What are the treatments for high ALT levels?
Patient's Query
Hello doctor,
I am 57 years old. I have an athletic build and about 15 to 17 percent body fat. I lift weights five days a week and stay active on the weekends. My yearly physical included a metabolic panel, which I had done a week earlier. My aspartate aminotransferase, level was slightly higher (47 u/l). My alanine transaminase was within the usual range (36 u/l). Bilirubin was 4.4 mg/dl, whereas alkaline phosphatase was normal at 47 u/l. My doctor has ordered that I repeat the test in a few weeks due to the increased AST (aspartate aminotransferase). I am concerned about this.
How concerned should I be? Also, could this be due to my workout schedule? I was also extremely anxious at the time of the test due to another medical issue that was resolved. And, I had a flare-up of tennis elbow from playing golf the day before. Finally, for approximately six to eight weeks before the test, I had been taking an ashwagandha supplement. Could any of these contribute to the elevated aspartate aminotransferase? How concerned should I be?
Kindly help.
Hello,
Welcome to icliniq.com.
My observation and experience say that you might be having Fatty liver. Your parameters are not bad. But still, high alanine transaminase aspartate aminotransferase is a cause of concern. I would strongly recommend you to get yourself an ultrasound abdomen to check on fatty liver. This is the first step. I am a doctor who does not rush for many investigations. I believe in a simple approach. If your ultrasound is normal I would ask for further investigations. As far as the workout is concerned. No workout can increase liver enzymes only if you are taking any high-dose supplements they could raise your liver enzymes. Do not worry Western Liver Association guidelines state that if liver enzymes are more than three times the upper normal limit then we need to be aggressive. I need to know the ultrasound report. Alcohol consumption details. Any supplements if you are taking them. Do not worry. You need to trust me. I will give you an accurate diagnosis and will share the treatment.
Revert with the asked details for better help. I hope that you got your answer. Please, let me know if you want some help.
Take care.
Thank you.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
My alanine transaminase is normal. It is just my AST that is elevated. Is that not so? As for alcohol consumption, I generally would have perhaps two or three beers twice a week. Perhaps a few times a year (three or four) I would binge but nothing too crazy. My laboratory has never been high before. So, this caught me by surprise. Currently, I am not taking any supplements. Previous to the test, I was taking ashwagandha, creatine, magnesium, vitamin D, and a multi.
I will ask my doctor about an ultrasound when I see him in a few weeks. If I do have Fatty Liver, what is the prognosis? Is this life-threatening or shortening? Can it be controlled?
Kindly help.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
Aspartate aminotransferase and alanine transaminase both parameters are seen together. Aalanine transaminase signifies acute insult to the liver. AST signifies that yes liver is affected but chronically. You have alcohol consumption regularly which could be one of the reasons for the rise in AST.
I suppose you have Fatty liver. It has a very good prognosis. Just stopping alcohol consumption and further weight reduction would make your liver enzymes settle down. Ask your doctor to prescribe you vitamin E. It helps as an antioxidant of the liver. I do not find any reason to worry if you have any questions please ask me.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
Patient's Query
Hi Doctor,
Thank you for the reply,
Your intuition was correct. I received my ultrasound results. It confirmed I have fatty liver. I am having a lot of anxiety about this result. I cannot speak to my primary doctor. I am hoping you can look at my test results and provide me with a clearer picture of how much trouble I am in. Primarily, I suppose my questions are:
1. Based upon the ultrasound and other tests, can you estimate how severe my fatty liver may be or what stage I might be in?
2. Can you offer any insight as to whether this is simple steatosis or something more serious like NASH (non-alcoholic steatohepatitis)? What is the probability that this is a very serious condition?
3. Are there any clues as to the cause of this, whether it is metabolic, or alcohol related?
4. Is there anything to suggest how long I have had this condition? Is it likely that I could have fatty liver without having abnormal blood tests?
5. In your experience, what is my prognosis and what do you suggest I do?
6. Do you believe my condition is likely reversible and how long might that take?
Generally, this was moderate consumption – perhaps two to four beers twice a week. A few times a year I would binge drink – consuming eight or more – but this would occur no more than six or seven times a year on average. Could this have triggered the rise in my AST and the fatty liver? As for metabolic, I have high blood pressure which is seemingly well controlled by Lisinopril. My last doctor visit my BP was 117/70. In the past my fasting glucose is between the low 90s and low 100s. However, my HDL is generally not above 50. I believe most recently it was 47. I lift weights vigorously five days a week and walk approximately three miles every morning. I am 5 feet 11 inches tall. Weight at the time of the blood test was 200 pounds with a waist circumference around 35.5 inches. If of interest, my doctor ordered a number of liver-related blood tests – Ferritin, Iron+TIBC, Ceruloplasmin, Mitochondrial Antibody, and ANA screen. All came back normal. I can provide those if helpful.
