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Old 01-31-2011, 12:11 PM   #1
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ALT=62, AST=123, ALP=64 How serious?

In early January I had some abnormal liver function test results. Below is comparison to two other tests and the current labs normal range (I wish I could format things):

.............1/3/2011.......8/14/2009...3/31/1997..lab Low..lab High
NA+....... 142...................141.........139... ......128........145
K+......... 4.6....................3.9..........3.8. ........3.6........5.1
TCO2..... 26.....................NA..........24... ........18..........32
CL-........ 105...................100.........102... .......98........108
GLU........131-H................256........99.......... .73..........118
CA......... 9.6....................9.2.........9.5.. .........8.........10.3
BUN........16.....................15.... ......20...........7...........22
CRE........0.4-L.................1.1.........1......... ..0.6........1.2
ALP........64......................93... ......72...........42........141
ALT (SGPT)62-H................41.........24.......... 10..........47
AST (SGOT)123-H...............9.........15...........1 1.........38
TBIL.......0.8....................0.8... ......0.6.........0.2........1.6
ALB........4.......................3.9.. ......4.4........3.3........5.5
TP.........7.1.....................7.3.. ......7.4.........6.4........8.1

My background:

I am 62 and male. I am on Testosterone HRT of Androgel applied via a gel to upper arm each morning. I have pre-Diabetes or am controlling Type 2 diabetes with exercise and diet depending on whose definitions you want use. My last two A1C's were 6.4 and more recently 6.1. I have lost over 40 pounds and been exercising a lot; mostly running 3 to 6 miles 2 to 4 times per week and averaging about 8 to 20 miles a week.

In the week prior to blood test, I over-did my exercise. I did some killer weight lighting to the point I could hardly move my upper body two days before the blood test. I also did some hill running that pushed past normal exhaustion. I don't remember taking any ibprofine, but I could have. I don't really drink to excess, but do like a glass of wine for dinner. The night before the test I had two glasses of red wine and then some brandy after dinner, (which is much more than normal). I have also been taking a variety of supplemnents to boost bone health, muscle health and glucose.

Since the test I have stopped drinking all alcohol. I have cut down and now stopped all suplements and am exercising more moderately. I just had a second blood test and will get the results in about a week.

I now realize that extreme exercise up to 6-8 days prior to a blood test can raise AST. That pain medications and alcohol can raise ALT and other liver enzymes.

At first I wanted to say this was all a problem with exercise, but my CRE is low not high, so that doesn't seem to make sense.

From what I have read, chromium and Vitamin D can raise liver enzymes, which I have been taking for about two years in mdoerately large doses. So that might have contributed.

Similarly, type 2 diabetes, and being overweight (still have 25 more pounds to get to ideal weigh but my BMI is overweight no longer obesse) could contribute to high liver enzymes. And the warning information in the Androgel says that in a 3-year study of 162 men, 15 had one or more abnormal test results involving: elevated ALT, elevated AST, elevated testosterone, elevated hemgolbing elevated cholesterol, elevated creatine.

So now for the questions:

How bad is an ALT=62 and AST=123? Should I be concerned about a low CRE? Does the AST/ALT ratio of just under 2 suggest alcohol problems? Does the normal ALP mean things aren't too bad?

If my new test numbers come in with "high" for ALT and AST, should I ask for an ultrasound of my liver, or just give it some additional time for no alcohol, no supplements, etc to let my liver clear out before another liver enzyme blood test in say 3 to 6 months? And if I do just wait for some time to see if the liver functions go back to normal, how serious is an ALT=62 and AST=123, as I really want to get back to the gym to work out and continue loosing weight as I want to really get my blood glucose under control.

Would a high AST from hard exercise or work-outs be dangerous to my liver and health?

Any insights would be very helpful! Thanks.

 
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Old 02-04-2011, 09:49 AM   #2
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Re: ALT=62, AST=123, ALP=64 How serious?

OK, I just got the results back from my second liver enzyme test.

