Dear Dr. Roach: I switched to nonalcoholic beer a week ago due to an upcoming fibroscan on my liver later next month. I was diagnosed with a mild fatty liver this past August. I’m experiencing insomnia, plus I get up to urinate five to six times a night. Previously, it was only two to three times a night. Any thoughts or recommendations?
A.C.
The most important recommendation I have is to continue keeping off alcohol. Even the relatively modest amount of alcohol in beer is not a good idea in people with MASLD (metabolic dysfunction-associated steatotic liver disease, what we used to call “fatty liver”). Switching to nonalcoholic beer was a wise choice. Alcohol probably increases the risk of liver disease worsening into conditions such as steatohepatitis, fibrosis and ultimately cirrhosis. (A fibroscan is a test to look for fibrosis of the liver.)
Why you are having to urinate more at night isn’t completely clear to me. If you are drinking more nonalcoholic beer than you were drinking regular beer, this would explain it. The effect of alcohol on urination is complex; alcohol initially suppresses the antidiuretic hormone (ADH), which causes increased urine output. The ADH levels are lower later on, so it’s possible that while drinking beer, you got rid of your fluid faster.
When you have excess urinating at night, the first step is to stop drinking so much (of any fluid) in the evening and nighttime. If this doesn’t solve the problem, it’s time to consider issues with the prostate (for men) and bladder (for men and women).
Alcohol also has variable effects on sleep, and if you are used to drinking most nights or every night, your body could be going through a mild withdrawal where insomnia is very common. I expect this to get better over time, and I recommend avoiding sleep medications, either over-the-counter or prescription. If the sleep problem continues, there are behavioral treatments you can try. Just ask your primary care doctor.
Dear Dr. Roach: I am a healthy 63-year-old female. I recently applied for a life insurance policy. I submitted my blood work and was surprised when my GGT level came back significantly elevated. All of the other liver-enzyme tests, including the ALP, ALT and AST, were completely normal and have been for years.
I followed up with my primary doctor, who ordered a sonogram on my liver that also came back completely normal, with no signs of fatty liver disease. I typically will have two glasses of wine if I’m out to dinner, which is around two to three nights per week. My primary care doctor said that they do not typically order the GGT test, especially when all other enzyme tests are normal. Do you think I need to follow up further?
K.C.
I agree with your primary doctor. The GGT is a liver enzyme that is elevated in many liver conditions. It is extremely sensitive, meaning that it will almost always be elevated with many liver diseases. But it is not specific, meaning that it can be elevated without any significant liver disease. (When I was a student, one resident joked that the GGT level goes up “if you look at the liver sideways.”)
Even your very modest alcohol use might be enough to raise the GGT levels slightly. But given the other normal blood tests and your normal ultrasound, I do not recommend further testing.
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 [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
