“Well, it looks like your liver enzymes are a bit high on your bloodwork.” That comment or something like it is repeated by me a few times a day in the office. Liver enzymes are a part of a typical chemistry panel that is checked for a physical exam or with numerous other standard blood work-ups.
So, when they’re high, what does that mean? Overall it means something is irritating and at least slightly damaging the liver. It could be anything from Chronic Hepatitis C to Autoimmune Hepatitis to a reaction to a medicine or supplement and so on. But the most common thing for it to be is fatty liver. And there are specific types of fatty liver. Bear with me in getting an idea of what these basic types are because it does make a difference. First, there is nonalcoholic fatty liver disease (NAFLD). This involves deposits of fat in the liver cells not caused by excess alcohol intake. It is the most common specific liver disease, probably involving over 20% of the population. If you’re obese (BMI of 30 or higher), your odds are more like 70-80% of having NAFLD.
Then there is the next stage of fatty liver called nonalcoholic steatohepatitis (NASH) where the fatty deposits have started to more seriously inflame and damage the liver. About 5% of those with NAFLD progress to NASH and about 15% of those with NASH progress to a final stage of nonalcoholic cirrhosis where liver failure or even liver cancer can occur.
What causes this whole spectrum beginning with NAFLD and sometimes ending in cirrhosis? The big risk factors are the very things that are becoming an epidemic in our country, namely, obesity, diabetes, high triglyceride, hypertension, and a hugely common condition called metabolic syndrome which is a combination of several of these other problems.
As you might have guessed, there are also alcohol-related versions of all of these fatty liver problems. If a man drinks more than two alcoholic drinks per night or a woman drinks more than one per night, alcoholic fatty liver disease (AFLD) and its whole progression to cirrhosis, can begin. So if you are drinking this amount and beyond your liver is at risk and you need to either cut down or stop to keep a healthy liver. But in the rest of the space here we want to stay with the nonalcoholic versions of fatty liver.
If you find yourself being told that your liver enzymes are high on a blood test, especially if it happens more than once, some further testing will likely be carried out. Further blood testing, such as for hepatitis C and other causes, will probably be checked. Often an ultrasound of the abdomen will be obtained to see if the liver shows fatty deposits or any other problems. The problem is that these simpler tests can’t really distinguish well between NAFLD and the more serious NASH or even cirrhosis. Only a liver biopsy can really do that, and as you can imagine we don’t want to expose everyone with fatty liver to that kind of invasive procedure, although sometimes it may be necessary.
So practically speaking, if your liver enzymes are high and perhaps you’ve gotten an ultrasound and it shows fatty liver, what’s to be done? If you’re drinking in excess, cut down or stop. Besides that, a low carbohydrate diet (typically 100 grams of carbs or less daily), regular aerobic exercise (for example, 30 minute fast walk or the equivalent almost every day), and, if you’re overweight, a 10% weight loss for starters, are some of the most effective treatments for this. By the way, rapid crash dieting is not the way to go as it can sometimes make fatty liver worse. There are also meds which can be considered for treating fatty liver. But lifestyle changes are what really work best, although they are always much easier to understand than to actually do.
So if you find yourself in this ever growing group with fatty liver, make a specific plan with your physician. We’ve seen this problem remedied over and over when people actually make these lifestyle changes for the long haul. You’ll almost certainly feel better, and after all, your liver does a lot for you; help it out.More
We all have goals and aspirations for our lives that are going unmet. Our dreams usually aren’t lofty. They center around being with family, traveling, or maybe enjoying a favorite hobby. What keeps us from achieving these goals? For many of us, it is the physical challenge of playing in the backyard with younger, faster family members. Maybe it is the inability to easily walk through the exotic city streets or along the trails of a National Park. Sometimes it’s the after effects of a chronic illness like diabetes or heart disease. Our bodies just aren’t working the way we want them to. We want to change but don’t know where to start.
Trinity Medical Associates is pleased to announce the launch of our Wellness Nurse program. Katie Ellis, a registered nurse and certified personal trainer, is now available for private, one-on-one visits at our VitalSigns facility in Hardin Valley to develop a personalized exercise and wellness program to help you achieve your goals. During each half hour visit, Katie will work with you to develop a specific exercise plan for your ability and goals. She can demonstration each exercise and train you to be comfortable performing these exercises. Being part of our VitalSigns and Trinity team she will reinforce the medical plan you and your doctor developed, the nutritional information available through our medical nutrition management program, and the teaching provided through our various VitalSigns programs. This is fully integrated healthcare at its best. Nutrition, exercise, and wellness all working for one single purpose: the health and well-being of the patient.
Katie will also be participating in our upcoming VitalCoach program. Participants will utilize their mobile devices to track their activities and receive regular feedback and coaching on their success. National studies have shown that health coaching can increase a patient’s success at staying healthy and being active. Stay tuned for more details.
If you’d like to schedule a Wellness Nurse appointment with Katie please call 539-0270. Visits are $25 and billable to insurance for established Trinity patients.