Fasting Glucose 146, High
A1C 6.3% High
Protein 6.9%
Albumin 4.5%
Bilirubin 1.2
Bili-Direct 0.4 High (range 0.0 to 0.3)
SGOT (AST) 46 High (range 5 to 40) (previous test 123)
SGPT (ALT) 81 High (range 5 to 50) (previous test 62)
Alk Phosphatase 68 (previous test 64 normal)

So rather than having an AST/ALT ratio of almost 2 which would be close to alcohol liver damage, I now have an AST/ALT ration of 0.57 or <1, which implies potential fatty liver.

I am amazed that strenuous exercise a few days prior to a liver blood test caused my AST to be 123 and then when I laid of heavy exercise just prior to my second blood test, the AST value dropped to 46. While 46 is slightly above the "normal range" for this lab (5 to 40) it is just slightly elevated compared to where it was. So I feel much better about that and that having abstained from alcohol for several weeks also probably helped.

The ALT, which is more liver specific is more of a concern. The doctor told me that there was little he cold do except to encourage me to continue with lifestyle changes, no alcohol, limited supplements, exercise to reduce weight and visceral fat. He told me to continue what I was doing and come back in 3 months for another test.

So, anyone have any idea how serious it is for a pre-diabetic (or a type 2 diabetic who is controlling blood glucose with just diet and exercise) to have an ALT about 60% greater (or 1.6 times) the normal max reading and a AST/ALP ratio of about 0.6?

Any thoughts would be appreciated.

Thanks

 
Old 02-05-2011, 01:50 PM   #3
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Re: ALT=62, AST=123, ALP=64 How serious?

After me recent test results, talking to my doctor and getting a perspective from someone who has numbers like mine, I feel that if I keep loosing weight, exercise, go ultra light on alcohol (save one glass for just special occasions), I hope to work toward normal test results.

http://www.healthboards.com/boards/showthread.php?t=755480

I appreciate this website!

 
Old 05-13-2011, 01:34 PM   #4
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Re: ALT=62, AST=123, ALP=64 How serious?

OK, I am feeling better after my third set of tests!

I took the test yesterday, made sure that I did no real exercise for almost 11days (which has been difficult for me), so there would not be any spikes in AST & ALT due to exercise.

I have been cutting back on supplements for the past couple months to just a few that are not suppose to raise liver enzymes. I have added Milk Thistle to what I take. I also have been working on loosing a little bit of weight (lost about 5 pounds--could stand to loose another 20 pounds). Most importantly I have been abstaining from alcoholic beverages except for an ocasional celebration (small glass of red wine at Mother's Day dinner, beer at lunch after finishing a half marathon about two weeks ago).

The following are some of my recent blood work results:

Gasting Glucose 143 H
A1C 6.1 H
Total Protein 6.7 (range 6.4 to 8.4)
Albumin 4.4 (range 4.2 to 5.5)
Globulin 2.3 (range 2.0 to 5.0)
AST 32!!!!!! (range 10 to 45)
ALP 99 (range 25 to 136)
ALT 68H (range 5 to 52)
Total Bilirubine 0.4 (range 0.2 to 1.2)
Direct Bilirubine 0.1 (range 0.0 to 0.3


OK, so my AST is now within the "normal range!"

However, my ALP (more liver specific) is still above the normal range. My ALP has gone from 24 in 1997 to 41 in 2009 to 62-H in Jan of 2011, to 81-H in Feb of 2011 and now back down to 68-H in May of 2011.

Since the lab's range for ALT is 5 to 52, a value of 68 is "high," but about 1.3 times the high value. From what I have read that is "mildly elevated" and the trend is in the right direction.

I guess, I will keep working on life style changes and see about another test of liver enzymes in a few more months. I have a doctor's appointment for another blood test at the end of July.

So my questions for the group...

How serious is an ALT of 68 (normal lab range 5-52)?

Should I reserve judgement until I see if it goes lower? Any advise from folks who have experience in this would be appreciated.

