What supplements would cause high AST or ALT?

[GarthF]

I'm really freaked out right now, because it's Saturday night and I have no doctor to contact. My Quest Lab results just came back. My AST is 95, and my ALT is 66. Back in April my AST was 21, and ALT was 27. I'm overweight, but I rarely drink. Very rarely. The same day (evening) after my test was taken on my birthday, I had 2 beers and the next day I had strange pains underneath my belly button similar to the feeling when I had diverticulitis, along with difficulty urinating. It's weird. Lately I've been taking the following supplements and vitamins:

L-Citrulline (Bulk Supplements) - 1.5 TBSP 2x daily
L-Lysine (NOW) - 1000mg - 1 daily
Pygeum (Swanson) - 1 daily
Vitamin K2 - 100mcg daily
Nature Made Stress B Complex - 1 daily
Vitamin D3 - 5000IU daily
Krill Oil - 700mg daily

Any ideas what it could be? Even though I'm overweight, I only eat healthy foods and drink a lot of water. It just seems suspect to me. I feel fine otherwise and have been going to the gym and hiking. It doesn't make sense.

Edit...My gallbladder was taken out years ago. I'm also currently on HCG monotherapy 1000IU every 3 days.

I just started exercising heavily. I'm hoping that's the culprit. This is interesting:

Muscular exercise can cause highly pathological liver function tests in healthy men

To investigate the effect of intensive muscular exercise (weightlifting) on clinical chemistry parameters reflecting liver function in healthy men.Fifteen healthy men, used to moderate physical activity not including weightlifting, performed an 1 h long ...

www.ncbi.nlm.nih.gov

 

[MarkM]

It's my understanding that hard exercise can increase your ALT and AST numbers. At least that is what my research has shown me and is backed up by my own lab work when I am in my work out phase. I get on these kicked of working out hard and then backing off. When I am working out hard my ALT and AST normally increase from the 20 range on both to the mid 40 range. When I back off my routine they always come back down.

I believe if you are working out heavily you should take a break a week before lab tests to see "real numbers" that are not elevated because you are working out.

It's similar to having an ejaculation two days before labs can increase you PSA and prolactin levels.

I'm not a doctor, just sharing with you my personal findings.

 

[lukas_az]

none of those....add some NAC to lower them, amazon banned it, you can it directly from places like bulksupp or nutrocost

 

[GarthF]

It's my understanding that hard exercise can increase your ALT and AST numbers. At least that is what my research has shown me and is backed up by my own lab work when I am in my work out phase. I get on these kicked of working out hard and then backing off. When I am working out hard my ALT and AST normally increase from the 20 range on both to the mid 40 range. When I back off my routine they always come back down.

I believe if you are working out heavily you should take a break a week before lab tests to see "real numbers" that are not elevated because you are working out.

It's similar to having an ejaculation two days before labs can increase you PSA and prolactin levels.

I'm not a doctor, just sharing with you my personal findings.

That's the conclusion I came to, but I'll contact the doctor tomorrow and get his opinion. The trainer pushed me hard exactly 5 days before the test. This website has a graph that shows AST and ALT levels close to their peak around 4-5 days after strenuous exercise:

Muscle Damage and Elevated Liver Enzymes - Unlocking Insights - Explore Our Articles

Discover the link between strenuous workouts, muscle damage, and increased liver enzymes.

blog.insidetracker.com

I didn't know that about PSA and prolactin. I'll try to abstain, thank you!

none of those....add some NAC to lower them, amazon banned it, you can it directly from places like bulksupp or nutrocost

I'll keep this in mind if it's not exercise related, thanks!

 

[sammmy]

"difficulty urinating" is a serious symptom requiring liver/gallbladder/kidney examination.

Meanwhile I would stop Pygeum (complex mixture with untested safety) and L-Citruline (high daily amount).

 

[Neil]

Do you know your A1C? One of the biggest causes of liver issues is NASH (fatty liver disease). It's an epidemic actually, a disease of carbs and affluenza. Do you know that only 2% of Americans at 60 years or above are metabolically healthy? And below 60 only 12% of Americans are. My wife has NASH, and her ALT and AST were above the reference range. Mine was close to being over-reference as well. For the last 13 months we've been on Keto, my wife has lost 22lbs and I've lost 46lbs. Our liver values are nice and centered in range now. It also helps with ED and morning wood.

 

[ryan98366]

I have had strange values in the past. My advice is don't stress, retake the labs in 3-4 weeks. Make some adjustments. Don't exercise and drink water. One time was FT T was 3 instead of the usual 35-40. It was just an off lab.

 

[JimGainz]

Choline and inositol were an old school body building fix for fatty liver after a cycle. 2-3 grams of each for a month. Look it up - it works.

 

[Dicky]

Do you know your A1C? One of the biggest causes of liver issues is NASH (fatty liver disease). It's an epidemic actually, a disease of carbs and affluenza. Do you know that only 2% of Americans at 60 years or above are metabolically healthy? And below 60 only 12% of Americans are. My wife has NASH, and her ALT and AST were above the reference range. Mine was close to being over-reference as well. For the last 13 months we've been on Keto, my wife has lost 22lbs and I've lost 46lbs. Our liver values are nice and centered in range now. It also helps with ED and morning wood.