Hello,
Welcome back to icliniq.com.
I have read your query, and I can understand your concern.
First of all my friend this was not intuition it is just about the experience. I am Professor of medicine and teach many MD students. so as far as your questions are concerned, I must say that fatty liver is not only the sole reason for any activity like alcohol consumption or being overweight in your case. It is combination of many factors. That cute weight as well as moderate alcohol consumption as well. I would say this has been going around for at least one or two years. Now important is the treatment. Stop alcohol consumption completely and start rigorous exercises to reduce your body weight. You should shred least 10 % of your body weight. I recommendation high dose of Vitamin E it has as liver stimulant and reduces the fatty liver. You can read content on fatty liver and Vitamin E ahead with what I have mentioned and take a year time to reduce your body weight as discussed and get your reports repeated. I am confident that you will get them normal reports next year if you follow my advice.
I hope this will help you.
Thank you.
Patient's Query
Hello doctor,
Thanks for the reply.
I hope I did not insult you in any way by using the term intuition. That was not my intention. If so, I apologize. You have been incredibly helpful and professional. If I am understanding the instructions correctly, I have nothing major to worry about at this point. I simply need to lose weight and abstain from alcohol. Is that correct? No real concern with NASH/ASH or anything more serious than simple fatty liver at this point?
Hello,
Welcome back to icliniq.com.
I have read your query, and I can understand your concern.
I am proving my confidence I teach post graduate students. I teach them this way I ask him based on the reports what could be the diagnosis and I prove that diagnosis with the help of the further investigations. So, my students are learning good. I cannot use the word NASH in your case because you do consume alcohol I do understand if within moderate quantities but still you do. It is nothing serious if you follow my advice. Start weight reduction and avoid fatty food and alcohol and see how the thing works. I always there for your any help.
I hope this will help you.
Thank you.
Patient's Query
Hello doctor,
Thanks for the reply.
I am still processing all of this in my mind. I will see my physician a week from today. You have been so very helpful. I have a couple of additional questions I had like to ask.
1. From your experience, is there anything in my results, either blood tests or Ultrasound, that would hint that this may be Steatohepatitis rather than simple Steatosis?
2. Is there anything in the results to indicate stage or degree of Fatty liver. I am looking at something early or mild or something more difficult to manage.
3. In your opinion, should my doctor have enough information to make a full diagnosis, or will additional testing be required biopsy or otherwise? Thank you once again for your knowledge and kindness.
Hello,
Welcome back to icliniq.com.
I have read your query, and I can understand your concern.
In your reports I could not appreciate the stage of fatty liver. Your doctor has not mentioned that. Your laboratory parameters are good, so I do not think there is any issue pertaining to liver disease moreover we see that in cases of early liver disease we have reduce platelet count. In fact we teach that if you see a low platelet count in a patient who is alcoholic then and try to understand that the patient may develop chronic liver disease in the future and this is an early sign of chronic liver disease, so low platelet is a sign of early sign of early chronic liver disease.
You can ask your doctor to get you a fresh bracelet count and if your doctor allows or your insurance allows then the best test to know that it is Steo hepatitis or what is Fibro scan.
Fibro scan will give you a clear picture and will tell how much fibrosis your liver has developed.I hope it helps you. If you have any questions, please ask me.
I hope this will help you.
Thank you.
Patient's Query
Hello doctor,
Thanks for the reply.
I know it is incomplete. However, based upon the available information, would you say it is more likely that not that this is an earlier stage?
Hello,
Welcome back to icliniq.com.
I have read your query, and I can understand your concern.
I was busy at the conference. I must say the coincidence that it was on liver disorders only. This is indeed an early stage rather I would use the word this is just starting. I am pretty sure that your liver is fine, and you just need to do what I suggested. Once you get the fibro scan results write back to me. The ratio thing you are talking about is not for fatty liver it is mostly used in cases of chronic liver disease to check out the prognosis.
Stop doing unnecessary research on google. You will end up getting confused. Whatever questions you have in your mind ask to me directly. My answers would be authentic crisp and clear.
I hope this will help you.
Thank you.
