Dr. Amy Nett: Great question. I am not sure why the liver enzymes went up. I’m guessing that you mean AST and ALT. What I would do in this case—I mean, honestly, sometimes it just happens. We just see bumps in AST and ALT, and they come back down. A couple things I would think about doing. I love that you brought in milk thistle. Glutathione is also good. Sometimes I actually do milk thistle and N-acetylcysteine actually instead of glutathione. I’ve seen some people doing really high doses of N-acetylcysteine, something like 900 mg t.i.d. I haven’t seen literature to support that, so I haven’t quite had it in me to do such a high dose, but I’ve done N-acetylcysteine at doses of maybe 600 or 900 mg twice daily, so N-acetylcysteine, milk thistle. There is also a formula from Bioray, and it’s called Liver Life, and that’s an herbal formula. Dr. Schweig in our practice uses that one, so I picked up that supplement from him. I’ve used the combination of NAC, milk thistle, and Liver Life in a patient where something very similar happened. Her AST and ALT bumped up pretty significantly, I want to say into the 60s maybe. Like one was 44, and one was 62, something like that ballpark. We used those three supplements for six weeks. I didn’t otherwise change her treatment at that time, and they did start trending down, and they’ve come back down to normal. So that is what has worked for me previously. I don’t know what the cause of it is. Looking again at the history. Yeah, I don’t know. I rarely, rarely see it, though, with the antimicrobial protocol, so I’m not inclined to think.
And Brent’s asking — Laura, Brent is asking, “Did she lose a good amount of weight?” But Brent, wouldn’t that affect cholesterol markers more than like AST and ALT? Because I would definitely think cholesterol could increase when you’re doing all that. So Brent, Laura said that she lost 20 pounds. So sometimes I wish we could have you guys talking on this so I wasn’t the interpreter here. So Laura, Brent says that he often sees a bump in liver enzymes with significant weight loss.
So, okay. Brent has seen that, and then Laura said she lost 20 pounds over two months, so her patient lost 20 pounds over two months, a bump in liver enzymes. It sounds like, Brent, you’re saying you see that with significant weight loss? So that would be reassuring.
I would still probably get some additional—the glutathione, milk thistle. Check out the Bioray Liver Life one, and see what you think about that because Laura I think you have a background in herbal medicine, right, as an acupuncturist? So you might be able to look at that and see if it’s something you’re familiar with layering in for her. I’ve had success with it, so check it out. Maybe think about doing the NAC, maybe instead of glutathione if the glutathione itself isn’t working. I think it’s unlikely to be the herbs that she was taking. Again, just like with the constipation, as we just talked about, sometimes people have idiosyncratic reactions to medications or supplements, so it’s entirely possible that it was. I think it’s a lot less likely, and HMO doctors do commonly panic when they see the things that we put our patients on. I get that a lot because they’re just not familiar with them, don’t know the safety, and it’s kind of a medicolegal thing for them. They’re just going to say, “I don’t know. You should probably get off that.” And that’s fine. So that’s where it’s our responsibility to say, “You know what? I haven’t seen this a lot. Let’s just continue to track it, get labs every six weeks or so.”