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Does fasting affect Liver Ast/Alt tests?
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Does fasting affect Liver Ast/Alt tests?

Does fasting typically affect the liver function tests?  My doctor told me I didn't need to fast before a bunch of tests that were recently done.  So I ate lunch (bean burrito) and had a diet coke about 2 hours before the tests ... I need a clean bill of health for a job I have been offered.

Liver function tests were high as well as sugar.  I'm sure the sugar was caused by eating but what about the liver function tests?  They weren't *way* out of line ... AST was 60 and ALT was 85 I think but could have the numbers reversed.  Pretty sure I don't have hepatitis ...

Background:
* Male
* 6'0", ~210lbs
* drink moderately (2 drinks a night, 4-5x a week).  
* pretty active generally
* have been injured for much of the past year--could stand to shed a good 20-30lbs
* most of my extra weight in the mid section
at 6'0" 210lbs.  
* vegetarian

Will be getting a retest in a couple days.  Anything to eat or avoid in the days before the test?   Am I a likely candidate for a fatty liver?  I am not *fat* by any real measure but do have some extra weight around the middle.
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24 Comments Post a Comment
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96938_tn?1189803458
Avoid the alcohol for a few days, if you are able. I once knew a guy very well who was very smart, except about small numbers. He was always getting 2 and 5 confused.
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Avatar_m_tn
Eating before will affect glucose but not LFT's. Alcohol day or two before test will raise ALT & AST's.

Also any meds like tylonol, etc can raise LFT's.

Since you said you are over weight in mid-section possible fatty liver.

You may want to rule out hepatitis if those #'s don't go down.


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179856_tn?1333550962
drink moderately (2 drinks a night, 4-5x a week).  

Yes alcohol likely is the culprit  (for the sugar perhaps) and the liver enzymes if anything.  Next time, fast from the night before and take the test in the morning and see what happens.
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979080_tn?1323437239
When you do tests the number 1 rule is be consistent.

When I first started testing I thought it is best to fast before
but I got tired of skipping breakfast and having to go to lab
in the am (busiest time to go to drawing station)

since I have no glucose problem I now go in the pm and I expect
my glucose to be high after lunch , no big deal.

in terms of alcohol , meds ect.... common sense applies
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Avatar_m_tn
I decided to get tested when my LFT's were just above the cut-off; around low 40's.

I didn't drink and figured that they should be lower.  It turns out that was positive for antibodies.  I'm glad that I got tested, and even more glad that I wasn't a heavy drinker.  It's tough getting diagnosed, but it is far worse being infected and not knowing it.

Why not get an elisa or riba antibody test based on your high LFT's?

Also..... I'm not a doctor..... but I believe that the protocols for getting accurate test results recommend fasting prior to blood draws.  If this was an important test that a job or insurance hinged upon having good scores.....I'm not certain you got good advice.  Fasting only would have improved your scores, I believe.  

Hmmmmmm......why are you getting retested in a few days?  Is it because the tests were invalid due to not following the fasting protocol?  Or that they were too high and you now want to lower them?

I would avoid drinking from NOW right up to when you are tested.  No painkillers/ NSAIDS, Tylenol etc.  They see what your liver function tests look like.  Since you are getting retested why not get an antibody test as well?  They are cheap and you are there anyway.  Avoid any rigorous exercise since that will also raise LFT's (the destruction of tissue raises LFT's  (I *think* it's ALT; not AST.  One of them.  ; ) )

By the way...... my slightly high AST and ALT scores were low enough that my doctor pooh-poohed the idea that I might have some form of hep.  Turns out that he was dead wrong.  Having the test results and that small bit of information that I was probably one of the smartest things that I ever did....... and yes, against Dr's advice.

best,
Willy
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Avatar_m_tn
I think the primary reason for fasting is the blood glucose test. I doubt that eating would affect LFTs.

"...For example, males have higher transaminase levels than females. And, African-American men have higher AST levels compared with Caucasian men.  Even the time of day that a blood sample is drawn may influence the level of transaminase elevation. People appear to have higher transaminase levels in the morning and afternoon than in the evening.  Food intake does not appear to have a significant effect on transaminase levels.  Thus, levels do not significantly differ in the fasting and non-fasting state.  Finally, transaminase levels may vary from day-to-day...."

http://www.liverdisease.com/liverenzymes_hepatitis.html
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179856_tn?1333550962
To be honest I don't know why I said or implied that fasting might change your liver enzymes - alcohol yes but food no. I never fasted for an enzyme test unless it included my cholesterol.