Nice work my friend.

 

[Wilson7]

Always check CK along with LFTs if you exercise esp resistance training or eccentric work (long down hill run) that results in soreness/muscle damage. My AST/ALT used to be in the 80 - 100 range, usually ALT higher. ALT has a longer half life in circulation and will remain elevated longer than AST. My CK used to run in the low 2000's. That was 20 years ago when I lifted heavy. When I'd take a week off exercise (vacation for example) my LFTs would drop into the 60's, AST even lower and CK in 1000 - 1200 range. Been in HRT T and little ND for 30 years. Now LFTs are in the low 60's and CK about 1500 with exercise. GGT always < 15, everything else normal. I've had liver US to R/O fatty liver. First, take a week off exercise and recheck, include GGT and CK in the next set of labs, if elevated get a liver scan.

 

[StoicDoc]

I’m a primary care doc, so I’ll take a crack at this…

Most likely exercise and or lab error, but let’s review the findings and potential causes.
Both your AST and ALT were elevated. AST is not liver specific and can certainly be elevated with muscle damage. ALT is liver specific, though.

The four most common causes of acute hepatic injury are:

Congestion (cardiac failure)
Hepatobiliary
Infection (viral, usually)
Toxin (alcohol, acetaminophen)

The only likely culprit from this list would be acute viral hepatitis and not that likely if you are vaccinated, careful about where you eat, and don’t share needles.

I would also think fatty liver less likely, given normal enzymes not that long ago. It is possible, I suppose, that you hit a “seam” of fatty deposit and are seeing the results of releasing toxins stored there, but…

I would think about keeping the bottom four supplements and losing the top three; they are of dubious benefit and perhaps questionable sourcing (?).

You could consider taking one capsule of Jarrow milk thistle daily, abstain from alcohol completely, moderate your exercise, and retest in 3-4 weeks.

 

[StoicDoc]

If transaminases remain high, can consider an US and GGT. Exercise has to be pretty intense to create a substantial increase in CK and is usually accompanied by significant muscle swelling, pain.

Additionally, you could have been seeing the tail of a retained stone in your liver, something that happens occasionally despite having had your gall bladder removed.

 

[rifter]

I've been fighting this exact issue for close to a decade. I exercise excessively - weight training 5 days a week 1.5 to 2.5 hours with multiple sets taken close to failure, often times, beyond. I've done this for close to 20 years. After 20 years, you do get progressively better at causing muscle damage to your own body.

My AST & ALT average around 200. The more intense my training becomes, the higher levels of AST/ALT. The less intense the exercise, the lower the values. I've proved this multiple times with my own bloodwork. I could be a snow-flake and these elevations could be innate to me, my lifestyle or genetic make-up. I don't take drugs and I don't drink or abuse OTC NSAIDS etc. Other people do not appear to have this elevation issue.

AST & ALT are not-liver specific and they have vastly different half-lives.
If I take a lighter week of training, that 200 above drops to 100. If I take 1.5 weeks off completely, those values are around 75. Maybe longer would be needed for me to return to normal values. I don't know. I've had MRIs which showed no abnormality and even had some gastroenterologists order a biopsy -- which I refused.

Doctors do not understand this. The argument they present is "ALT is more concentrated in the liver than muscle tissue" or "I've seen blood tests from iron men and professional athletes, and none of them look like this". A quick google search will yield numerous papers indicating that ALT is in fact found in the liver, heart, muscles and kidneys. You will also find countless case studies, some very recent, which deal with this exact issue.

If your elevations are truly due to training or skeletal muscle damage, then any number of supplements will not be helpful. TUDCA, NAC, fish oil, milk thistle, etc. will not be effective at reducing the aminotransferases to baseline. Save your money.

To me, the most irritating is that when your doctor sees these elevated enzymes, you will often be denied treatment with medications that are metabolized by the liver.

As Stoicdoc suggested above, GGT, ALP, billirubin and CK are useful in determining whether the increase is due to muscle damage or another condition, however, in my experience, is still not enough for a doctor to disregard other potential causes of liver damage and prescribe any needed medication.

Either way, I'm writing this response out more out of frustration with the issue than anything else. My best advice is to find a gastroenterologist/doctor that lifts.

 

[Graham]

Only thing that has ever raised mine was alcohol and NSAIDS

 

[StoicDoc]

Rifter: That is both very unfortunate and interesting. I suppose your doc has tested you for the more unusual causes of liver disease, both benign and not so benign? Your health has otherwise been good and there has been no signs of progression in these findings? Can you post the citations for some of the case studies you have found?

Thank you!

 

[rifter]

Oh definitively - They've looked at everything from hepatitis to autoimmune conditions to NAFLD. But none of my labs have resulted in markers which would suggest further testing.

Health has been good. Didn't feel any difference when the transferases were at ~70 vs. ~200.

