I’ve had a slew of questions regarding elevated Liver enzymes, the Zone, Paleo, CrossFit etc. We have two clients, both pharmacists, who had stunningly high liver enzymes, particularly ALK (alkaline phosphatase). Frequently AST and ALT are also elevated, occasionally even bilirubin. Both clients have seen a dramatic reduction in liver enzyme levels with the adoption of a Paleo diet…for one individual he also had a con-founder of hyperinsulinism. The doctor of one client said: “It is preposterous… dietary manipulation cannot change liver enzyme status…the decrease must be due to another factor…” This person has had high liver enzymes for over 20 years…the only change was dietary, that mainly being the adoption of a gluten free Paleo diet. What a mis-informed IDIOT.
Here are a few links and abstracts to the topic….Sorry I can not get deeper now but this is a section I’ll flesh out in the book. Sorry also for the lack of comments processing on my part. We just moved the gym to a new 6,000sqft location and I’m pooped…only about 50% finished with that project. Here are those links:
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J Clin Gastroenterol. 2005 Aug;39(7):630-3.
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Cirrhosis in children with celiac disease.
Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey. hudemir@hacettepe.edu.tr
BACKGROUND: Liver involvement represents an extra-intestinal feature of celiac disease (CD) and shows a clinical spectrum varying from nonspecific reactive hepatitis to cirrhosis. Here we report the association of cirrhosis with CD in 5 children. PATIENTS AND METHODS: The mean age of the patients was 9.4 +/- 2.8 years. Viral, metabolic, and autoimmune etiology of liver disease was ruled out. Intestinal and liver biopsies were performed to confirm the histologic diagnosis in all subjects. RESULTS: Three of the patients had chronic diarrhea and hepatosplenomegaly in whom diagnoses of CD and cirrhosis were established at presentation simultaneously. In the other 2 patients, CD was diagnosed following an initial diagnosis of cirrhosis. At diagnosis, alanine aminotransferase (range, 64-271 IU/L) and aspartate aminotransferase (range, 90-225 IU/L) values were elevated. After 1 to 5 years of a gluten-free diet (GFD), normalization of serum aminotransferase levels and clinical improvement were observed in 3 patients with strict GFD. The other 2 patients without improvement of the liver disease had poor dietary compliance. CONCLUSION: CD may be associated with severe hepatic damage in children and strict GFD may have beneficial effect on the course of liver disease. Serologic screening of CD should be included in differential diagnosis of chronic liver disease of unknown origin.
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Am J Gastroenterol. 2000 Aug;95(8):2009-14.
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Detection of autoantibodies against tissue transglutaminase in patients with celiac disease and dermatitis herpetiformis.
Department of Internal Medicine, Charité, Humboldt-University, Berlin.
OBJECTIVE: Endomysial autoantibodies (EmA) are specific for celiac disease. The target antigen has been identified as tissue tranglutaminase (tTG). Our aim was to study the accuracy of a newly developed enzyme-linked immunosorbent assay (ELISA) for easy detection of tTG autoantibodies. METHODS: Thirty-one sera from patients with histologically proven celiac disease and 23 healthy controls were examined for EmA using monkey esophagus and human umbilical cord as substrate. IgA-tTG autoantibodies were determined by newly developed ELISA. Additionally, sera from patients with dermatitis herpetiformis (n = 20), inflammatory bowel disease (IBD; n = 32), chronic liver disease (n = 36), and diabetes mellitus (n = 19) were tested. RESULTS: The sensitivity of the tTG autoantibody ELISA accounted for 90% detection in patients with untreated celiac disease. The specificity was 76% owing to positive values in the lower range in patients with IBD (15%), chronic liver disease (36%), and diabetes (22%), all of whom were negative for EmA. In dermatitis herpetiformis patients 90% were EmA-positive. Of these, only 47% showed elevated tTG autoantibodies. Preincubation of sera from dermatitis patients with tTG abolished immunofluorescent staining of endomysial structures. CONCLUSION: Detection of mid- to high-titer tTG autoantibodies is highly specific for celiac disease. However, in the low-titer range, overlap exists with liver disease, IBD, and diabetes. Tissue transglutaminase autoantibodies may evolve as a new screening and follow-up method for celiac disease. Although tTG seems to be a major autoantigen in dermatitis herpetiformis, the low sensitivity of both tTG ELISA and immunofluorescence using human umbilical cord suggests differential involvement of tTG in this disease.
These two abstracts had nice clinical data attached. A simple pubmed search with the terms “elevated liver enzymes celiac” produced over 30 citations. A google Search with the same terms produced enough reading to keep one out of trouble for a decade or two. Our general practitioners are so overwhelmed with paperwork and reticent to continue their education it’s really buyer beware with regards to health and medicine.
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16 Comments
Robb,
I work in transplant, specifically I am now the director of a procurement organization (the group that works with patients who become brain dead and end up to ultimately be organ donors). I was talking to a liver transplant surgeon recently and he said in the near future the predominant reason for liver failure will be NASH (Non-Alcoholic Steato-Hepatitis).
