Fatty Liver

[Meerkat1234]

Hello everyone. A haematologist rang me yesterday and said I have a macrocytosis with no anaemia. My red blood cells are too large. She wants further blood tests and a liver scan. She mentioned fatty liver. I am concerned as I already have a liver enzyme not working now this. Appreciate any help. Thanks.

[humanbean]

I have a macrocytosis with no anaemia.

Macrocytosis is a condition of having large red blood cells. When red blood cells are either large or small they aren't good at transporting oxygen around the body and people can become breathless very easily.

Large red blood cells could be caused by low levels of Vitamin B12 and/or low levels of folate. Ask your doctor if you could have these tested and make sure to get a copy of the results.

Small red blood cells (microcytosis) could be caused by low iron and/or ferritin (iron stores).

The average size of red blood cells is indicated in a Full Blood Count by the level of MCV i.e. Mean Cell Volume.

If someone is extremely low in B12/folate and has slightly low iron/ferritin levels there is no way to tell what the result will be in terms of red blood cell size. In fact being low in iron could end up disguising low B12 / folate (or vice-versa).

Doctors often wait for their patients to become anaemic (i.e. haemoglobin is under range) before testing and treating nutrient deficiencies. But sometimes people can be extremely low in iron/ferritin or B12/folate and still not be anaemic.

Where there are nutrient deficiencies they need to be treated with or without anaemia.

One of the biggest problems that patients face is that, suppose the lower level of the range for haemoglobin is 120 g/L and the patient has a result of 120 g/L. This is technically within the range so the doctor thinks this is fine. But what if the patient feels best with a level of 130 g/L ? With doctors always believing that a test result which is in range is perfect the doctor and the patient will never find out that they would feel much better with a result of 130 g/L.

As long as someone doesn't have Pernicious Anaemia(PA), Vitamin B12 can be easily supplemented with over-the-counter supplements, although getting the right type and the right dose is essential for success. It can be easily found online. Someone with PA would need injections of B12 because they can't absorb B12 via diet or from pills/capsules, but unfortunately getting injections of B12 is not easy.

It is a good idea if both B12 and folate are low that B12 should be supplemented for a week before adding in folate supplements.

In someone with low iron, and with low haemoglobin, iron supplements can be bought in the UK without prescription. But it is important to get the right type because lots of people struggle to tolerate iron, so ask for advice if you want to raise your iron and/or ferritin.

Once you have the appropriate tests done post the results and ask for feedback from the forum.

Two useful links :

cks.nice.org.uk/topics/anae...

cks.nice.org.uk/topics/anae...

[Meerkat1234 in reply to humanbean]

Hi humanbean. My doctor left me three and a half years without B12 and would only give me one every three months when I asked him recently. I now go to an osteopath and have just had a loading dose. It is my liver that I am worried about. Thank you for your detailed reply. I appreciate it.

[SlowDragon Administrator]

As you know you are currently extremely hypothyroid that’s not at all surprising

pubmed.ncbi.nlm.nih.gov/105....

Macrocytosis is found in up to 55% patients with hypothyroidism and may result from the insufficiency of the thyroid hormones themselves without nutritive deficit. Normocytic anemia, so-called uncomplicated anemia, arises due to thyroid hormones deficit itself not followed by nutritive deficit.

How much levothyroxine are you now taking

How long on this dose

[Meerkat1234 in reply to SlowDragon]

Hello SlowDragon. I am worried about my liver. I am now on 50 levothyroxine for eight weeks soon. What does thyroid do to the liver.

[SlowDragon Administrator in reply to Meerkat1234]

Have you booked new blood test for 9am latest. Only drink water between waking up and blood test, and last dose levothyroxine 24 hours before test

Highly likely results will show you to be ready for next dose increase in levothyroxine

Being hypothyroid will result in high cholesterol

As dose levothyroxine is increased cholesterol levels will reduce

This link explains the possible link between liver and hypothyroidism

palomahealth.com/learn/fatt...