Sorry sometimes at work I go to fast and then look at what I've written and realize it is absolute garbage with no basis at all. I know what meant but I don't believe in any way fasting would change your liver enzymes.
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190885_tn?1333029491
sounds to me like your an alcoholic...maybe not too bad yet but on the way...it's real hard to admit you have a drinking problem...i would try stopping all drinking for a year or so...it will really help you lose weight and should make you feel better...and will most likely bring your alts and asts down..good luck....billy
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1117750_tn?1307390169
2 drinks a night for 5 days a wk , hardly an alcoholic
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Avatar_m_tn
If you have hep C there is no good amount of alcohol.
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979080_tn?1323437239
alcohol is a naturally occuring substance

let`s not completley demonize it

I was socially drinking before dx , especially the week before

my first PCR I just got back from a vacation with nightly cocktail hours ect...

I stopped to zero after dx and to this day my first VL is the lowest despite

alcohol , diet ect....

My father was dx at age 70 (geno1 , VL 400k) He is now 82 enjoys a glass

of red wine here and there has no fibrosis and generally does not think about

Hep C.

Just saying................

common sense is to omit alcohol yet studies show that even with Hep C alcohol

consumption has to be significant to really make a difference.
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Avatar_m_tn
I wouldn't mind having a drink every once in a while, but I am doing my best to preserve my liver in the hope that I will rid myself of this virus before the damage has gone to far, so I don't drink at all. Everyone makes there own decision about what's most important to them. At least we should be well informed!
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Avatar_m_tn
Thanks for all responses.  Received the test results by mail today and they were:

Alt 42
Ast 90
Albumin 4.9
Globulin 2.8
A/G ratio 1.8
Bilrubin 0.4

Yeah, I'm hardly an alcoholic though i appreciate the sentiment ... no reason for me to be downplaying it on an anon internet forum in any case.   And yes, my alcohol consumption will decrease in the next year because I'm going to a "dry" place.   Should also be able to lose some weight while there but that's a digression.

I want the retests for two reasons:

a) to check that this was just an aberration.  I likely did have two glasses of wine the night before the test as I wasn't instructed to do otherwise.
b) because I want a clean bill of health before going overseas ... the forms ask if each item is negative/normal or positive/abnormal and I'd like a clean sheet all the way down so the embassy doesn't raise any eyebrows when processing my visa.

I'll get a Hep C test done also ... Hep B was negative.  Re-test is tomorrow ... have had nothing but water to drink today except for a glass of OJ this morning.

Thanks again!
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568322_tn?1370169040
How high was your blood sugar?

Co
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568322_tn?1370169040
Normally, where are the aminotransferases?

AST is found in a diversity of tissues including liver, heart, MUSCLE, kidney, and brain. It is released into the bloodstream when any one of these tissues is damaged.  It's not specific for liver damage.....and you did say......

"have been injured for much of the past year"

MUSCLE damage perhaps?

Co
P.S.  Alcohol use as well as obesity causes fatty liver.  20-30 lbs around your middle is pre-diabetes.  
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Avatar_m_tn
Yeah, I'm an extreme sport guy ... so I've torn a rotator cuff, broken a finger or two and torn a calf all in the past year.  I meant that I hadn't been as active as normal ... the weight gain is largely a result.  

I'm pretty strong (maybe 10lbs of belly fat, not 30) but I could stand to lose some weight no doubt.

Co--no idea where the aminotransferases are normally.   Normal range is 10-40 AST and 9-60 ALT.

Blood sugar was 119 but that's 2 hrs after lunch--it should be high I'd assume then?
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568322_tn?1370169040

What I meant is that muscle injury/damage can cause the AST to be elevated....and yours is elevated.  


2 hours after eating, a normal blood sugar is 140-160.

Co
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233616_tn?1312790796
fasting should result in lower blood sugars. Of course, that's why they are recommended before labs involving a blood glucose test, to get a true low reading on what your resting blood rate is, how much glucose remains in your blood after many hours without new fuel.
docs doing liver labs don't all remember to suggest this fast...but it's good to do it so you'll know.

chances are your drinking is effecting your Blood Sugars, why? Because the liver has to store the high octane fuels for later use...the alcohol is poisonous, and gets detoxed and stored first, then your food does, the liver tries to keep a reserve and sent the rest to the body for storage, but too much every night and it can't keep up, and you end up with more liver cell death (high alt etc.) . Overeating alone can also do this, as it produces the same chemicals as alcohol consumption but at a slower rate.

here's what wikipedia offers on the chemical process:

Ethanol has a dehydrating effect by causing increased urine production (diuresis), which causes headaches, dry mouth, and lethargy. Dehydration also causes fluids in the brain to be less plentiful. This can be mitigated by drinking water after consumption of alcohol. Alcohol's effect on the stomach lining can account for nausea.

