DEAR DR. DONOHUE: I am a 68-year-old woman in excellent health. I recently had standard blood tests done. My doctor said my liver enzymes were high. He said he finds this only in people who drink. I do not drink, and never have. He said the only other reason he knew was high fat intake. That doesn’t fit me either.

I am concerned. If neither drinking nor high fat intake is causing the elevated enzymes, what is? — B.B.

ANSWER: Enzymes are proteins within all body cells. They keep cell chemistry moving at optimum speed. Some enzymes are unique to a particular organ or limited to a few other organs. A rise in the blood level of liver enzymes indicates some damage to liver cells. The height of the rise offers an estimate of the degree of damage.

All the hepatitis varieties (A, B, C) raise liver enzymes. An attack by the immune system on the liver does the same. Hemochromatosis, an inherited condition in which an overload of iron enters many organs (including the liver), is another cause of an increased blood level of liver enzymes. Congestive heart failure can elevate them.

I don’t think your doctor said a high-fat diet is a reason for high liver enzymes. I’ll bet he said fat infiltrating the liver can lead to a leak of liver enzymes into the blood. This is a common condition, with a name: nonalcoholic fatty liver disease, NAFLD. Between 14 percent and 20 percent of the adult population has it, to a degree. It’s not an immediate health concern. However, it can progress to NASH, nonalcoholic steatohepatitis, liver inflammation that produces liver scarring and eventual liver cirrhosis.

Faced with a patient like you, a doctor can opt to treat you for NAFLD and see if the enzymes drop. The treatment is weight reduction, cutting back on fatty meats and whole-fat dairy products, limiting the use of food prepared with lots of sugar and exercising daily.

The other approach is testing for all causes of enzyme elevation. If no diagnosis is forthcoming, a liver biopsy almost always reveals the cause.

DEAR DR. DONOHUE: I’m always surprised you don’t mention Miacalcin (calcitonin-salmon) when discussing drugs for osteoporosis. I had been on Fosamax for a decade. My doctor offered Miacalcin as an alternative, and I have had a decent response. — S.L.

ANSWER: When other osteoporosis medicines can be used, they’re usually chosen over Miacalcin. Many doctors feel they do a better job. Furthermore, a popular Miacalcin product is a nasal spray, and some patients don’t like that. It’s also comes as an injectable, and an oral preparation is soon to appear.

You are an example of someone who is a natural for Miacalcin use. Incidentally, calcitonin is a hormone made in the pancreas. One of its effects is to stop bone breakdown. Salmon calcitonin has a greater effect than human calcitonin. The product is now manmade.

DEAR DR. DONOHUE: I am a 73-year-old man in excellent health. My cholesterol is 204 mg/dL (5.23 mmol/L), my LDL cholesterol is 128 (3.3) and my HDL cholesterol is 63 (1.6). I do four miles a day for exercise. If I want to indulge, what is the least of three evils: sugary dessert, high-salt food or high-saturated-fat dish? Is there any harm in eating that kind of food three to four times a week? — M.B.

ANSWER: You’re in good health, with no signs of heart disease. Your blood pressure is normal. Your cholesterol levels are OK. If you want, you can indulge in any one of your “evil” foods once or twice a week. If you want to do it three times a week, then pick one day for a meal with saturated fat, another day for a meal with a sugary dessert and the third day for a meal with salt. That’s enough. If your lab values change, then go back to the more ascetic diet.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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