Elevated Liver Values - Should I Be Concerned?

[madman]

I just received a call from my family physician regarding my overall blood work everything overall looked ok except my ALANINE AMINOTRANSFERASE is slightly elevated says HI 57 RANGE <50 U/L she wants me to go for further test for liver I am worried?



What could cause this?

 

[zorro]

Had you recently taken Tylenol? Mine has been elevated before (it was this last blood work actually) - Tylenol is often to blame. Anytime it comes up a little high, my doc always has me retest in 2 months and it's always been normal again.

 

[Vince]

Muscular exercise can cause highly pathological liver function tests in healthy men https://www.excelmale.com/forum/sho...hological-liver-function-tests-in-healthy-men

 

[madman]

No Tylenol, I did exercise heavy the night before my blood test. Finished my workout at 9pm and bloods were taken the next morning at 7:30am...........................hoping when I go for further tests it is related to the strenuous exercise?

 

[Vince]

good chance it's just from over-exercising

 

[MikeXL]

Strenuous exercise can cause elevated liver enzymes. This is because the so-called liver enzymes are not specific to the liver, they are in muscle as well. However, AST is in much greater concentration in muscle cells than is ALT. Thus, it stands to reason, and this has been born out in studies that strenuous exercise raises AST more than ALT.

If the raise is ALT only. It is very likely the liver. That said, very many things can do it. Most not of a concern at all. Tylenol use can. As can any drug.

Finally, people will proclaim that if you GGT is ok, it is not the liver. This is false. Although GGT is in fact the liver, often in pharmaceutical hepatitis or viral hepatitis AST and ALT is raised and GGT is not

Muscular exercise can cause highly pathological liver function tests in healthy men https://www.excelmale.com/forum/sho...hological-liver-function-tests-in-healthy-men

 

[Vince Carter]

We're you atleast 8 hrs (if not 10+) when you were tested...I find it is always advisable, even if Drs and labs contradict, that you should be 8-10hrs fasted anytime you have a CBC and/or CMP. I also strive to be 72hrs post gym before I have any of these pulled. You should retest under these more ideal conditions before you lose any sleep over it.

 

[madman]

I was about 8.5 hrs fasted. When I go for further blood work I will try waiting 72 hrs post workout. Thanks.

 

[madman]

Strenuous exercise can cause elevated liver enzymes. This is because the so-called liver enzymes are not specific to the liver, they are in muscle as well. However, AST is in much greater concentration in muscle cells than is ALT. Thus, it stands to reason, and this has been born out in studies that strenuous exercise raises AST more than ALT.

If the raise is ALT only. It is very likely the liver. That said, very many things can do it. Most not of a concern at all. Tylenol use can. As can any drug.

Finally, people will proclaim that if you GGT is ok, it is not the liver. This is false. Although GGT is in fact the liver, often in pharmaceutical hepatitis or viral hepatitis AST and ALT is raised and GGT is not

A lot of the literature on pubmed states strenuous exercise can raise both AST and ALT.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291230/

Mind you I always thought it was mainly AST that gets elevated so hope it is related to the heavy lifting.

 

[MikeXL]

Yes the study that you quote is exactly the one that I had in mind when I it has been born out in studies. However, go to the graphs of AST and ALT embedded in the link. You will see that the AST raise by 18 and ALT by 4 at the peak

A lot of the literature on pubmed states strenuous exercise can raise both AST and ALT.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291230/

Mind you I always thought it was mainly AST that gets elevated so hope it is related to the heavy lifting.

 

[Gene Devine]

Slightly elevated liver enzymes can be caused by many many things and are probably one of the most seen my physicians.

Most physician's "in the know" don't worry about slightly elevated enzymes and will just keep an eye on it.

Getting liver tests with just a above range is overkill.

I also have slightly elevated liver enzymes. I train like a mad man and like to have a few beers every night after a hard day of work and hard day in the gym...it's normal.

If it were me; I'd pass on the liver tests unless you are exhibiting symptoms of liver pathology...if not...skip it and just keep an eye on it.

 

[madman]

Thanks again for your advice everyone!

 

[Vince]

Jason has a video on liver health. https://www.excelmale.com/forum/showthread.php?6192-How-to-Optimize-the-Health-of-Your-Liver

 

[madman]

I waited until the next week to go for the test my gp requested. I went on Thursday February 16 in the early morning had blood drawn 7:22am. I could have looked at my results online the next day but did not want to work myself up as I thought I would wait and hope that I do not received another phone call from my gp. Have not heard from my gp since the test so hoping it was ok. So it has been just over a few weeks since my results came back and I went online today to look at them.

Overall the tests related to the liver came back in range except ALT and AST still slightly elevated? Not sure what to make of this.

Here are my results:

COAGULATION STUDIES

INR 1.1 RANGE 0.9-1.2


GENERAL CHEMISTRY


ALBUMIN 41 RANGE 35-52 g/L

BILIRUBIN TOTAL 7 RANGE <20 umol/L

ALKALINE PHOSPHATASE 107 RANGE 40-129 U/L

GAMMA GLUTAMYL TRANSFERASE 26 RANGE 14-62 U/L

ALANINE AMINOTRANSFERASE HI 59 RANGE <50 U/L

ASPARTATE AMINOTRANSFERASE HI 38 RANGE <35 U/L




Do any of you take any supplement that has actually improved your ALT/AST? Also I had worked out 60hrs prior to my blood work. Was hoping to have at least 3 full days from workout and I know a week without lifting would have been ideal.


