elevated liver enzymes post-DS anyone?

I'm posting this on the RNY & DS forums because RNYers & DSers both supplement more than other WLS. I suspect (hope?) that this problem can be rectified w/ diet and/or supplement changes of some kind.

My liver enzymes have been normal my entire life until after my RNY, at which time they started slowly rising. They have now risen to the point where my PCP wants me to see a GI specialist. I called my RNY surgeon who states that that is NOT typical in most post-op patients and that I should go see the GI specialist.

I don't drink or do drugs and I eat healthy. I do supplement with protein powder and I take only the vitamins recommended by the ASMBS nutrient/vitamin recommended amounts. (I read that Splenda can cause elevated liver enzymes due to the poisons in it that allow the chlorine molecule to bond w/ the what-was-sugar molecule in place of the carbon molecule it's replacing. So I even quit Splenda to see if it would lower the enzymes. No cigar.)

I have researched this issue and have found no correlation between RNY and increased liver enzymes post-op. BUT, I did find a lot of information that states that body builders who supplement with protein powders have repeatedly been advised to stop the protein powder whenever their liver enzymes become elevated.

Anyone have any relevant info to share on this topic?

Thanks

Wen

PS... The details follow.

My liver lab results from back to my my 1st 6 month post-op lab to now.

Test Name	Reference Range	02/13/08 Result	05/13/08 Result	04/29/09 Result	08/06/10 Result	09/24/10 Result	01/28/11 Result	03/25/11 Result	03/30/11 Result
TP (Total Protein)	6.3 - 8.2	6.7	6.8	7.4	6.9	6.5	6.9	7	6.7
ALB (Albumin)	3.5 - 5.1	3.9	3.8	4.1	4.1	3.7	4.3	4.3	4
AST(SGOT)	17 - 59	18.0	40.0	58.0	125.0	82.0	84.0	109	86
ALT(SGPT)	21 - 72	18.0	18.0	73.0	189.0	144.0	156.0	158	141
ALK PHOS	38 - 126	64.0	57.0	54.0	53.0	54.0	56.0	60	52
CON. BILI (Direct Bilirubin)	0.0 - 1.1	0.0	0.0	0.0	0.0	-	0.0	0	-
Bu (Indirect Bilirubin)	0.0 - 1.1	0.4	0.4	0.4	0.6	-	0.4	0.3	-
TBIL (Bilirubin Total)	0.2 - 1.2	0.3	0.5	0.4	0.3	0.3	0.2	0.2	0.2

The vitamins I take daily.
1 prescription multi-vitamin (therobec)
1 super B complex (used to do 2 daily until the enzymes started worrying me)
8 calcium per day (2 tablets 4 x per day for a total of 2550 mg per day of calcium citrate & 2000 iu of vitamin D)
1 2500 mcg sublingual B-12

I used to take Lexapro for GAD but stopped it when my liver enzymes kept going up because I read it can increase them. I hoped that would lower them. No cigar. I take no other prescription meds. (I'm supposed to take salt tablets for chronically low blood pressure, but it is literally like taking ipecac - so I just salt the bajesus out of my food.)

Last but no least, I have NO symptoms. In fact, I feel just fine and dandy - other than worrying about the elevated liver enzymes!

Edited to add: I forgot to add, I started at about 255 - 260 lbs when I had my RNY 08/20/07 and dropped almost all my weight in the first 6 months. I've maintained at well below my original goal - staying right around 130 lbs since I raised my calories to stop losing and have maintained with no trouble what-so-ever. (I've seen "people" - not medical professionals - but just "people" say that losing weight causes elevated liver enzymes - but I am not losing anymore and haven't been since I started maintanence. So it's not that.)

 Elevated liver enzymes are not uncommon post DS, during the fast weightloss phase.  About 4 years post op, not so common.  Are you still losing a lot of weight?  What kind of RNY do you have, proximal or distal?

No, not losing.  Maintaining for quite a while now (during which time they still continued to go up).

Proximal RNY

After the massive weight loss, mine went down to normal but have been running mildly high for no known reason for over a year now.

I'm totally stumped, too.  My surgeon thinks it's from taking too much vitamin d.  And maybe from b-12 shots, but probably not.  But my vitamin D is still in the 30s, so I disgree anyways.

I had an mri of my liver, pancreas, and bile ducts and still nada.  Normal. 

We're at the point of "heck, I dunno...lets retest and retest to see if they magically go down"  ha.

The GI specialist/hepatologist isn't a terrible idea.  They are pretty neat if you get a good one!  And they could at least set your mind at ease by testing the liver.