The first link below is fairly recent and has a ton of other references. Looks like an analysis or meta of some sort - not savvy enough to appreciate the distinction between various papers.

Some of the papers:

Body Building and Aminotransferase Elevations: A Review

In addition to liver injury, elevation of aminotransferases can be caused by strenuous exercise and use of muscle-building and weight-loss supplements. The purpose of this review is to discuss the various mechanisms of elevation of aminotransferases related ...

www.ncbi.nlm.nih.gov

https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.20548

Transaminase Levels and Vigorous Exercise - PMC

www.ncbi.nlm.nih.gov

Strenuous Exercise-Induced Tremendously Elevated Transaminases Levels in a Healthy Adult: A Diagnostic Dilemma

The liver function test (LFT) is a commonly performed test in clinical practice in order to assess well-being of the liver; however, derangement in liver enzymes, however, may not necessarily imply an underlying liver pathology. The standard liver function test measures alanine aminotransferase...

www.hindawi.com

 

[sammmy]

I've been fighting this exact issue for close to a decade. I exercise excessively - weight training 5 days a week 1.5 to 2.5 hours with multiple sets taken close to failure, often times, beyond. I've done this for close to 20 years.

This is a rather extreme example of over training. I do not think the OP does that training so that would not explain his enzyme elevations.

 

[GarthF]

"difficulty urinating" is a serious symptom requiring liver/gallbladder/kidney examination.

Meanwhile I would stop Pygeum (complex mixture with untested safety) and L-Citruline (high daily amount).

That's strange, because I thought Pygeum was safe, but not saw palmetto? I suspect the L-Citrulline. It's impossible to know how safe these Bulk Supplement bags are. It's just a bag of powder from China. Most of the reviews you see are because Bulk Supplements offered a free sample of another product if you review the one you purchased.

Do you know your A1C? One of the biggest causes of liver issues is NASH (fatty liver disease). It's an epidemic actually, a disease of carbs and affluenza. Do you know that only 2% of Americans at 60 years or above are metabolically healthy? And below 60 only 12% of Americans are. My wife has NASH, and her ALT and AST were above the reference range. Mine was close to being over-reference as well. For the last 13 months we've been on Keto, my wife has lost 22lbs and I've lost 46lbs. Our liver values are nice and centered in range now. It also helps with ED and morning wood.

I know nothing about that. I'll look into it. I've always eaten healthy, but carbs are my biggest weakness late at night or when I was stressed during all the "peaceful protests." I've since stopped this habit.

I’m a primary care doc, so I’ll take a crack at this…

Most likely exercise and or lab error, but let’s review the findings and potential causes.
Both your AST and ALT were elevated. AST is not liver specific and can certainly be elevated with muscle damage. ALT is liver specific, though.

The four most common causes of acute hepatic injury are:

Congestion (cardiac failure)
Hepatobiliary
Infection (viral, usually)
Toxin (alcohol, acetaminophen)

The only likely culprit from this list would be acute viral hepatitis and not that likely if you are vaccinated, careful about where you eat, and don’t share needles.

I would also think fatty liver less likely, given normal enzymes not that long ago. It is possible, I suppose, that you hit a “seam” of fatty deposit and are seeing the results of releasing toxins stored there, but…

I would think about keeping the bottom four supplements and losing the top three; they are of dubious benefit and perhaps questionable sourcing (?).

You could consider taking one capsule of Jarrow milk thistle daily, abstain from alcohol completely, moderate your exercise, and retest in 3-4 weeks

I'll look into the Jarrow milk thistle, thank you. In the mean time, I finally spoke with my endocrinologist and he wants me to stop the supplements you suggested and he's going to send me a script to retest. I spoke with him about GGT, but this is what he wants to do first. He didn't mention 3-4 weeks, though. The L-Citrulline seemed to help me during workouts, so it would be disappointing if that's what it is. I looked up liver stones, and it seems that the pain or discomfort would have been felt in a different area than what I felt underneath my belly button, correct?

Sorry if I didn't get a chance to respond to everyone else's post. I really appreciate the feedback and will let you know what happens!

 

[Vince]

Effect of Biotin Supplementation on Serum Liver Damage Indicators. We studied how biotin supplementation influenced liver enzyme tests (Table 1). The data show increased aspartate aminotransferase (AST) levels in the biotin-supplemented group (p < 0.050); however, the values were in the normal range (55.0–352 U/L) [30] ...
National Center for Biotechnology Information › pmc
Dietary Biotin Supplementation Modifies Hepatic Morphology ...

 

[GarthF]

Effect of Biotin Supplementation on Serum Liver Damage Indicators. We studied how biotin supplementation influenced liver enzyme tests (Table 1). The data show increased aspartate aminotransferase (AST) levels in the biotin-supplemented group (p < 0.050); however, the values were in the normal range (55.0–352 U/L) [30] ...
National Center for Biotechnology Information › pmc
Dietary Biotin Supplementation Modifies Hepatic Morphology ...

Sorry, but that's Greek to me. I clicked on the link, but it was incomplete. Are you talking about my vitamin B possibly causing this?