Autoimmune Hepatitis

“Hey Plucky, would you ever think a liver wouldn’t

know something about hepatitis?”

“No way Morgan!”

“Me either, but I’ve been asked about autoimmune hepatitis and 

I really don’t know much about it. This is what I know. And, I’ll 

give you some reference places to find out more”

AIH in General

Hepatitis is generally described as injury to the liver with inflammation of the liver cells. Autoimmune Hepatitis (AIH) occurs when your body makes antibodies against the liver tissue because it mistakes your liver as a harmful object and begins to attack it. Although you have injury to your liver, it is more of an autoimmune disease. The exact cause is unknown, AIH, like many autoimmune diseases, is thought to be because of certain bacteria, viruses, drugs, toxins and failure of the immune tolerance mechanisms in a genetically susceptible host. Genetically, the human leukocyte antigens (HLA) on chromosome 6 are the most commonly described association with AIH.

Chromosome What?

“Morgan, what in the heck is chromo…whatever 6?”

Well Plucky, chromosomes are the structures that hold genes. Genes are the individual instructions that tell your body how to develop and function-they govern physical and medical characteristics, such a hair color, blood type, and susceptibility to disease.”

“I think I’m getting it!”

“Your body is made up of individual units called cells. You have many different kinds of cells like liver cells, skin cells, blood cells, etc. In the center of most cells you have a nucleus. That is where your chromosomes are located. So, when I said AIH can be due to your genetic susceptibility, I mean there is a genetic abnormality in the chromosome that holds genes related to your immune response-chromosome 6.”

Potential Causes of AIH

“OK, back to possible causes of AIH. Viruses such as the hepatitis viruses, measles virus, cytomegalovirus and Epstein-Barr virus can also trigger autoimmune hepatitis. However, this is difficult to assess, as viral infections may occur years before the autoimmune disease manifests symptoms, and the evidence suggesting hepatitis viruses as a trigger are very weak.

Some medications may be the culprit including oxyphenisatine (a laxative withdrawn by the U.S. Food and Drug Administration), methyldopa, nitrofurantoin, minocycline, atorvastatin, interferon, and diclofenae. 

Pollutants such as carbon tetrachloride (CCI₄), an organic compound once used extensively as a cleaning fluid, refrigerant, and insecticide may also account for the condition.

Another environmental pollutant is trichloroethylene (TCE), an organic solvent that was widely used as a metal degreaser. 

Henry Kunkel, 1973

Discovery and Study

The earliest writings describe a form of chronic liver disease prevalent among young women and characterized by an excessive increase in serum protein and gamma globulins. In 1951, Kunkel et al, termed the condition “hypergammaglobulinemic chronic hepatitis”. Since then, it has been known by various names including lupoid hepatitis, chronic active hepatitis, chronic aggressive hepatitis, plasma cell hepatitis, and autoimmune active hepatitis.

Testing and Types

Today it is simply referred to as AIH and is classified into three types based on serum antibody profiles (blood work). Abnormal values in your liver function test (LFT) will be the first place to check. Type I is the most common with about 75% of people diagnosed while Type II is linked to the other 25%.  There is also Type III which is very rare in the United States.

Several tests will be ordered to check for various autoantibodies. Type I is characterized by the presence of anti-nuclear antibody (ANA) and anti-smooth muscle antibody (SMA). 25% of patients will have cirrhosis at presentation and have association with other autoimmune diseases such as celiac disease, type I diabetes, rheumatoid arthritis, ulcerative colitis, and autoimmune thyroid disease.

Type II is characterized by the presence of anti-liver Kidney microsomal (LKM) 1 and/or anti LKM3 and/or anti-liver cytosol 1 (LC1) antibodies. The test for these autoantibodies will usually be a serum protein electrophoresis (SPEP).

Type III is characterized by the presence of anti-soluble liver antigens/liver-pancreas antibodies (SLA/LP)

Diagnosis and Treatment 

Once you have been diagnosed with AIH, the general treatment involves corticosteroids that suppress the immune system. Research indicates most patients achieve full remission in about 3 years but, must stay on the medications for life or they will relapse.

“As I’ve said before, I’m a liver not a brain and I don’t know much about AIH. This has been a very brief overview and if you would like to learn more, I have included a list of websites that will give you a more in-depth look at autoimmune hepatitis. I also put a list together of some online support groups that might be helpful.”

