Mildly Elevated Liver Enzymes

[RenoMick]

My question is about liver enzymes that seem to have been very mildly elevated, but for a chronic period of time.

About 4-5 years ago, I got flagged after blood donation as having a high ALT reading.

I'm a 38 year old male, caucasian, with a high BMI (32-33), but am very physically fit.  I'm 5'10" and 220 pounds, but I do 6+ hours of cardio exercise per week, as well as lifting weights 5 or so days per week.  I have a mesomorph body type.

So, anyway, going back to about 4-5 years ago, my GP had me cease all alcohol and other non-necessary medications/supplements, and after about 4-6 months of complete abstinence from alcohol all liver enzymes were normal except for the ALT, which remained at 51 (not even "high" on some scales).

So, my GP referred me to a GI expert, they did numerous other blood tests, found nothing; did an ultrasound, found nothing; found out that I was a "carrier" for Alpha-1 antitrypsin deficiency, but that I did not "have" the deficiency as such.  From everything I've read on the Internet, the hetrozygous "MS" phenotype for Alpha-1 (which is what I have) has an "unknown but currently presumed non-problematic" effect on the lungs and liver.  The GI folks also suggested that losing weight might well help out the LFTs, but they said it was hard for many people to do -- hence the fact that they did the blood tests and ultrasound before I even attempted to lose weight.

Where it got to with the GI expert was that they could not find a definitive cause for the elevated ALT, and said that the only other thing they could do was a liver biopsy.  My GP said an emphatic "no" to a liver biopsy, as he said it was just not worth the risk of a serious complication (in doing a biopsy) for such a mild elevation.

So, here we are several years down the road, and my GP had me do a standard blood panel (including LFTs) at the end of August.  The results came back with an ALT of 75 and an AST of 54, but with all other liver parameters (GGT, ALP, LDH, bilirubin, albumin, etc.) being perfectly normal.  All other things like cholesterol, blood lipids and glucose are also all normal.

I rarely consume alcoholic beverages at all anymore (maybe 2 days per month), but since I have been on a serious fitness program, I do a lot of fairly heavy weight lifting (e.g., leg squats of about 300 lbs.)  Until I started the heavy weight lifting, I never had an elevated AST level, to the best of my knowledge -- before it was only ALT that was elevated.

I have a follow-up appointment scheduled with my GP for a couple of weeks from now, but I guess I'm just looking for a sense of how worried I should be about the LFT numbers?

Thanks in advance for any insight.

P.S., since I am a regular blood donor, I'm routinely screened for hepatitis B & C, and so I know that neither of those are present.

P.P.S., I had a follow-up blood draw on 9/11, and my ALT had gone from 75 to 56, whereas my AST had gone from 54 to 60.

[ankh151]

A related discussion, elevated liver enzymes was started.

[CoghanB]

You mentioned that you are very physically fit.  A couple years ago I started working out with a personal trainer, and my liver enzymes went way up.  My Dr. wasn't even aware, but I found out that working out the long muscles (in my case it was my arms) enough to cause soreness is also enough to cause elevated liver enzymes.  3-4 times normal is common.  If I were you, I would refrain from exercise for one week prior to retaking the liver enzyme tests and see what happens.  I did and mine dropped right back down.  I was all a wreck thinking I had liver cancer until I learned this info.  Since then I have learned that body builders have elevated enzymes all the time from intense workouts.  It is worth checking in to.

[Kevin Pho, MD]

It seems like a comprehensive evaluation has been performed, which would rule out many of the more common causes of mildly elevated liver enzymes.  

A liver biopsy would be considered if the elevation exceeds 3x the upper limit of normal.  

At this time, you can consider serial monitoring, as you are doing.  Refraining from medications that can raise liver enzymes, as well as limiting alcohol use can be considered.

If the enzymes continue only to be mildly elevated despite normal testing, periodic monitoring may be all you need.

This question can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[Kalio1]

I'd see a Heptologist. Something is doing it.