February 28, 2018 at 10:48 am #1017Archived PostsModerator
I have a 46 yo female, presenting with deep depression, anxiety, weight gain and exhaustion. History of adverse childhood events through maternal line. Mother is obese with T2D, father’s family history of liver issues and cancer.
Female’s blood tests showed abnormal liver function – serum gamma gt level 60 u/L (range 5.00-36.00 u/L). Serum total protein high at 72 g/L (range 68.00-82.00 g/L) Serum ALT high at 32 u/L (range 00-33 u/L). Her serum cholesterol is 4mmol/L, serum cholesterol/HDL ratio 2.2mmol/L. Client does not drink alcohol. Her serum chloride is 106 mmol/L (range 95-105 mmol/L).
Until 5 months ago client was a director in fast paced advertising agency, her GP signed her off with anxiety and depression; she believes she is suffering from burn out. Although not currently working, client still highly stressed and deeply depressed. She also cites persistent sugar and carbohydrate cravings and cannot cut sugar out of diet or lose weight. Her HBA1c is 36mmol/L (range 20-41). Her BMI is 28.7. Blood pressure 123/79. She is currently sedentary.
Client has previously, but recently stopped taking Citilopram 40mg for depression as states it isn’t alleviating depression/anxiety. She is currently following an adrenal protocol consisting of Dr Wilson’s Adrenal Rebuilder, Dynamite Adrenal food supplement and vitamin B complex.
My initial thinking was to work to help her to balance her blood sugar levels, however after reviewing her blood test results, I wonder if she may need further tests to rule out celiac dx, or whether she may be showing signs of NAFLD and the liver support should be the focus. Any guidance would be greatly appreciated.
Posted By Shani Shaker 28/2/2018
liver function, depression
March 6, 2019 at 10:50 am #1019Christine BaileyModerator
Many thanks for your question about your client suffering with ongoing low mood and depression.
You mentioned that your client has raised GGT levels. Gamma-glutamyl transferase (GGT) is an enzyme found in many organs throughout the body, with the highest concentrations found in the liver. GGT is elevated in the blood in most diseases that cause damage to the liver or bile ducts. An elevated GGT level suggests that a condition or disease is damaging the liver but does not indicate specifically what. In general, the higher the level, the greater the damage to the liver. Elevated levels may be due to liver diseases, such as hepatitis or cirrhosis, but they may also be due to other conditions, such as congestive heart failure, diabetes, or pancreatitis. They may also be caused by alcohol abuse or use of drugs that are toxic to the liver. The other markers are within the range but I note that ALT is on the high end which again can indicate liver issues including cirrhosis.
In some cases, viral infections may be a consideration. Yes, it could reflect NAFLD but that is a diagnosis her GP should make. Other treatable causes of liver disease must be ruled out by appropriate testing (e.g., hepatitis B or C), and other liver functional parameters (e.g., blood clotting factors) should also be measured. As these are medical issues and therefore it is important the clients speaks to the GP as to whether further tests, repeat tests or scans are required. Yes, you could consider ruling out coeliac disease as well. In view of her low energy you may wish to rule out viral infections with an advanced viral screen too.
I note she was on medication – is your client taking other medications that may be impacting on the results? Clearly her current cravings for sugar will not be helpful either.
If the condition is NAFLD then you may wish to consider supplements like vitamin E, NAC, omega 3 fats, Milk thistle extract, & phospholipids, for example.
You mentioned she is taking adrenal supplements – have you completed a test to suggest an adrenal issue? Both of the supplements contain glandulars so this may be too much for your client particularly if she is experiencing anxiety. You may wish to look at something to give her more resilience, rather than increasing cortisol output. In view of the family history, tackling blood sugar imbalances may be important and could be helpful for mood. NAC can be helpful for anxiety and can also help with detoxification support.
With regards to depression and low mood, you may wish to consider genetic SNPs such as those associated with MTHFR. Consider hormone imbalances including thyroid too. Nutrients to help boost mood include omega 3 fats, probiotics, vitamin D and B vitamins / magnesium. Studies suggest a direct link between insulin resistance and depression. In a small clinical study, treatment of depressed patients with the insulin-sensitizing drug pioglitazone alleviated depression while simultaneously improving their cardio-metabolic risk profiles.
Kemp DE et al. Use of insulin sensitizers for the treatment of major depressive disorder: A pilot study of pioglitazone for major depression accompanied by abdominal obesity. J Affect Disord. 2011 Jul 20. https://tinyurl.com/yd9kvd2v
Physical exercise is one of the best ways to boost mood as well as light exposure – simply encouraging your client to exercise daily if possible outside would be helpful.
Lactobacillus helveticus (L. helveticus) R0052 has been researched, in combination with another proprietary probiotic strain, Bifidobacterium longum (B. longum) R0175, as a probiotic for psychological health
Arseneault-Breard J, Rondeau I, Gilbert K, Girard SA, Tompkins TA, Godbout R, Rousseau G. Combination of Lactobacillus helveticus R0052 and Bifidobacterium longum R0175 reduces post-myocardial infarction depression symptoms and restores intestinal permeability in a rat model. The British journal of nutrition.Jun 2012;107(12):1793-1799. https://tinyurl.com/yb5yzggk
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
GI Flora (dairy free) (ARG) – take 1 twice daily – https://tinyurl.com/zrbvo8g
Stabilium 200 (ARG) – take 4 in the morning – https://tinyurl.com/hhz7228
NAC Enhanced Antioxidant (ARG) – take 1 twice daily – https://tinyurl.com/jq8krhz
5-MTHF Plus Forte (ARG) – take 1/2 tablet daily
Pro Greens (ARG) – take 1 scoop daily – https://tinyurl.com/gtqgbyo
Vitamin E Succinate (ARG) – take 1 twice daily
NT Factor Chewables (ARG) – take 1-2 daily
I hope this helps answer your question
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