High ALT and Gamma GT readings

I just found your website through Google and am anxious to see if you can shed light on something that has been puzzling (worrying ?) me for years.

For the last 10 years (ever since I moved countries) my ALT and Gamma GT readings have been very high...ALT has averaged 80 (peak was 134 about 2.5 yrs ago and today it's 99). Gamma GT has averaged 95 (peak was 132 about 5 yrs ago and today it's 110). AST has been normal (average of 30).

I am a non-drinker, non-smoker and to the best of my knowledge enjoy excellent health and suffer no symptoms of any kind. I have tested negative for Hepatitis A, B and C. Ultrasound has revealed a slightly fatty liver. My GP has said only to keep a healthy diet and not to worry. Is this the correct advice? That's it? Watch my diet? What does a fatty liver mean to my health? Should I be concerned by the high Gamma GT and ALT readings or not?

[Kevin Pho, MD]

You have had a reasonable initial workup for the elevated liver enzymes.  You note having a negative hepatitis screen and ultrasound showing fatty liver.  

Regarding the fatty liver, alcohol is a common cause of this - but you state you're a non-drinking.  The other possibility is NASH (non-alcoholic steatohepatitis).  The exact cause of NASH is unknown. However, it is seen with increased frequency in people with certain medical conditions such as diabetes mellitus and obesity. It is diagnosed in about 7 to 9 percent of people in the United States who have a liver biopsy. Most affected people are between the ages of 40 and 60 years, although the condition can also occur in children over the age of 10 years. NASH is diagnosed more often in women than in men.

At this time, there are no treatments that cure NASH. The main goal of treatment is to control the conditions that are associated with NASH, such as obesity and hyperlipidemia.  I would consider observing the liver enzymes to make sure there is no elevation.  If there is, then a liver biopsy may be considered.    

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.

Thanks,
Kevin, M.D.

Bibliography:
Kaplan.  Patient information: Nonalcoholic steatohepatitis (NASH).  UptoDate, 2004.

[huntsman2009]

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[Hadock28]

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