Did you ignore GP wanting you to eat gluten for 6 weeks coeliac blood test. Not worth the upset in my view. You already know you’re gluten intolerant

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential

[Knowsnothing in reply to Meerkat1234]

Being hyper or hypo can affect the liver, sort the thyroid levels out and most times it corrects itself the liver that is, when I was very hyper my liver struggled when back in range it sorted itself out.

[Meerkat1234 in reply to Knowsnothing]

Morning Knowsnothing. Thank you for your reply and telling me about your liver. You have really helped me not to worry. I appreciate it. Take care

[SlowDragon Administrator]

Was reading on your previous post you are now getting B12 injections …..well done for organising this yourself

How many B12 injections have you now had ?

The next thing to address is your very low folate levels

Have you start taking any folate or a vitamin B complex yet?

Perhaps initially only start with just folate

Try Jarrow Methyl folate 400mcg daily

uk.iherb.com/pr/jarrow-form...

[Meerkat1234 in reply to SlowDragon]

Morning SlowDragon. We organised the B12 injections privately with an osteopathic practice. Getting nowhere with the doctor. He reluctantly gave me one and then said every three months. That wasn’t enough as I had so many B12 symptoms and it was the neurological ones that I was worried about, after being left three and a half years without any. I have now had one from the doctor and a holding dose from the osteopath. I plan to have one every six weeks with the osteopath but one a month if needed. I feel a lot better. Thank you for your link about the liver and hyperthyroidism. That has put my mind at rest. Thank you for the link about macrocytosis, you said it was that. I am pleased there is no anamia. I still have low Vitamin D, and haven’t tried B complex vitamins or Ferritin or Folate. I wiget the Folate you say. I did ignore the doctor about celiac disease as I cannot tolerate even a crumb of gluten as it makes me so unwell. My blood test is due on 13th of August after being on 50 mcg of levothyroxine. Thank you for relaxing my mind. I really appreciate it.

[SlowDragon Administrator in reply to Meerkat1234]

well done you’re making great progress…..despite a useless GP

Onwards and upwards

Daily folate next

Also……If you can manage to get out into the sunshine to help improve your vitamin D that would be a start

Can you tolerate eating sardines or salmon? Both are Rich in vitamin D

Other vitamin D rich foods here

bhf.org.uk/informationsuppo....

[Meerkat1234 in reply to SlowDragon]

Thank you SlowDragon for your praise and encouragement, it means so much. I have been sitting in the garden in the sun. I like salmon and have been trying to eat it but still having digestive pain. Thanks for the link about Vitamin D rich foods. I will try sardines as well. I still don’t know how to sort out my digestion. Betaine HCL gives me pain. It has been an uphill battle but you have been there every step. Thank you so much.

[SlowDragon Administrator in reply to Meerkat1234]

Try a (small) teaspoon of “Apple cider vinegar with mother” in a glass of water or squash to drink with your food

Drink with a straw to avoid damaging your teeth

Start with very small amount “Apple Cider vinegar with mother” in a glass of squash see if you can tolerate that

King Oscar sardines on Gluten Free toast …..grilled lightly……utterly delicious

[Meerkat1234 in reply to SlowDragon]

Thank you for all that information. My husbands likes sardines too. Sounds delicious definitely. I so appreciate all this help SlowDragon.

[SlowDragon Administrator]

ACV with mother

Available in all Heath food shops

Small bottle about £3

hollandandbarrett.com/shop/...

hollandandbarrett.com/shop/...

[Meerkat1234 in reply to SlowDragon]

Thank you SlowDragon. I will get some. I so desperately want to have proper dinners again with my husband. I am so sick of carbohydrates only.

[SlowDragon Administrator in reply to Meerkat1234]

once you get next dose increase in levothyroxine metabolism will begin to slowly pick up

Initially only try a tiny bit a meat or liver

Little by little you should see improvements, especially now your getting regular B12 and once you start folate too

[jade_s in reply to Meerkat1234]

Great advice from SlowDragon!

Meerkat, if ACV doesn't agree with you (it gives me migraines), you can also try lime juice in some water with meals.

