From the Guidelines
You should take a weekly vitamin D pill for three months, then switch to over-the-counter vitamin D at 2,000 IU daily for three months, and finally reduce to 1,000 IU daily for maintenance, as your current vitamin D level is low, which is a common issue in patients with liver disease, as noted in the EASL clinical practice guidelines on nutrition in chronic liver disease 1.
Your lab results indicate no signs of infection, anemia, or HIV, with normal blood sugar (HgA1C), thyroid function (TSH and free T4), triglycerides, cholesterol levels (both LDL and HDL), and kidney function. However, your liver enzymes are elevated, which requires attention.
- You should decrease your Tylenol use and alcohol consumption to help reduce the strain on your liver.
- Reducing dietary fat is also recommended, as high fat intake can exacerbate liver issues.
- Given your history of hepatitis A earlier this year, an acute hepatitis panel has been ordered to investigate your current liver health further.
- It's beneficial to continue decreasing trans fats in your diet while increasing healthy saturated fats, as your cholesterol levels are currently within normal limits, and no medication is needed at this time.
- The EASL guidelines suggest that vitamin D supplementation is reasonable for patients with chronic liver disease, particularly those with advanced disease or non-alcoholic fatty liver disease, to achieve a serum vitamin D level above 30 ng/ml 1.
From the Research
Patient's Lab Results and Recommendations
- The patient's lab results show no sign of infection or anemia, and their HIV test is non-reactive 2.
- The patient's vitamin D level is low, and they will be prescribed a medication to take one pill weekly for three months, followed by over-the-counter vitamin D supplements of 2,000 IU per day for three months, and then 1,000 IU per day for maintenance 2.
- The patient's HgA1C, TSH, free T4, triglycerides, LDL, and HDL levels are all within normal limits.
- The patient is advised to continue decreasing bad trans fat in their diet and increasing good saturated fat in their diet, with no need to start medication at this time.
Liver Enzyme Elevations
- The patient's liver enzymes are elevated, and they are advised to decrease their Tylenol and alcohol intake, and reduce fat in their diet 3, 4, 5.
- The patient reports having hepatitis A earlier in the year, and an acute hepatitis panel will be added to their tests 3.
- Elevated liver enzymes can be caused by various factors, including non-alcoholic fatty liver disease, alcoholic liver disease, medication-associated liver injury, viral hepatitis, and hemochromatosis 4, 5.
Vitamin D Supplementation and Liver Health
- Vitamin D supplementation may improve liver enzymes, oxidative stress, and inflammatory biomarkers in adults with non-alcoholic fatty liver disease 6.
- A randomized clinical trial found that vitamin D supplementation significantly increased serum 25(OH)D3 levels and decreased serum malondialdehyde and high-sensitive C-reactive protein in patients with non-alcoholic fatty liver disease 6.