I now realize that my AST was high due to my heavy exercise program just prior to my test at the beginning of the year.

ALT is suppose to be more liver specific than AST, but my last three readings have all been "higher" than normal lab ranges. Just mildly elevated, but still higher than normal.

Last edited by Robert32asp; 05-16-2011 at 11:45 AM. Reason: edits and additional info

 
Old 07-22-2011, 02:13 PM   #5
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Re: ALT=62, AST=123, ALP=64 How serious?

Just got my latest lab reports back. ALT=27; AST=16.

Both are well within the normal ranges!

I have really cut down on both the wine/beer I drink and tried to eat very healthy as well as take a capsul of milk thistle each day. I have lost a little weight since the beginning of the year and I have done a lot of exercising.

I blame the high AST reading on excessive exercise and the high ALT reading on having some alcohol the night before the test as well as maybe a slight fatty liver that was made better by exercise and a little weight loss.

I have to say that I am really disappointed in the lack of comments I have gotten on my original post, but there is a lot of good information on the website, but one has to dig for it.

If anyone reads this I can tell you that as long as your liver functions are only mildly elevated (i.e. ,2 to 3 times normal max) and based on my experience, I wouldn't get too worried as within 6 or 7 months you should be able to get them down to a normal range with some work and effort. Good luck to anyone reading this.

P.S. my Cre is still borderline low 0.6 and they are now saying that my kidneys are just "efficient."

Last edited by Robert32asp; 07-22-2011 at 02:16 PM. Reason: added Cre test result

 
Old 12-07-2011, 10:33 AM   #6
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Re: ALT=62, AST=123, ALP=64 How serious?

congratulations on working things out. your post was reassuring to me--at 61, high BMI but in pretty good shape otherwise, and I like my martinis, have ALT AST in high normal range--to see what you have accomplished made me feel better about where I am as I am starting to increase my workouts and cut back on the alcohol before I hit problems down the road. Cheers!

 
Old 12-07-2011, 10:52 AM   #7
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Re: ALT=62, AST=123, ALP=64 How serious?

I am glad, my posts helped you. I know that when I first got my "high" or abnormal readings, I really couldn't find any good answers about how serious things were.

Ultimately, I began to find bits a pieces of informaton on the internet, but wasn't sure what was "truth" and what might be fiction. I had really hoped that this forum would have had more action and people getting back to me about if this was serious or not.

Even my doctor really wasn't all that sure about how serious the readings were. The lack of information was what concerned me. Also there are lots of horror stories of people with compromised livers or kidneys on this forum, so the potential for horible things is real.

Ultimately, things turned out OK for me and I now feel I understand some of the causes of the high readings.

At any rate, congratulations on deciding to adopt a more healthy lifestyle.

There is a good book that I just got. It is called "Younger Next Year: Live Strong, Fit, and Sexy - Until You're 80 and Beyond." I highly encourage you to consider getting it, especially if you are anywhere near age 40 or above.

Good luck

 
Old 12-15-2011, 12:28 PM   #8
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Re: ALT=62, AST=123, ALP=64 How serious?

Thank you for sharing your story and I'm glad the lifestyle changes are helping you. I am 26 yrs old and tested positive for AST (~100 U/L) and borderline high for ALT (60 U/L) last week despite testing normal three months ago (17 AST 15 ALT). I have just started lifting weights again for the first time in a very long time (years) and did very rigorous workouts leading up to the test. I don't know if exercise played a rold in this rise or not, but your story is fascinating.

I would really appreciate it if you could respond based on your experience
1) How long does it take roughly for your AST/ALT values to normalize after ceasing exercise (assuming it is exercise-induced)- i have found 7-10 days somewhere online but I would appreciate your input.
2) Have you found any good information online regarding AST/ALT and exercise/protein consumption (I started taking whey protein a few weeks ago)
3) How have you changed your workout regime since first testing high? Do you still workout or are you afraid it might raise your levels if you do so

Thank you!

