60 replies to this topic

[D12A]

Hi guys, I got on bandwagon through Reddit.

 

I am looking to enhance the liver function. Now, I hope this forum is open to 'new age' stuff but last December

I went to a private doctor who is "one foot in modern medicine, one foot in alternative stuff". Cost some money but

it was 3-hour examination along with fascinating conversation. She used some kind of electromagnetic device and computer

program to scan for issues I am having: poor cognition, acne that does not go away, incredibly poor fat absorption, tiredness, fatigue,

and anxiety. I don't feel horrible but I swear, I am operating at like 30% capacity and am capable of much more.

 

The method used different frequencies and basically, my liver was in the red zone on the scanner aka nothing good. It was fascinating, because

stuff did not stop there with vagueness. She then went deeper, focusing on liver. The final conclusion was cholestasis of the liver. However, that method

is not perfect because it won't tell you exactly WHY. In some cases, a diagnosis have many alternative causes.

 

I am a skeptical person. I went through a bunch of frustrations with regular docs. I insisted on blood tests etc. There is a constant problem that shows up

frequently - elevated ALP. That's it. No AST, GGT are abnormal. Just ALP. I have liver tests over a span of 9 months around 4 times. It was in normal range once.

Upper limit is 125 but in all cases it was as follows: 135, 147 and recently 150.

 

The prescription for me was: rowachol, turmeric, lecithin granules, milk thistle oil etc. I don't know if they helped because I still can't digest fats very well. I still have

same symptoms. However, I was also told that it most likely will be too weak a regimen and it is probably right. I met this woman in a different country and can't go back

easily for further investigations. However, it seems clear. Liver is struggling.

 

At the same time, I am skeptical of this. My diagnosis was cholestasis caused by mechanical blockage of some sort. I had ultrasounds(multiple places), endoscopy but it

never revealed anything wrong. My gallbladder is clear, there are no deviations in hepatic system.

 

I searched for other ways to help it and found this forum. Also, strangely Reddit steroids section talks a lot about liver protection because oral steroids really are hepatoxic. People

claim stuff like TUDCA is awesome. My issue is that I wasted ton of money on stuff that never helped me at all. I came to this forum for more targeted approach to my symptoms.

 

I'd like to add that I train in the gym 6 times a week, I cook all my food and I eat no junk ever. I was also looking to stuff like homemade kefir, sauerraut because maybe fat digestion is impaired due to bad bacteria. But that stuff never aleviated anything after months of use.

 

Any guidance on this?

[Dorian Grey]

Bile is key to fat absorption and ALP elevation is a good indicator of sluggish bile flow, so your diagnostic appears accurate.  

 

Sluggish liver / cholestasis used to be a common diagnosis in the middle of the 20th Century, but has fallen out of favor now days.  This is unfortunate, as I feel it is a common cause of liver distress.  

 

I've worked hard to keep my liver in tune over the years as I'm rather fond of alcohol, and have done a lot of research and trial and error with supplements over the years.  I've found when it comes to bile flow, enhanced absorption Curcumin and a highly refined form of Lecithin/Phosphatidylcholine known as PPC (polyenylphosphatidylcholine) gave the best results.  Curcumin stimulates bile flow, particularly when taken with the fattiest meal of the day, and Lecithin "thins" bile, helping to move thickened/muddy bile through the biliary system.  

 

Bile colors the stool brown, & Curcumin actually gives results you can see practically overnight.  I've used Turmeric & simple/unrefined lecithin too, but haven't seen impressive results from these.  

 

Simple Curcumin is poorly absorbed, thus enhanced absorption formulas have emerged.  One way of enhancing absorption is adding "piperine", a component of black pepper.  This works well, but piperine has a side effect of modulating glucuronidation lower in the liver.  I haven't read a lot of horror stories about this, but glucuronidation is important for metabolism of toxins, so it may be unwise to interfere with this process.  It may well be that at low doses, a Curcumin/Piperine combo shouldn't be problematic. 

 

Micronization is an alternate process/formula for enhancing absorption of Curcumin, and I find this preferable, as there are no adverse effects from this method.  Life Extension's "Super Bio-Curcumin" is an enhanced absorption forumula without piperine, so I assume it is micronized, though it doesn't state this on the label.  This is the only form I have used, and I've been very happy with it.  Super Bio-Curcumin isn't cheap, but I've found one cap of this per day is all it takes to keep my stool dark brown, indicating good bile flow.  I also take a cheap/generic Turmeric supplement to fill in any gaps, as some say the co-factors found in Turmeric are important to the overall benefit from Curcumin.  

