12 yo with liver enzymes and dysbiosis

12 y.o. w/Elevated Liver Enzymes, Leptin, Insulin, SED
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ruth.galbraith
Message 1 of 2 , Sep 29
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12 y.o. girl with elevated AST, ALT, fasting insulin, leptin, SED.  Please help! (Not my forte.)

Have been seeing patient for 1.5 years. Presented with multiple sxs, most concerning to Mom & patient being rapid weight gain that seemed out of proportion to caloric intake. Hx pneumonia 3 x, on ABX each time.  Mom said it all started after that.  Other sxs were chronic vaginal “yeast” (itchy rash), reflux, multiple joint pain, constipation.

Have done a lot with her, including US BioTek IgA/IgE/IgG, Elimination & Challenge (don’t think she was/is as compliant as she should be) & gut healing; stool testing which revealed Citrobacter & Enterobacter (Rx’d course of Bactrim b/c neither very susceptible to natural agents); DB-7 for insulin resistance; treating hypothyroidism I dx’d with Levothyroxine 75mcg.

Labs I received this AM are WORSE than previous.  Should I refer her?  [Her mother will be VERY resistant to this, as they’ve seen GI specialist & endocrinologist and both were strongly dismissive, told her she needs to just stop eating so much and exercise.  Mom afraid this is scarring daughter, psychologically.]  I have had almost no clinical experience (oddly) with liver pathologies in the past 10 years, so in very unfamiliar terrain. (Also little experience with insulin resistance.)

Her labs today (we only re-tested Abn’s from May, but now wishing I’d done at least FBS):

BUN: 14 [7-20]

Bilirubin Total 0.2 [0.2-1.1]

Bilirubin, Direct 0.1 [</=0.2]

Bilirubin, Indirect 0.1 [0.2.-1.1]

AST 33 [12-32]   [30 in May]

ALT 54 [8-24]   [37 in May]

Leptin LAST TIME (today’s results not yet in) 19.7 [1.4-16.5]

SED Rate 36 [<20]   [31 in May]

Fasting insulin 36.4 [2.0-19.6]   [Was 20.1 in May!]

I included BUN and bilirubin above, as they seem particularly relevant, but all other values on CMP were mid-ref range, FYI.

FBS in May 82; A1c in May 5.6

Last BMI was 27.8; I’ll get it again today.  She is overweight, but not obese.

I simply haven’t dealt with liver stuff.  NAFLD?  Other?  Not sure what next step should be (in terms of testing, imaging, referral or Rx).

Any help very welcome (even if it seems elementary to you)!

Thanks,

ruth

Ruth Galbraith, ND

Keene, NH




Mona Morstein
Message 2 of 2 , Sep 30
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Hello, Ruth,

Here is my interpretation:  The antibiotics negatively affected her microbiome, beginning a weight gain process, which you unfortunately aggravated by adding in another microbiome affecting antibiotic.

Remember, if a bug is not sensitive to the listed natural antimicrobials, there is always garlic, which is the best antimicrobial via Nigel Plummer’s research anyway.  There is Neem, etc, other natural ones not tested for.  I think it’s best to not use antibiotics treating stool dysbiosis as we measure it.

It seems this woman needs a LOT of microbiome building—fermented foods, fiber, probiotics.  Perhaps some constitutional hydrotherapy or Kniepp wraps/bandages as I learned about them reading NDNR and Susan Ceranko’s articles.

She needs a low carb diet, exercise and likely some sort of detoxification process.

Mona Morstein, ND, DHANP
Tempe, AZ
www.diamend.info
Executive Director: Low Carb Diabetes Association