Another contributing factor is the presence of products from the breakdown of ethanol by liver enzymes. Ethanol is converted to acetaldehyde by the enzyme alcohol dehydrogenase, and then from acetaldehyde to acetic acid by the enzyme acetaldehyde dehydrogenase. Acetaldehyde (ethanal) is between 10 and 30 times more toxic than alcohol itself,[5] as well as being cocarcinogenic (not carcinogenic solely by itself) and mutagenic.[6]

These two reactions also require the conversion of NAD+ to NADH. With an excess of NADH, three enzymes of the Citric Acid Cycle are inhibited (citrate synthase, isocitrate dehydrogenase, and alpha-ketoglutarate dehydrogenase) essentially shutting it down. Pyruvate (the end product of glycolysis) starts to accumulate, and the excess NADH drives lactate dehydrogenase to produce lactate from pyruvate in order to regenerate NAD+ and sustain life. This diverts pyruvate from other pathways such as gluconeogenesis, thereby impairing the ability of the liver to compensate for a drop in blood glucose levels, especially for brain. Because glucose is the primary energy source of the brain, this lack of glucose (hypoglycemia) contributes to symptoms such as fatigue, weakness, mood disturbances, and decreased attention and concentration.

Alcohol consumption can result in depletion of the liver's supply of glutathione[7] and other reductive detoxification agents,[6] reducing its ability to effectively remove acetaldehyde and other toxins from the bloodstream. Additionally, alcohol induces the CYP2E1 enzyme, which itself can produce additional toxins and free radicals.[8]

In addition, it is thought that the presence of other alcohols (such as fusel oils), by-products of the alcoholic fermentation also called congeners, exaggerate many of the symptoms (congeners may also be zinc or other metals added primarily to sweet liqueurs to enhance their flavor); this probably accounts for the mitigation of the effects when distilled alcohol, particularly vodka, is consumed instead.[9] A 2009 study provided evidence that darker-coloured liquors, such as bourbon, cause worse hangovers than lighter-coloured liquors, such as vodka. The higher amount of congeners found in darker liquors compared to lighter ones was indicated as the cause.[10]

Most people of East Asian descent have a mutation in their alcohol dehydrogenase gene that makes this enzyme unusually effective at converting ethanol to acetaldehyde, and about half of such people also have a form of acetaldehyde dehydrogenase that is less effective at converting acetaldehyde to acetic acid.[11] This combination causes them to suffer from alcohol flush reaction, in which acetaldehyde accumulates after drinking, leading to immediate and severe hangover symptoms. These people are therefore less likely to become alcoholics.[12][13]

It is often said that hangovers grow worse as one ages; this is thought to be caused by declining supplies of alcohol dehydrogenase, the enzyme involved in metabolizing alcohol.[9]

notice, the biggest culprit, acetaldehyde is for all practical purposes a form of nail polish remover....highly toxic. Even a couple beers a night is like taking a sip off of that.  Next time you get a chance, smell a bottle of nail polish remover and decide if it's a good thing to drink!!

mb
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Avatar_m_tn
Thanks, As far as I can tell there are also many positive benefits of drinking 1-2 alcoholic beverages per day.  Red wine and beer in particular (my drinks of choice when I drink) are both thought to be helpful for a variety of issues.  

In my case I am guessing it isn't the alcohol but rather that I am eating too much and not exercising enough.  2 drinks a night for a guy my size (200lbs) shouldn't be too much of a problem; I'd guess it would be more of an issue for a smaller person.  I suspect that as I work my way back into shape and start dropping weight that my levels will go back to normal and we're testing at a local maximum right now.  That said it's certainly something to keep a close eye on.

I kind of wonder if my vegetarian diet is causing problems also.  I tend to eat a lot of beans, tofu, etc, in order to get protein and wonder if maybe I am actually overdoing it.  Is there any correlation between too much protein (tofu or legumes specifically would be wonderful) and liver function?  Anybody happen to know?

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233616_tn?1312790796
You should read a book called "diet for a small planet".

It helps us learn how to combine plant proteins to get the most from them.

The lack of protein leads to many disease processes and eating just tofu or beans can cause major deficiencies.

Toxic by products are produced by many food we eat so overeating taxes the system, but so does not getting the raw material to rebuild cells which is why this book is so helpful.

