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Elevated AST level. Liver ultrasound normal, hepatitis tests negative. What is causing high AST level?

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General & Family Physician
Practicing since : 1978
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Female, 21, elevated AST level (897), other enzyms' levels within limits. Tests are done every 6 months. No visible problem. Liver ultrasound done - nothing found. Hepatitis and mononucleosis tests - negative. Muscles tests were fine. Elevated AST level first observed 2 years ago, was around 1400. Appendictomy was performed 6 months after that. Doctor's visted were unable to find the cause of the elevated AST. What in your opinion could be causing this?
Posted Mon, 23 Jul 2012 in Liver and Gall Bladder
Follow-up: Elevated AST level. Liver ultrasound normal, hepatitis tests negative. What is causing high AST level? 10 minutes later
Other test results (done 2 days ago, almost identical to tests done 6 months ago):
total protain=6.6, albumin level=3.6, total bilirubin=0.4, direct bilirubin=0.3, ALT=24, Alk Phosphatase=57;

Only AST at critical level of 897Cf
Answered by Dr. Pavan Kumar Gupta 6 hours later
Hello and thanks for the query.
AST is present in significant amounts in liver,skeletal muscles,heart and erythrocytes.Injury to any of these organs or cells can result in release of enzymes in circulation.
Consequently increased levels of AST should result in prompt clinical evaluation including abdominal imaging studies and laboratory assessment of hepatocellular,muscle or cardiac causes.
Further medications like erythromycin can also result in increased levels of AST.
Till now several cases have been reported in literature where AST was found to be as high as 50 times than normal values and barring few cases where some malignancies or auto immmune diseases was found,most of them were normal.

Indeed absence of any pathology over a long period of time in a healthy individual with very high levels of AST makes us to believe it to be a benign problem.
Many cases have been seen where very high levels of AST was observed for 10 years or more without any associated pathology.
Laboratory results should always be interpreted in conjunction with clinical examination,medical history and other findings.
Single enzyme elevation along with no other lab finding suggests your problem to be benign in nature however you should be in regular touch with your doctor and keep on having a close watch on the situation.
I hope to have answered your query however you may revert to me for any further query.
Best of luck.
Above answer was peer-reviewed by
Follow-up: Elevated AST level. Liver ultrasound normal, hepatitis tests negative. What is causing high AST level? 9 hours later
Thank you for your response. It made me feel much better.
I have another question. Do you think that heavy exercise could also increase AST levels? I am a fitness instructor and personal trainer, so excessive exercise is just my way of living. For last couple years I’ve been training every day. There are many controversial opinions on the subject. Please let me know what you think.
Also I’ve heard about an herbal supplement called Milk Thistle. It’s supposed to be very beneficial in the lowering of the liver enzymes levels. Did you hear about this product?
Answered by Dr. Pavan Kumar Gupta 2 hours later
 heavy exercises can't increase your AST levels to such high levels.

At this point, there is not enough scientific data to say whether or not milk thistle can help liver problems. Some early research suggests milk thistle may aid people with alcohol-related liver disease. Other studies show no improvement in liver function in this group of people.

More information is needed before doctors can say milk thistle actually benefits the liver.
Although I am not against your use of milk thistle.You may give it a try.
Above answer was peer-reviewed by
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