In the past few years my ALT has been in range between 43-45 RANGE <50

 

[Nelson Vergel]

Exercise is what is causing your slight elevation. It is not pathological. It is just the product of increase muscle breakdown that has to be cleaned up by the liver.

Only taking a long break from the gym may help. Or you could try taking 500 mg NAC twice per day as an experiment.

 

[madman]

Thanks Nelson makes sense. I love to train. Will look into giving NAC a go!

 

[Nelson Vergel]

Most Potentially Hepatotoxic Meds Revealed: Real-World Data Analysis​

Publish date: July 16, 2024
By Edited by Shrabasti Bhattacharya
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TOPLINE:​

An analysis of real-world evidence identified 17 medications, many not previously regarded as potentially hepatotoxic, that have high incidence rates of patient hospitalization for acute liver injury (ALI), offering insights on how to better determine which drugs carry the most significant risk and warrant liver monitoring.

METHODOLOGY:​

• Without a systematic approach to classifying medications’ hepatotoxic risk, researchers have used case reports published on the National Institutes of Health’s LiverTox, which doesn’t account for the number of people exposed, to categorize drugs’ likelihood of causing ALI. The objective was to identify the most potentially hepatotoxic medications using real-world incidence rates of severe ALI.
• Researchers analyzed US Department of Veterans Affairs electronic health record data for almost 7.9 million individuals (mean age, 64.4 years; 92.5% men) without preexisting liver or biliary disease who were initiated in an outpatient setting on any one of 194 medications with four or more published reports of hepatotoxicity. Drugs delivered by injection or intravenously, prescribed for alcohol use disorder or liver disease treatment, or used as an anticoagulant were not included in the study.
• The primary outcome measured was hospitalization for severe ALI, defined by alanine aminotransferase levels > 120 U/L and total bilirubin levels > 2.0 mg/dL or the international normalized ratio ≥ 1.5 and total bilirubin levels > 2.0 mg/dL within the first 2 days of admission.
• Researchers organized the medications into groups on the basis of observed rates of severe ALI per 10,000 person-years and classified drugs with 10 or more hospitalizations (group 1) and 5-9.9 hospitalizations (group 2) as the most potentially hepatotoxic. The study period was October 2000 through September 2021.

TAKEAWAY:​

• Among the study population, 1739 hospitalizations for severe ALI were identified. Incidence rates of severe ALI varied widely by medication, from 0 to 86.4 events per 10,000 person-years.
• Seventeen medications were classified as the most potentially hepatotoxic (groups 1 and 2). Seven of them (stavudine, erlotinib, lenalidomide or thalidomide, chlorpromazine, metronidazole, prochlorperazine, and isoniazid) had incidence rates of ≥ 10 events per 10,000 person-years. The other 10 medications (moxifloxacin, azathioprine, levofloxacin, clarithromycin, ketoconazole, fluconazole, captopril, amoxicillin-clavulanate, sulfamethoxazole-trimethoprim, and ciprofloxacin) showed incidence rates of 5-9.9 events per 10,000 person-years.
• Of the 17 most hepatotoxic medications, 11 (64%) were not classified as highly hepatotoxic in the published case reports, suggesting a discrepancy between real-world data and case report categorizations.
• Similarly, several medications, including some statins, identified as low-risk in this study were classified as among the most hepatotoxic in the published case reports.

IN PRACTICE:​

“Categorization of hepatotoxicity based on the number of published case reports did not accurately reflect observed rates of severe ALI (acute liver injury),” the researchers wrote. “This study represents a systematic, reproducible approach to using real-world data to measure rates of severe ALI following medication initiation among patients without liver or biliary disease…Patients initiating a medication with a high rate of severe ALI might require closer monitoring of liver-related laboratory tests to detect evolving hepatic dysfunction earlier, which might improve prognosis.”
The study illustrates the potential to use electronic health record data to “revolutionize how we characterize drug-related toxic effects,” not just on the liver but other organs, Grace Y. Zhang, MD, and Jessica B. Rubin, MD, MPH, of the University of California, San Francisco, wrote in an accompanying editorial. “If curated and disseminated effectively…such evidence will undoubtedly improve clinical decision-making and allow for more informed patient counseling regarding the true risks of starting or discontinuing medications.

SOURCE:​

The study, led by Jessie Torgersen, MD, MHS, MSCE, of the Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, was published online in JAMA Internal Medicine.

LIMITATIONS:​

The researchers listed several limitations, including the possibility that reliance on laboratory tests for ascertainment of acute liver injuries could introduce surveillance bias. The study focused on a population predominantly consisting of men without preexisting liver or biliary disease, so the findings may not be generalizable to women or individuals with liver disease. Additionally, researchers did not perform a causality assessment of all outcomes, did not study medications with fewer than four published case reports, and did not evaluate the influence of dosage.

DISCLOSURES:​

This study was partly funded by several grants from the National Institutes of Health. Some authors declared receiving grants and personal fees from some of the funding agencies and other sources outside of this work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.

​

• HEPATOLOGY

 

[granger]

its obv never a good thing and could scale back dose. IF was just working out you would of had it PRE t aswell. also if was normal to have above normal levels chances are enough people work out for that to be included in teh range.. so likely not from working out as guys here would like to atrribute it and MOSTLY from the test.. this is a KNOWN thing not sure why guys put there head in the sand bout it.. now is slightly over clinically significant? prob not really esp if other liver function is good re billrubin etc.