Case Study: A Patient With Elevated Liver Enzymes

I recently saw a 47 year old woman named Martha who was found to have abnormal liver function (elevated liver enzymes) on a blood test. Her ultrasound scan revealed a fatty liver. Increasing nausea, bloating and abdominal discomfort prompted her doctor to conduct these tests.

Past history

Onset of severe inflammatory and infective lung disease (affecting the small bronchial tubes in the lungs) beginning 18 months ago. Type 2 diabetes, high blood pressure, high cholesterol and triglycerides, osteoporosis and the autoimmune skin disease psoriasis.

Martha’s own doctor had prescribed the following medication:

• Multiple courses of antibiotics to treat infection in her lungs
• Prednisone, which is a steroid to lower inflammation in the lungs
• Glicazide to lower blood sugar
• Risedronate and vitamin D to increase bone density
• Irbesartan/hydrochlorothiazide to lower blood pressure
• Pravastatin to lower cholesterol
• Esomeprazole to reduce stomach acid and relieve reflux

So at any one time this patient’s liver had to metabolize and deal with the waste products of seven different drugs. That’s hard work even for a healthy non-fatty liver!

Since starting these drugs, Martha has experienced rapid weight gain from 154 pounds to 191 pounds and yet her diet had not changed. This is incredibly common in patients of mine who begin taking several medications. Martha also experienced increasing fatigue and her blood sugar had risen so that she now required insulin. Because she is so tired, she no longer feels inclined to exercise. Just getting through each day is hard enough.

My recommendations for my patient

• The thiazide diuretic (hydrochlorothiazide) that she was given to treat her blood pressure is known to worsen diabetes and can promote magnesium deficiency. Therefore a magnesium supplement is necessary.
• For the osteoporosis I recommended a high strength vitamin D supplement, a good mineral supplement and an exercise program.
• Cholesterol and triglycerides can usually be reduced with a lower carbohydrate diet. The diet is in my book called I Can’t Lose Weight and I Don’t Know Why.
• Acid reflux is almost always caused by food intolerance and small intestinal bacterial overgrowth, which causes fermentation in the gut and  hydrogen and methane production. I asked Martha to remove gluten, dairy products and sugar from her diet.
• To reduce her elevated blood sugar and blood fats, I gave my patient Berberine capsules.

I also referred Martha for physiotherapy on her lungs and taught her deep breathing and coughing exercises.

In my practice I work with naturopaths and nutritionists who are passionate and highly skilled and enable me to treat my patients holistically. This provides the ideal model for primary care medicine and is a paradigm that I believe modern medicine needs to embrace.

The above statements have not been evaluated by the FDA and are not intended to diagnose, treat or cure any disease.