it’s very likely that enzymes just fluctuate mine stay under 40 but for our quest diagnostic lab reference range their considered high, I went on Prozac and it shot them up to 60 and 70 then I lowered my dose and it went back to 40s so it may be meds??? Do you take any?

[Lorelle09 in reply to mtk0925]

The meds I take for Lupus I have been taking since 2014 and I have taken blood tests every three months since I have been on the meds and my enzymes have always been in the normal range until April of this year so it’s not the meds. Thanks for replying though. I also thought it was from Omeprazole I started taking in April but I stopped in May and my enzymes have still fluctuated.

[Lorelle09 in reply to Lorelle09]

I also haven’t had a drink since 2010.