 

All PPC comes from a single source in Germany, and is relabeled by many brands.  PPC is a highly refined polyunsaturated component of Lecithin, and as it is polyunsaturated, it is prone to oxidation, thus fresher is better.  PhosChol (brand) is the biggest mover of PPC, thus this is the brand I prefer.  PPC is also the primary component of "Essentiale Forte", which is a popular alternative where PhosChol isn't available, so this might be the best option if you can't get PhosChol shipped to your area.  Fresher is also better with Essentiale Forte, so I would choose a supplier that moves a lot of product.  Check the expiration dates to insure freshness.  Both PhosChol and Essentiale Forte should have at least a year to go before expiration if they are fresh.  

 

SAM-e (S-Adenosylmethionine) is another excellent liver tonic.  Also known as "AdoMet" in Europe, SAM-e is pharmaceutical grade, and offers powerful liver protection, though it is not associated with bile flow so much as Curcumin & PPC.  Natural Vitamin-E is also important to me, as fatty liver and fatty liver disease have become common due to the switch away from saturated fats to vegetable oils in today's diet.  The "PIVENS Trial" showed Vitamin-E to be perhaps the best medicine for fatty liver disease.  Avoid synthetic (dry) E like the plague and take only the natural form, preferably with "mixed tocopherols". It should say "Natural" on the label and come in a gel-cap formulation.  

 

These four supplements have kept my liver about bullet-proof, and at 60 years of age, I'm still enjoying wine, women & song with normal liver enzymes, ALP, GGT, good digestion and remarkable health.  Do some homework on these supps, & you'll see, these truly are today's liver supplement superstars.  

 

Best of Luck, & let us know what you think of these, & how they work for you.  

Edited by synesthesia, 01 December 2016 - 04:55 PM.

[D12A]

Thank you for information, this is helpful. I was told by that doctor that turmeric might not be enough and I should order some kind of Curcumin

supplement because absorption is hundreds of times better. Maybe, you refer to the same thing, need to dig into my email archives. And yes,

I used Lecigran lecithin but honestly have not spotted much change. Also, used swedish bitters. They helped somewhat but I forgot to persist

longer term.

 

I will research your post however and will try out the supplements because they helped you.

[joelcairo]

It sound to me like many of your symptoms could be due to overtraining and consumption of steroids and bodybuilding type supplements. Personally I don't think trying to optimize your liver function is the way to go. Just ease into more of a normal healthy diet and lifestyle.

[D12A]

It sound to me like many of your symptoms could be due to overtraining and consumption of steroids and bodybuilding type supplements. Personally I don't think trying to optimize your liver function is the way to go. Just ease into more of a normal healthy diet and lifestyle.

I just want to clarify. Firstly, I consume no supplements even basic stuff like creatine or protein powder. Reason for this is because I count my macros and get enough stuff from food. I tried both and saw no benefits, so it is waste of money for me. Also, I would know if I used steroids. I find highly annoying when people who lift weights are assumed to be using something. I don't. My testosterone is in good state and there is no need for me to switch off my balls natural production for more gains. I don't care about that.

 

Doing nothing also solves nothing. I have bad digestion, my brain does not work well and my career depends on extremely good cognitive abilities. Also, people into fitness usually care more about diet than couch potatoes. I cook all my food and know importance of nutrition and recovery. It is waste of time to train without both of those sorted.

 

Now, I recently found that there is plenty of evidence for liver enzymes being elevated a lot in healthy individuals who engage in weightlifting. According to studies, GGT is the distinguishing test to find out if it is liver issue. If it is normal, then there might be other issues but it is also appearantly normal for athletes to have elevated liver enzymes in some cases. My doctor definitely did not know that and I will tell him next time.

 

In the end, I find my symptoms annoying. There is something wrong and poor fat digestion indicates bile secretion issues OR maybe villi of small intestine are damaged. Normal people digest their fats. I have issues and there is a reason for it. One also has to remember that elevated liver enzymes for prolonged period of time damages liver, bile ducts and gallbladder. So, finding out if it is indeed liver issue is important. I hope it is not. But this is why I work with doctor and ask questions people who have experience.