REFERENCES

AASLD Practice Guidelines. Diagnosis and management of Autoimmune Hepatitis.

http://www.aasld.org/sites/default/files/guideline_documents/autoimmunehepatitis2010.pdf

Hindawi Publishing Company Journals. Hepatitis research and treatment.

http://www.hindawi.com/journals/heprt/2011/390916/

National Digestive Diseases Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. Autoimmune Hepatitis.

http://www.niddk.nih.gov/health-information/health-topics/liver-disease/autoimmune-hepatitis/Pages/facts.aspx

World Journal of Gastroenterology. Autoimmune Hepatitis, one disease with many faces:  Etiopathogenetic, clinico-laboratory and histological characteristics.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284362/

Wikipedia. Chromosome 6 (human).

http://en.wikipedia.org/wiki/Chromosome_6_(human) 

ONLINE SUPPORT GROUPS

AIH Support – provide information and support to people with AIH and their friends and family.

http://autoimmunehepatitis.org.uk/ 

Drugs.com AIH support group – this is a question and answer forum.

http://www.drugs.com/answers/support-group/autoimmune-hepatitis/ 

MD Junction AIH online support group – a community of patients, family members and friends dedicated to dealing with AIH, together.

http://www.mdjunction.com/autoimmune-hepatitis 

I Have Autoimmune Hepatitis – an anonymous support group with information on diagnosis, treatment, symptoms, along with personal stories and experiences with AIH. “You’re not alone.”

http://www.experienceproject.com/groups/Have-Autoimmune-Hepatitis/89362

Blood Tests Specific to the Liver

“So Morgan, last time we were talking about getting blood drawn and the Complete Blood Count test. Once I’ve had this, why would I have to have another blood test?”

“If your CBC comes back with abnormal values Plucky, your doctor will need to know more. You see, the CBC gives you an overview of your health. More specific tests are needed to narrow down where your problem might lie.”

LIVER FUNCTION TESTS

Liver Enzyme Tests, formerly called Liver Function Tests, measure various chemicals in your blood made by your liver. Various liver disorders alter the blood level of these chemicals. These tests are not diagnostic of a specific condition; they indicate that there may be a problem with your liver function.

ENZYME TESTS

Liver enzyme tests measure current liver cell injury by the amount of enzymes that are leaked out of damaged or dying liver cells. 

• Alanine aminotransferase (ALT). This is an enzyme that helps process proteins. It is found mainly in your liver cells and to a lesser degree in your kidneys, heart, muscles and pancreas. ALT is measured to see if the liver is damaged or diseased. Low levels are normally found in your blood. When you have a liver disorder, the liver cells spill this enzyme into your blood, raising the level.
• Aspartate aminotransferase (AST). This enzyme plays a role in your metabolism-the process that converts food to energy. AST is also found mainly in your liver cells and when your liver is damaged the same process happens as with your ALT. However, AST can also be released if heart or skeletal muscle is damaged. For this reason, ALT is usually considered to be more specifically related to liver problems.
• Alkaline Phosphatase (ALP). This is also an enzyme found mainly in the liver. It can also be found in your bones, intestines, kidneys and other organs. The liver makes more ALP than the other organs or the bones. Some conditions cause large amounts of ALP in your blood. These can include rapid bone growth, bone disease, hyperparathyroidism (a disease that affects how much calcium is in your bones), vitamin D deficiency or damaged liver cells.
• Lactate dehydrogenase (LD or LDH). This is an enzyme found in almost all of your body’s cells (as well as in bacteria) and is released from cells into the fluid part of your blood (plasma) when the cells are damaged or destroyed. Thus, the blood level of LDH is a general indicator of tissue or cellular damage.
• Gamma-glutamyl transferase (GGT). High levels of this enzyme are found in the cell membranes in tissues in the liver, bile duct and the kidneys. Bloodstream GGT levels will be higher in people with diseases of the liver and bile ducts. This test can be used to determine the cause of elevated ALP. Both ALP and GGT are elevated in disease of the bile duct and in some liver diseases, but only ALP will be elevated in bone disease. Increased GGT level indicates that a person’s liver is being damaged but does not specifically point to a condition that may be causing the injury. GGT can be used to screen for chronic alcohol abuse (it will be elevated in about 75% of chronic drinkers). 
• 5 “N” Tase (5’NT). Higher levels of this enzyme will indicate a problem with bile secretion. Hepatitis C or cirrhosis can cause blockage of bile flow.

PROTEIN TESTS

Liver function tests look at levels of proteins made by the liver.

• Bilirubin (BIL). When red blood cells complete their lifecycle and breakdown naturally, they produce bilirubin. It’s a yellow pigment that’s passed on to the liver and excreted in your bile. Most of the time, the body produces as many red blood cells as it breaks down. However, if the red blood cells break down more rapidly or if liver function becomes impaired, bilirubin levels in the blood rise. In patients with Hepatitis, bilirubin levels tend to fluctuate. A prolonged persistent rise in bilirubin for a patient with chronic Hepatitis C usually indicated severe liver dysfunction. When your bilirubin is high the whites of your eyes and your skin will be a yellowish color (jaundice). This is one of the three tests used to determine your wait time for a liver transplant. There are two measurements for your bilirubin.

