Elevated liver enzymes and exercise

[Marc1955]

There have been a number of threads recently that got me interested in the issue of exercise as a cause of elevated liver enzymes. We all know that the enzyme levels can jump around and be affected by many different environmental factors. But I've noticed some people saying "I'm not concerned about my elevated enzymes because I exercise a lot and thats the cause."

According to my reading on the Internet, exercise does elevate enzymes, but it is more likely to elevate the AST than the ALT, because the AST is not produced exclusively by the liver but also by muscles. If you exercise strenuously you may very well increase your AST.

Nowhere could I find any suggestion that the pattern of an elevated ALT score so that it exceeds your AST score can be the result of exercise. All the literature I found pointed to some kind of Hepatitis or other liver damage as the source of an elevated ALT over the AST. Not exercise.

Do other's have thoughts or experience to confirm or deny this? My impressions from my reading is that if you have an ALT score that is double your AST score you should consult with a physician, even if the ALT score is not that high. This is not a normal state of affairs and indicates some ongoing damage to the liver. My understanding is that the normal state of affairs is for the AST score to be higher than the ALT score.

[Bobby1952]

   All I know is if you are tested for Hepatitis and other liver problems are negative then the cause of elevated enzymes can be strenuous excercise.

[Tippyclubb]

I know this is a little off topic but though I would post it anyway.  My AST is 97 and ALT 98 which have both doubled during tx.  After my second week of tx both numbers dropped in the 20's.  After one month of tx numbers started to rise.  Nurse said it could be due to OTC I was taking, which would be Tylenol.  This is all I was taking.

I am conducting a little experiment, which is not easy with my nightly fevers and no Tylenol for a month now.  Oops I did take two, a few weeks ago.  I am having blood work done Monday and I am curious to see if those levels dropped.

I know this is a long shot but just thought I would try.  

[nygirl7]

I think you'd have to really be excercising strenuously to raise them enough for it to matter - otherwise doctors wouldn't automatically think to test us for Hep in the first place, the question would be "do you exercise rigorously on a regular basis?" but that's not what they say they say "is there any chance you have been exposed to hep I want to run a test".............."do you have any tattooes or piercings?" right?

But as far as I've heard no doctor ever assumes you were working out.

Not as scientific an answer as yours but...what I've always figured!

[jmjm530]

I had a symptomatic acute stage when I contracted the virus over 30 years ago. Sky high enzymes, wine colored urine, yellow eyes, jaundice, light stools, flu symptons, etc. Later, I became asymptomatic with enzymes in the slightly elevated range, common with chronic HCV.

However, over the next several years I had 2-3 what would be be termed acute relapses where my enzymes (alt and ast) shot skyward (toward 1000 or more) mixed with extreme fatigue and at least once dark urine if I remember correctly, maybe some jaundice. In each of those instances I'm pretty sure the relapses were brought about by vigorous exercise.

Then, about seven years after infection, I stopped having these enzyme spikes in spite of vigorous exercise until about three years prior to treating when my enzymes again started to approach 1000 with extreme fatigue. My heptologist at the time likened it to an acute reaction and in fact we decided to put off treatment until things calmed down. In this instance there were three possible culprits -- vigorous exercise, Hep B vaccination and Chinese Herbs. I'm pretty sure it was either the Hep B vaccination or Chinese Herbs or a combination of the two.

-- Jim

-- Jim

[eureka254]

Your thread was right on time, at least for me.  I also recently learned about the possible association of elevated AST/ALT with muscle strain, but my understanding is that it is generally low on the list of differential diagnoses.  

From a personal experience standpoint, my son has had elevated AST/ALT/Alk Phos since last month (86/116/124 respectively), and had tons of work-up: all the heps were ruled out, as well as gallbladder concerns.  He is not medicating and abstains from alcohol, so it's been quite a puzzle for his doctors -- they have yet to identify the cause, and his elevations have continued all month. Of note, he did have a shoulder/muscle injury almost in the same timeframe as his elevated levels, so it certainly begs the question you are posing, but his doctors have not "attributed" his high liver enzymes to exercise or injury -- they continue to draw blood and monitor his levels in seeking a diagnosis.  I don't know whether there will eventually be information to confirm or deny your hypothesis, but I know I'm wondering about it as well and asking similar questions.
~eureka