High Bilirubin

Medical Q&A [Moderated]
1

I’ve lost about 100 pounds over the last few years and have been in pretty good health for 3-4. When I was fat my liver enzymes were elevated, but I was otherwise ok on my blood work. Just got my blood work back from my GP. Overall the numbers are pristine, including cholesterol, liver enzymes, etc, but two questions:

  1. My bilirubin has been elevated for at least the last 3 years. It was 1.4 in 2019, 1.9 in 2020, and 2.0 just recently, vs. a top end reference range of 1.0. I’ve seen some indication on the internet that strenuous exercise can contribute to high bilirubin. Is that the case? Is there anything to be concerned about here? I don’t have records of bilirubin prior to 2019.

  2. My T levels aren’t great either. I recall a Jordan rant where he said not to worry about low T. So instead I will ask about odd moves year over year - my dhea is up about 100 points to 435 and by total t is down 100 points to 311. Shouldn’t they move in tandem?

2

  1. I don’t think I would attribute this to strenuous exercise. However, we don’t have quite enough information to be able to comment on this finding, since there are many potential possibilities for this. Some are benign, others less so - would recommend discussing this with your physician.

  2. Is there a specific reason your DHEA and total testosterone levels are being measured? They are quite difficult to interpret in isolation (i.e., in the absence of clinical symptoms suggestive of hypogonadism), and this is compounded by the cyclic increases and decreases in blood levels throughout the course of a day. We have two podcasts on the topic of testosterone that are worth checking out.

3

Regarding my high bilirubin level, I went back to my doctor and he ordered an abdominal ultrasound, they found fatty infiltrations in my liver, but the ultrasound was otherwise normal. He’s asking me to avoid animal fat and iron.

The result isn’t surprising because of how obese I was. My ALT and AST have both been in the low 20s for a couple of years after having been in the high 30s / low 40s.

I have read that being in a calorie deficit can cause high bilirubin levels. Is the more likely cause of the high bilirubin the calorie deficit or the fatty liver?

Is this an indication that further weight loss is a good idea? My current waist circumference is 35.75”. I’m 6’2” and currently about 213 [down from 305].