Patient's Query
Hi Doctor,
Thanks for the reply. I wanted to thank you once again for the incredible guidance and comfort you have provided over the past two months. Your knowledge and insight have been invaluable. Since you and I first addressed my fatty liver, I have lost approximately 23 pounds (six or seven weeks). My body weight is now 178 pounds (24.8 BMI). I did not intend to lose so much weight so rapidly. However, once I stopped drinking alcohol and cleaned up my diet, it came off very quickly. I'm still adjusting to how much I need to eat to have enough calories for my workouts and such. I met with my doctor last week. He had me redo my labs (attached). The results were all very promising. My doctor did not think a fibro scan or other imaging were necessary. His recommendation was largely the same as yours -- avoid alcohol, fried foods, and fatty foods, and maintain my current weight. He wants to redo my labs once again in six months and then have another ultrasound in 12 to check the status of the fatty infiltration of my liver. I have also started a vitamin E supplement (400 IU daily). Does this sound like a reasonable course of action to you? I have a few additional questions for you:
- Do the current lab results indicate my liver is functioning normally?
- Does this suggest I do not have any form of liver disease?
- Does the fact that the enzyme levels normalized so quickly (4 weeks) suggest I do not have significant liver damage or that what damage might exist can be healed?
- What should my expectations be?
- I do not really understand what it means for fatty liver to be reversed or managed?
- Is this evidence of that happening?
- What are the benchmarks of success? How will I know?
Finally, I have some specific questions about diet.
- Can I eat eggs a couple of times a week?
- Can I have pasta dishes -- spaghetti, lasagna, etc. once or twice a week?
- Can I eat red meat on occasion?
My test results do not indicate any metabolic issues. Most of the online sources are in reference to metabolic-related fatty liver. I am not sure how much of that information applies to my situation. Thank you once again for your kindness and expertise.
Hello,
Welcome back to icliniq.com.
I have read your query, and I can understand your concern.
I am glad to hear that you have lost weight, and your reports are definitely improving. Now I am coming to your questions. If you follow a good lifestyle and eat properly with diet and exercise then your lab works would rebin the same or even may improve. But if you again indulge in the activities you were previously and stop exercising and compromise on the diet then again your labs will degrade. Vitamin E is a very good choice in case of fatty liver disease. I frequently prescribe that to my patience, but I prefer to use 600 milligrams instead of 400 milligrams, but I guess 400 milligrams is quite enough for you. You can eat egg white only remove the yellow portion. No pasta spaghetti will do harm to you. They are not healthy. If you want a very good lab reports, then you have to be very strict with yourself. Occasionally red meat is fine but occasionally only. you can simply make a rule that occasionally if you consume something which is not good for your health like pasta or red meat then you have to compensate it by doing more exercises for the next two to three days than usual. The right diet and right exercise are the key. Do not think that your labs have improved so you can eat anything you want.I know I am being strict, but the fact is that you have to be strict with yourself. I am always available for you. I will only guide you the way I guide my patient set my clinic and my post graduate MD students.
I hope this will help you.
Thank you.
Patient's Query
Hello doctor,
Thanks for the reply.
- Could you please explain the concept of reversing or healing fatty liver?
- Are these labs evidence of that?
- Or is that dependent upon the outcome of the ultrasound next year?
- I know this is now a lifestyle with no end date; however, I am curious. What are proper expectations on my end?
Finally, am I safe to assume my liver is functioning normally and is not significantly damaged based upon these results or is that not able to be determined? I guess in effect I am asking whether or not I have liver disease rather than simply excess fat on the liver? I am not sure if there is a distinction, honestly. Thank you once again. You have no idea how much I have appreciated you. All my best.
Hello,
Welcome back to icliniq.com.
I have read your query, and I can understand your concern.
Right question you have asked now Let us talk about reversal. If I take your scenario. I would say that you are on the reversal mode only. But remember my friend the reversible thing is only possible when you strictly follow the lifestyle. There are cells in our liver which start accumulating the fat inside them and cause fatty liver if not treated or given the right direction This converts into liver cirrhosis.Liver cirrhosis comes many years after the diagnosis of fatty liver. When you are diagnosed with fatty liver, and you achieve a good lifestyle then the faces are removed from your liver and your liver start functioning normally. Once you develop liver cirrhosis then we can only increase your life span, but we cannot revert it back to a normal liver.Currently your liver is functioning well, and I am very happy that you have achieved the reversal. I always get glad when my patients show signs of improvement. You are one of my patients who have achieved the reversal to the most possible extent at this stage and so early. I am proud of you. Be strict with yourself as I am with my MD students because if I am not strict, they will not learn. So be strict with yourself enjoy life do exercise and avoid fatty food. I am happy and indeed very happy after seeing your reports. You can become a motivation for people suffering from fatty liver disease. I can talk about it for hours, but I have limitations to answer. If you really want to show your gratitude, I will request, you to rate me on my own google profile that people see. I am sharing with you. If you wish you can give ratings and write what you feel for me.
I hope this will help you.
Thank you.
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