ALT

[MK03]

Dear Doctor,

Below are my LFT results from a routine exam in September:
ALT - 52 (12-78 U/L)
AST - 27 (10-37 U/L)
BIL. DIR. .2 (0.0-0.2)
BIL. TOTAL 0.9 (0.2 - 1.0)
ALK 45 (38-136)
ALBUMIN 8.1 (6.4-8.2)

My doctor was not concerned with the ALT at 51 because it's in normal range for the lab. I worry because last year it was 34 and everything I have read suggests problems such as viral hepatitis, etc. with ALT >30. I consume, on average, 15 drinks per week. Although, consumption June-August was more because of my wedding, honeymoon and many social gatherings. I also gained 15 pounds since the test last year. I am 5'9 and weigh 202. I can't think of any exposure to hep c. I also want to point out I had a terrible bronchial infection which brought me to the Dr. and I just happened to have my yearly exam while there. What do you think is the likely culprit? Alcohol, weight, viral hep or just an anomaly? Thank you in advance.

[Thomas D Schiano, MD]

nope--i think you are heading in the right direction

[MK03]

Hello, Dr. Just wanted to update you since I received the results from my re-draw. Results returned negative for hep A/B/C and ALT reduced to 19. I guess the diet - dropped 10 lbs - and limited alcohol intake really helped. One last question so you can go on helping others. My AST was 21 and this is the first time my ALT is actually more than AST. Anything with which I should be concerned?

[Thomas D Schiano, MD]

i do not think that your risk for having acquired HCV from these modes of transmission is high at all.

[MK03]

Dear Dr.,
I have decided to redraw mainly for peace of mind. I am eating much healthier now and have strictly limited my alcohol intake to under 10 drinks per month. Hopefully, the ALT will decrease. But my question has to do with hep c risk factors. I have a few tattoos, which were done in a professional setting almost 13 years ago, and have shared a rolled banknote for snorting drugs a few times a decade ago. This was not a common occurrence and I chalk it up to being young and dumb. I have read mixed opinions on the banknote risk and understand it to be theoretical but low. More likely to occur in those with nasal damage due to frequent and heavy use. I am going to ask for a hep panel but would like to know if there is a great likelihood to have caught hep c 10+ years ago through either of the two risk factors mentioned. Thank you.

[Thomas D Schiano, MD]

this is hard to say--this is not a lot of weekly alcohol frankly--just keep in the back of your mind the intake if your liver tests are elevated again

[MK03]

Thank you, Dr. This forum is an excellent resource. One last question, if you'd be so kind. I have cut down on my alcohol intake significantly since my test in September. Do you think it is okay to continue drinking 2-3 beers 2 times per week? I enjoy my craft beer but certainly don't want it to cause any long term significant problems.

[Thomas D Schiano, MD]

it is in fact possible that the infection and the OTC meds contributed

[MK03]

Dear Doctor,

Thank you for the response. I appreciate your time and value your opinion. I remembered I had blood drawn in June 2012 for an unrelated issue. My ALT at that draw was 23. So, it was even less than the 34 in 2011 and much less than the 51 this past September. Does your opinion change with his new information? How possible is it my level spiked mainly because of the bronchial infection and OTC meds I was surely taking? Just wantrd to make sure you have all the information and there is no need to draw again before my next scheduled physical in September. Thanks again for your time.

[Thomas D Schiano, MD]

i am not overly concerned sabout the liver tests.  fatty liver is very common and can be exacerbated by frequent alcohol use.  losing some weight I am confident will help things.