6 weeks off antibiotics, update on my elevated enzymes saga

Hi all!
Some of you may remember that I've been struggling with elevated liver enzyme since getting sick (or since starting taking ABX... I can't tell which one it is, or both).

I thought I'd post the discussion I just had with my LLMD about the matter as it's contain information that might prove useful to some going through the same thing than me.
Conversation Keywords: elevated enzymes, ABX protocole, fatty liver, micro dose minocycline

If you have a moment, I would also be interested in having your opinion on my case, most specifically if you think it makes sense for me to go for the mino/clarythromycin route suggested.

here is the exchange:

****************************
ME:
Hi Doctor,
Regarding past results for my liver enzymes:

- Current values: elevated AST/ALT: 48/100
- July 2018, 1.5 month after getting bit, on DOXY: elevated AST/ALT: 51/79
- May 2018 no Lyme, normal AST/ALT 34/30
- October 2018 no Lyme, normal AST/ALT 32/33
- June 2017, no Lyme, normal AST/ALT 33/32
- April 2017 no Lyme, elevated ALT 49
- March 2017 no Lyme, elevated ALT 54.

It's hard for me to conclude anything. Altho my levels were normal most of the time, it did came at as elevated 2 months in a row early 2017.
But Lyme (or is it Doxy?) made my enzyme constantly elevated.

***************
LLMD:
My thoughts are that you most likely have a fatty liver that does not like antibiotics however....

Borrelia miyamotoi will cause elevated liver enzymes, so will ehrlichia and anaplasma (2 co-infections that are seen with Lyme).

You have been on doxycycline, which does kill all of those bacteria....and you did not start with high, high levels of liver enzymes until after being on antibiotics, so I still think that the problem is your liver not liking the antibiotics.

I have put people with persistent elevated liver enzymes on a low dose of minocycline (50mg twice a day to start) and when the liver tests are better (over time) then added other antibiotics.

about 2-3 people out of 1,000 will have problems with prolonged liver enzyme elevation. The catch is that if you push too hard, the enzymes will go up much higher and stay there, so I would not

want to do that, but how would you feel about starting a low dose of antibiotics?
************************
ME:
Thank you so much for your time. I understand your explanation, and it does bring up questions.

1- about the fatty liver. Is having a fatty liver possible, even if I've been very healthy for the past 10 years of my life? I'm seeing Dr. ***** after seeing you in mid January. I will request the liver test.

2- Regarding the elevated enzymes. I noticed is that since I started taking ABX (Im including the month I took doxy ABX in this), my AST/ALT was "slightly" elevated but constant at around 40/75.

Even when I added Bactrim for a while which elevated my creatinine, my enzymes stayed the same.
So for the whole first 3 months of your protocol (doxy, clary, malarone), things were constant.
It seems to me that it's only when I added ALINIA from the second protocole (Mino, Clary, Alinia, Rif) that my enzyme skyrocketed to 138.
(Note that I never actually had the chance to add Rifampin to the mix, as things went high 2 weeks after adding Alinia to the Mino/Clary combo I was already on).

In other words, I'm wondering if Alinia could be the main offender here? For what it's worth, while I was taking it, my tears, semen and urine turned a pale but bright yellowish color.

3- Based on that. Could it make sense to start again your protocole #2 with only Minocycline and Clarythromycin for a couple weeks, and see how the liver reacts?

4- My concern with low dose Mino: I heard of bacteria resistance when ABX are not used in combination. Isn't that something we should worry about?

5- It's unfortunate that I never reached the point to take the Rifampin in my protocol (the protocole aborted shortly after adding Alinia). I feel like Bartonella have been my biggest struggle since the beggining. I've read that Bartonella can cause elevated enzymes too. Could it be a factor?
************
LLMD LAST REPLY:
Yes you could start with just minocycline and clarithromycin a couple of weeks and see how that goes.

