High Liver Enzymes (ALT & AST) After WLS

I has my surgery on 08/02 this year, and had a reguler physical on 09/20.  MOST all was good!  Chlostrol and Trigylerides down, incl blood pressure... BUT my liver enzymes (ALT and AST) were very high 122 and 119 and was retested 4 days later at 128 and 142.  I tested negative for hepatitis.  I have a email from my surgeon's nurse who said liver enzymes are "routinely testing high" in patients with recent WLS.  I quit my Lipitor per Dr. as well. WHY does WLS contribute to high liver enzymes after surgery?  Are our bodies processing too much fat? Protien? Not enough protein?  I know I can't seem to get near 65 or 70 grams per day.  Any anwers out there? Help!

i dont know why it happens but it does. my liver enzymes were elevated but my bariatric doc wasnt concerned because he said it was normal for a little while post op.

they should check your gallbladder function if they are concerned, alot of people end up getting gallstones post op which can cause elevated liver enzymes. they did an ultrasound but also a gallbladder function test on me and determined everything was ok, i forget what its called. if your ducts are blocked it can cause a problem with liver enzymes.

*edit to add- its called a HIDA scan

Thanks for the info.  If I may ask, do you remember how high your liver enzymes were?

I have liver disease, its called PBC (primary biliary cirrhosis) I was stage 3 when I was diagnosed in May 09.  My liver Dr (Hepatologist) suggested I have this surgery so that when I needed a transplant in the next 5 or so years I would not be denied due to being overweight.  My ALP is over 600 which is down from over a thousand.  If you are taking actigal or in my case I take URSOFORTE that should bring down the numbers.  Urso or actigal is the only medication available right now for liver disease.  There is no cure but the Urso or actigal does slow it down.  I would suggest that if you are concerned go and see either a GI or a Hepatologist.  Don't mess around with your liver and don't leave it to a non specialist like a bariatric physician.  I say this because my liver function tests were elevated for over 20 years and I was seen by OB GYN's, Rheumatologists, Primary Care Physicians and no one thought about looking further into it.  I could have been on this medication for the last 20 years and not be stage 3 right now.  The sooner you take the meds if you have a liver issue the longer it will take to advance. 

Thanks!

It would make sense that the enzymes would be high for a while as the liver is taxed pretty heavily in its role in metabolizing the fat that we're losing, and it often isn't in the best of health pre-op due to our obesity (this is why alcohol is a no-no with my surgeon during the weight loss period.) I suspect that the low-carb diets that are popular in many of these programs may add to it some as well, given that the liver is also involved in metabolizing the protein and fat needed to maintain the glucose levels that get starved by the low carb diet. This may be why my surgeon doesn't emphasize low carb as he maintains a liver specialty alongside his bariatrics.

Did your surgeon's nurse see the test numbers, or just hear that the numbers are elevated? I don't know if there is a number above which serious action should be taken, but I would expect that your PCP giving your physical would panic if they were seriously high as opposed to "we need to watch this" high.

Protein deficiency can also be a part of it - if we don't consume enough protein, the body has to strip our muscle mass of its protein to get the amino acids (which comprise the protein) that are essential to most every bodily function, and you guessed it - the liver is a part of that cycle, too. So, adequate protein consumption helps to ensure that we don't have to strip our valuable muscle mass to survive.

Rapid weight loss (with or without surgery) is a balancing act between short term imbalances created by the limited and unbalanced diets and rapid metabolism of the fat stores, and the long term benefit of the weight loss. This is why we all need to stay in close contact with our surgeons and PCPs and do all the labs and checks they require to monitor this balance as we go thru this.