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Blood work result showed elevated AST and ALT level. Is this serious? Worried for alcoholic hepatitis

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Blood work Results 03/27/13 AST 176 (0-33 range), ALT 78 (0-45 range) Alkaline Phos 90 (30-125 range), Billirubin 0.8 (0.2-1.5 Range), GGT, 27 (0-65 Range), Total Protein 8.3(6.1-8.2 range) Albumin 5.9 (3.8-5.2 range). Blood Work 09/22/2011 AST 29, ALT 32, Alkaline Phos 104, Billirubin 0.6, Total Protein 7.6, Albumin 4.7. Blood Work 05/18/2009 AST 35, ALT 30, Alkaline Phos 124, Billirubin 0.4, Total Protein 7.7, Albumin 5.0 Blood Work 03/23/2009 AST 33, ALT 31, Alkaline Phos 112.

My recent results had shown a large increase in AST and ALT. My question is how high are these considering. My research is leading me to think Alcohol Hepatitis? I do drink about three times a week. Each weekend I drink one night maybe 6-10 drinks During usually twice with each occasion being about 2-3 drinks. Im 35, 165 pounds. 13% bodyfat. Workout once or twice a week. I havent had a drink now in a month. I didnt have a drink for about 14 days prior to the most recent test. What are your thoughts, should I go for another test now? Do these numbers look serious? My last test which was about 1.5 years apart from this test that shows high numbers. Could this level of drinking really do this level of increase. I did work out 5 days prior to the test that was so hard that I could barley walk the next 3 days, or about 3 days from my test. Could this being 5 days away have a effect on my results?

Posted Sun, 5 May 2013 in Digestion and Bowels
Answered by Dr. Ratnakar Kini 10 hours later
Thanks for posting your query.
I am Dr.Ratnakar Kini and I am pleased to answer your query.

Yes the AST and ALT are raised. Anything more than 2 times the upper limit of normal is considered significant.
Alcohol is the likely cause in your case. You can repeat the test 4 weeks after you stop drinking alcohol.
I hope that answers your question.
If you have no more questions kindly rate this service.
Dr.Ratnakar Kini
Above answer was peer-reviewed by
Follow-up: Blood work result showed elevated AST and ALT level. Is this serious? Worried for alcoholic hepatitis 3 days later

Thank you for your response.

What are your thoughts that went unanswered in my first question about working out. Do you think a strenous workout could scew the levels 4-5 days prior to my test. I recall being so sore after my workout and having a hard time walking 3 days prior to the test.
Given the information I provided from my historical LFT tests. Would you be leaning more in favor of a mild fatty liver, or would you lean more towards a more serious alcohol hepititis considering I had normal values 18 months prior?
Clearly if the levels are raised due to alcohol consumption, ceasing alcohol is #1 priority. I have also read possible taking Milk Thistle, Drinking more than 2 liters of clean water a day. I already exercise and have a low fat percentage. What other advice would you give to your patients in regards to ways, or foods they should consume that might help the recovery faster. Example: instead of just Veggies, I have read Broccoli may be the best to add due to its fiber content.
Currently I am taking fish oil pills, Green Tea supplement and a Multivitamin called Animal Pak. Its ingredients are below are for 2 servings a day. Currently I am only taking half (or one). Do you think anything listed below or any supplements I listed above should not be taken with a inflammed liver?

