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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What does an ALT level of 56 indicate?

Answered by
Dr.
Dr. Klerida Shehu

Gastroenterologist

Practicing since :2006

Answered : 2265 Questions

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Posted on Wed, 9 Sep 2015 in Digestion and Bowels
Question: I’m concerned that my most recent liver ALT level was 56, which is about 20 points higher than 2 years ago. The lab my doctor is using says the normal range is up to 75 but I’m reading elsewhere that the upper limit should be much lower. I’m worried not only about the level at 56 but also the rise from 2 years ago. Note that the lab 2 years ago said the upper limit was actually 32. Does this just mean that they’re using a different measurement method and my level hasn’t really risen 20 points? Note that I’ve been taking 200 mg Wellbutrin for at least 10 years and I’ve read it can raise ALT liver levels. If I were to get off the Wellbutrin, would that lower my ALT level? Note that I had been on an SSRI for almost 20 years and got off of it about 4 months ago. (I did a gradual taper.) I have functioned adequately but not great since getting off of it. My anxiety has definitely been higher. Realistically, I don’t think I can handle also getting off of the Wellbutrin now but I am worried about the ALT level. Note that other than widespread arthritis issues that doctors haven’t been able to explain, I don’t have any physical health problems. I don’t have any problems that I’ve are associated with liver disease. I remember that my doctor said my AST level was normal but I don’t remember the exact value. So my questions are:
A)     How worrisome is the 56 level?
B)     Has the level risen 20 points in 2 years or is that just a lab-specific measurement issue? If the former, how concerning is this?
C)     Will getting off Wellbutrin lower my ALT levels or is the impact of Wellbutrin on the level permanent? Even if it will lower the levels, I assume I shouldn’t get off of it right now.
D)     What additional advice do you have?
I appreciate any advice you have.
doctor
Answered by Dr. Klerida Shehu 16 hours later
Brief Answer:
Following answer to your queries...

Detailed Answer:
Hi and thank you for asking!
I read carefully your queries and understood all your concerns.

Following I would try to answer all your queries.

A. Your ALT level (56 U/l) is not too high and you shouldn’t worry about it. It’s just slightly elevated (40-50 U/l is the maximum of norm) and it may be related to Wellbutrin side effects. On that case ALT need to be more than 200 U/l in order to stop medical treatment.

B. With regards to increased level with 20 points in two years it may be related to changes on laboratory Kits and ranges. On the other hand it may be related to Wellbutrin side effect as I already explained to you.

C. You don't need to stop your treatment especially Wellbutrin until transaminases level (ALT, AST) are up to 200 U/l.

D. In order to give you a more accurate medical advice I need to have more information and medical data from you:
- Did you use alcohol, and how much?
- Are you overweight?
- Do you have fatty liver?
- Have you ever done abdominal ultrasound?
Meanwhile, I would like to recommend you as follows:
- Use foods like vegetables, fruits.
- Avoid fatty and sugar foods.
- Increase physical activity.
- Use silymarin and vitamin E as antioxidants for the liver.
- Avoid alcohol.

I’m waiting to have more information from you.
Meanwhile, I wish you health!
Dr. Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Klerida Shehu 3 hours later
Thanks for your feedback. I do feel better to read that. I’ll answer your questions and then I want to ask a few more.
- Did you use alcohol, and how much? Answer: Rarely. Maybe just a drink or two per month.
- Are you overweight? Answer: No, I’m 5’5” 135. I do store a lot of excess fat in my abdomen, though. My abs look chubby even though the rest of me looks lean.
- Do you have fatty liver? Answer: I don’t think so. No doctor I’ve seen has mentioned it.
- Have you ever done abdominal ultrasound? Answer: I don’t think I ever have.
My remaining questions:
A)     For a long time, I’ve wanted to quit caffeine. I think it would help my anxiety disorder and perhaps my arthritis. (I once had a stretch without caffeine and my joints felt better.) I’ve been gradually reducing and proud of my progress. However, I’ve also read that caffeine can protect against drug-induced liver damage and now I’m worried that it might be bad if I stay on the Wellbutrin but come off of caffeine. Is that something to worry about? If I were to go like a month without caffeine and have the ALT level re-checked, would that be OK? Would ALT level be unlikely to skyrocket in that month?
B)     I used to have Monster energy drinks often (about 1 can a day) but I’ve been off of them for about 2 weeks. I had sugar-free ones but I’ve read that some of their other ingredients might be bad for the liver. Do you think it contributed to the problem? Maybe it was the reason for the 20 point increase in 2 years since that’s about when I started having them.
C)     I also have a slight iron deficiency, though I recently (about a month ago) started taking a supplement for it. Could the deficiency have contributed? Do I have to be careful about taking the supplement? I’ve read too large a dose can be bad for the liver too.
D)     Do you think anything else I take might be bad for the liver? We already discussed Wellbutrin. I also take Benadryl, Flonase, Loratadine, fish oil, vitamin D, Vitamin B complex, and hyaluronic acid.
Thank you.
doctor
Answered by Dr. Klerida Shehu 15 hours later
Brief Answer:
Following answer to your queries