[joelcairo]

Sorry for the suggestion, but in your post you talked about info you had picked up from a steroids forum. Anyway I would stand behind my suggestion that the cognitive problems and fatigue might be alleviated if you gave your body more off days to recover. Do you have concrete evidence that these things stem from liver problems, or is this all based on that one diagnosis? From your description I'm not sure if that medical test is to be trusted or not.

[D12A]

Sorry for the suggestion, but in your post you talked about info you had picked up from a steroids forum. Anyway I would stand behind my suggestion that the cognitive problems and fatigue might be alleviated if you gave your body more off days to recover. Do you have concrete evidence that these things stem from liver problems, or is this all based on that one diagnosis? From your description I'm not sure if that medical test is to be trusted or not.

 

Yes, I wrote such a wall of text that I completely forgot about it. I just googled stuff on liver and Reddit steroids had lots of information about it.

 

Regarding training, this year I had a couple of months where I did not go to the gym because I was in different city, very busy. Mostly did running. My digestion was same, cognitive problems did not go away and fatigue did not dissipate.

 

The only evidence is doctor's opinion + test results. It is just the beginning of investigation. Maybe, it will turn out to be different issues. It's just that I am not fully-functioning human. I know because 5 years ago I could sleep through the night, feel rested in the morning, solve problems easier and had no problems with digestion. 

[aconita]

Try sodium bicarbonate (baking soda) in drinking water during meals, 5g/day should do but up to 20-25g are possible, best is sodium bicarbonate mixed with potassium bicarbonate 4:1.

 

Consider supplementing iodine as Iodoral or Lugol's or SSKI.

[D12A]

Try sodium bicarbonate (baking soda) in drinking water during meals, 5g/day should do but up to 20-25g are possible, best is sodium bicarbonate mixed with potassium bicarbonate 4:1.

 

Consider supplementing iodine as Iodoral or Lugol's or SSKI.

 

Can I please get an explanation on why you recommend this? The guy who posted after me made an effort to explain his experience and it will be useful for me

and people around the world who stumbles upon his post. Why do you recommend what you wrote? The first thing that came to my mind was that it makes no sense.

I don't want highly alkaline stuff in my stomach, especially when eating because it reduces stomach acid and makes digestion of protein worse. Maybe, I am wrong, so

what is the reasoning behind your recommendations?

[aconita]

Pancreatic juice

The pancreas produces 1,000-1,500 mL (1-1.5 qts) of digestive juices per day. These juices consist primarily of water, NaCl (salt), and NaHCO3 (sodium bicarbonate). The purpose of the sodium bicarbonate is to neutralize the high acidity of the chyme (food plus stomach acid) raising it to an alkaline pH of 7.1-8.2. This both stops the action of gastric pepsins and stomach acid and prepares chyme for the process of nutrient absorption, which takes place in the small intestine.

Pancreatic enzymes

In addition to containing sodium bicarbonate to neutralize the action of the digestive juices, pancreatic juice also contains a number of digestive enzymes (optimized to function in an alkaline environment) that help finish off the digestive process started in the stomach.

 

https://jonbarron.or...s-and-digestion

 

In facts sodium bicarbonate helps digestion.

 

PH is of great importance especially for fats digestion, which are the trickiest, as well as temperature and a sluggish thyroid leads to lower than optimal temperature plus altered endocrine balance which of course is of great importance for digestion as well as for general well being.

 

Since you are not doing well it would be smart to start questioning what does make sense to you or not.

 

Because sodium bicarbonate is extremely safe and cheap as well as iodine is (especially SSKI) wouldn't be easier to just give them a try than sitting here to speculate about theories?

 

.

 

[zorba990]

For billary issues, Increasing phosphatides may be The easiest thing:
https://www.ncbi.nlm.../pubmed/9748591
" lecithin increases biliary lipid secretion, which mainly comes from the contribution of high density lipoprotein (HDL) and hepatic microsomal pools of phosphatidylcholine and cholesterol. In addition, a lecithin diet enhances bile secretion and prevents bile acid-induced cholestasis"



There are many herbs that can help, but I'd suggest seeing an expert before using things like minor bupleurum so your individual situation is taken into consideration.

Edited by zorba990, 03 December 2016 - 10:50 PM.

