ALT, AST getting high

[Moeymitt]

I am back again. Nice to see there are still some oldtimers left from this past year. welcome to everyone else. I have used this forum up until June after my second bx in four years.
History: female, dx four y.o/ Geno 1. First bx(2001) stage/grade1, second bx in June stage1 grade 1. In Oct of o4 ast went from 30 to 70 then up to 170 this past spring. Last monday I went for my 6 month check up and ALT was 301, AST 197. yikes!! My doctor all along has been telling me if I decide not to tx that I would most likely live my whole life out with this getting out of hand.. I have had it since 1973.I spent about 6 months here on the forum getting help and support in making my decision not to tx.  Now he said I should start tx. Besides for the RUQ pain, I have no other sx. I am active triathlete who just spent last summer going around the NW doing races and totally forgetting I had hep C. It was great. This last blood work really threw me for a loop. Anyone else have high AST?ALT's? I don't drink or smoke, don't do any drugs and have been on a vit. regimen since dx in 01.

Happy New Year  and good health to all of you.

[couldn't think of a nickname]

My diet isn't that bad, it used to be worse. I had no idea quercetin is not supposed to be good for the liver. Ironically, that one bothered me less than some of the other stuff. I stopped taking it because I didn't feel it was working. Sometimes you just know.
Yes, I do have the other issues, the main one is the thalassemia. I really don't want IFN either, as I feel it might over-ramp up my immune system, so-to-speak.
Larger trials are coming, I think data on 950 is only a few weeks away. I expect the combo arm to show a better than 5 log drop in 2 weeks. I shouldn't say that, as it is only my guess, but oh well, I said it earlier anyway. Let's face it though. No medicine is natural to the body, and will have some side effect, the question is, to what degree? No matter what they do, and how much they can help, they are still chemicals un-natural to our bodies, so the shorter the better. A necessary evil for us.

[Forseegood]

I agree with you for the most part, only that most of the things that I take are food substances, and we eat food anyway and have to, so I don't think they could be doing that much harm to anyone - unless someone was taking mass amounts...the things you mentioned mostly act differently on the body -one from the other, so it's kind of an apples oranges thing. I do feel quercitin isnt a good thing for the liver, with all that I've read. Like I said, maybe for some people.

Also I don't see how an "offending substance" could still do anything to your liver enzymes long after you've quit ingesting it.
I just hope these new drugs go into bigger trial settings sooner than later, as I remember you had some pre-existing conditions that keep you from doing present treatment, and I can see your hesitations there...

[couldn't think of a nickname]

I admit it is frustrating at times to try things that work for others, but not for me, but, I have slowly come to the conclusion that maybe these things don't react well with my body.
I have always had allergies, etc., so it is possible my body is overly sensitive to things. I even took the autoimmune capsule from Dr. Zhang a couple of times, but it had no effect.
I believe some day drugs will be targeted to the individual instead of the masses, as we are all so different, but I don't think that is coming that soon. In fact, I think part of my problem before was some things, the vitamins in particular, got my immune system revved up (just a theory of mine).
The odd thing is, that when I first started the God's Remedy, for about a month, I felt better than I had in 10 years. That kind of wore off after that. I was quite surprised when I got my blood work done and saw my numbers went the wrong way. But, that goes to show you that sx's and numbers don't correlate.

[Forseegood]

I know I'm laboring a point here, as I'm wont to do now and then, but sometimes we can never really know for sure what causes alts to rise exactly, whether it be a combo of biological things, etc.  And of course, the plain hep advancing is prob the culprit with most of us anyway...though it can advance very, very slowly...I know of many, many people who had mostly normal readings since diagnosis, then they just start to go up because of the inflammation in the blood, sad but true...But then again, I have friends like Shiela who came here a while ago, she's almost 70 having had the hep for a long, long time, and her enzymes are pretty elevated and have been a long time and she still has very low liver damage her last bx being a 0, with her it's not specifically a liver disease, it's giving her immune probs... There are just too many variables to always give exact calls on some of these things to me. Not even the docs can do it half the time.

With me it was pretty cut and dry, I took my regimen and they were always just slightly elevated, in the mid 40's. Stopped and it rose to the high 70's 80's... Went back on and it went back down to the mid 40's again. It is a question of how long they stay at these ranges too, so it just not a question about them spiking for whatever reason. I've always maintained there are too many mysteries about most of these things, with just a lot of educated guessing. Just my take.

