Question: I am a 37 yr old male from England UK. I saw gastro consultant as original LFT reported high ALT and high bilirubin.4 months ago. On re-test recently ALT normal as were all other bloods, linked to LFT except bilirubin still at level 26 .Ultrasound however "appeared" to show fatty liver. I hardly ever drink, so not alcohol related. Consultant thinking NAFLD, which he says is reversable with more exercise and some weight loss. I am hardly over weight maybe a little stomach fat, but not excessive. I read in a recent study people with a high bilirubin level don't tend to suffer from liver fat, as bilirubin acts as an antioxident against it ? My concern is that what I forgot to mention to my consultant is that I suffer from gout, about one major attack a year, lasts about 4 days (for last 6 years) and have high uric acid levels. I take 600mil Ibuprofen when attack occurs, but not on permanent meds. Is it true gout can sometimes appear on liver similar in appearance to liver fat and it could be this rather than NAFLD ? Secondly, my father was diagnosed with sarcoidosis (not specific liver) when he was my current age. He only lived 3 years after diagnosis. I read sarcoid can appear on liver , & again look similar to liver fat. Is that true ? As someone who tends to get anxious, I am concerned that what may look like liver fat, could be one of these two things? Other than high bilirubin and ultrasound showing what looks like NAFLD, I have no other symptoms. My consultant has asked me to return in 2 months for repeat bloods. Note - Two minor things, I don't think they are related but I wake up most nights half way through with a really dry mouth, and need half a cup of water to get me through til morning., and whenever I get a common cold, if I have a cough, it always seems to take longer to clear up than most people, although always does in end.

Hi Original bloods that were abnormal 5 months ago - Albumin 52 (normal range 35-50) Total bilirubin 26 (normal less than 21) ALT 78 (normal 10-60) On retest 2 weeks later - Albumin 53 Bilirubin dropped to 19 ALT dropped to 60 EBV VCA IgG detected- recent (doctor asked if I ever had glandular fever, but I haven't.) Hepatitis A-C negative Latest results from last week - My doctor has them still , but talked me through them and said all normal except bilirubin high. Did not say exact level. ALT down to about 30. My uric acid was not checked, however I have a home checking meter, and that currently says 10.2 mg/dl. Normal range (3-7) 10 is about average whenever I have checked it. Have changed diet to low purine and trying to bring it down without permanent meds. I did have an acute gout attack about 5 weeks ago. Could that be what is thought to be liver fat, rather than liver fat itself ? Does uric acid get processed by the liver as well as kidneys, and the crystals show up like fat on the liver ?

Thanks you for your reply. What in your opinion should my doctor be looking for checking next ? If it is NAFLD due to uric acid levels, do you think this is reversable if I can get the uric acid lowered down ? How long does NAFLD take to return to normal liver ? What would you suggest to help lower uric acid levels ? I already looked at diet and trying to lose a little weight (I am not very much over weight though). I am also trying to do more exercise. Any other suggestions please ?

Thank you for your replies. For my final question, I would like to mention the fact I have a home meter for checking my uric acid levels. Yesterday it was 9.2mg/dl When I woke up today, I checked the levels before I even got out of bed and it was 12mg/dl. Within an hour it had dropped three points to 9.7 mg/dl. I had not eaten or drank anything to make a sudden change. Does this sound normal that uric acid could change so quickly ? I am wondering if I should believe my home meter of not. I checked to ensure enough blood for the reading, and that seemed ok. If my high uric acid , is the cause of fatty liver, I am keen to understand why I personally have had high uric acid levels for 7 years, with a gout attack about once a year. I am nervous of just taking allopurinol to lower the uric acid by force. I feel if my body is producing that level of acid in the blood, it must be doing it for a reason. It is surely that reason that I need to understand, before going to permanent medication ? Would you agree ? My blood pressure is good and normal. This was checked recently, as I understood uric acid could cause cardio issues. I wonder if my body just produces high uric acid levels naturally for no reason, and that is the cause of fatty liver, or if both are the results of something else ? I really feel understanding this is the key, rather than just force the levels down through allopurinol, as that might mask the underlying reason ? What are your thoughts please ?