[D12A]

Thank you for contribution.

 

I only questioned this because we need enough stomach acid to digest our food well. But, of course, it is more complex than that and pH is indeed

rather alkaline in some areas of intestines. And yes, from my chemistry lessons, I remember that enzymes for example have a certain shape like a key

fits in a door lock. Slight change dramatically reduces the "fit" factor and there are many factors, temperature, pH that can reduce it's effectiveness. Just like

cooking an egg denatures protein. I am going to try out all suggestions here and see an expert to find out the cause.

[Skyguy2005]

"I cook all my food and I eat no junk ever."

 

What kind of food do you eat? Perhaps a more plant-based, less meaty diet would help/.

[Kinesis]

Try sodium bicarbonate (baking soda) in drinking water during meals, 5g/day should do but up to 20-25g are possible, best is sodium bicarbonate mixed with potassium bicarbonate 4:1.

Consider supplementing iodine as Iodoral or Lugol's or SSKI.

Can I please get an explanation on why you recommend this? The guy who posted after me made an effort to explain his experience and it will be useful for me
and people around the world who stumbles upon his post. Why do you recommend what you wrote? The first thing that came to my mind was that it makes no sense.
I don't want highly alkaline stuff in my stomach, especially when eating because it reduces stomach acid and makes digestion of protein worse. Maybe, I am wrong, so
what is the reasoning behind your recommendations?

[Kinesis]

Try sodium bicarbonate (baking soda) in drinking water during meals, 5g/day should do but up to 20-25g are possible, best is sodium bicarbonate mixed with potassium bicarbonate 4:1.

Consider supplementing iodine as Iodoral or Lugol's or SSKI.

Can I please get an explanation on why you recommend this? The guy who posted after me made an effort to explain his experience and it will be useful for me
and people around the world who stumbles upon his post. Why do you recommend what you wrote? The first thing that came to my mind was that it makes no sense.
I don't want highly alkaline stuff in my stomach, especially when eating because it reduces stomach acid and makes digestion of protein worse. Maybe, I am wrong, so
what is the reasoning behind your recommendations?

You could try going the other way during meals ... take a tablespoon or two of cider vinegar with a fat-containing meal. This, along with milk thistle, improves my fat digestion markedly.

[D12A]

Hi, so I tried Super-bio curcumin for 2 weeks but it did nothing. I am yet to try phospho-something because it is very hard to get it in UK. Seems like the only source is Germany.

 

Also, how effective would eradication of H Pylori be? I had a positive test but then, it seems that a lot of people have them naturally without symptoms. One of the effects is lowered stomach acid.

So far, I have elevated ALP and H Pylori infestation. Is it worth to take the treatment for them? Antibiotics will probably eradicate some of them but then gut flora will also be affected.

 

 

[Dorian Grey]

Did you re-check your ALP after the Bio-Curcumin?  Did you notice stool was darker brown while on it, indicating better bile flow?

 

PPC (polyenylphosphatidylcholine) may be more available in UK as "Essentiale Forte"

 

The treatment regimens for H Pylori are omeprazole, amoxicillin, and clarithromycin (OAC) for 10 days; bismuth subsalicylate, metronidazole, and tetracycline (BMT) for 14 days; and lansoprazole, amoxicillin, and clarithromycin (LAC), which has been approved for either 10 days or 14 days of treatment.  I don't know how liver toxic the antibiotics used are, but you should get more info by searching the LiverTox site.  

 

https://livertox.nih.gov/

 

Watch for "cholestasis" as a side effect as this can really gum up the works if you've already got bile flow problems.  

 

I'd prefer to avoid the treatments using PPI's (proton pump inhibitors), as many experience rebound acid overload when they try to go off PPI's and some tend to get stuck on them.  PPI's are getting a notorious reputation for adverse effects with long term use and I would avoid getting stuck on them long term like the plague.  

 

If you can treat the H Pylori avoiding antibiotics known for cholestatic effects and avoid getting stuck on PPI's, it might be worth a try, but I'd exhaust other options first if I could.  

[Junk Master]

Just want to say I always appreciate Aconita's advice.  I've been around bodybuilding for over 20 years, thought I'd seen and heard just about everything when it came to liver health, and I've never heard something as easy as that!

 

Multi Gracie!