Oh, and I hate protein powder, so it's definitely not that :)

Milk thistle is supposed to support liver function and lower liver enzymes.  I'm giving it a serious whirl by taking 4 capsules of it/day.  We'll see.

My pancreatic lipase is also elevated, mildly.  Also no known cause.

see i have see both RNY & DS postops (both in maintenance) through the years that say that - that their liver enzymes have been elevated with no symptoms & for no apparent reason. 

i know they can be elevated immediately post-op & the biology of why.  but when you're a couple of years out or so in maintanence, i just dont feel like that should happen. 

i dont have the GI appointment until another week or so, and i can help but be worried. 

a healthy liver is not SUPPOSED to leak enzymes into the blood.  there has to be a reason its doing it.  if they cant FIND what it is, it will literally drive me insane. 

My GI mentioned something briefly about possibly the enzymes just having a new set point after weight loss.  I wasn't paying too much attention though as I was there for something else more troubling.

I'm not personally concerned because I had the mri to verify that I don't have any abnormalities.  Your enzymes could be waaaay worse, I wouldn't worry at the moment until after you see the GI.  I read about a guy with enzymes in the 1000s with no known cause...that would be far more worrying to me.

yea, ur right, it could definately be worse

if i had liver enzymes in the 1000s i would have probably fell out right then! lol

I also take milk thistle extract (silymarin).  I used to see a naturopathic doctor, actually a few years prior to WLS, who first told me about it's helpfullness in healthy liver functioning.  I get mine from GNC, it's 200mg, 80% silymarin.  As always, some formulations are more easily absorbed, or have a higher bioavailability, than others.  I agree that it's not common to have higher liver enzymes after the WL period.  This is from wikipedia on it:

Silibinin (INN), also known as silybin, is the major active constituent of silymarin, the mixture of flavonolignans extracted from milk thistle (Silybum marianum) consisting of silibinin A and B, isosilibinin A and B, silicristin and silidianin. Both in vitro and animal research suggest that silibinin has hepatoprotective (antihepatotoxic) properties that protect liver cells against toxins.^[1][2] Silibinin has also demonstrated anti-cancer effects against human prostate adenocarcinoma cells, estrogen-dependent and -independent human breast carcinoma cells, human ectocervical carcinoma cells, human colon cancer cells, and both small and nonsmall human lung carcinoma cells.^[3][4][5][6]

Chemically modified silibinin, silibinin dihydrogen disuccinate disodium (trade name Legalon SIL) a solution for injection, is used in treatment of severe intoxications with hepatotoxic substances, such as death cap (Amanita phalloides) poisoning.^[7] There is also clinical evidence for the use of silibinin as a supportive element in alcoholic and grade Child ‘A’ liver cirrhosis.^[8]

Pharmacology

^{Poor water solubility and bioavailability of silymarin led to the development of enhanced formulations. Silipide (trade name Siliphos), a complex of silymarin and phosphatidylcholine (lecithin), is about ten times more bioavailable than silymarin.[9] It has been also reported that silymarin inclusion complex with β-cyclodextrin is much more soluble than silymarin itself.[10] There have also been prepared glycosides of silybin, which show better water solubility and even stronger hepatoprotective effect.[11]}

^{Silymarin, as other flavonoids, has been shown to inhibit P-glycoprotein-mediated cellular efflux.[12] The modulation of P-glycoprotein activity may result in altered absorption and bioavailability of drugs that are P-glycoprotein substrates. It has been reported that silymarin inhibit cytochrome P450 enzymes and an interaction with drugs primarily cleared by P450s cannot be excluded.[13]}

^{[edit] Toxicity}

^{The acute toxicity of silymarin and silybin were investigated by oral and intravenous route in various animal species. No mortality or any signs of adverse effects were observed after silymarin at oral doses of 20 g/kg in mice and 1 g/kg in dogs. The median lethal dose (LD₅₀) after intravenous infusion values are 400 mg/kg in mice, 385 mg/kg in rats and 140 mg/kg in rabbits and dogs. These data demonstrate that the acute toxicity of silymarin is very low.[citation needed]}

^{Similarly, its subacute and chronic toxicity are very low; the compound is also devoid of embryotoxic potential}

Yea, I've heard that from several people on here.  I just hate to start anything new before I see the GI specialist. 

So I think I'll wait to try something on my own until after he finishes with me one way or the other. 

But if they don't figure out what it is & throw up their hands like I should just deal with it, I will probably try milk thistle while I wait to get a second opinion. 

How are ALL your labs?

Fat-soluble vitamin deficiencies can cause elevated liver enzymes.  Anemias can cause elevations

Have you had your gallbladder out yet?  Do you have a fatty liver?

Some ideas,

Pup