This is (IMO, a diet related condition) where the liver becomes so congested with fat that it completely fails. The funny thing is he said while it is strongly associated with obesity some obese people don’t develop this condition while others do. I have a strong personal feeling it has to do with diet and hyperinsulinemia. He is even seeing this condition in pediatric patients. He told me this is a new phenomenon. To have a physician say that diet does not affect liver function seems, uhm par for the course.
Craig-
That is creepily interesting! It is telling that some obese individuals develop fatty liver and others do not. This seems typical of Syndrome X/metabolic syndrome at large. It seems to affect everyone a bit differently and in enough wacky combinations it’s hard to zero-in on the root cause.
It’s funny you should mention bilirubin. I was diagnosed with Gilbert Syndrome at the age of 12, which basically means that my liver overproduces bilirubin at a ridiculous amount. In turn, this overproduction causes my skin and the white of my eyes to have a yellow tint to it, and on some days it’s really off the charts!
I’ve been doing Paleo for 6 months now and on a recent trip back home, everyone (and I mean everyone!) noticed how white my eyes were and how they never saw them like that before. I’m wondering after reading your article if my diet has something to with that…I hope so, it would be a great “side effect”!!
i was just wondering if i was told that my liver enzyme was somewhat high like 113 what does this mean? what are the normal values. anybody help thank you
There are several enzymes…Alkphos is normally ~32-130. We have seen numbers as high as 500 in folks with un-diagnosed gluten issues. One month after a paleo diet the number dropped to 45. This was a 48 year old pharmacist.
I wanted to give a big thanks to Rob who suggested through a mutual friend that my son likely has celiac, he’s almost 4 and has hardly gained a pound in the last year. He had a super bloated stomach and a handful of other symptoms that led me to think something wasn’t quite right with his digestive system. We’ve had him off of gluten now for about a month and he’s already put on a couple of pounds, his bloated stomach is virtually gone and his pale almost greyish complexion is now gone, replaced with filled out rosy cheeks. Thanks Rob! We are so grateful to be on the right track now with getting our little guy healthy again.
My pleasure Shelly, Glad I could help.
Hi, I may be clutching at straws but am trying to clutch at something as I am desperately worried about my LFTs. In early April my Gamma GT was 140 and ALT 60. GP advised no alcohol for 6 weeks (I only drink 14 units a week if that) and repeat tests last week having had not a single drop of alcohol. I work in medicine so got the tests done through my consultants. Gamma GT now 167 and ALT 65. Don’t have Hep B, Hep C, have previous Hep A (I think I had Hep A vacc in 97 before India) and liver ultrasound was clear with no sign of fatty liver, stones, gallbladder clear, kidneys and spleen clear. Going back to see my GP tomorrow and want more bloods. Had a colonoscopy in 2002 due to ongoing bloated, diarrhoea etc and this was clear. My friend the Gastroenterologist put it down to IBS. Still have bloating, diarrhoea etc after some foods. Do you think it is worthwhile testing for coeliac? Will also ask re diabetes. Many thanks
Susie
Susie-
I;d just go right to the issue and assume a gluten problem. Go grain. legume dairy free for a montha nd then you will know. I;d be shocked if you do not see improvements.
Thank you, I will let you know what transpires
Take care, Susie
my 26 year old daughter has had chronic diarrhea for 1 1/2 years with elevated liver enzymes. she’d drink 30 oz of water during the night.
after one week off all gluten the diarrhea is gone and she sleeps through the night.
last week a liver specialist sent in test for hepatitis even though prelim test are normal and spoke of a liver biopsy. he would not even entertain the possibility of celiac. any thoughts from anyone!
Susan-
The gold standard is really just removing the most problematic foods, and see if she gets better. Grains, legumes and dairy being the main offenders. Keep us posted.
Recently went for routine physical and labs showed elevated AST. This promptly more labs,which revealed borderline mitochondria antibody. Labs repeated and now elevated AST and ALT.Gi NP visit is now testing for celeac,no physical s/s. and negative Hepatitis labs. Is increased thirst at night possible sign of celeac disease?
Lynn-
run of the mill diabetes is more common for increased thirst.
Celiac testing is wickedly inconclusive…If it was me, I’d eliminate all grains, legumes and dairy for a month, see how you feel, then reintroduce.
About a year ago after years of problems found out I had Celiac disease. Eight months before that I had slightly elevated liver enzymes. The doctor said celiac would not affect them. After 6 weeks of gluten they were normal, but are on the high normal. Any input on this.
I also forget to mention that I had my gallbladder removed and the doctor said I have “gallbladder disease” without the gallbladder. Could this all be interlinked?
sandi:
yep
http://www.celiac.com/articles/119/1/Gall-Bladder-Disease-and-Celiac-Disease—By-Ronald-Hoggan/Page1.html
Hi Rob, I’m a 40 yo male with peripheral neuropathy of unknown cause in all extremities for about 6 months now. My medical history is that of elevated bilirubin (both direct and indirect, but mostly indirect) for years now as well as horrible GI complaints. The only link I can associate with the neuropathy is digestive, including the liver. Any ideas, dietary recommendations? Thanks
Alex-
1-Gluten free, dairy free paleo diet. Lowish carb, high in veggies.
2-Little bit of sun every day.
3-1-2 grams of r-alpha lipoic acid. 2 divided doses before 2pm, with meal.
Let me know how that goes, I”ve worked with a few other folks with similar issues.