Underlying bartonella can be a cause of elevated liver enzymes including when you take something to kill it the enzymes can go up.

Yes even if you were a healthy guy before getting sick....fatty liver is due to eating bad fats + carbs+ sedentary lifestyle and is the #1 cause in the US for needing a liver transplant.

Most likely if you were healthy and active it is not the underlying problem, but still it is better to look for it and know it is there.

So, start on minocycline regualr dose, add clarithromycin- let's see what your liver enzymes do.

Post Edited (Alxander) : 12/13/2018 1:41:14 PM (GMT-7)

I think a break and then doing the mino/biaxin is not a bad idea. Then you can do labwork, make sure things are going ok, and can consider rotating/adding things in at that point. I don't know why but my vibe is that mino has fewer resistance issues than some of the other abx, maybe I'm wrong on that... I've certainly heard of people using low-dose mino or pulsing that drug (especially when the herxes were too strong).

Alinia is known to turn most body fluids yellow. It's disconcerting but based on what I've heard innocuous.

I think mine is from researched nutritionals. Have you considered Alka seltzer gold? Also do you have access to an IR sauna or epsom salt baths?

If you have a well experienced and knowledgeable LLMD, he should of informed you to get on herbs that offer liver support, like xpeetzax stated Milk Thistle. It's a "must" dealing with chronic lyme disease, considering you may be on antibiotics for a long time.

A good quality brand of Milk Thistle and Alpha Lipoic Acid, along with doing baking soda water drinks on occasion will help keep your liver enzymes down, along with keeping your kidneys healthy.

Drink lots of water, water is basically all you should be drinking dealing with this disease. Also walking on a treadmill, help flush toxins out, or sitting in a tub full of hot/warm water....

I think there's quite a bit of information out there showing that Babesia can also raise liver enzymes, just anemia in general, like you said even borrelia may do it.

https://www.aldf.com/babesiosis/

said...
Laboratory findings may include hemolytic anemia with an elevated reticulocyte count, thrombocytopenia, proteinuria, and elevated levels of liver enzymes, blood urea nitrogen, and creatinine.

Astroman:
Your reply resonated so loud that I decided to hold into the ABX protocol one more week to see if enzymes would keep their downward thread like they did for the past 6 weeks.
Good thing I listened to you; despite not starting ABX, my enzyme went up (from AST ALT 48/100 to 70/117)
I was pretty shocked and discouraged to find that out from last Monday blood work, but at the same time I told myself at least I didn't add ABX to the mix.

I asked my LLMD why the enzymes would go up like that off ABX, as they were decreasing on a constant manner since I stopped my protocole. I asked if one of the MANY supplement and vitamins I'm taking could cause that.
The only response I got was to stop any MILK THISTLE product for now.

... not sure why.

The reason I wanted to push hard is because my infection is fairly recent (6 months old) and I started 2 weeks after bit. I was hoping to push away the bacteria as much as I could since it was probably wasn't that deep inside me... but I guess that option is off the table now that I've been off treatment for 7 weeks and don't see the light at the end of the enzyme tunnel right now.

One day at a time..

Hi Lapis!

Yeah, I'm myself baffled about dropping the Milk Thistle.

Unfortunatly I cannot really tolerate coffee since getting sick (from what I understand, it could be from my Bartonella).

Not sure what is green tea extract BUT I've been drinking 1 cup of organic green tea every day for about a month now. Heard it was good for enzymes and good vs babesia...

I'll purchase some beetroot supplement.

Thank you for all your advices

Couldn't help myself to insist to ask my LLMD why I was asked to stop Milk Thistle.
She told me she wants to see if my Liver has an intolerence to it (I guess she saw some people with that?)

But to me that unexplained raise of Enzyme despite OFF ABX might have more to do with me adding Glutathione to my supplement list 2 weeks ago.
I'll see how my next lab OFF Milk Thistle comes up, but if there's no downward thrend, my next step is top quit Glutathione supplement and see how things go.