Resolution of Fatty Liver but Increased Liver Enzymes?

At Origins Incubator our clinical support includes collaborating on challenging cases, so that together we can find solutions to puzzles that initially defy explanation. 

Unraveling the Mystery: A 50-Year-Old Woman's Weight Loss Struggle

In this week's case presentation, we encountered a 50-year-old woman endeavoring to shed excess weight. Despite consuming what might be deemed a substantial amount of protein—100 grams per day—she found herself grappling with weight loss and peculiar laboratory findings. Surprisingly, her creatinine levels, which are typically associated with reduced dietary protein intake, were low, and her total protein levels were also diminished.  

Peeling Back the Layers: Uncovering Underlying Conditions

So, what could account for these anomalies despite her focus on quality protein sources? Our investigation revealed an underlying idiopathic myositis—an inflammation of the muscles. Furthermore, despite her commitment to a healthy lifestyle, she exhibited elevated liver enzymes, with no apparent risk factors or medication use.

Upon deeper examination, we uncovered a confounding element: she had fatty liver disease, which had paradoxically improved despite the ongoing rise in liver enzymes. This paradox prompted us to adopt a functional medicine approach, emphasizing dietary and lifestyle modifications. While she had made significant strides in weight loss, the last few pounds proved stubborn.

A Comprehensive Approach: Addressing the Interconnected Factors

As we pieced together her complex medical profile, we recognized the interconnectedness of her conditions. Her muscle inflammation, exacerbated by rigorous exercise, likely contributed to mild rhabdomyolysis. Additionally, her use of Ozempic, combined with the loss of both fat and muscle mass, further complicated the picture.

To address these multifaceted issues, we developed a comprehensive plan. Recognizing the role of muscle breakdown in elevating liver enzymes, we explored interventions to reduce inflammation and enhance protein absorption. We also considered the potential benefits of carnitine supplementation, aiming to optimize mitochondrial function and support muscle health.

Conclusion: Embracing the Complexity of Health

By adopting a holistic perspective and considering the interplay of various factors, we formulated a tailored approach to guide our patient on her journey towards wellness. Our collaborative effort underscores the importance of viewing each case as a mosaic of interconnected pieces, rather than isolated diagnoses. Together, we continue to support her in navigating the complexities of her evolving health journey.