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What causes elevated AST and ALT levels?

DOCTOR OF THE MONTH - May 2014
May 2014
User rating for this question
Very Good
Answered by

Radiologist
Practicing since : 2002
Answered : 6421 Questions
Question
hello i have hep c and recently got my liver tests back. Can u explain them to me. Some things are high and some are normal My alt is 176, my ast is 156, my GGT is 68, my alp is 105, my alb is 4.4 my bilt is 0.4 my glob is 2.2 my tp is 6.6 and my XXXXXXX is 51.

How serious is it that my ALT and AST are high..and what should i do and what does it mean..is this indication that I have scarring in some form..?

How can i bring down the levels..
Posted Fri, 23 May 2014 in Liver and Gall Bladder
 
 
Answered by Dr. Vivek Chail 2 hours later
Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi XXXX,
Thanks for writing in again.

I am glad to be replying to you.

As in our earlier discussion, AST and ALT may be moderately elevated in cases of liver scarring or even remain normal in some patients. Scarring is seen more in people who consume alcohol regularly. If you consume alcohol then please reduce your intake and try to stop taking alcohol.

Also, an AST/ALT ratio greater than 2 supports a diagnosis of alcoholic liver disease, as does an elevated γ-glutamyl transpeptidase level (GGT) in the setting of an AST/ALT ratio greater than 2.

If you do not have alcohol regularly then the AST/ALT ratio is a dependable marker of fibrosis stage and cirrhosis in patients with chronic HCV infection. In this case an aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio >1 suggested cirrhosis. The further confirmation of liver scarring or cirrhosis can be made only by imaging and liver biopsy.

I would like to know if you are taking any treatment for your hepatitis C infection.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by
 
Follow-up: What causes elevated AST and ALT levels? 25 minutes later
hello, I have not had any treatment for the Hep C, only natural things like liver support etc.

As far as drinking, I don't drink a lot but have a drink sometimes, maybe 1 or 2 a week.

you said " lso, an AST/ALT ratio greater than 2 supports a diagnosis of alcoholic liver disease, as does an elevated γ-glutamyl transpeptidase level (GGT) in the setting of an AST/ALT ratio greater than 2.

If you do not have alcohol regularly then the AST/ALT ratio is a dependable marker of fibrosis stage and cirrhosis in patients with chronic HCV infection. In this case an aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio >1 suggested cirrhosis. The further confirmation of liver scarring or cirrhosis can be made only by imaging and liver biopsy.


do u think u could explain that to me a bit more simply...what you mean and how it relates to me. Also u didn't mention if there is anything to do besides not drinking to bring down levels.

Any food or natural things that could help?
 
 
Answered by Dr. Vivek Chail 4 hours later
Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

Your alcohol intake is acceptable and not really a risk for liver disease. The AST/ALT ratio more than 2 is for people with chronic alcohol intake and not you.

In your case the AST/ ALT ratio is less than 1 so cirrhosis is not expected right now keeping in mind your enzyme levels. However, there have been patients in whom even with normal enzyme levels (AST and ALT) cirrhosis may be seen. SO what I mean is that AST and ALT levels are not absolute markers for development of cirrhosis. Imaging does play an important role and regular ultrasound scan and an occasional CT scan of abdomen if necessary might help to pick cirrhosis in its earliest stages.

Food to include in your diet

Fresh fruit and vegetables.
Complex carbohydrates.
Adequate amounts of protein.
Foods rich in fibre.
Foods low in fat.

Foods to avoid

Fried foods.
Fatty foods especially saturated and hydrogenated fats.
Processed food and junk food.
Foods containing additives and pesticides.

People with chronic hepatitis C should reduce the amounts of iron rich foods in their diet. These include red meats, liver, oysters, tuna, sesame seeds, apricots, prunes and iron-fortified cereals.

It is important to avoid taking iron supplements, unless advised by your doctor. Multivitamin tablets often include iron, so check the label. It is also important to be aware that vitamin C increases the absorption of iron from food.

Overweight patients with a fatty liver who reduce their weight are likely to experience an improvement in fat-related liver abnormalities. Consequently people with chronic hepatitis C should try to maintain a normal weight in order to avoid additional stress of their liver.

People with hepatitis C should, where possible, avoid drinks that contain caffeine or try to reduce their intake.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by
 
Follow-up: What causes elevated AST and ALT levels? 7 hours later
thank you, its been helpful understanding all of this more. Thank you for your patience.


I have not gone the way of taking heavy drugs to try and cure my Hep C as I have read so much about it and makes me weigh things up alot. I have heard there are new possible cures for Hep c. Would u know about this and how things are looking in this regard?
 
 
Answered by Dr. Vivek Chail 5 hours later
Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

Treatment for hepatitis C patients is one of the difficult questions to answer as you may already know. The main problem is with adverse effects which can cause further problems to you. I will present some of the facts which are in practice and both the advantages and disadvantages of taking treatment.

Advantages:
Taking medications in the only proven method to clear the viral load. Interferon and ribavirin are known to help in this regard. Treatment has also been shown to improve the health of the liver by reducing inflammation. It may also be able to reverse fibrosis or even cirrhosis. Rarely this can also be seen in those not taking treatment. If treatment is successful then you no longer are at risk of infecting others.

Disadvantages:
The major disadvantage to treatment consists of the side effects. Not everyone necessarily experiences them. It can take a few months after the treatment ends before the drugs are cleared from your system. Ribavirin can take up to 6 months to clear. This could impact on your work, relationships, and on your social life. This might mean you have to tell people that you are doing treatment and therefore that you have hepatitis C.

Occasionally, the side effects can be so severe that they could force you to abandon treatment. You could be left with an illness after you stop treatment, such as thyroid disease or diabetes.
There is also the possibility that treatment might not work for you.
Some people have reported that the side effects have persisted, leaving them feeling unwell long after the end of treatment.

Treatment may take 24 to 48 weeks to complete.

Recently Two drugs that have already been approved for safety by the FDA and the European equivalent are Telaprevir (Janssen) and Boceprevir (Merck/MSD).

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by
 
Follow-up: What causes elevated AST and ALT levels? 4 hours later
U mentioned having a few drinks a week, won't effect the liver even though i have hep c. I just wanted to double check that info. I would to be able to still have a glass of wine or 2 a week., but since getting the test results..I have been more worried about doing that.

Any thoughts..

I think i may have gotten Hep c..during my teen years..and thats a long time ago. I really don't know as I can't think of only 1 time that it might have been possible. i am now 58, which means it was about 40 years ago..how does it look for having hep c after so long...?
 
 
Answered by Dr. Vivek Chail 1 hour later
Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi,
Thanks for writing back with an update.

Research shows that that heavy alcohol intake (50 grams/day or more) contributes to fibrosis on liver biopsy in patients with HCV independent from other predictors. This intake is equivalent to 5 or more drinks per day (an average "drink"--one 12-oz beer, 5 oz of wine, or one 1.25 oz shot of hard liquor--contains approximately 10 grams of alcohol).

This is classified as moderate drinking. Since you take 1 or 2 drinks per week, it is very less in quantity and you are not a moderate drinker.

It is important for you to get tested for viral load and if possible genotype testing if possible. This will tell the ability of virus clearance by your system. If your system clears the virus then there is not much to worry about.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by
 
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