AST/ALT Levels and Exercise

--I'm 38yo male recovering from morbid obesity having lost 150 w/ 110 to go. I'm against stomach stapling so am doing this the natural way. Because of a massive 'skin suit' I hired a personal trainer for building muscle in hopes it will help take up more of the skin than my daily cardio. I also have taken injectable testosterone for many years supervised by an endocrinologist and have had no problems. I take no other supplements other than one a day vitamin and I drink green tea. I had my gallbladder out 8 yrs ago.
--I just had a physical with a liver panel. I have a liver panel every 6 mths because of being on testosterone. My levels have always been normal. This time my ALT was 63 and AST was 163. Both have a threshold of 60. All my other levels were just below or right at the center of the normal range (bilirubin .6, alkaline phosphatase 47, albumin 4.3) My Dr. scared me badly and has ordered an ultrasound and tests for hepatitis and scheduled a liver function series and says I could have cirrhosis or fatty liver disease or toxicity from the testosterone. Apparently having an AST of more than twice the ALT indicates alcohol abuse?  It is true that I used to drink more than I should have, but only allow myself beer one night a week for a year now due to trying to lose weight. I was never an alcoholic, although I do feel I consumed more than was healthy.
--Friday night before the Monday morning of the test I had a very intense workout with my trainer. I was so sore Saturday I took Motrin all day and couldn't fully straighten my arms out fully without pain until Monday evening. After researching, it seems AST and ALT could be raised from intense exercise, but do the levels support that? My Dr. wants to go through with all this testing and I'm just not sure it is necessary to hit the panic button yet. At least not before retaking the AST/ALT levels when I haven't been working out so hard. I saw conflicting info that only AST would go up with exercise, but then other info saying ALT could also rise. My Dr. seems to think that exercise would only contribute a point or two to the level and wouldn't account for a sharp increase like this.
--Point blank my question is whether an intense workout could really be enough to push my levels that high?

[Kevin Pho, MD]

I would agree with your physician's assessment - it would be unlikely that vigorous exercise would raise the liver tests significantly.  

The ultrasound and hepatitis panels are a good idea to evaluate for some of the major causes.  Many medications, including Motrin, can also raise the liver function tests.  

As you mentioned, alcohol can raise the liver enzymes with a 2:1 AST:ALT ratio - I would certainly suggest stopping if there is continued alcohol use.  

If the enzymes continued to be markedly elevated, you can consider a liver biopsy for a more definitive diagnosis.

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.
Medical Weblog:
kevinmd_b

[CoghanB]

Well certainly not the answer I had hoped for.  We'll see and I'll post back what is found.  I also noted that my magnesium level, previously on the low side (I had been told to take cal-mag supplements in the past) is now 2.2, with 2.2 being the normal threshold, so it has increased quite a lot since last time.  Doing more research, I also found the some information on that.  Higher than normal magnesium levels can be caused by "illness or injury that causes muscle breakdown" which would support my theory.

Perhaps I'm holding on to false hope, but it just seems that I've quit smoking, quit drinking to excess, started eating a healthy diet free of sugar and have lost all this weight.  If I do all that and my liver gives up, then what was all of this for ya know?

[CoghanB]

Well certainly not the answer I had hoped for.  We'll see and I'll post back what is found.  I also noted that my magnesium level, previously on the low side (I had been told to take cal-mag supplements in the past) is now 2.2, with 2.2 being the normal threshold, so it has increased quite a lot since last time.  Doing more research, I also found the some information on that.  Higher than normal magnesium levels can be caused by "illness or injury that causes muscle breakdown" which would support my theory.

Perhaps I'm holding on to false hope, but it just seems that I've quit smoking, quit drinking to excess, started eating a healthy diet free of sugar and have lost all this weight.  If I do all that and my liver gives up, then what was all of this for ya know?

[PortiaElgin]

I hear you.

Do you have severe pain in your liver? Is pain radiating to shoulder or to the back at all?

Interesting that you can exercise so much and have elevated enzymes. I am exhausted when my enzymes are elevated.

I hope you feel better.

Judy

[CoghanB]

Actually, I have no pain at all.  I feel better at this moment (other than I'm coming down with a headcold) than I have in years.  My joints formerly so painful I could hardly hobble along are great.  My digestion, previously touch and go, has been great.  Energy level is fine.  Thinking of going up on my cardio from 45 to 60 minutes a day actually.  So I'm just shaking my head and saying how in the heck could I possibly have liver disease?  Oh well, I went in and got the additional tests and am awaiting results.  If I am right about this, and the whole thing was blown out of proportion, I am going to definitely get a new Dr.  

[CoghanB]

For those who might be interested,I came across some interesting info in a medical article. Typical pattern after heavy, weight bearing exercise involving muscle damage... begins a 8-14 hrs after the workout, peaks in 24-48 hrs, and returns to normal in 4-6 days. Typical increase is to 4 times normal,which on this scale would be 240... my increase wasn't even quite three times normal, so that is a huge relief.  

I will update again when I get the results back.  

[CoghanB]

Got my new results in today.. and I'm in perfect health!! Not even a hint of fatty liver, no cirrhosis, nothing.  ALT/AST back down to 40 and 41 respectively.  So the answer to my question is YES exercise can send up ALT and AST considerably.

I am SO relieved!  I hope everyone on this board has as much good luck and good news as I have just received!

[JCXRFreak]

A related discussion, Heavy Exercise, High Liver Function Tests was started.