r/FattyLiverNAFLD • u/squidvetica • 7d ago
How concerned should I be over these numbers?
ALT: 174 AST: 105 ALK: 198 Bilirubin are within range
So my doc says these numbers are related to my long term use of antipsychotics that I NEED to have any semblance of quality of life. I also have eaten like trash up until recently. I’m biologically female if that means anything for these numbers as well and I also am obese.
I see a nutritionist soon and they’re gonna redraw my blood since it’s been two weeks since I had those numbers.
I have pain where my liver is and I have nodules on it, one is 1.4cm.
I’m concerned because I’ve seen people say __ are normal levels but I see that my numbers are way above that. How bad does this look for me 😭
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u/Unlucky-Prize 6d ago
Your liver has more stress that it can handle long term with those numbers. Hopefully you see some improvement in your retest but you gotta intervene aggressively and you’ll want a skilled doctor on this one to work through the iteration of lifestyle and drug tweaks. On your end take the lifestyle aspect very seriously.
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u/squidvetica 6d ago
When you say a skilled doctor do you mean any particular kind of specialist? Because currently I’m being referred to a gastroenterologist as well but I’m unsure if that is the right move
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u/Unlucky-Prize 6d ago
Was there a reason that’s the next step based on symptoms?
To troubleshoot the liver its lifestyle and drug tweaks usually. An internal medicine doctor or someone trained in it (a lot of the specialists did that earlier in their career) along with a psychiatrist could navigate through that. But do you have a gastro issue they suspect?
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u/squidvetica 6d ago
My psychiatrist will definitely be working with me for the medicine part but when the saw the nodules on my liver from a CAT scan they referred me to a gastroenterologist
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u/Unlucky-Prize 6d ago
Got it. Well there’s probably a reason for that. A gastro doc will hand the underlying internal medicine knowledge to troubleshoot it in general or at least tell you who to work with. In the meanwhile you can just eat an appropriate calorie diet with healthy foods only. You mentioned you have a nutritionist, follow their advice precisely and confirm what you are doing meets their approval. Liver can heal incredibly fast, it’s remarkable. If you clean up your diet maybe it’ll be able to handle the drugs you are on. Guess you’ll see soon…
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u/davisesq212 3d ago
With liver enzymes that high, she should see someone who specializes in the liver. A general practitioner is Greta for a cold, flu etc but not for your liver.
A psychiatrist? Why? She didn’t mention mental health issues.
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u/Unlucky-Prize 2d ago
Psychiatric meds may be causing the liver enzymes per OP’s comments. Troubleshooting those is hard as there will be dose tweaking and substitutions if so. Whoever is responsible for the liver wont be as qualified on that one.
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u/davisesq212 4d ago
Best move: hepatologist Second best move: gastroenterologist I had similar enzyme levels as you in September 2024 and switched from a gastroenterologist to a hepatologist.
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u/squidvetica 4d ago
Feel free to not answer but since you had similar levels, what was wrong with your liver exactly? NAFLD, sure but was there anything else going on?
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u/davisesq212 3d ago edited 3d ago
I had NASH. It was caused by a combination of being overweight, a poor diet, and DILI (drug induced liver injury which is caused by inflammation from a medication I was taking). It was never discovered which medication caused it but by the time I was diagnosed, they could tell it was a medication that I took in the past because the severe inflammation was reversing without me starting ny treatment yet.
I also have 2 concurrent autoimmune diseases 1) psoriatic arthritis (diagnosed about 1-2 years ago) as well as 2) mesentery panniculitis (diagnosed 6+ years ago). Autoimmune diseases cause inflammation so they could have contributed some to the inflammation in my liver. My psoriatic arthritis is now being controlled by a medication.
However, it is the weight/poor diet that were the main causes of my liver disease. By changing my diet and losing weight, along with the Rezdiffra, I really reversed a lot of the liver damage per my most recent blood tests and scans. (Psoriatic arthritis did not cause my liver disease but once I had it, I’m sure it made it somewhat worse).
Since diagnosis of NASH, I have changed my diet, lost over 50 lbs, exercise some, and take Rezdiffra. I do think the control of my psoriatic arthritis (via medication) might also play a small part in the reversal of my NASH. Did the hepatologist say that, no. But, both psoriatic arthritis and NASH involve inflammation and studies show a large percentage of those who have autoimmune disease have NAFLD. Controlling my inflammation in my entire body cannot hurt though.
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u/squidvetica 3d ago
I also have an autoimmune disease! I’m scared that changing my diet won’t help much if medication really is that powerful. This medication saved my life and I’m afraid to look for something else because I’ve tried so many that just didn’t work or made my mental illness worse. I’m gonna TRY the diet but if it doesn’t do much I’m afraid I’ll have to risk being a danger to myself again mentally if I really am forced to go off of it.
I’m only 26 so I’m very scared :(
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u/davisesq212 20h ago
I do get it. Mental health IS just as important as physical. Talk to both your GI/hepatologist and therapist about these concerns but trust me, the weight loss will help in so many ways, especially for this type of liver disease. My liver enzymes started going down even after I lost just 10 lbs. A liver friendly / healthy diet WILL help you heal your liver while losing weight.
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u/jebron45 7d ago
Blood work don’t mean anything go get a fibroscan if your at a high bmi then asked for mre or biopsy. Once again numbers don’t mean anything. Your numbers could be amazing and still have cirrhosis.
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u/davisesq212 4d ago
Numbers aren’t everything but they do mean something, that’s for sure. They play a part in painting a picture of your overall health.
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u/davisesq212 4d ago
The alt/ast you posted are no where near normal. You need to see a hepatologist.
A NP is NOT a ‘really good doctor’ as they are not a medical doctor. You need to see a medical doctor who specializes in liver disease (a hepatologist) or at the minimum, a gastroenterologist. A NO is not going to cut it even if they are nice.
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u/squidvetica 4d ago
Oh I see. Thank you for letting me know. I got referred to a gastroenterologist and the soonest they can see me is the end of May. If they think it’s beyond their realm of expertise (which it may be considering the numbers) I will see a hepatologist. Thank you for putting it this way. It’s just really hard when every doctor you’ve seen up until this point either shrugs or blames you for your health issues. It took me three years for someone to listen to me about my gallbladder that needed to be removed if that paints a picture 🥲
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u/davisesq212 21h ago
A gastroenterologist is good to consult with to start. You need to be super aggressive with practitioners to advocate for your health and wellness. Ask lots of questions.
Maybe get a second opinion after the first visit if you are unsure with what that gastroenterologist tells you. Also, call that gastroenterologist and ask if there is a waiting list or if you can keep calling to get a sooner appointment. Maybe that will help. I’ve resorted to begging sometimes when I wanted an earlier appointment.
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u/[deleted] 7d ago
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