 
Old 12-15-2011, 01:01 PM   #9
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Re: ALT=62, AST=123, ALP=64 How serious?

Quote:
I don't know if exercise played a role in this rise or not, but your story is fascinating.
I would wager that weight lifting was a huge part of your AST value.

Becareful with supplements as they can be a big cause of ALT & ALP abnormal readings. Investigate each supplement you are taking for any impact on ALT. ...and especially cut back on alcohol and also give up taking any pain relief medications for a month or two prior to your next blood work.

Quote:
I would really appreciate it if you could respond based on your experience
1) How long does it take roughly for your AST/ALT values to normalize after ceasing exercise (assuming it is exercise-induced)- i have found 7-10 days somewhere online but I would appreciate your input.
2) Have you found any good information online regarding AST/ALT and exercise/protein consumption (I started taking whey protein a few weeks ago)
3) How have you changed your workout regime since first testing high? Do you still workout or are you afraid it might raise your levels if you do so
  1. I too have seen times in the range of 7 to 10 days - I stopped all exercise for nearly 2 weeks prior to my tests. That seemed to work well for me.
  2. I am a 62 year old guy, so body building is not really in the cards for me. I do eat a low GI, palio-like diet, so I get plenty of protein, just not too much dairy. I can't really help with this.
  3. I still work out, but have shifted more to light free weights and shorter running distances. I did a 5K last weekend.

    The main change has been that my cardio treadmill runs from gotten a lot shorter. Instead of 60 to 120 minute treadmill runs to prepare me for half marathons, I am doing 30 to 55 minute cardio on a treadmill. I am also doing less near-max heart rate running. I use to regularly do running for a good part of each training at 90%+ of Max measured heart rate. I now try to keep it well below 80% max heart rate, except for brief intervals every now and then. I still work up a sweat.


I hope that the above helps. Again, I wouldn't worry too much about incurable liver disease with your mildly elevated readings, if I were in your shoes (but you get to worry about whatever you want to and should work with a doctor of your choice).

Good luck to you.

 
Old 12-15-2011, 04:29 PM   #10
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Re: ALT=62, AST=123, ALP=64 How serious?

Thank you for your detailed response! My doctor (who happens to be a rheumatologist) who contacted me yesterday (via his assistant) feels that I should have the test repeated next week - as a worrier I would prefer to retest sooner than later. I am not into body building either, but as fairly lanky (6'4 190) single fellow I felt it was time to head back to the gym (around 1 month ago) to start sculpting the guns.
I will push the test to late next week to allow for 8-9 days of rest (had a heavy chest workout Tuesday, the day before I received the results). I will report the results when I get them. Since you are obviously knowledgeable regarding this matter and state that the AST/ALT are "mildly elevated" then that is somewhat reassuring. The AST value increased 6-7x from the previous result of 17 to 100 so I would think that at least a modest increase and indicative of liver damage, don't you agree? If I do not hear from you, happy holidays!

 
Old 12-15-2011, 11:27 PM   #11
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Re: ALT=62, AST=123, ALP=64 How serious?

Quote:
Originally Posted by Julian18 View Post
.....I will push the test to late next week to allow for 8-9 days of rest (had a heavy chest workout Tuesday, the day before I received the results). I will report the results when I get them.

..The AST value increased 6-7x from the previous result of 17 to 100 so I would think that at least a modest increase and indicative of liver damage, don't you agree? ...

Good to push the test off, but you may actually want even a bit more time, but that should drop things to the point that you shouldn't be as worried (fingers crossed).

As to your AST going from 17 to 100, well my AST went from normal to 123 and it is now normal again, so I don't think that for me there was any long term liver damage. You are a lot younger and in theory, your body should have greater recouperative powers than my old body.

Good luck, even if your results aren't completely normal, I'll bet there are going to be a lot better. Talk to your doctor, get a copy of your lab results and the old ones that scared you so you have all the data.