Ingredient     Amount     
Calories     16     
Total Carbohydrates     1g     
Protein     3g     
Vitamin A     9900IU     
Vitamin C     1g     
Vitamin D     680IU     
Vitamin E     300IU     
Thiamin     76mg     
Riboflavin     76mg     
Niacin     82mg     
Vitamin B6     72mg     
Folic Acid     400mcg     
Vitamin B12     6mcg     
Biotin     300mcg     
Pantothenic Acid     76mg
Calcium     2g     
Phosphorus     228mg     
Iodine     150mcg     
Magnesium     133mg     
Zinc     30mg     
Selenium     50mcg     
Copper     600mcg     
Manganese     11mg     
Chromium     6mcg     
Potassium     200mg     
Lysine     300mg     †
Methionine     500mg     †
Leucine     100mg     †
Valine     760mg     †
Threonine     48mg     †
Glutamic Acid     700mg     †
Phenylalanine     560mg     †
Arginine     2g     †
Siberian Ginseng     2g     †
Oriental Ginseng     250mg     †
Smilax officinalis     500mg     †
Protogen A     200mcg     †
Inosine     500mg     †
Pyridoxine     200mg     †
Carnitine     25mg     †
Lastly, Once my liver values return to Normal, how often do you recommend that I have these levels rested to ensure everything is ok?
Thanks for taking the time to read and answer
Answered by Dr. Ratnakar Kini 2 hours later
Yes strenuous exercises do alter the liver enzyme levels. But the ratio of AST/ALT remains less than 1. If it is more than 1, it may not be due to exercise induced raise. Exercise induced raise in liver enzyme levels return to normal levels in about a week's time.
In your case exercise induced raise in liver enzyme levels is less likely since the AST/ALT ratio is altered.

Fatty liver remains asymptomatic and the liver enzymes remain within normal limits. If the enzyme levels are raised, it indicates inflammation - Hepatitis.

For treatment, the one main step is STOP DRINKING ALCOHOL.
Yes, Milk thistle is a supportive medication that helps the liver to function well.

Anything XXXXXXX in antioxidants is good. The supplements you are taking are good and I don't find any ingredients in them which are contraindicated in alcoholic hepatitis.

I hope that answers your question.
If you have no more questions kindly rate this service.
Dr.Ratnakar Kini
Above answer was peer-reviewed by
Follow-up: Blood work result showed elevated AST and ALT level. Is this serious? Worried for alcoholic hepatitis 2 days later
Hello Dr. XXXXXXX Kini,

I have FIVE questions for you. Please read below.

First, I appreciate your feedback. However I am confused by your statement because everywhere I looked states that after exercise the AST levels would be much higher because the concentration of AST is much higher in muscle, than ALT is. Therefore making the ratio of AST/ALT more than two. Not what you suggested such as "remains less than 1"

Matter of fact one of the studies, Published in the British Journal of Clinical Pharmacology (Volume 65, Issue 2, pages 253–259, February 2008)
states that EVERY single subject ended up with a AST/ALT Ratio higher than two after a workout. (Question 1)I wanted to know what your thoughts were on this.

With that being said, I had another series of Blood Work done 21 days after the results of my last test. My AST went from 176 down to 22, Then my ALT went from 78 down to 45. Every other Liver test such as ALB, GGT, TBIL, BIL, ALK and PT (Prothrombin Time) where all normal.(Question 2)What are your thoughts regarding this?

If I had damage to my liver due to Alcohol, (Question 3) would you expect to see this level or normalization just after 21 days from such a highly elevated test?

If the thoughts are this was from Alcohol and this level of normalization after 21 days is not out of the ordinary, (Question 4)is it somewhat safe to say that the inflammation of the liver was very minor.

(Final Question 5) Or does it look like in the end, my original thoughts from my research online that it was indeed from Exercising?

I look forward to your thoughts. Thanks so much!!

Answered by Dr. Ratnakar Kini 4 hours later
1. Sorry, there was a small error. It should read as
But the ratio of AST/ALT remains less than 2. If it is more than 2, it may not be due to exercise induced raise.

2. The liver enzymes have returned to normal.

3.After abstaining from alcohol, the enzyme levels may return to normal in 3-4 weeks.

4. Yes probably minor.

5. Since the ratio of AST/ALT is more than 2 , I still consider alcohol as the probable cause. If CPK level was tested and if it was also high in addition to these, then I would have said it could have been due to vigorous exercise.

I hope that answers your question.
If you have no more questions kindly rate this service.
Dr.Ratnakar Kini

Above answer was peer-reviewed by
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