Detailed Answer:
Hi back
Thank you for providing more of your medical data.

You are reporting that you don't consume alcohol and are not overweight. I am glad to know that. With regard to abdominal ultrasound I suggest performing it, so you can better evaluate liver structure.

Now I will answer your queries:

A.     With regards to caffeine recent studies show caffeine positive effect on protecting liver and its function. However, in people who are under treatment with antidepressant it isn’t advisable to consume caffeine, because it has a negative effect on depression and anxiety. In my opinion, if you quit caffeine (and continue using Wellbutrin), this wouldn’t have any negative effect on your overall health and on your liver functions. You don’t need to do any test after quitting caffeinated drinks.

B.     You are reporting that you have used energy drink like (Monster energy drink), which have a lot of principle actives that may affect liver function. Niacin is one of those ingredients that can cause elevated liver transaminases (AST and ALT). This is why I strongly recommend repeating liver panel test after 10-12 weeks of quitting energy drinks.

C.     With regard to Iron supplements use I don't think it has raised your liver transaminases. You should take larger dose of iron and for a long time in order to damage the liver.

D.     On the following paragraph I would describe the known effect on liver function of other medications you are taking:
•     Celexa which is an antidepressant to (as Wellbutrin), has been accused to cause elevated liver enzymes.
•     Benadryl and Loratadine are antihistamine medications and it is not known to cause liver damage (elevated liver enzymes).
•     Flonase is a medication of cortisone family and it hasn’t side effects on liver function.
•     Hyaluronic acid is usually applied on joints by injection. It’s not metabolised by liver and can’t cause liver damage.

Hope I have answer your questions.
Best regards
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Klerida Shehu 3 days later

Thanks for your reply. I talked to my primary care physician and got a printout of the test results. It says my SGPT (ALT) level was 56 U/L with a normal range of 25-75 U/L. Does this mean they're using an unusual measurement unit? They appear not to be using international units per liter, though I read on a website that for ALT levels IU/L and U/L is a 1:1 conversion. I don't know if that website is right, though, and if the lab my doctor used is saying the low end of normal is 25, it seems like they're using a unit of measurement with much higher absolute numerical values than the standard IU/L. My doctor looked at the test result and said I'm "smack dab in the middle" and I "have a completely healthy liver" but I'm worried something strange is going on with the measurement units and ranges here. Do you know what the U/L to IU/L conversion is? Would you conclude that my ALT levels are normal or mildly elevated? Either way, though, you still think I can go a long period without caffeine and don't even need to worry about getting the level re-checked? Thanks!
doctor
Answered by Dr. Klerida Shehu 19 hours later
Brief Answer:
Please follow,,,

Detailed Answer:
Hi back
I read carefully all your concerns and I can say as follows:

1. IU international units is converted 1:1 to U ( national units).

2. The normal range for ALT may be different from lab to lab and that has nothing to do with the unit or international unit.

One laboratory can use IU and the normal range can be different from lab to lab and from those that you see online.

This is why your doctor says that you have normal ALT level. He is based in this rule that the normal ranges for laboratory exams changes form lab to lab. An exam should be interpreted based in normal range of the specific lab that the test is done.

3.Otherwise there is nothing worried with your Alt level even if we mentioned that the upper limit of normal is 40 UI/l ( based on literature).

In clinical practice Alt level is called significant high when it is more than double the rate.
I still think that you can quit to caffeine and there is no need to repeat the ALT level.

wishing you all the best
Dr.Klerida










Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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