During my vegetarian years I saw many friends become quite ill because they did not subscribe to my scientific approach to it...it's the same today...I know several sickly, boozing, smaoking vegetarians....don't quite get why they don't see the ironies inherent is these choices, but you can definitely harm your organs by not learning what works and what does not....one of my friends died due to their "healthy choices".
read the book.  BTW you only absorb 5% of what you take in, so eating incomplete proteins can permanently damage the heart and more.

mb
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1117750_tn?1307390169
whu is tofu and beans not enough?
protein is protein surely
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Avatar_m_tn
Well, what I've read on the subject is that different protein sources are made up of different sets of amino acids.  In order to get complete proteins and thus complete the AAs you may need to combine several sources.  It used to be thought that one needed to get the complete set of AAs from within a meal (or even with one's diet) but this turns out to be untrue.  As long as one has all available AAs from either within the body or within the diet over time all is well.  There's more on this here:

http://www.ivu.org/faq/protein.html

MerryBe, Yes, I've read some of Diet for a Small Planet and have heard some of it from other sources.  How did your transition back to eating meat go?  How are you picking your meat sources now?  I've been having some trouble lately, ahem, processing soy and have been considering switching back to some lean meats for protein after 15 years as a vegetarian.  This latest bit with regard to my liver may be the final straw.
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233616_tn?1312790796
jusjames...nope wrong, proteins are not absobable in plant form, not to the same degree.  you may absorb so little protein from plant sources that both size, heart function and all else is effected. Absoption of plant proteins is far far lower than those from animal sources. That's because only complete amino acid chains can be absorbed through the intestinal wall, and plant proteins are incomplete chains.

desertsand
well, I'm not as brave as you...I lasted 5 years...and I was not a vegan, I still ate milk, cheese and eggs.

I credit this lactovegetarianism with why I did not get sick while so many of my friends did.

if you are going to persist, I would study things like B12, carnosine, heck the lsit is endless, you will need supplementation and close attention not to create amino acid defieciencies. google protein deficiency and read up...it's scary.

I transitioned back to fish first..did it one night so as not to ffend my new roomate, who had just cooked a freshly caught sockeye for me...and I decided not to offend her by refusing it......it was revelatory.
I had spent 5 years trying to keep my friends healthy with supplements, herbs and an understanding of nutrition, but it was a losing battle...they expected better health due to eliminating the "evil meat"...and none were truly being proactive in educating themselves....it took the death of a vegan faster to wake them all up, and even then they would not listen to me.

Personally, I just realized passing up the highest sources of protein when we finally had a steady source was counter productive to health. I mean, look in nature, critters mostly vegan, like apes etc still covet the occasional egg...why is that.  Why does a goat know when it is deficient in magnesium to eat a certain tree bark high in it...why does a hypothyroid patient crave coconut...the one oil that corrects the disease....why....because our molecules know more than we do, that's why.
Later science proves what we only knew intuitvely...and then we all go oh...duh...

pure and complete amino acid chains give us the building blocks of life. they allow for more metabolism, more repair, better immune systems. As long as we keep our elimentary canal working by not over indulging (too much protein causes putrefaction in a slow bowel) we are fine.  The system should never have more than a 24 hr cycle...the culprit for not having this turn around causes far more disease than all else.
\more fiber, less sugar, high quality fresh fruits veggies, small protein portions and unrefined whole grains will produce the healthiest humans. eliminate or severely restrict refined carbs and sugars, (white flour and sweets) and you will flourish.
Also, this type diet will keep hcv at bay longer....insulin and IR, both cause hcv to progress more quickly...thats why alcohol and sugar should be avoided....they both cancel out interferon which helps us fight the virus. Calorie resricted mice live 1/3 longer lives...why? same reasons, less calories=better immune systems.

Yes, I'd rethink it...the best example is India, small people, tiny, because where protein is restricted size is effected....it's not genetic, it's nutritional. Same thing was seen throughout asia, but now we are seeing bigger people, especially since the advent of trade and increase in fishing fleets and refrigeration....means more protein, better storage and distribution of the same...

down side, if they eat too much they get same things we do...clogged arteries...bottom line is watch your HDL LDL ratios, cook with good oils, don't go hog wild and start scarfing bacon wrapped everything, but an occasional strip in not the killer....it's the excess fat of any kind that can be.
I have to say, I still enjoy my fresh fruit and whole grains, everyday, but it's more interesting to have the variety (we eat meat 3-5 times a week, fish 2 or 3 times) and know I'm getting quality protein without the constant effort of combining tastless things that became extremely boring and tedious after a while.
for my 2 cents, there nothing wrong with meat or fish, Christ even cooked and fed it to his disciples....so how bad can it be.

So glad you are reconsidering!!
have a nice roast chicken and call me in the morning!!

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1117750_tn?1307390169
thanks
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