After continuing to struggle with my digestive issues and getting no where with my doctor, I decided to order some blood work in the beginning of May. I found a couple of sites where patients can order their own blood tests. The best value was through HEB grocery store and it’s called Ulta Lab Tests. They had some great deals and I put together a panel that worked for me. I received my results starting the next day and by the next week, all of my results were available.
I won’t go into everything I learned, but there were some significant findings. My cholesterol was crazy high, higher than it’s ever been. A few other wellness markers were worse than my 2016 numbers (like C-reactive protein), but some were actually a little better (like triglycerides). However, three liver enzymes were out of range, and one of them, ALT, was really high.
Considering I’m not an MD and have never considered liver issues before, I immediately started researching. My original thought was alcohol, but when I read about alcoholic fatty liver, AST should be higher than ALT, and my AST was only a little above normal, whereas my ALT was like three times the upper end of normal. That brought some relief, but I knew alcohol would still be a problem, so I decided to have no more than one drink a day (or beer tasting that adds up to that amount), and only do that on occasion.
The question still remained, what was causing my elevated ALT?
In my reading, I learned about liver cleanses and herbal liver supplements. My friends and I still crack up when I mention coffee enemas, but I think there’s a little fear that I might actually be serious one of these days!! I decided to start looking up side effects of the medication I was previously on, since I had only stopped taking everything a few days prior to my blood getting drawn.
My first thought was duloxetine, as it was definitely a problem child when I decided to quit cold turkey. I probably should have read about the withdrawals prior to stopping, but of course, I didn’t. I learned that duloxetine could cause about a 3x increase in ALT in approximately 1% of patients who took it (Reference). I read that it could take 1-6 months to show up and by this time, I had been on the medication for approximately 6-months. I also had liver enzyme test results from December 2017 and prior, and everything was fine at those times. I was convinced that the duloxetine was the culprit, which was sad because after going off it, I definitely appreciated the benefit it had on my lumbar stenosis.
I decided to give it a month of no medication and retest my liver enzymes. A month later, they were all within normal. I then started fish oil to start improving my cholesterol. I saw a new GI doctor recently, as I was still struggling with digestive issues, and he wanted to order blood work and also rechecked my cholesterol. The liver enzymes continue to be normal and my cholesterol, while still high, has come down significantly. My triglycerides have further decreased, as well. I definitely feel like I am on the right track!
The new GI doctor also checked autoimmune blood markers and ordered an abdominal and pelvic ultrasound. Everything was fine with the autoimmune tests, although one of my alpha-1-antitrypsin marker was on the low end of the really large reference range (have I vented about 95% coverage probability reference ranges recently?). I think everything was fine with the blood tests, but the ultrasound confirmed that I do have a fatty liver. Luckily, this is something that can be improved with diet, and the liver is an amazing organ that heals itself well. I just had no idea prior to that abnormal blood test that I could have liver problems, but now that I know, everything makes sense, including my family history that I do know.
Looking at that article again, I see duloxetine is primarily metabolized by Cytochrome P450 CYP1A2 and CYP2D6. I have some SNPs for CYP1A2, so maybe that’s related? Speaking of SNPs and DNA, I got my DNA sequenced through 23andMe sometime in May. Since I don’t know half of my medical history, I wanted to see what information I could get from my genome. I wasn’t super thrilled with the 23andMe reports, but I loved that I could take the raw data and view it, as well as put it in other reporting sites. I have become so fascinated with genomics as a result, mostly studying Cytochrome P450, but recently I skipped ahead to see that I have some well-studied polymorphisms for non-alcoholic fatty liver disease in the GCKR and TRIB1 genes. Knowing this not only fascinates me, but it motivates me that it may be even more important for me to modify my diet than other people. Genomics could explain why I have these issues when I’m not terribly overweight and I am active, although not as active as I used to be. It also may be related to why my alpha-1-antitrypsin marker was on the low side, but I will need to do a lot more research to be completely sold on this hypothesis.
I love the fact that my body is my own personal chemistry lab and I can use blood markers and genomics as a way to understand why I have certain struggles. Looking back, I have had plenty of issues with chemicals and pharmaceuticals (side effects, allergies, etc.) and since most everything is metabolized by the liver, it is clearly all related. I know that genetic polymorphisms don’t guarantee problems, rather only increases your predisposition to them, but so far, everything I am learning makes perfect since with what I have and currently am experiencing. I tend to continue my personal science project and would love to somehow pick up a MS degree in genomics! Until then, I will continue to write about what I am learning.
I also started a Facebook group called “Shiny Healthy People” where I hope to create a community of people who are interested in improving their health. So far there are six of us, but who only knows what the future holds!!