As for liver enzymes, mine were above range when I was hypothyroid, but getting on the right amount of meds has brought them way down. Don't get discouraged x

Glad to hear you're getting more regular B12 already. Folate will also help You could ask the osteopath for 6 'loading doses' given over 2 weeks, since you have been without for so long. That is standard treatment in the UK.

[Meerkat1234 in reply to jade_s]

Hello jade-s Thank you for your encouragement. I am trying not to get discouraged. SlowDragon has helped me from the beginning of joining this forum. She is wonderfully helpful. I have had the 6 loading doses from the osteopath. Thank you for telling me about the lime juice.

[jade_s in reply to Meerkat1234]

Great to hear! Yes this forum is amazing Best wishes xx

[AS14]

I was told I had a fatty liver when I had gallstones years ago, told nothing to worry about.

Around 2 and half years ago I started getting pain round my liver area serious pain, considering A&E one day. It was during the height of covid so I decided against and instead got an urgent appointment with gp. I had extremely high liver enzymes with high ferritin, almost twice the top of the range and very crp of 18.5, the top of its range is 5. I was scared to death. Gp said normally she’d want me to go straight to hospital but due covid I had to decide if I wanted too, I decided against it.

So instead gp arranged an ultrasound and recommended I see liver specialist which I agreed to but even urgent appointments were taking much longer at this time. I asked is there anything I can do myself, she said lose weight and couldnt suggest anything else.

I thought while I wait for a scan and to see a doctor I’ ll see if I can help myselfthought there must be something I can do. I did a lot of research, online and youtube, I cant remember names or which videos specifically but I know I just typed in fatty liver and came across several. All liver specialists, not some random person claiming some strange cure. I also joined the fattty liver group on facebook too.

To sum it up it basically comes to this,,

Cut out all sugar, cakes, biscuits sugary drinks everything with added sugar.

Dont eat excessive carbohydrates, I cut out carbs at main meal and replaced with extra veg and salad. Breakfast had zero sugar ( shredded wheat), bread was whole grain.

Fruit is ok but theres some lower in sugar than others, berries and canteloupe melon are very low, but even so dont eat too much. I ate two portions a day. I stayed away from all high sugar fruit, bananas, grapes etc. Fruit is very good for you, full of important nutrients and although its not the same as sugar added to food I decided to choose lower sugar fruits and not over do them.

I went to skimmed milk ( arla bob milk is nice), still drink it now .

And lose weight, I know its incredibly hard when hypo, I was and still am very symptomatic in that area but being strict with my diet managed to lose several stone in 18 months. This was with zero exercise, couch and bed bound most of the time.

Its also important to cut out any unnecessary medications and supplements. Youre trying to take as much strain off your liver as possible.

Your liver like the rest of you can gain fat, when that fat level in your liver becomes too high it can cause scaring and damage over time, however your liver has the ability to repair its self, not always possible but be quite remarkable in its repair process. So the aim is to remove some fat and give the liver time to repair itself.

A sensible very low sugar, healthy carbs( and not too many) over time should with some weight loss fix it.

No alcohol at all.

I must admit there were days when I was so fed up, eating grilled chicken, fish veg etc every day was hard especially while over Christmas, the house was full of chocolates and treats but I never strayed once. I’d had a fright and that was enough to keep me going.

Within a few weeks my blood tests started to improve a little and when the appointment came round for scan and consultant I declined. This was after Id spoke to another gp in the practice and Id done a great deal of research and found that if “ fatty liver” was the cause all Id be recommended by consultant to start with is exactly what Id discovered myself, diet and weight loss.

In 9 months my liver enzymes returned to normal and pain was gone, 18 months for high ferritin to return to mid range and crp to fall to 1.5.

I never did go for a scan, my diet is still good, not as strict, still low sugar but pretty much what you’d describe as a balanced diet.

Its not complicated, its all down to diet, but you must be consistent and yes there’ll be days when youre fed up but its worth it. Ignore any scare mongers, I came across a few but the majority of people can turn this around, Ive seen enough people including myself to know it can be done. Depending on the extent of the fat in your liver it can be turned around in few months, but even a lot of fat and raised enzymes can be improved dramatically over time. Its consistency with diet and some weight loss that does it.