[couldn't think of a nickname]

Thanks for the input. I have tried doing things differently as well. I took Schizandra. I took just milk thistle. I took Quercetin. I took just a good multivitamin. I tried locally grown honey for allergies. Had docs look at everything I have used. Even on Zhang's protocol, I was on 2 different ones and got on them slowly, and deleted some. All I know, is, that my enzymes were lower before every single thing I tried. Since all of those either produced no reduction, or made my enzymes much worse, it doesn't seem logical to worsen things more. What really bothers me, is that things that are supposed to help, made things worse. Sometimes things don't work for some people, and I am one of them.
I have to wonder if I never did any of those things, if my enzymes would have stayed lower, like they had for years. In other words, doing things to help me turned out to be counterproductive. Nothing changed much until I tried to do things.

[Forseegood]

Hey just wanted to say, just because you had couple of bad experiences with supplements, herbs doesn't necessarily mean that none of them will work for you - same could be said of people's very first sexual experiences, excuse the analogy...ha ha! I remember reading that combo treatment you mentioned once and I personally wouldn't take that, it had too many different elements in it, some a little suspect...and a few few bad apples could of been the culprit(s)! Smearing the reps of the other "nice" ones! Boy, I'm killing these metaphors and similes!

Granted, you have to know what you are doing with them, and it can be a process in seeing which ones are right for you...that's why I introduce one at a time (except for the things that are commonly known as benign, like Vit C and Calcium.) Take only a very a small amount at first, then gradually build up to an amount that is tolerable for you individually. Then test, maybe with just each one. I know it sounds like rather an involved process, but to me it's well worth it. Especially if you are doing the watching and waiting thing, you could be helping inflammation and giving much needed extra nutrition to yourself, because to at least my way of thinking after all the studying and consulting with experts I've done....there can be certain deficiencys going on with a person with a compromised liver, and these go some way in correcting this situation. I don't really take a lot of herbs anyway, what I'm mostly taking is extra "food" that you eat anyway. Like artichoke supplementation, it's got a very good acid for us, and I just don't eat artichokes that often, who does?

Like Schizandra berry, it is just a berry, and many people, including Dr. Weil and many others, think this is a very good food substance for the liver with natural cleansing properties. I would just start with a little bit of that and vit c, vit e. Then add in a little bit of selenium, a mineral that you can get in nuts, etc. These things are very benign, you can do a bunch or research on them and you won't get many bad hits at all. I don't personally take milk thistle, I used to for years, but it just started disagreeing with me a few years ago. I made sure I tried it by itself with all things remaining the same when I could see that something wasn't agreeing with me, and sure enough it was the culprit.

There are many people who do take combo treatments out there and here at this board who say they benefit greatly from them, and that's great for them, they are saving money cause it's cheaper than the way I do it. One has to realize that certain combo treatments are better then others as well, the one you were taking might just be a bad one. There are also combo treatments that are easier to call, say with just three or four elements in them, like alpha lipoic acid, vit c, NAC, etc. That's an easier way to go, once you have tested each element. But many of the things that I am talking about are really benign and I'd hate to see you miss out on their benefits because of some creepy herb you took in that combo treatment you took, dragon something or the other, whatever it was.

Now I might get some flack for telling you all this, and that's okay, it's okay to disagree with me, but this is my take on the situation. For you to be a bit cautious of even the very benign glucosamine&chondrointin tells me that you just had a bad experience. Many, many docs now prescibe this and it's really harmless and could perhaps benefit you a lot if you are having joint and muscle aches.

As for the gerd thing, I had that a few years ago, and I took a very well known product in europe (not here so much) called Betaine HCI (with pepsin) or it has a general name of TMG. It's just made of sugar beets and pepsin and that's all. It took those burpies and bad digestion away in about a few days and I've hardly ever had them since. I tell people about it and many don't seem too keen to try it, and that's okay, all I can say is it works wonders for me and I would always opt for something natural like this then taking an Rx with possible side effects, toxins, etc. But that's just me. (And that's not to say that all things natural are necessarily good for you, or don't have toxins.) Sometimes you don't have any choice but taking an Rx, like with treatment (for a lot of people.) And I do agree with HepC guy, we might of been going a little overboard in saying high alts have to do with something else then the actual hep, cause unfortunately, it might be just the hep and little else. One has to investigate as we all said earlier. Just my opinion, as I always say, take what you want and leave the rest behind. Hope you had a great holiday!

[couldn't think of a nickname]

Pretending you're playing quarters : )

I use Bragg's ACV, I order it by the quart as it is less than $4. On a salad though, I use balsamic vinegar. I LOVE that vinegar.

[jmjm530]

CTON said prev: "...but when on tx, there are other things going on"
---------
But ain't that the truth. :)

[couldn't think of a nickname]

I can't remember which I started first, they may have been around the same time. I take one teaspoon in a full glass of water once daily, but many take it 2 or 3 times per day. My doc suggested once per day, that is how often his wife takes it.
From what I have read, it should work by itself, but when on tx, there are other things going on.