1. Total bilirubin (unconjugated). This measures the levels of all the bilirubin in your blood.
2. Direct bilirubin (conjugated). Measures the bilirubin that has been processed by the liver and attached to other chemicals.

• Albumin (ALB). As we’ve talked about, is the major blood protein made by the liver. One function is to keep the blood from leaking through your blood vessels, which can cause fluid retention in the ankles (edema), lungs or abdomen (ascites). Low levels of albumin may be due to liver injury or kidney disease, malnutrition or even a low protein diet.
• Prothrombin time (PT). This measures how quickly your blood clots, which is dependent on clotting factors (proteins) that are made by the liver. PT is used as a marker of advanced liver disease and can indicate blood clotting problems where it takes you longer to stop bleeding. Your lab may also give PT results that have been converted to an internationally recognized and easily comparable value that’s called the International Normalized Ratio (INR). The INR is one of the three factors used to determine wait time for a liver transplant.
• Alpha-fetoprotein (AFP). This test is used as a marker for potential liver cancer. Not everyone with liver cancer has this marker. Pregnant women usually have higher levels of this protein which is also used to look for problems in pregnancy. You may have higher levels of this protein if you have hepatitis or cirrhosis.
• Total Protein (T/P). This test measures the two main proteins in your blood: albumin and globulin. This test will give your A/G ratio. Normally there is a little more albumin than globulins, giving a normal A/G ratio of slightly over 1. Because disease affects the relative amount of albumin and globulins, the A/G ratio can provide a clue as to the cause of the change in protein levels. A low A/G ratio may reflect over production of globulins, such as seen in autoimmune diseases, or an underproduction of albumin such as may occur with cirrhosis, or it could be selective loss of albumin from the circulation, as may occur with kidney disease. A high A/G ratio suggests underproduction of immunoglobins as can be seen in some genetic deficiencies and in some types of leukemia.

“Oh my, look at the time! I’m sorry Morgan but I have to go. This is really great information you’re sharing with me but I have a photo shoot to do. As you know, Sunburst Oranges was the recent recipient of the American Liver Foundation Greater Los Angeles division’s first annual “Liver Lover” award and I am accepting of their behalf.”

“That is so great Plucky! I have seen you and Sunburst Oranges at some of the Liver Life Walks working really hard to spread awareness about liver disease and sharing those delicious Plucky brand oranges. I’ll finish this up and you can read it later. Just a couple of things before you go. Would you bring me back some of those oranges? And, can I have your autograph?”

"Very funny Morgan!"

“O.K., where were we? Yes, we just finished with the blood tests specific to the liver. I’m including one more because it is the third test used to determine your wait time for a liver transplant.”

OTHER TESTING

• Creatinine, is a breakdown product of creatine, which is made by the liver and transported to your muscles. Your kidneys excrete the waste product creatinine and, when your kidneys are damaged, creatinine levels rise. When your liver stops functioning in end-stage liver disease, this can cause serious kidney problems as well.

Lab tests, or bloodwork, can give important clues about your overall health and the health of your liver. I strongly suggest keeping a copy of all lab results. This will give you your “baseline” and allow you to watch for changes in your health over time. This will also help you, and your doctor, to check the impact of any treatments you undergo.

Again, factors such as age, gender, stress, meds, infections and a host of other things can all affect your test results. So, keep all these factors in mind when reviewing your lab results. Understanding your test results may seem confusing at first. But, they can help you take charge of your health and understand why your doctor prescribes certain tests and medications.

With practice, over time, it will all become easier to understand. "I've got to go see what our new 'rock star' plucky is doing at this photo shoot so, until next time, LOVE YOUR LIVER!"

Morgan d' Organ

 

Complete Blood Count

COMPLETE BLOOD COUNT

“Morgan, what do you mean, they stick you with a needle and suck out some of your blood? I don’t think I want to do that!”



“It really doesn’t hurt Plucky. And blood tests are an easy, non-invasive way of letting your doctor know what is going on inside of you.”

The first basic blood test, whether you’re having a routine physical or if a problem is suspected, is a Complete Blood Count (CBC). This is not a diagnostic test, it is the starting point for a diagnosis. If this test comes back normal, great, go on your merry way and have a great day. If it shows you have any abnormal values, it tells your doctors where these abnormal values are and a more specific test will be ordered.