Try not worry , it can be done

[Meerkat1234 in reply to AS14]

Hello AS14. Thank you for all this reply all about your story. It is very kind of you to share with me like this. I am scared about how bad it is. I have been living on carbohydrates for years and I have been taking benzodiazepines since 2003. I also smoke. I also take medicine for the neurological symptoms which came in 2020. These have been better since I got the holding dose of B12 injections. When they mention your liver anyone would panic. SlowDragon sent me a link that it can be caused by hypothyroidism which has eased my mind. I do have pain like you had. I had a scan looking for gallstones a couple of years ago but I don’t know if the doctor would have looked at my liver. I didn’t have gallstones thank goodness. I have one enzyme not working properly. I also get red palms which is a sign of liver disease. I will try not to worry. The haematologist said she wasn’t worried about my liver but she mentioned fatty liver and told me I need a liver scan. I will try to stay calm and you have really helped me this afternoon sharing all this with me. Bless you. I will try to do what you have said. Thanks again.

[bookish in reply to Meerkat1234]

I am glad that you are now getting some vit B12 and that your neuro symptoms are improving. Not sure which neuro meds you are taking also, but benzodiazepines can themselves deplete vit B12 and folate (B9). The liver needs sufficient B12, so will improve with further injections, as will your red blood markers. Best wishes

[Meerkat1234 in reply to bookish]

Hello bookish. Thank you. I do feel stronger with the B12 injections and like you say it will make my liver and red blood cells better. Best wishes to you too.

[AS14]

I totally agree its linked with hypothyroidism however its very common in people who aren’t.

Regardless of the cause it tells you what it is in its name- too much fat in the liver.

Having optimal thyroid hormones is important for helping maintain a healthy weight but diet is still crucial in fatty liver.

I do understand how hard it is, but weight loss ( nothing extreme), and the way of eating Ive mentioned is the only way to fix fatty liver.

Its nothing to panic about but it is something you should be paying attention too, it wont go away with out making some diet changes and can progress. You sound like theres been no significant changes to your liver other than some extra fat, as I said a few months could easily resolve it for you.

[Meerkat1234 in reply to AS14]

Thanks for all your encouragement and advice. It has been difficult to change diet with such poor digestion. I also have Autism/ADHD which have gastrointestinal problems that come with them. SlowDragon said try ACV so I will try that. Thank you for saying don’t panic. This comes with my conditions. Thank you for calming me down. You are very kind. I will try to make the changes like you did.

[SlowDragon Administrator in reply to AS14]

If you read previous posts Meerkat1234 is currently on an very very limited diet as she’s extremely hypothyroid (bedridden/wheelchair) having been left on just 25mcg levothyroxine for years and only now finally making progress since joining this forum

…she really doesn’t need extra worry of a long list of foods to avoid at this stage or be looking at weight loss at the moment

[Meerkat1234 in reply to SlowDragon]

Thank you SlowDragon for that comment. I appreciate it.

[AS14 in reply to SlowDragon]

All I was doing was try to help.

. My own health is bad Im still wheelchair bound and only just came from completely bed bound. I am not able to use my phone often so can not keep up with all posts and my advice comes from what I saw today. Had I read previous posts my answer would of reflected that.

I also understand the limited diet, I have a very close family member who is autistic and has a very restricted diet, who I have to cater for so I know how difficult it is.

I was simply trying to help and ease op’s worries with something I have experience with. I did the best I could given my own limitations.

[Regenallotment Ambassador]

do you get the Zoe Health email updates/newsletters?

I was just reading that came today and they were talking about studies and one was for fatty liver (non alcoholic version).

It’s study 3. From this page apparently good results from specialist diet joinzoe.com/learn/nutrition...

It talks about a nutriact dietary pattern, sounds like it involves increasing good fats they also said cholesterol went down.

🌱

[Meerkat1234 in reply to Regenallotment]

Hello Regenallotment. I have never heard of that. Thank you for the link. That is kind of you. I will have a look.