Q. My ALT is 53 and AST is 137. Can this be due to my heavy workout sessions?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jul 24, 2020

Hello doctor,

My ALT - 53 (50 is the upper limit), and AST - 137 (35 is the upper limit).

I recently had a full blood test done and the above figures were elevated. Doctor wants me to have an ultrasound. I have read online studies that suggest doing a heavy weightlifting workout can elevate these numbers for up to seven days post workout. I had a very heavy workout three days prior to the test, after five months period of no exercise.

I do not drink and my BMI (body mass index) is perfect. Cholesterol is well within healthy ranges. No other health issues. I am 38 years old.

My question is, is it reasonable to suggest that exercise could be the cause of the elevated figures? Could I not just do a retest of blood rather than do an expensive ultrasound straight away? How often have you seen exercise affect these numbers?

I am currently Ramipril 7.5 mg per day (very mild IGA nephropathy) and Finasteride 1 mg per day (hair loss).



Welcome to icliniq.com.

Well, I completely agree with what you believe in-strenous exercise can cause this sorts of enzymes levels. An ultrasound may not provide important information, however, a complete set of liver profile can help to establish the cause of it. Namely, the other values in liver profile such as GGT (gamma-glutamyl transpeptidase), ALP (alkaline phosphatase levels) and total bilirubin (TB). I would expect if you can share those if done together.

The ALT (alanine aminotransferase) is purely a liver based enzyme, while the AST (aspartate aminotransferase) can come from various other body tissues such as heart, skeletal muscles, bone, and blood. So the pattern of AST and ALT which is more than 2:1, is highly suggestive that the source of these enzymes is probably other, not liver given your history of heavy exercise the skeletal muscle stress seems to be the cause.

Do not go for an ultrasound, but I want if you could share the other lab values that you have done with them. You can simply upload all the reports. If I found that the rest of liver enzymes like GGT and ALP, TB, are within normal limits, then this would add another layer of certainty. I also want to know, for how long you have been using Finasteride as it can cause liver dysfunction sometimes.

Thank you doctor,

I have been on Finasteride 1 mg for 2.5 years with no side effects. I had a blood test 12 months ago and everything was fine. I have attached the report for your insights. Please note the protein in urine levels are expected due to IGA nephropathy and are not a concern.



Welcome back to icliniq.com.

Thanks for providing further information and test results (attachment removed to protect patient identity). Yes, I agree with you, the ALT and AST seem to be raised due to sternuous exercise and coming from the muscles of your body and not otherwise. Please note that this minor damage to muscles can be dealt easily with some increased water intake and good urine output, but in conditions of excessive stress to the muscles can cause rhabdomyolysis, a myopathy muscle damage with release of a significant amount of CPK (a muscle enzyme) and can lead to acute kidney injury (AKI). Since your creatinine and urea and rest of electrolytes were within normal limits, this bring me relief.

You can just repeat in a week time, only ALT and AST, then let me know if they are abnormal again. The levels if raised within 1.5 times upper limits of normal, such as for AST the level does not fall above 51, and for ALT 75 are considered nonalarming. But any level above this is a concern for us. I expect these levels will settle with a maximum of 4 days (the average life of these enzymes). You should be avoiding strenous exercise now and until your tests are completely normalized.

Take plenty of water, approximately 3 liters in day. Or even higher at times of exercise. Finasteride is fine and does not seem to cause these enzyme elevations.

Investigations to be done:

Check CPK levels plus ALT and AST in a week time.

Preventive measures:

Take plenty of water and avoid strenous or heavy exercise for now till the enzymes are normalized.

Regarding follow up:

Follow up after a week.

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