Cause of Elevated Liver Enzymes

[Rick S.]

Last August, 2002, I experienced what appeared to be food poisoning for about 2 days, with high fever and diarhea (diarrhea), which then went away, but was followed by upper gastro-intestinal issues including bloating, belching, discomfort after meals...I had an extremely bad taste in my mouth, which was unfamiliar to me...it ranged from metallic to sour to chalky.   I previously had H Pylori...and was treated again with a 2 week course of PrevPac.   Symptoms improved somewhat while on the antibiotics but returned soon after I was done with them...My doctor surmised that I may have had Giardia (no stool test had been taken)and placed me on Flagyl for 2 weeks ending in early December.   While the major taste issue had subsided, I developed an insensitivity to alcohol and coffee ...I am a moderate to light drinker, but began to notice starting in late December, 2002, that after I had a few drinks, beer or wine, I would wake up slightly nauseus the next day and my spleen and liver felt slightly congested.   The reason I know that my spleen and liver were slightly congested is due to the fact I had Epstein Barr Virus activated 3 different times in my life, the last episode was in 1988.   I went to my doctor and had blood tests taken for liver profile, Hep C (already had antibodies for Hep A and Hep B).  All hepatitis screens were normal.  My ALT was 67 and my AST was normal.  I had assumed that the antibiotic treatments may have caused the elevation and the discomfort along my rib cage... I have also been taking herbal supplements now to support the liver since taking those tests, and a Super Green Foods complex along with Acidopholous.  I limited my alcohol intake for over a month.  I went back and retook the liver profile, and my AST was 50 and my ALT was now 86.  I know there is something not right with my body...my doctor told me to stop taking the herbs for 2 weeks and to retake the tests again before sending me to a specialist.   I guess my concern is that the Epstein Barr situation may have been re-activated by my issues over the last 6 months including heavy dosages of antibiotics....that is the only time my spleen and liver have felt congested in my life.  After being off the herbs for several days, I am now nauseous after meals, and the bloating and dyspesia has returned.  I will be retaking the tests in a week and a half...What would you suggest as a next path to pursue when I see my specialist?  How can we prove whether or not Epstein Barr may be causing distress with my liver (the fact my spleen is somewhat tender is suspicious to me)?  If it does turn out to be Esptein Barr, what are my options for treatment?

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

There are many causes for elevated liver enzymes. Almost any medication can cause an elevation of liver enzymes - it would be wise to repeat the liver enzymes off the herbal medication.

Alcohol can also raise liver enzymes, although typically the AST is greater than the ALT (not your case).

Hereditary hemochromatosis (HHC) is a common genetic disorder.  Screening should begin with a serum iron and total iron binding capacity (TIBC).  An iron saturation of greater than 45 percent and serum ferritin concentration of greater than 400 ng/mL in men and 300 ng/mL in women supports the diagnosis of HHC.

Hepatic steatosis and an associated condition, non-alcoholic steatohepatitis (NASH), may present solely with mild elevations of the serum aminotransferases, which are usually less than fourfold elevated. NASH is a condition more common in women and associated with obesity and type 2 diabetes mellitus.

Ebstein Barr virus (EBV) can cause hepatitis and thus increase liver enzymes.  Tests for this virus includes antibody testing from the blood.  A liver biopsy would be the definitive test to find the exact cause of the elevated liver enzymes, however this should be discussed with your personal physician.  

Treatment of EBV is mainly supportive, although studies with steroids and antivirals (acyclovir) have been done.  They are options you may want to discuss with your personal physician.

I would repeat the liver tests off the herbal medications.  Further evaluation could then include a liver ultrasound and possible tests for hemochromatosis.  A liver biopsy would be the definitive test for diagnosis, but not before the non-invasive tests I previously mentioned.

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.

[Johnny Mac]

I recently had a physical examination, that included a blood test after a 12 hour fast.  I have genetically low cholesterol, it was 154, but my HDL was 35 and my Triglicerides (triglycerides) were 157.  Last year my Triglicerides (triglycerides) were 197, and I have been cutting down on pasta and other starches.  Obviously, I cut down not out. My Liver enzymes were AST 59 and ALT 82.  I am 50 years old and am about 30-40 lbs. overweight.  I know in years past my liver enzymes were slightly elevated, but I never paid much attention to them.  Also, I almost never drink alcohol.  If I have two glasses of wine per month, that is alot for me.  I recently joined a health club and have started excercising regularly.  
I know my father (deceased) had low cholesterol and I believe he had elevated liver enzymes also, as his PMD told him to not drink any beer.  He drank 2-3 shots of scotch per day, and rarely more than that.  
I guess my concern aside from the elevated numbers, is this: are they all related?  HDL 35 LDL 88  Cholesterol/HDL ratio 4.4, Triglycerides 157 and AST 59 & ALT 82.  I am otherwise in apparent good health.  I know exercise will raise my HDL, and further dieting will take care of my triglycerides.  My PMD wants me to have my blood tested again in a month, meanwhile he told me to drink NO ALCOHOL.  While that is no challenge for me, I'm starting to doubt that it will have any effect.  Are there some vitamins or other dietary supplements that I can take to help with my enzyme levels?  I don't want to take them before having my blood re-tested, but I suspect getting all of my numbers within normal limits can add to my longevity.

[Z81]

A related discussion, What are the causes of elevated liver enzymes was started.