Dear Dr. Roach: I am a 77-year-old woman.
I am five feet, two inches tall and weigh 107 pounds. I take no medication. When I went to the doctor last week, he found that my alkaline phosphatase was 176, my ALT 10, and my AST 11. He told me I had fatty liver and to get a scan, but I had no way to get to the place to have it done. He did not say anything else about it. I have no symptoms. Does this sound like fatty liver to you? I did not really like my doctor, but with my insurance it is hard to change doctors.
If I do have fatty liver, is there anything I can do for it?
Fatty liver is an increasingly common problem. Risk factors include being overweight and having diabetes, high blood pressure and abnormal blood cholesterol levels. Alcohol use is also a cause of fatty liver, and all people with fatty liver are strongly recommended to abstain from alcohol entirely. The primary treatment is diet and weight loss.
It sounds like there was some missed communication between you and your doctor. Fatty liver is a possibility; however, it does not seem likely to me, as you have not identified any of the risk factors, and you are certainly not overweight (if anything, you are a bit underweight). Further, although the alkaline phosphatase can be elevated in fatty liver (yours is just a bit high), it is more common for AST and ALT to be elevated, which yours are not.
An ultrasound scan is a good, but not definitive, way of looking for fatty liver. A liver biopsy is still the definitive test, but it’s often not done in people whose history, physical exam and ultrasound are all suggestive.
A slightly abnormal alkaline phosphatase does not necessarily mean you have a liver problem. Bone issues (fractures, Paget’s disease of bone, high thyroid and parathyroid hormone levels) can cause a high alkaline phosphatase, too.
Additional liver tests — checking the gamma-glutamyl transferase level (also known as GGT) or specifically what kind of alkaline phosphatase you have (by isoenzyme analysis) — can make the source of the elevated alkaline phosphatase clearer.
Getting an ultrasound scan and additional blood tests is a reasonable place to start. Unfortunately, lack of confidence in your physician is a different problem. If you really can’t get a new doctor, then you need to have a conversation about proceeding with evaluation in such a way that you can do so while being confident that you are getting good advice.
Dear Dr. Roach: I love popcorn, but when you look close there are so many hard hulls! Are they hard on the stomach? Can you eat too much?
Popcorn has a lot of fibre, including the nondigestible bran of the kernel (also called the hull). Fibre is generally healthy for you, aiding in digestion and making you feel fuller, and foods high in fibre may reduce risk of some chronic diseases.
However, too much fibre, especially if your system is not used to it, is absolutely a potential problem. It can cause bloating and gas, and in rare instances can cause an obstruction in the bowel. This is not likely with any reasonable amount of popcorn.
Doctors used to think that in people with diverticulosis, which is little outpouchings in the wall of the colon, popcorn could cause inflammation and infection. However, recent studies have shown this is unlikely.
Finally, enjoy popcorn air-popped, without oil or butter or too much salt, for the healthiest option.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu