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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Medical
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Experience:  14 years experience in the field of Family Practice
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I've had a issue where my tongue becomes more and more

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Hi, I've had a issue where my tongue becomes more and more yellow, moving from the back of the tongue forward. After using a tongue brush/scraped (which produces a thick coating on the tongue), it would only take one day for the yellowness to return.
I have had this for a few years now though I originally put it down to drinking a lot of milky tea a day. Now my diet is dairy-free and meat-free (I do supplement with B12 and calcium).
I have raised liver enzymes, particularly ALT which has moved between 70 to 198 and then back down to lower 100s over the past year.
Ultrasound was clear - no fatty liver or scarring.
I don't smoke either and drink alcohol very irregularly. I was drinking large amounts of caffeine each day but I stopped this two weeks ago.
I have also had a rather low neutrophil count on tests taken within the last six months.
Could this be connection to my liver? If it is bacterial, can it be treated?
Anthony Bray MD : Hello!
Anthony Bray MD : i would suspect that the tongue coating as you describe it may be related to reflux. I have seen this pattern in patients with reflux problems.....
Anthony Bray MD : i do not think your elevated liver enzymes are related to the tongue coating issue... I do think that this finding would warrant following and investigation as to the cause however. You likely have had this, I would guess... Have you been tested for hepatitis A, B and C??
Anthony Bray MD : these would be the most common viral causes of elevated liver enzymes.... Hep B and Hep C would be the most common causes of infection related chronic liver enzyme elevation....certain medications may be a cause--- even too much Tylenol may cause this....
Anthony Bray MD : Auto-immune disease may be a potential cause... There are potential problems of auto-immune hepatitis .... Liver inflammation can be an aspect of some auto- immune disorders too such as mixed connective tissue disease for example--- so testing to include checking for inflammatory diseases with checking screens for inflammation( c- reactive protein and sed rate) plus screens for auto-immune disease such as ANA and rheumatoid factor should be part if eventual work up if the liver....
Anthony Bray MD : For what I suspect may be reflux related tongue coating you may have benefit to try some reflux precautions. These would include waiting 1.5 hours after you eat before lying down. Also elevate the head of the bed 4 to 6 inches....

Pretty much been tested for everything they can think of which include autoimmune hep, except immunoglobulin levels and cholesterol.

Anthony Bray MD : The elevation of the head of the bed may be accomplished with using blocks under the bedposts at the head side....

The yellowness also appears during the day, but after a nights sleep doesn't seem as bad. If it is reflux, is this something I would notice?

Anthony Bray MD : This puts the trunk at an incline and helps to reduce or prevent as much high reflux from the stomach into the esophagus....
Anthony Bray MD : Yes typically it would be noticed as at least an occasional problem such as heartburn if this were the source but people do vary in the presentation of this problem....

I understand. I would say that I have never had heartburn. Never in my life, in fact.

Anthony Bray MD : it might be related to bacteria and food effects.... Of course everyone has these factors.... I do wonder about your history of low neutrophil count... This might be a factor.... This is unusual problem especially at your young age....
Anthony Bray MD : from your history alone I can't tell if the low white count is really clinically significant....
Anthony Bray MD : I have seen perfectly healthy patients that just tend to run a lowing white cell count but not have any problems....

The doctor said it might indicate that I have had a bug recently. It was only the neutrophil level that was low. And it wasn't very low. Just below what would be expected. All other white blood cells seemed fine.


I think this did warrant a test for Epstein-Barrs, but that was negative.


Could drinking hot drinks alone be the cause?

Anthony Bray MD : OK I see... That sounds that you would fit with the healthy individual with a slight low neutrophil county hen and that this may not be clinically significant....
Anthony Bray MD : Have you tried gargles twice a day or so with Listerine or similar product?? I think this might be helpful to the problem....

I use chlorhexidine gluconate, occasionally.


Not noticed anything yet.


I'll go to the doctors in that case and get it checked out. Wasn't sure if it was a concern or not or whether with my current raised liver enzymes it was an expected side effect.


I mean, symptom, not side-effect

Anthony Bray MD : Again I would say that having such a coating on the tongue is if a nature that everyone tends to experience to some degree. It is a common general phenomenon. It is sometimes hard to always distinguish the borderline if normal/abnormal such as with the complaint of fatigue for example. ( everyone gets tired but it is a common presentation of certain medical problems... Not always clear at what pint fatigue becomes pathological symptom... The tongue coating issue is a bit similar in this regard....)
Anthony Bray MD : No I would not expect a connection between the tongue coating and the elevated liver enzymes.... These would seem to me to be very separate issues....

Thanks for your help. That's fine then. Must go.

Anthony Bray MD : Ok take care! Let me know if you later have further questions! I will be happy to get back with you!!


Anthony Bray MD : You are very welcome. I hope that the discussion has been somewhat helpful for you
Anthony Bray MD : Best regards,

It has. Though I understand with the nature of the issue it isn't easy to sort out.

Anthony Bray MD : Anthony Bray MD
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