Question:
Elevated Liver Enzymes

I just got a copy of my 6 month postOp bloodwork - and I will grant you - I don't know a whole lot about what all of the numbers mean. I am post RNY (9/15/09). Consult wt 389, Surgery weight 3190, Current wt 249. I'm losing slower than I expected to - but am less active due to a back injury, recently started pain mgmt and am hoping this will help. My AST, ALT and Alkaline Phosphatase levels are elevated - and they weren't at 2 months post op. My weight loss has slowed in the past 3 months, compared to the first 3, though even in the first 3 I only lost 36 pounds. Granted - I am down over 60 pounds in 6 months, and over 140 pounds since 2008 when my journey to surgery began - but I'm wondering if these enzymes are playing a role in the slow (slower than I want) weight loss - and if anyone knows about these enzymes and how they work. I know they liver metabolizes fat - I DO drink my water, my protein intake is good - the rest of my bloodwork looked ok - other than my B12 level is also slightly high (surprise). I have very sever fatigue, irritability and some other symptoms of liver disease - I do not drink, and never have (other than an occasional social drink - I can normall count my yearly drinks on 1 hand). Any thoughts, insight, etc would be appreciated. I do have a call into my primary care to go over the bloodwork, and of course my surgeon and I will be going over in in a couple weeks at my 6 month visit. I stopped in here because there's almost always someone on here who's "been there, done that" and has good insight. Thanks in advance for your help and advice. So many of you have helped me with answers to other posts, and your positive attitudes already. Oh - I have been over weight since I was a teen - about 6 years ago I lost 140 pounds on my own, but regained 170 - which was the breaking poing that made me realize I needed something that would help me make the permanent life changes that would make this my last time of LOSING weight - and just heading to a stronger, healthier me. There's more information in my profile, and it's public, so you can read it w/o friending me if you want to. Sorry the post is SO long - hopefully I have given you guys enough iformation to send some back my way. Thanks! Hugs, Diane    — Diane324 (posted on February 23, 2010)

February 23, 2010
About 6mo before my weight loss surgery my liver enzymes were also very high, I had a repeat test done in 3mo and came back fine, I'm really not knowledgible of the liver enzymes but was very worried about it, My dr told me not to worry about it, sometimes they do go up, for some unknown reason, I know its really scary! By the way my lap band surgeon done a liver biopsy when he put in my band and that all came bk normal. Good Luck and Try not to worry, I know easier sd than done. Praying everything will be fine, God Bless
   — T R.

February 23, 2010
http://www.labtestsonline.org/ I highly recommend this site for factual patient oriented information on lab tests. I've been involved in clinical lab work for many years and the organizations associated with this site are legit....including my own professional affiliations. I'm also banded (July 08).
   — T_D

February 23, 2010
My liver and thyriod both did some fluctuation in the first year. My doctor said that the liver can be 10X normal and still be ok. He adjusted my meds for cholesteral and it was ok.
   — trible

February 23, 2010
i am 5 1/2 yrs post rny and lost 110lbs (pre-surg 250, now 140). i have maintained that loss (except for 5-7 lbs up and down). about a year ago i started having elevated liver enzymes, something i'd never had before. my doctors were watching them and the levels stayed consistent. i, too, do not drink or smoke. i finally went to a liver specialist. he ordered a sonogram of my liver which revealed a "fatty liver". this is areas of fat within the liver.i asked why is this coming up now? why didn't it appear when i was fat? the answer is... they don't know, but it is common in post bypass patients. if your labs stay level, meaning they don't rise, your elevation doesn't mean too much. you don't say how elevated they are. good luck!!
   — libby17326

February 24, 2010
Diane, your very best bet for a good answer is your doctor that ordered the tests. Have you had your gall bladder removed? Sometimes it is difficult for our bodies to process all of the high fat foods we (used to), eat, and can raise enzymes. Alcohol is another culpret, but since you don't drink, that is not the issue. Loosing and gaining large amounts of weight, as so many of us have done in the past can also irritate the liver. Congrats on your outstanding weight loss! Keep up the great work!
   — Bonnie H.

