Liver function. Trying to avoid Dr Google.

[HurdyGurdy19]

A recent blood test has shown "a significant rise in your ALP to 213 and ALT to 179". I have to have another blood test next week.

I have no idea what these letters and numbers mean, and I am having to stop myself from googling.

Can anyone explain them to me?

I have blood tests every 6-8 weeks as I have Rituximab infusions to control symptoms of Rheumatoid Arthritis.

I have no joint symptoms, have never smoked, drink so little alcohol I'm practically teetotal, haven't been ill recently, and had Covid and flu jabs on 19th October (these were questions asked by the rheumatology nurse when they rang to advise the blood test results - I was flustered, and didn't think to ask what the results meant).

How’s your weight and diet? Being overweight with a poor diet and little exercise can cause high levels, could that be the cause?

I had high ALT levels for some time, though my ALP levels have remained normal. I've been under investigation for Non-alcoholic Fatty Liver Disease for a few months though MRI scans have been inconclusive.

Even though I really wasn't a big drinker, I stopped almost all alcohol except for the odd special occasion and my ALT levels have now gone right back down into normal range. I've lost about a stone in weight too without otherwise doing anything else.

My understanding is that drinking alcohol can cause this rise, as can some medications. Get advice from your GP, or liver consultant if you currently have one.

I would presume that you are having your liver function monitored because the drug you are on can affect it? So that is the most likely reason for the abnormal blood tests. I've had a similar experience with a different medication that I was on affecting my kidneys. The doctors will balance the risks vs the benefits of you continuing with your medication. I had to stop my medication and swap to something else, but that isn't always the case, they might just keep an eye on it or change your dose or something. Either way, try not to panic. This is exactly why they do the blood tests with particular medicines so that they can monitor the situation and step in before any major issues arise. I know it is a worry but the system is working - they have spotted something that needs reviewing and are doing it. Sounds like your medical team are on the ball and I am sure they will be in touch if anything needs to change, but they are the people to talk to about it. Do you have a nurse specialist attached to your Consultant?In my experience they are really good at providing explanations and reassurance in this sort of situation. I hope you're ok and get answers soon.

My liver enzymes are abnormal , in September I was diagnosed with NAFLD and went low carb and have lost 1 1/2 stone , had my bloods redone last week and one has got worse , one slightly better and my FIB-4 is indeterminate for fibrosis so I’m being referred . I have lots of autoimmune conditions and am steroid dependant , I’m also a non drinker and although overweight my BMI is 26 so not too bad .

Thank you. Yes, overweight and lazy, I'm ashamed to admit. This may be the kick I need to lose weight.

I cook lovely healthy meals and tell myself I'm "on a diet", but ignore all the unhealthy stuff I eat.

Next to no exercise, but I do have a pedal machine under my work desk, and I've started doing short, 2-3 minute, exercise videos on TikTok - one every hour during working hours.

I've also got a weighted hula hoop that I will get out again.

Thank you for sharing that.

I'm 100% certain that it's nothing alcohol related in my case. I haven't had any referrals yet to a liver specialist, but I guess that may be the next step once the results are back from my next blood test.

A doctor told me the liver function tests are set very, very low, so nearly everyone fails them, panics and cuts down on their alcohol intake/weight. A quick, cheap method to improve the nation's health.

Thank you for your reassuring words. Yes, the blood tests are monitoring how the Rituximab is affecting me. Hopefully it'll become clearer after the next blood rest, but, as is often said on threads, I suspect "the first post nailed it".

Thank you. I hope your referral comes soon and you get some answers. Well done on the weight loss though. I think that would help me as well.

I have never drank a drop of alcohol in my life and got the same diagnosis NAFLD

It's due to poor lifestyle
You need to exercise and eat healthy ...like real food. Avoid processed and increase fresh veg.

Otherwise it can lead to full blown liver cirrosis and lead to you needing a liver transplant.

Diet will make the difference however low carb might backfire if you substitute carbs with saturated fats so meat, cheese, bacon, coconut, sausages and similar foods. If you have a fatty liver, a high fat diet is going to make things worse.
Opt for unprocessed, fresh food with a focus on fibre, complex carbs, lean meats, low GI food. Who advised you to go low carb for NAFLD @Floralnomad ? Processed meats (sausages, bacon) and red meats which are the core of many low carb diets will increase inflammation and fat accumulation in the liver.

@MatchaTea I’m practically vegetarian . I didn’t go low carb just for the NAFLD , I went low carb because my HBa1c means I’m pre diabetic and I have Addisons disease and it is recommended for weight loss for that . I just happened to get all these results at the same time . I did speak to the GP and he was happy with the low carb diet . I cook from scratch mainly and don’t eat lots of fats . My other issue with weight loss is my exercise tolerance is very limited because I have COPD and a quite severe pectus excavatum so it’s basically walking . For how much is wrong with me I’m surprisingly healthy .

Please may I ask how you got on. My ALP was 215 in July 24 (Dr did not call me as my thyroid dose was too high. I was retested for my thyroid in Oct. 24 it went back to normal but my ALP was still high and had come down to 199. She went onto ask about my bones and I said I felt ok. She said no worries, enjoy your Xmas and let’s see afterwards. After the call I remembered that I had twisted my ankle back in May. I saw a muscular specialist and had an MRI which showed slight swelling on the ankle and I had a steroid injection. Called the Dr back and she said she’s not worried about me as the swelling must have caused the elevation. I asked if I needed another blood test and she said steroids mess with bloods and stay in your system for 3 months. I am now getting myself worked up as I do suffer from anxiety. I don’t know if I should make another appointment for bloods just to put my mind at ease. Thank you

@Mermaid2sea - I had a follow up blood test, as requested. I didn't hear anything else from them, and when I queried if everything was OK, I was told that they would only contact me if there was a issue.

I've got a rheumatology appointment next month, so I can ask more then.

I hope you can get some resolution, as you will only worry until you know what's what x

Aww… Thank you so much for replying back so promptly. I’m glad all seems well.
i know i should tell myself its ok as the Dr seemed fine and said she is not worried about me so that’s reassuring.
Good Luck next month. xx