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Old 08-31-2012, 12:46 PM   #1
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high ast and alt doctor is stumped

I did not really have any symptoms, it just came up on my yearly checkup. Have a artificial mitral valve so have a yearly echo and labs. AST is 357, ALT is 719. Had an ultrasound, came back normal. Tests for hepatitis are negative and all other liver, pancreas and gallbladder tests are normal. They don't believe it is related but I had a colonoscopy almost two weeks ago and was on lovenox. My INR did not come up enough after 3 days back on coumadin so had to keep taking the shots for a week after the colonoscopy. I did have some abdomen tenderness then but thought it was because I was so bruised from the shots. So now going to wait a week and retest. I am overweight but I guess fatty liver usually won't show levels this high. Anyone ever run into something like my case?

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Old 08-31-2012, 07:41 PM   #2
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Re: high ast and alt doctor is stumped

I'm not a doctor, but my wife had an aortic valve (artificial) put in many moons ago...

I remember when researching the advantages and disadvantages of artificial vs porcine valves, one of the disadvantages with artificial valves is that they rupture red blood cells as the little doors of the valve slam shut against the frame of the valve. A process known as hemolysis.

These ruptured blood cells spill their contents (a substantial portion if which is iron) into plasma, and your body then recycles this material back into new blood cells.

One area of interest I am currently studying is the role of iron in liver disease. Iron is a powerful pro-oxidant and is associated with liver inflammation in a number of disease processes. I have read how hemolysis can cause problems with high iron, and thought of this when I saw your post. I haven't looked into whether this is a known issue with artificial heart valves or not, but I thought you might want to look into this.

You might request a "full iron study" with your next blood work to rule this out as a possible contributing cause to your high liver numbers. Iron studies are very cheap blood labs and your doctor shouldn't object to this.

From what I've read, high iron is most problematic in the liver when combined with high intake of polyunsaturated fats and oils (margarine, fish oil, vegetable oils, deep fried food, etc), where iron acts as a catalyst for lipid peroxidation of these polyunsaturated fats.

When you get the results from your iron study, pay attention to "ferritin" as the upper limits for "normal" are set quite high. Usually around 200 to 400 depending on the lab. Your doctor may consider ferritin in the upper third of the normal range as nothing to worry about, but many believe "optimal" levels for ferritin to be in the lower half of the normal range, with 40 to 80 often stated as desirable, and ferritin over 150 as unhealthy, particularly when dealing with liver inflammation that can not be explained by other means. Google around on: Iron, too much of a good thing, for more on this.

High iron is very easy to fix with "therapeutic phlebotomy" or dietary measures, so if iron is your problem, this could be a good thing.

For fatty liver, especially with a diet high in polyunsaturated vegetable and seed oils, vitamin-E has been found to reduce inflammation, including that caused by high iron. Google around on: fatty liver and vitamin-E for more on this.

Best of Luck to you, and stay healthy!

Last edited by BillinSD; 08-31-2012 at 08:11 PM. Reason: addition

 
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Old 09-01-2012, 12:08 AM   #3
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Re: high ast and alt doctor is stumped

Thanks for the info. I took a look at test results and my ferritine level last November was 230. I will mention this to my doctor.

 
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Old 09-01-2012, 07:20 AM   #4
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Re: high ast and alt doctor is stumped

You're welcome Mr V... A serum iron, transferrin saturation, and iron binding capacity (TIBC) blood test will show if you have excess "free iron", which is the most problematic kind.

Moderately high ferritin is usually considered relatively safe, as iron stored as ferritin is non-reactive. Problem is, ferritin can leak, and different processes in the body can cause it to break down releasing free/reactive iron into plasma.

Again, when it comes to free/serum iron and transferrin saturation, numbers in the middle or lower half of the normal range are more desirable than numbers up near the tippy-top of the accepted range. With iron binding capacity, more is better.

Coffee and tea drank with meals will reduce iron absorption from food... Vitamin-C and acidic drinks/foods like orange juice or tomatoes will INCREASE iron absorption from foods. Polyunsaturated vegetable oils will react with excess iron causing problems. Saturated fats (butter / animal fat) do not oxidize as easily.

Vitamin-E will lower lipid peroxidation in the liver from any cause (fatty liver or iron) and is recognized as the best "medicine" for fatty liver by medical and government health institutions.

Lower your iron numbers and your liver numbers will come down too!

 
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