February 24, 2010
When I had elevated liver enzymes my dr. ordered a sonogram where they found that the cause was gallstones. My gallbladder was then removed. (All of this was before my weight loss surgeries.)
   — ksp1155

February 24, 2010
Hi - a little more information - my gall bladder was removed in 1996 (the old fashioned way and I've got the 12" scar to prove it LOL). I also do not have my appendix (as of 2006) but I'm pretty sure that doesn't do anything. I was struggling with pre-diabetes before the preOp weight loss (fasting blood sugars in the 112-118 range) - they are now in the 70s and 80s fasting or not. I am off fluid pills, blood sugar pills, blood pressure meds, TWO acid reflux meds, valium, and probably a few others I can't remember. I still take allergy meds, migraine preventatives, SUPPLEMENTS!!!!, synthroid and coumadin. I am hoping to go off of coumadin at some point - there is no clear cut cause for my 2 DVTs (at once) and the 2 PEs (3 months after stopping DVT treatment) - but my weight was 389 lbs. My surgeon feels it is reasonable to consider a trial off of coumadin after major weight loss. I guess we need to define "major" - probably not 140 pounds, maybe if I can get to Onderland? I DO NOT dump - now, I haven't pushed that to it's limits, but I have had bites of things. I have maintained my soda sobriety 100% - I'm pretty sure that if I even try it - I will go back and that I am actually an addict. Coke is my "soda drug" of choice. That shiny red vending machine, with the water drops on the giant bottle pictured on the front of the machine - looking so icy cold and wanting me .... Dear Lord, I need a boyfriend!!! Here are my levels, current(normal ranges) Nov '09: AST - 53 (15-37) (Nov 09 = 17) Alkaline Phosphatase - 152 (50-136) (Nov 09 = 108) ALT - 93 (30-65) (Nov 09 = 40) My B12 and Folate are slightly elevated, but my primary care said not to worry - that is fine, especially since we can have problems with that down the road. I did get to talk with the PC, he is repeating the test and adding hepatitis tests and a full liver panel and we will go from there based on the new test results. I will also be seeing my RNY surgeon March 8th - so I think he will be able to add a lot of insight into this since it sounds like these values can bounce around a lot as the weight comes off. I know hormones and other things are stored in the fat and have to be released as we lose weight - and the PC did say that they could be 10x higher than this and I could still be ok (not that he would ignore it, as he is not ignoring this). We may follow with an ultrasound. A CT last fall (postOP) indicated "fatty liver changes" - but didn't specify if they were good changes or bad changes. One would think that any changes with weight loss would be a decrease in the fat stored in the liver - but I don't know if that is how the process works. Does anyone know if a fatty liver is less efficient at metabolizing fat? And yes - I have lost and gained more, then lost more, then gained even more .... all in all, I have probably lost over 500 pounds in my lifetime. I have lost 280 pounds just in the past 6 years. (140 in 2004, 140 since 2008 - gaining 170 in between wasn't part of the plan). I have NOT gained any weight since January 2008 (with the exception of occasional temporary fluid fluctuations). I do seem to lose anywhere from 3 to 6 pounds in a week then sit at a weight for weeks then repeat. Thanks for the replies so far - and if anyone has anything more to add with the additional information or comments on the additional questions, I would love to hear more. Also, feel free to PM me. Yes, I talk a lot, but communicating is the best way to get and give information. Hugs - Diane
   — Diane324

February 25, 2010
Hi... RNY in aug 09, down 101 pounds, they did a liver biopsy during surgery, diagnosed with NASH, non-alcoholic steatohepitits.... basically "fatty liver" no cure, you can only prevent it from getting worse. never had an elevated liver enzyme until 2 weeks ago. they call it the "silent disease" alot of people have it and dont know it. I dont drink/never been drunk, so imagine my suprise. I've done some research and still dont totally get it. good luck
   — MarthaJ0110

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