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Elevated cholesterol levels and ALT. Normal Colonoscopy. Biopsy shows fat in colon. Is it due to high ALT?

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General & Family Physician
Practicing since : 2005
Answered : 2568 Questions
Please review the blood results attached. Please note that there are four pages. This shows three years 2010, 2009, 2007.
In recent years, the Drs have told me to watch my cholesterol. So I have been doing that. I have also started taking 1000mg of fish oil and 500 mg of Niacin. I would like you to review the documents and look at the other items to see if there are changes in my eating habits or additional supplements I should be taking. For example the ALT has always been quite high and the CO2. Are there things I should be doing for this? During a recent colonoscapy (recommended as my father had rectal cancer, not for any other reason), they did a biopsy and found fat in my colon. I was told not to worry about it. But it seems like the ALT maybe related? I would appreciate a full review of the blood work. An explanation of the items I should be concerned with. And recommendations in terms of diet or supplements (especially around ALT and CO2 - but a full review please). I have included a link to the file, as it was larger than the 2MB allowed.
Posted Sun, 22 Apr 2012 in Cholesterol
Answered by Dr. Prasad 19 hours later

I was able to view the reports submitted by you. The reports seem normal except for marginally raised cholesterol levels and Alkaline Transaminase (ALT).

Reviewing your reports individually;

1. 2007: Blood counts were normal; Biochemical tests were normal except for marginally raised levels of ALT
2. 2009: Biochemistries reveal abnormal cholesterol profile, marginally high ALT and marginally low carbon dioxide levels.
3. 2010 is almost similar as in 2007. The reports revealed normal blood counts, marginally raised ALT and abnormal serum cholesterol.

Alkaline transaminase is a liver enzyme. High levels occur due to acute liver cell injury. We suspect liver cell injuries when the levels are above 120mg/dl (more than 3 times the normal levels). Hence the levels reported are not concerning at all.

Carbon dioxide is an essential gas that controls respiration. Levels go low during excessive breathing and during anxiety. They improve with controlled breathing. When the levels are steep low, we suggest serial monitoring of carbon-dioxide levels and breathing assistance is initiated.
The low level of Carbon dioxide in 2009 is incidental and not worrisome.

Serum Cholesterol has been persistently raised since 2009. Lifestyle modifications are the key now. I am happy that you have already started on diet modifications to control them.

Fat in the colon on regular colonoscopy examination is expected in normal subjects.

To answer your query about dietary habits, you will need a low calorie and low fat diet (<7% Saturated fat). Avoid alcohol, as its intake can deteriorate the Liver function. Regular physical exercise (up to 5 hours a week) is also essential. Maintain your weight within ideal limits.
Regular monitoring of liver function and lipid profile annually is recommended.

Hope I have answered your query. I thank you for posting your query here. Should you have any more concerns, I will be available to address them.
Above answer was peer-reviewed by
Follow-up: Elevated cholesterol levels and ALT. Normal Colonoscopy. Biopsy shows fat in colon. Is it due to high ALT? 3 hours later
Ok, I understand the answers. In regards to Alkaline transaminase, what controls this liver enzyme. Why would it be slightly elevated? (genetics? diet?). What things can be done to bring it down into a "normal" range or make sure it doesn't continue to be elevated?

Also, as I am working on my cholesterol, I am taking Niacin. Will Niacin affect this enzyme? And what levels of Niacin are good to bring my HDL up?
Answered by Dr. Prasad 1 hour later
Hi Again,

First, ALT refers to Alanine Transaminase and NOT 'alkaline' transaminase. I apologize for my mistake in the previous reply.
Now to answer your queries:
1. What control ALT?     
Alanine transaminase is an enzyme produced by liver. Along with other enzymes ALT helps in a few biochemical reactions which are essential for body metabolism (metabolic role of liver). The enzyme is secreted by liver cells called hepatocytes.
Genetic factors play a role in controlling its secretion. However they are affected more by ‘environmental factors’ such as high fat, high protein, high calories, certain medical drugs, alcohol, infection and so on. Low levels are suggestive of liver failure. These factors affect the liver gradually and sometimes there is acute elevation due to acute damages. Such acute damages are what we clinicians are worried off. Hence my reply - "Not concerning at all”.
Moreover once elevated it is essential to keep the environmental factor under control for recovery. And recovery usually takes long time.

2. What things can be done to bring it down into a normal range or make sure it doesn't continue to be elevated?
All you need is "keep the environmental factors affecting the liver" under control. That means strict dietary and lifestyle changes - low calorie / low fat diet, restricting alcohol, avoiding certain hepatotoxic drugs.
Obesity is another factor which plays a role in moderating liver functions. Hence it is ideal to keep your body weight within limits.

3. Will Niacin affect this enzyme?
Yes, Niacin can affect this enzyme. However when there is no preexisting liver disease / liver failure, the doses given to you (less than 2 grams) does not cause significant rise. So it doesn’t concern me. Liver enzymes are too monitored annually while on this drug.

4. What levels of Niacin are good to bring my HDL up?
The positive effects of Niacin when LDL levels are high are still debated. When LDL levels are low, Niacin is known to increase HDL levels. Doses between 500 mg to 2 grams are suggested for these positive effects.

Hope you accept my answers.

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