[D12A]

Did you re-check your ALP after the Bio-Curcumin?  Did you notice stool was darker brown while on it, indicating better bile flow?

 

PPC (polyenylphosphatidylcholine) may be more available in UK as "Essentiale Forte"

 

The treatment regimens for H Pylori are omeprazole, amoxicillin, and clarithromycin (OAC) for 10 days; bismuth subsalicylate, metronidazole, and tetracycline (BMT) for 14 days; and lansoprazole, amoxicillin, and clarithromycin (LAC), which has been approved for either 10 days or 14 days of treatment.  I don't know how liver toxic the antibiotics used are, but you should get more info by searching the LiverTox site.  

 

https://livertox.nih.gov/

 

Watch for "cholestasis" as a side effect as this can really gum up the works if you've already got bile flow problems.  

 

I'd prefer to avoid the treatments using PPI's (proton pump inhibitors), as many experience rebound acid overload when they try to go off PPI's and some tend to get stuck on them.  PPI's are getting a notorious reputation for adverse effects with long term use and I would avoid getting stuck on them long term like the plague.  

 

If you can treat the H Pylori avoiding antibiotics known for cholestatic effects and avoid getting stuck on PPI's, it might be worth a try, but I'd exhaust other options first if I could.  

 

I have not but will ask doctor about it. I would say that color was browner but I don't think it's wise to attribute it to curcumin. I also started taking Swedish bitters around twice a day after meals. I do not swallow them, just swish for 2-3 mins. First 5-6 times I got a horrible headache for around 30 mins and lots of gurgling in liver area. And next day stool was indeed darker. The effects however ceased somewhat. I no longer get any side effects and there is no gurgling anymore.

 

I was put on metronidazole in April for 2 weeks because they found an overgrowth of specific bacteria. It is not considered harmful but gastro wanted to get rid of it. I had some side effects and one I remember was really pale stool. It was not even yellow, it was really pale. I don't think taking them was wise and it changed nothing.

 

As for treating H Pylori, there is a huge article online on using herbs and mastic gum: http://www.mygutsy.c...drenal-fatigue/

[Aardvark202]

Though I don't know the actual evidence linking milk thistle tea to the liver, I think it is relatively side effect free and can't be too bad of a bet to try.  It is an ingredient in Protandim®, which was one of 6 supplements actually showing extension of max lifespan in mice in the NIA's Intervention Testing Program mouse lifespan studies.  In addition, it's a common drink in Sardinia, one of the official "Blue Zones".

[normalizing]

Though I don't know the actual evidence linking milk thistle tea to the liver, I think it is relatively side effect free and can't be too bad of a bet to try.  It is an ingredient in Protandim®, which was one of 6 supplements actually showing extension of max lifespan in mice in the NIA's Intervention Testing Program mouse lifespan studies.  In addition, it's a common drink in Sardinia, one of the official "Blue Zones".

 

what are you refferences for protandim enhancing life and milk thistle tea being consumed in sardinia? ive never heard of this and i read about their diets and lifespan

[Aardvark202]

hazy,

 

I'm very sorry, I just realized after double checking that only the median lifespan was significantly extended, not the max.

 

Here's the NIA link: https://www.nia.nih....ing-program-itp

 

Here's the original study: http://sabatinilab.w...-Aging_Cell.pdf

 

And here is the original article I read about Sardanian's drinking milk thistle tea: http://www.today.com...our-life-t13951

 

Another: https://books.google...tle tea&f=false

 

 

[normalizing]

yeh thanks. i already checked on Protandim tho, it seems a gimmick. all the ingredients are already in most supplements out there for cheaper and its nothing unique or interesting. its advertisement at its best.

[Aardvark202]

Ya I agree, 100% gimmick.  Says something about the ingredients though.  I just get each of them separately.

[RWhigham]

The intestinal villi cells have a very fast turnover rate. They are generated at the villi base, move up the sides of the villi like on a conveyor belt, and don't last very long at the tip. If the anything interferes with the proliferation of new cells at the base, kiss your digestion goodby. I personally, started feeling much better without gluten, but it took more than a year for abdominal tenderness to resolve. I was not sufficiently gluten sensitive for a clinical diagnosis - just had a lifetime of abdominal tenderness that I mistook for normal.