Remember, your blood generally consist of 2 major parts, plasma and cellular elements. The plasma is the liquid part of your blood and allows it to flow easily. The other part consists of blood cells (red blood cells, white blood cells) and platelets. The Complete Blood Count (CBC) measures the cellular part of your blood, plus RBC indices. The RBC indices provide information about your hemoglobin content and size of your red blood cells.

The following is what your CBC will be measuring:

White blood Cells (WBC) fight infection. There are many types of WBCs and each fights infection in a special way.

Neutrophils: An important infection fighting WBC. The number your doctor looks at is your absolute neutrophil count (ANC). A healthy person has between 2,500-6,000.

Band cells: Slightly immature neutrophils.

T cells – T type lymphocytes: This WBC is of key importance to the immune system and is at the core of adaptive immunity, the system that tailors the body’s immune response to specific pathogens. They are like soldiers who search out and destroy the targeted invaders. T cell activation is measured as a way to assess the health of patients with HIV/AIDS and less frequently in other disorders.

B cells – B type lymphocytes: This WBC works chiefly by secreting antibodies into your body’s fluids. Each B cell is programmed to make one specific antibody. For example Plucky, one B cell will make an antibody that blocks a virus that causes the common cold, while another produces an antibody that attacks the bacteria that causes pneumonia. When a B cell encounters the kind of antigen that triggers it to become active, it gives rise to many large cells known as plasma cells, which produce antibodies.

Monocytes: This type of WBC develops in your bone marrow then goes into your blood, where they circulate for a few days and then go into your tissues. They then develop into one of two mature WBCs. Either dendritic or macrophages.

Eosinophils: These WBCs become active when you have certain infections from parasites, autoimmune diseases, eczema, hay fever or leukemia. Low levels indicate alcohol intoxication or over production of certain steroids such as cortisol.

Basophils: These WBCs contain the anticoagulant heparin and also histamine which promotes blood flow to tissues.

RBC Red Blood Cells carry oxygen to and carbon dioxide away from the cells in your body. The CBC measures RBCs in many ways, but the simplest measure is either Hemoglobin (Hgb)-the part of each RBC that carries iron or Hemocrit (Hct)-the percent of RBCs in the blood. When the Hgb and Hct fall too low, it’s called anemia.

MCV Mean Corpuscular (cell) Volume measures the average amount of space occupied by each RBC. A high MCV can indicate liver disease and/or alcohol abuse.

MCH Mean Corpuscular (cell) Hemoglobin measures the average amount of oxygen-carrying Hgb found in your RBCs. A high MCH can indicate anemia. Alcohol abuse can also be a contributing factor of high MCH.

MCHC Mean Corpuscular (cell) Hemoglobin Concentration. This is an Hbg/Hct ratio. A calculation of the average percentage of hemoglobin inside a RBC.

I want to add that corpuscular refers to blood cells.

RDW Red Cell Distribution Width is a measurement of the amount that RBCs vary in size. A high RDW means that your RBCs vary a lot in size. To determine a possible cause for this, a comparison is made to the MCV. One cause can be liver disease, another can be a type of anemia.

PLT Platelets help control bleeding. The medical term for platelets is thrombocytes. Platelets are produced in your bone marrow. You may bruise easily when your platelet levels are low and you may bleed even when you’re not injured. Your risk of bleeding goes up when your PLT drops below 20,000. A high or low PLT count is a sign of a blood or bone marrow disorder. A low PLT count is seen with viral infections, certain drugs such as acetaminophen, leukemia, autoimmune disorders and various other causes. Additional blood test will be required for this.

MPV Mean Platelet Value is an indicator as to whether the bone marrow is manufacturing PLTs normally. An MPV measurement can enable your doctor to detect a problem before it shows up in a PLT test.

NOTE: Your doctor may order a WBC differential test. This would include absolute neutrophil count or % neutrophil, absolute lymphocyte count or % lymphocytes etc… This is to determine the cause of abnormal results of your WBC on your CBC.

The following is what the CBC portion of your lab results might look like:

Each lab has different normal ranges and each person’s normal can vary depending on your age, gender, ethnicity and a few other things. Therefore, I did not talk about normal ranges of any test. If you fall out of your normal range, it will be clearly indicated so you will know. Usually with something like an *, an H if it’s high or an L if it’s low.

“Morgan, why do I need a blood test, I’m not sick or anything?”


“Well, a blood test tells your doctor if there is a problem before you even feel any symptoms. Early detection, in most cases, will result in a better prognosis. Do you know that I have a dear friend who was feeling fine and had a blood test that came back with a very high WBC count. This could mean she had a really bad infection or maybe even leukemia! Of course, the doctor ordered several other blood tests. All additional tests came back normal thank goodness. The doctor told her abnormally high white blood cell count could have been caused by stress in her life or even an error at the lab. Anyone can make a mistake. But, the most important thing to remember is “knowledge is power”. And, the sooner you have information about a health crisis, the better the outcome will be.”