[jmjm530]

Curious, did you try the apple cider vinegar before you started taking the Priolosec or only with the Prilosec? Now that I'm on Nexium I have a little vinegar on occasion with a salad but I'm figuring the Nexium is buffering the vinegar somewhat. Also curious how much apple cider vinegar you take daily. I've been up to 2 Nexium a day with only partial success. Hoping things will get better when treatment is over.

-- Jim

[jmjm530]

Thanks for the informative articles.

Regarding a spike in LFT's, I think the key word is "continuing".

In my case, the spike lasted 8 months which was more or less predicted by my hepatologist based on the assumption it was caused by either an herbal formulation, the hepatitis B vaccine, or a combination. Of course I was very worried but he kept telling me they would normalize and it did.

After 8 months, my liver enzymes returned to normal and in fact my viral load eventually dropped from 35 million IU/ml (prior to the spike) to 16,000 IU/ml (a couple of years after the spike.)

Moey, in your case, you really need to look at your lifestyle and see what might have caused the spike. My guess would be your triathlon training as I've also had exercise-induced spikes in the past.

Bottom line, I'd take everything into consideration with your treat or not to treat decision -- but I'd still make your biopsy results primary in that decision. I know you've had a recent one but if your enzymes are still high in six months or so, maybe a fibrosure or fibroscan test would help fill in the gaps before your next biopsy.

-- Jim

[TnHepGuy_]

A continuing spike in LFT's can be an indicator of increased inflamitory activity, which in turn can be an precursor to further histological progression.


Here are a few articles realted to LFT's and histology:

<a href="http://www.hivandhepatitis.com/2003icr/03_assld/docs/pegasys/102703_i.html">Patients with Chronic Hepatitis C and Normal ALT Levels Show Impaired Quality of Life But Significantly Lower Liver Inflammation and Fibrosis Progression Compared to Patients with Elevated ALT</a>

(from the study)

"<i>Patients with chronic hepatitis C and persistently normal ALT levels show significantly lower liver inflammation and fibrosis progression rate per year compared with patients with elevated ALT levels.</i>"


<a href="http://www.hivandhepatitis.com/hep_c/news/2005/ad/102105_a.html">Natural Course of Hepatitis C Virus-infected Patients with Normal ALT and the Effect of Interferon Therapy on Hepatocellular Carcinoma in Those with Elevated ALT</a>

(from the study)

"<i>The progression rate of fibrosis was slower (in patients with persistently normal serum ALT level) than in chronic hepatitis C patients with elevated serum ALT levels.</i>"


<a href="http://www.hivandhepatitis.com/2004icr/ddw2004/docs/0602/060204_c.html">Factors Associated with HCV Stage 3/4 Fibrosis</a>

(from the study)

"<i>Univariate analysis revealed a significant association of 2 X upper limits of normal ALT and AST (i.e. > 80 U/L) ... were significantly associated with stage 3/4 fibrosis.</i>"


<a href="http://www.hivandhepatitis.com/hep_c/news/042803a.html">Progression of Liver Fibrosis in HCV Patients with Normal and Elevated Transaminase</a>

(from the study)

"<i>Anti-HCV patients with PNALT (persistantly normal ALT levels) with an initial fibrosis of F0 or F1 were less likely to develop progression of fibrosis than those with elevated ALT....</i>"



TnHepGuy

[couldn't think of a nickname]

I have reflux too, and I also take Prilosec, but it has been better with using both for me. It is supposed to aid in digestion and neutralize stomach acid, which is supposed to reduce reflux. Many take it for weight loss. I actually put on 5 pounds during the first couple of months, which is what I wanted anyway. It is actually probably a better weight regulator more than anything.
Our massage therapist was drinking it straight. More power to her LOL!

[jmjm530]

Apple Cider Vinegar -- especially Bragg's Apple Cider Vinegar with the "Mother" -- has been been touted by many health aficionados  as an all-purpose cure for ailments ranging from arthritis to obesity to hypertension to reflux to weight loss to even premature aging. In fact, Paul Bragg's best-selling book is titled "Apple Cider Vinegar -- Miracle Health System. I'm reading from the cover of the book which I own.

Personally, I have always liked the taste of vinegar and have used in cooking and in salads for years. BTW it's also a great non-toxic cleaning agent for the kitchen and bath.

One of the more popular claims is that Apple Cider Vinegar can cure reflux. I'm not sure of the origin or substantiation of this claim, but all I can say is that it didn't work for me or for most of the folks over at various GERD (chronic reflux) forums I've visited. Just wanted to share that before anyone started pouring it down the hatch who has stomach/digestive/reflux problems. That said, it may work for you.