 

H. pylori is difficult to kill. It takes a big cocktail of antibiotics with attendant risks. You might try garlic juice or a garlic extract. https://www.ncbi.nlm...pubmed/11238826  The Garlicin Cardio extract does not give garlic breath to most people. My campylobacter infection was cured within hours by Garlicin Cardio after I had diarrhea for 3 weeks. Campylobacter is notoriously antibiotic resistant, but like H. pylori, sensitive to garlic. I took two tablets every couple hours during the first day, and again the next day just to make sure it didn't come back. I continue now to take 4 tablets a day to get all the health benefits of garlic without the stinky breath caused by eating fresh garlic.

 

Here is little basic nutrition every school child should learn, but may be surprising to some. Fats, carbohydrates, and proteins are digested totally differently. Your stomach only digests proteins.

 

(1) Fat digestion does not begin until its mixed with bile after leaving the stomach. Long chain fats are absorbed via various transporters, assembled into triglycerides, put into chylomicrons, and dumped into the lymph system. They travel slowly through the lymph system to an area near the neck where they enter the bloodstream. Chylomicrons peak in the bloodstream 4 hr after eating. Short and medium chain fats are dumped directly into the portal vein and travel immediately to capillary beds in the liver. The portal vein drains the intestines to the liver.

 

(2) Carbohydrate digestion starts with enzymes in saliva, but the stomach destroys these enzymes and temporarily stops carbohydrate digestion. Carbohydrate digestion resumes after leaving the stomach. Digestible carbohydrates are broken down into glucose and other sugars. The intestines contain many different specialized transporters that move stuff into the villi. Glucose is absorbed (actively transported) and dumped into the portal vein.  Nondigestible sugars and starches move on to the mammalian post fermenter. The appendix (a bacterial reservoir often vestigial in humans) inoculates the indigestible stuff with bacteria at the entrance to the post fermenter. In the post fermenter there is a very complex symbiotic relationship in which bacteria provide nutrients and control your health and appetite in exchange for their sustenance. It has been shown that a fecal transplant (FMT) from a healthy individual to an obese one usually cures their uncontrollable hunger instantly. (FMT is usually used to cure a C. difficile infection, maybe the only FDA sanctioned use).

 

(3) The human stomach is designed for one thing, to digest protein. Protein is tough, it requires a combination of acid, enzymes, and a lot of motion within the stomach to break it down. Once digested into amino acids, aminos like carbohydrates are absorbed into the portal vein which drains into liver capillaries.

 

Edited by RWhigham, 20 December 2016 - 11:25 PM.

[Dorian Grey]

Bottom line...  SAM-e is the ONLY liver supp shown to keep those with advanced disease alive.  

 

https://www.ncbi.nlm...pubmed/10406187

 

And PPC helps those without advanced disease stay healthy.  

 

http://www.phoschol....annComplete.pdf

 

SAM-e & PPC truly are the liver supplement superstars.  

[D12A]

I am wondering about another thing. I live in a country where especially in winter, there is little sun. Having tested my vitamin D levels, it came back at 100. According to this http://emedicine.med...088694-overview , it is literally maxed out. I eat eggs every day, quite a bit of fats and use no vit D supplements. So, this seems to imply that

I do digest fats somewhat because otherwise my fat soluble vitamin levels would not be that high.

[pamojja]

Was that a 25(OH)D or a 1.25(OH)D serum test? Was the 100 result reported in ng/mL or nmol/L?

 

Also, at the link you provided:

 

 

Physiological and pathological changes in the concentrations of DBP and albumin, such as in pregnancy, in malnutrition, in liver disease, in nephrotic syndrome, and in association with medications, among others, can affect the total and free fractions of 25(OH)D.

 

Edited by pamojja, 21 December 2016 - 10:43 AM.

[D12A]

 

Was that a 25(OH)D or a 1.25(OH)D serum test? Was the 100 result reported in ng/mL or nmol/L?

 

Also, at the link you provided:

 

 

Physiological and pathological changes in the concentrations of DBP and albumin, such as in pregnancy, in malnutrition, in liver disease, in nephrotic syndrome, and in association with medications, among others, can affect the total and free fractions of 25(OH)D.

 

 

25OH. And the result is in nmol/L.

[pamojja]

25OH. And the result is in nmol/L.

 

That's about 40 ng/ml. With a range of 20-100 ng/ml not that bad, but not anywhere near to maxed out.