Morgan d’ Organ

Liver Awareness - Globulins

“Morgan here checking in with you again as we are finally done celebrating the New Year”.

“To refresh your memory Plucky, we were talking about the proteins your liver produces. The last time we were discussing Albumin. Now we are going to dive into Globulins.”

I am telling you about these things because I looked at a blood panel report one day and could not understand much of it. All the symbols and numbers were so intimidating and confusing! It is scary being sick and not knowing what is going on inside you! If you learn a little more about yourself, you will be better equipped to understand some of the things your doctor discusses and maybe even know what is in those confusing reports. “

C’mon Plucky, time to 

get back to work!

“Today I’m going to explain Globulins and how they affect your health. Next time we’ll try to unravel those blood panel test results.”

GLOBULINS

As we have talked about before, proteins are the most abundant compounds in your serum (the rest of your blood after the red blood cells, white blood cells and platelets have been removed). Amino acids are the building blocks of all proteins. In turn, proteins are the building blocks of all cells and tissue. They are the basic components of enzymes, many hormones, antibodies and blood clotting agents. Proteins act as a transport substance for hormones, vitamins, minerals, lipids and other material. Lipids are fat-like substances in your blood and tissues. Your body needs a small amount of lipids to work normally.

Proteins also help balance the osmotic pressure of your blood and tissue. Osmotic pressure is part of what keeps water inside a particular compartment of your body. Other proteins play a major role in maintaining the delicate acid-alkaline balance of your blood (pH). pH stands for potential hydrogen. In addition, serum proteins serve as a reserve source of energy for your tissues and muscle when you are not ingesting enough.

“Good grief Morgan, what does all that mean?”

“First Plucky, your blood tells a lot about you and even though it sounds complicated you need to know a few terms. Second, Plucky, your osmotic pressure has to do with the pressure on the outside of your capillaries while your blood pressure is pressure from inside your capillaries. This is important because this is how your blood keeps at correct density and smoothly flows through your veins and arteries. When your Albumin level is low (osmotic pressure is low), it allows too much water into your cells causing edema. You know, like when your ankles or feet swell.  Now back to the Globulins:

Chemical structure of human serum
albumin (HSA). HSA is the most
abundant protein in blood plasma
and is an important transport protein.

The major serum proteins are divided into two groups: 

Albumin and Globulins. Globulins are a group of proteins in your bloodstream that help to regulate the function of the circulatory system. (Your circulatory system is responsible for transporting materials throughout your entire body.  It transports nutrients, water and oxygen to your billions of body cells and carries away wastes such as carbon dioxide that body cells produce.) Globulins are produced in the liver and immune system. They have multiple different functions; the group includes immunoglobins, enzymes, carrier proteins and complement. Your globulin levels will affect the amount of ample proteins in your bloodstream. If these proteins are not kept at the proper level, it can be difficult for your body to fight infections, clot, or transport nutrients to the muscles.

Human Circulatory System

Globulin is made up of different proteins called alpha, beta and gamma. The alpha and beta globulins are made by the liver, while the gamma globulins are made by the immune system. Certain globulins bind with hemoglobin, hemoglobin is another protein in your blood that carries oxygen from your lungs to your tissue and returns carbon dioxide back to your lungs. Other globulins transport metals, such as iron in the blood that help fight infection.

At certain times when your Doctor needs to get more information from your blood, serum globulin can be separated into several subgroups by Serum Protein Electrophoresis Test (we will go into the details of why and how later).

SUBGROUPS OF GLOBULINS

Lipoproteins of the blood, LDL and
HDL (cholesterol)

• Alpha 1 globulin (α1) – This fraction consists of:

High-density lipoprotein (HDL) the good type of cholesterol. Transcortin, aka corticosteroid binding globulin (CBG) or (serpin A6). Serpin is a serine protease inhibitor. Transcortin is a major transport protein for glucocorticoids and progestins. These are the hormone transporters I was telling you about, more specifically, estrogen. A female hormone.

α1 antitrypsin (α1AT) a protease inhibitor. This is the major protein associated with alpha 1 globulins. It inhibits a wide variety of proteases. Protease, also called proteinase or peptidase, is a type of enzyme that occurs naturally in living things and forms part of many metabolic processes. They form part of the larger systems in the body, including the digestive, immune, and blood circulation systems. When you have a virus (HCV or HIV) in your body, the virus uses a healthy cell for replication. It does this by making the healthy cell produce certain proteins the virus can use to make more copies of itself. Two of the proteins used by the virus are reverse transcriptase and protease.