-- Jim

[couldn't think of a nickname]

When I was a kid, it really tasted kind of sour. Maybe it was because you expect water to taste like water. My mother says she likes the natural stuff much better, as it is not as bitter, and I think that might be it. When I was a kid, we used Heinz ACV. Now, I like the taste. Since I have never been a huge fan of plain water, I actually like it better LOL!

There may have been 1 other reason why I didn't like it as a kid. My mom MADE me drink it!

[Forseegood]

Hey you! I wrote you a post a little farther down below!, if you have time...just always appreciate your input! But it's not like youre going to get 86ed from here if you don't! he he he!

[couldn't think of a nickname]

yes, a higher AST to ALT is often an indicator of progressed disease, and possibly cirrhosis. Platelets might be lower by then as well.

[Forseegood]

One more thing I forgot to add that's i've read, it's when your ast goes above the alt that is concerning...

[couldn't think of a nickname]

If you think that tastes bad, you should taste the kind from the supermarket. I gave some to my mom who is getting over a cold, and she said the pure stuff tastes much better-it is less bitter. If you put it in enough water, I don't think it is so bad, and I hated the supermarket kind when I was a kid. Maybe that's why I don't mind the pure stuff as much now.

Don't feel bad. It sat on my counter for months before I started using it, now I am afraid to miss a day.

[Forseegood]

Boy, you've unwittingly showed me what a hypocrite I can be. I'm always on people to change their diets for the better... that type of sanctimonious BS, and here, I have Apple Cider V. in my cupboard and I can't bring myself to drink it cause I just hate the taste...ha ha ha! But it's New Years resolution time...gonna down that stuff if it kills me! How hard can it be? Just chase it with some cran-ras juice or something! You are not the only one that touts it's medicinal properties, I know other people who benefit from it too. Thanks so much for the heads up on the points, message is yet another expense but well worth it if you find the right person. There are even people like Goofman that go to Extra terristials, takes all kinds!!!!

[jmjm530]

High ALT doesn't necessarily correlate with liver damage. Strenuous exercise, diet, herbs, rx drugs, supplements and a host of other things can influence enzyme levels. I know a lot of triathletes judiciously use pain killers and anti-inflammatories which can be a real problem if your liver is compromised.

I would therefore base my decision on whether to treat or not more on liver damage then enzymes or even viral load. If I read your post correctly you were stage 1 in '01 and are still stage 1 as of June. This is minimal liver damage that doesn't appear to be progessing. Therefore as a hard-to-treat geno 1, an approach of watch and wait could make sense, especially in light of better, newer drugs hopefully on the horizon.

In any event, before making any sort of decision I'd examine more closely my diet, including supplements, and perhaps tone down the exercise until my enzymes return back to base level.

-- Jim

[couldn't think of a nickname]

Thank you so much for the kind words.
I have had my massage therapist work mine, but they may be more reluctant to work that area. Self-massage is taught very well by the Trigger Point Therapy Workbook, though. My PCP did say he thought my muscle inflammation was likely HCV related. It also tends to come and go. If you are noticing it while doing certain movements, then yes, it is probably that muscle. Apple Cider Vinegar has really helped me though, in my opinion.

I get palps (PVC's?) on occasion. They are very annoying. They come and go. They can be from many sources-thyroid function being off, GERD, positional, stress, etc. The esophagus and heart are innervated by the same nerve-the vagus nerve-that is why a stomach disorder can be the cause of those as well (at least from what I read).

The eye pain can also be caused by trigger points-some in the area of the back of the head, near the other muscles I mentioned, and also the SCM (sternocleidomastoid) which is in the neck. I have said many times that this virus can cause inflammation of the muscles for a variety of reasons, and a strong immune response could be part of it. The virus is myotoxic, and toxins remaining in the muscles are basically what trigger points are.

[cuteus]

whats wrong with apple cider vinegar? I always liked the taste. when it was a fad to drink it for weight loss, I realized the stuff is not bad at all. ANd that is the supermarket kind!
I can't believe people don't like the taste! I guess my taste buds are odd.

[couldn't think of a nickname]

Glad I was of some help. GP's I don't think take the time or care sometimes to really help things like that. I think many don't really understand the widespread problem they can cause.

I have heard of the supplements you mentioned, and are intrigued by them. What has stopped me from trying it is that everything I have tried has made something worse, except for apple cider vinegar, so I have been reluctant to try it. apple cider vinegar can help arthritis too, by helping to flush out the crystals that form.