Fluctating liver values in athlete

Hello -
In 1998, my husband was rejected for giving blood b/c of high liver enzyme values (they only reported ALT as 217).  He was retested and they were normal.  Several months later he was rejected for life insurance b/c his liver enzymes were high again.  Again, he retested in a month and they were normal.  Dr. did not see the need for any followup.  In January 2011, he went for routine physical for the first time in a decade or so.  AST was 45, ALT 22.  March 2011 AST 40, ALT 22.  April 2011 AST 35, ALT 22.  All other tests, including all types of hepatitis, were negative.  Jan 2011 bilirubin at the top of normal range, but by April down slightly.  He is age 44, 5'11', 155 pounds, runs 20-30 miles/week at 6:30 pace; bikes 150-200 miles/week at 18+ mph average (been doing all this for 20+ years).  Only alcohol is 1/2 glass of red wine 4x/week in the last 2 years.  He's also a vegetarian who doesn't eat fruit or veggies (but takes a multivitamin).  Rarely takes any painkillers.

They want to do an ultrasound.  He is getting sick of all these tests that really haven't shown anything for these values that have probably been fluctuating since 1998 or before.

Can all this exercise be causing these fluctuating values?  Dr doesn't want to seem to consider it.  Also, he was treated with Accutane for severe acne from a teenager through early 20s.

Any advice, opinions welcomed, thanks.

[HectorSF]

Normally, where are the aminotransferases?
The normal range of values for AST (SGOT) is from 5 to 40 units per liter of serum (the liquid part of the blood).

The normal range of values for ALT (SGPT) is from 7 to 56 units per liter of serum.

The first test ALT was a mistake if they retested and found it to be normal.
Your husband's values are normal in most results. ALT is always normal. Only once (January 2011) AST was slightly high.

Not eating fruit or veggies could cause health issues! Not all nutrients are contained in vitamins. Plus drinking alcohol is toxic to the liver. Drinking alcohol the night before a blood test can effect the levels of AST and ALT. Luckily your husband is young if he continues such a diet he will become ill in time.

Sorry but I don't see the need to be concerned about liver disease. Some people have higher levels then others and labs have different norm levels. He was tested for hepatitis which eliminates one cause of liver damage.

It this doctor is a PCP primary care physician get a referral to see a gastroenterolgist and they will be able to determine quite easily if there is any reason for concern.

AST (SGOT) is normally found in a diversity of tissues including liver, heart, muscle, kidney, and brain. It is released into serum when any one of these tissues is damaged. For example, its level in serum rises with heart attacks and with muscle disorders. It is therefore, not a highly specific indicator of liver injury.

ALT (SGPT) is, by contrast, normally found largely in the liver. This is not to say that it is exclusively located in liver, but that is where it is most concentrated. It is released into the bloodstream as the result of liver injury. It therefore serves as a fairly specific indicator of liver status.


Hector