“Time-Out Morgan! I’m lost again. 

What’s does that mean to me?

“OK Plucky, that was a mouthful, I agree. However, it has to do with your cholesterol and I know you know about that. The protease inhibitors are important when your body is helping me fight viral infections like HCV and HIV. The HCV virus survives by replicating itself at a high rate. It does this by making healthy cells produce proteins that the virus needs to survive. Your healthy cells will produce proteases. You’ve heard about the new protease inhibitor drugs. These assist the protease inhibitors you already have!

• Alpha 2 globulin (α2) - Consists of:

Haptoglobin (HP). Binds the globin portion of free hemoglobin that’s made when red blood cells die (red blood cells have a life of 110-120 days). Haptoglobin transports this back to the liver for recycling. Haptoglobin is known as an acute phase reactant. Its level increases during acute conditions such as infection, injury, tissue destruction, some cancers, burns, surgery or trauma. Its purpose is to remove damaged cells and debris and rescue important minerals such as iron.

Macroglobulin (α2M). A protease inhibitor and one of the largest plasma proteins. It transports hormones and enzymes, exhibits effector and inhibitor functions in the development of the lymphatic system and inhibits components of the complement system and hemostasis system. Meaning, they act as back up inhibitors when inhibitors that are more specific are consumed during traumas which lead to major activation of the proteolytic cascade in coagulation and fibrinolysis. A proteolytic cascade occurs when several proteases activate each other; and, Fibrinolysis is a process that prevents blood clots from growing and becoming problematic.

Prothrombin (Pro). A coagulation factor that is needed for normal blood clotting. Prothrombin is a precursor to thrombin. Tests will measure prothrombin time (PT).

Ceruloplasmin (CER). Transports copper. An acute phase reactant. It is frequently elevated when you have inflammation, severe infection, tissue damage, and may be increased in some cancers. It is reduced in Wilson’s Disease.

• Beta globulins (β) – Consists of:

Low-density lipoproteins (LDL). The bad type of cholesterol.

Transferrin (TF). The main protein in the blood that binds to iron and transports it throughout the body. Beta globulins consist mainly of transferrin. The amount of transferrin that is available to bind to and transport iron is reflected in measurements of the total iron binding capacity (TIBC), unsaturated iron binding capacity (UIBC), or transferrin saturation.

Microglobulin (β2m). A class 1 antigen is a marker that is increased in serum during immune activation. Β2m values have emerged as markers for the activation of the cellular immune system, as well as a tumor marker in certain hematologic malignancies. Urine β2m values in both serum and urine can help distinguish a problem of cellular activation from a renal disorder.

“So Morgan! I think I am starting to get it! My blood is the lifeline of all those things my organs need to keep functioning properly, keep my immune system strong to fight invaders in my body. And help distribute all those proteins I need. WOW. Plus a sample of my blood will let the Doc know where something is going wrong in my body. Is that right Morgan?"

You’re getting the hang of it Plucky. The body is very complex and your blood provides you with nutrients and hormones that must get to the right destination. Healthy blood is very important for your life. Now we can finish up with the Gamma Globulins as they are important to your immune system:

• Gamma globulins (γ)

These proteins are also called antibodies. These globulins are the only globulins not produced in the liver; they are produced by the immune system. They help prevent and fight foreign substances (antigens), such as bacteria or viruses, causing them to be destroyed by the immune system.  

The most significant gamma globulins are immunoglobulins (Ig). Your body makes different immunoglobulins to combat different antigens. Sometimes your body may even mistakenly make antibodies against itself, treating healthy organs and tissues like foreign invaders – this is called an autoimmune disease.

THERE ARE 5 SUBCLASSES OF ANTIBODIES:

Immunoglobulin A (IgA). Found in high concentrations in the mucous membranes, particularly those lining the respiratory passages and gastrointestinal tract, as well as saliva and tears.

Immunoglobulin G (IgG). The most abundant type of antibody. It’s found in all body fluids and protects against bacterial and viral infections.

Immunoglobulin M (IgM). Found mainly in the blood and lymph fluid. It is the first antibody to be made by your body to fight a new infection.

Immunoglobulin E (IgE). Associated mainly with allergic reactions.

Immunoglobulin D (IgD). This exists in small amounts in the blood and is the least understood antibody.

IgA, IgG and IgM are often measured together to give your doctor important information about your immune system function, especially relating to infection or autoimmune disease.

“As you can see, your blood protein levels can tell your doctor a lot about what is going on with your body. Blood tests are routinely performed and I want you to be familiar with some of the symbols so as to better understand them. I’m going to talk about blood tests and how to interpret them next time. I’ll also go into what the normal ranges should be. Although normal values do vary from lab to lab. So, until next time, enjoy life and love your liver!”