 
Old 12-23-2011, 01:26 PM   #12
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Re: ALT=62, AST=123, ALP=64 How serious?

Hi - just wanted to share an update with my new test results. I have not received word from my doctor (and I don't want to read too much into this until I do) but a copy of the results were sent to my cell phone via the Gazelle App (great app - got results the day after the test).

The AST and ALT values came down to 16 U/L and 18 U/L respectively after abstaining from exercise for 9 days while the ALP remained relatively constant at 67. As I had stated before, these values had jumped to AST 100 U/L and ALT 57 U/L on December 9th (incidentally 1-3 days after heavy upper body workouts). As you mentioned before, it appears that exercise may influence and increase these levels beyond the "normal" range. Perhaps further study is warranted.

Nevertheless, I don't know if I will be able to continue my workout regime because it seems it can really spike liver enzymes! I will speak to my doctor to see what he thinks, and I might try to consult the opinion of an expert in hepatology before I get back into a routine. I hope that these posts will be informative to patients who feel lost/confused with the lack of information regarding these tests. Thanks for listening!

 
Old 12-23-2011, 02:41 PM   #13
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Re: ALT=62, AST=123, ALP=64 How serious?

Quote:
Originally Posted by Julian18 View Post
....Nevertheless, I don't know if I will be able to continue my workout regime because it seems it can really spike liver enzymes! I will speak to my doctor to see what he thinks, and I might try to consult the opinion of an expert in hepatology before I get back into a routine. I hope that these posts will be informative to patients who feel lost/confused with the lack of information regarding these tests. Thanks for listening!
I think your feedback is the kind of thing I would have liked to see when I was really scared by my results. Hopefully it will keep someone else from loosing too much sleep.

I know that the place where I got my original liver enzyme test, after a few weeks asked me to fill out a customer survey, and I told them that their service sucked as they should have told me ahead of time not to do heavy exercise the week prior to my test. I told them that just like warning people not to eat ahead of time for certain blood tests, they should warn not to strenously exercies for other tests.

I would like you to think about what you are going to ask your doctor and then let everyone know what he says.

First, I think you have characterized things a bit wrong from my limited and non-medical training perspective. My understanding is that heavy exercise causes certain muscel cells to "break down" and be rebuilt. This confuses the test as the test "assumes" that the broken down cells originate in the liver and damaged organ cells. Again the test assumes that liver damage is the cause of the broken down organ cells and can't tell that they are normal muscle cells.

If that understanding of mine is correct, then stopping your exercise program does nothing to improve your liver, it just removes a tiny bit of the normal junk that your liver is suppose to screen out of your blood stream.

The point of the liver enzyme test (as I understand it) is to identify a damaged liver and not to stop people from exercising.

If my understanding is correct, there is no reason to stop exercising as it probably has lots of great benefits. Again, talk this over with your doctor. Mine is all for me doing as much crazy exercise as I can handle, but not near any liver enzyme tests.

 
Old 12-23-2011, 03:07 PM   #14
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Re: ALT=62, AST=123, ALP=64 How serious?

I told them that just like warning people not to eat ahead of time for certain blood tests, they should warn not to strenously exercies for other tests.

I would like you to think about what you are going to ask your doctor and then let everyone know what he says.

First, I think you have characterized things a bit wrong from my limited and non-medical training perspective. My understanding is that heavy exercise causes certain muscel cells to "break down" and be rebuilt.


These are great points. It is such a shame that this information isn't conveyed to patients beforehand. If you are reading this thread please note I am not suggesting you cease exercise just because you observe an exercise-induced increase in liver enzyme levels. I do not have the answers yet, but I intend to seek answers from a doctor knowledgeable in this subject and I will share this information with you. Simply from scoping the internet for a couple of weeks, I have found arguments that, as you state, transaminase levels (AST or ALT) are only a potential marker of liver, muscular, heart, or brain damage and not necessarily indicative of liver disease.

Thanks for being supportive. Happy holidays.

 
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