Morgan d’Organ

 

NEW YEAR'S RESOLUTIONS 

Tis the season to be making resolutions.  Getting healthier is always number 1.   So, I thought, why not write about how to be healthier in 2015.   So, I’ll be talking about keeping me efficient and feeding me properly.  Nutrition and the liver are interrelated in so many ways.  We’ve talked about how everything we eat, breath, and absorb through our skin must be refined and detoxified by me.  So, all these things are either helping or hurting me.



HEALTHY RESOLUTIONS
 

 

Poor nutrition is not generally a cause of liver disease, except in alcoholic liver disease and liver disease found among starving populations.  On the other hand, good nutrition (a balanced diet and the proper amount of supplements) can actually help a damaged liver to regenerate new liver cells.  In fact, in some liver diseases, nutrition becomes an essential form of treatment.

A Healthy Liver is Like a Processing Plant

 Carbohydrates, proteins, fats, vitamins, and minerals go to the liver where they are broken down and stored.  Later, they are remade into whatever the body needs and carried through the bloodstream to wherever they will be used.  Even when the liver is damaged, these nutrients still come to the liver after they have been digested. But, once they arrive, the liver can’t process them, and they build up.  This build-up causes more liver damage.  As a result, what you eat, or don’t eat, is very important.  Your diet needs to provide nutrients without causing further damage.  I strongly believe that you should talk to your doctor about what your diet should include, or exclude. 

In general, your diet should include:

·         Plenty of fluids – 1 ounce of fluid for every 2 pounds of body weight.

·         Plenty of fruits and vegetables

·         Lean protein like fish, skinless chicken, egg whites and beans

·         Whole grains – oats, brown rice, barley and quinoa

·         Low-fat or non-fat dairy products

·         Healthy fats such as nuts, avocados, coconut oil, and olive oil.

Antioxidants

Most of the above are rich in antioxidants.  Antioxidants protect against free radical injury.  Free radicals are produced in all of us due to the body’s metabolic process. We’ll go into free radicals in just a bit.  Apart from protecting the liver, antioxidants have been shown to inhibit cancer cells, fight the aging process and protect the sight.

Oxidative damage is a frequent cause of liver cell injury, which is, most definitely, a path to worsening of chronic liver disease.  Cellular oxidation is a natural process where free radicals break down organic tissue.  Free radicals have to do with cells and molecules.  Cells are made up of many different types of molecules. Molecules consist of one or more atoms and, atoms consist of a nucleus, neutrons, protons and electrons.  Without going into a complete chemistry course, free radicals are formed when an atom is out of balance (an unpaired number of electrons).  The free radical will try to balance itself by attacking the nearest stable molecule, stealing its electron, which creates another free radical, beginning a chain reaction.  Antioxidants neutralize free radicals by donating one of their own electrons, ending the electron stealing process.

Some antioxidants and their best food sources.

·         Beta-carotene – found in many foods that are orange in color like sweet potatoes carrots, apricots, pumpkins and mangos.  Some leafy green vegetables such as spinach and kale are also rich in beta-carotene.

·         Lycopene – a potent antioxidant found in tomatoes, watermelons, guava, papaya, apricots, and oranges.

·         Selenium – This is a mineral, not an antioxidant.  However, it is a component of antioxidant enzymes.  Selenium is found in soil so, the amount found in foods grown in the soil depends on where they are grown.  Plant foods like rice and wheat are the major dietary sources.

·         Vitamin A – Foods rich in Vitamin A include liver L, sweet potatoes, carrots, milk, egg yolks, and mozzarella cheese.

·         Vitamin C – This can be found in abundance in citrus fruits, poultry, and fish.

·         Vitamin E – Found in almonds, walnuts, hazelnuts, pecans, legumes, spinach, broccoli, mangos and many oils such as safflower, corn and soybean.

Supplements and Vitamins

 

 

There are a host of over-the-counter antioxidant supplements and multi-vitamins.  In general, taking a multi-vitamin is a good idea for managing liver disease.  Be aware that not all multi-vitamins are created equal and you should, most definitely, talk to your doctor before beginning a vitamin regimen.   There are a few things to be aware of when choosing a multi-vitamin.

·         Vitamin A – although Vitamin A has several benefits to offer, it can be toxic to your liver in high doses.  No more than 5000 units per day.

·         Vitamin E – also has several benefits but, can be hazardous if taken in excess.  Anything more than 1200 IU per day can thin the blood and cause bleeding.

·         Iron – may promote the formation of scar tissue on your liver.  Those with chronic liver disease, especially those with cirrhosis, should take a multi-vitamin with no iron – unless your doctor has determined that you are iron deficient.

·         Vitamin D – Vitamin D deficiency is extremely common in people with liver disease, a supplement is probably a good idea.  But, be aware, it can affect blood sugar and blood pressure.

Plucky just tapped me on my left lobe.  He wants you to know that the above amounts are what “experts” suggest but, you really need to talk to your doctor about what your specific needs are!!  

Fat Soluble or Water Soluble?

Vitamins are classified as either fat soluble or water soluble.

·         Vitamins A, D, E, and K are fat soluble, meaning they dissolve in the body’s fat tissue before your body uses them.  Once they dissolve in fat stores, your bloodstream will absorb them as needed.  Any extra will be stored in the liver and fat tissue.  Once they have been stored, they tend to remain there.  So, if you take too much of a fat soluble vitamin, overtime you can have too much of that vitamin present in your body, a potentially dangerous condition.

·         Vitamins C and B and pro- vitamin A are water soluble, meaning they dissolve in water.  Leftover amounts leave your body through urine.  That means you need a continuous supply in your diet.

Benefits

·         Vitamin A – Fat soluble.  Helps maintain healthy soft tissue and is an antioxidant.  It also helps preserve mucous membranes and skin, this is important in immune function because it helps keep viruses and bacteria out.  Again, be aware, too much vitamin A can be toxic to your liver.  Predominately found in animal liverL, whole milk and some fortified foods.

·         Vitamin D – Fat soluble.  Imperative for bone health.  Without Vitamin D you would not be able to properly absorb calcium or phosphorus.  There has also been research in the areas of immunity and cardiovascular health promoting increased intake of Vitamin D.  The primary source is sunlight.  Other sources are fatty fish, eggs, beef and many dairy products are fortified with it.  There isn’t enough Vitamin D in natural sources, so a supplement is often necessary.  Vitamin D deficiency is extremely common in people with liver disease and may predict non-response to anti-viral therapy in Hepatitis C patients.  But, be aware that Vitamin D can affect blood sugar levels.

·         Vitamin E – Fat soluble.  Primarily an antioxidant and it protects other vitamins and fatty acids from oxidation.  It also protects red blood cells from oxidation and helps form new red blood cells.  It is found in foods such as tomatoes, spinach, almonds, and cereals.

·         Vitamin K – Fat soluble.  It is used by your liver in creating protein vital to blood clotting.  And, helping other proteins with cell growth and bone health.  There are many foods that contain Vitamin K.  Some of these are leafy greens, broccoli, onions, beans, turkey and soymilk.    

·         Vitamin C- Water soluble.  Needed for the growth and repair of tissues in all parts of your body.  It is used to form an important protein used to make skin, tendons, ligaments, and blood vessels.  Heals wounds and forms scar tissue.  Vitamin C can be found in citrus fruits, poultry, and fish.

·         Vitamin B – Water soluble.  B vitamins are a class of vitamins that play important roles in cell metabolism.  Although these vitamins share similar names, research shows that they are chemically distinct vitamins that often co-exist in the same foods.  B vitamins are found in whole, unprocessed foods.  They are particularly concentrated in meat such as turkey, tuna, and liver L. Some other good sources are legumes (like black beans), whole grains, potatoes, tomatoes, chili peppers, tempeh, nutritional yeast, and brewers yeast.

Importance of Diet

People with liver disease should pay special attention to their diet.  One that helps the liver function and protects it from working too hard.  Generally, a low-fat, heart smart diet is good for your liver as well as your heart.  Again, consult with your doctor about your dietary requirements.  This can seem overwhelming but, you can start with a few easy changes, like substituting:

·         Egg whites for whole eggs.  2 egg whites=1egg

·         Season foods with fresh lemon juice, herbs and spices instead of salt.

·         Ground turkey for ground beef.  You can use ½ of each.  Make sure both are “lean”.

·         Dark chocolate for milk chocolate or white chocolate.

·         Frozen low-fat yogurt for ice cream.

·         Unsweetened applesauce for butter or oil in recipes.

·         Extra virgin olive oil.  This should be your go to oil

·         Spinach, arugula, watercress and kale instead of iceberg or romaine lettuce.

·         Whole wheat flour for all purpose flour.

·         Air popped popcorn for chips

·         Turkey bacon for bacon

These things are by no means everything you can do, they are just a good place to start.  You should really steer clear of fast foods.  They are full of sodium and empty calories.  In conclusion, the best advice I can give you is to cook more often, eat fresh foods and talk to your doctor before making any changes to your diet.  So, as I always say, love your liver!  Look for us to get back to the importance of proteins in my next blog.

Happy 2015, Morgan