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Stubbornly elevated ALT and AST

Posted by Sophie93 @sophie93, Feb 22 8:01am

Hello everyone. Initially I have posted my question in the digestive health group, but I was referred here, so I hope that I can get some answers...

What could be causing the constant elevated numbers?
ALT in particular has been in the triple digits over the past few months, AST varies all over the place but it is again over the reference range.

For reference, I don't drink, I don't do any recreational drugs and I eat a healthy diet. I am really into physical activity as well. I don't have a problem with obesity, in fact, I am underweight. I don't take NSAID drugs or any other drug that is notorious for liver health

My doctor has done a series of tests in order to exclude any possible issues with my liver, such as ultrasound (no issues found i.e. I DO NOT have a fatty liver), tests for Hepatitis A, B and C (all negative). No issues with my gallbladder or any other part of my digestive system. My thyroid is functioning well.

Is there anything "hidden" that could be causing the stubbornly elevated ALT and AST? I'm particularly worried about the ALT, because it has been rising over time.

Interested in more discussions like this? Go to the Transplants Support Group.

Mentor
Rosemary, Volunteer Mentor | @rosemarya | Feb 22 8:17pm

@sophie93, I am a patient and have had a liver transplant. Thus my experience is the limit of my knowledge about liver enzymes. I can see that your doctor has already ruled out some of the common causes of elevated liver enzymes and I assume that you are not taking any over the counter meds or supplements and herbs without your doctor's approval because these can affect your liver function numbers and cause damage to your liver. The same can be said for drugs and alcohol.
Nearly 20 years ago, my liver enzymes were elevated and I was referred to a Gastroenterologist, and was eventually diagnosed with a rare liver disease that was (and still is) mostly unknown to most providers.specialists.

Are you under the care of a Gastroenterologist? Are you being monitored for the increasing liver enzymes?

Elevated liver enzymes
https://www.mayoclinic.org/symptoms/elevated-liver-enzymes/basics/causes/sym-20050830

REPLY
1 reply
footballmum | @footballmum | Feb 23 8:44am

Good morning
I'm not a professional by any means. I am a liver transplant patient with a incurable liver disease. I was diagnosed with primary biliary cholangitis. At the beginning they thought I had RA. Have you seen a rheumatologist yet? Elevated enzymes can be caused by RA. Maybe suggest that to your Dr first. Also remember not all liver diseases are caused by diet or alcohol. I'm a nonsmoker and non drinker, follow a healthy
Lifestyle but still required a transplant due to an autoimmune disorder. Hopefully this will be helpful.

REPLY
1 reply
bobweller | @bobweller | Feb 23 9:06am

I left you a comment in the other group. I had 2 liver transplants over 24 years. Read my other post. With me it turned into a bile duct issue and they performed surgery repositioning my ducts from my stomach to.small intestines with a shunt. They included my pancreas ducts in this surgery.

REPLY
1 reply
Sophie93 | @sophie93 | Feb 23 9:18am
In reply to @footballmum "Good morning I'm not a professional by any means. I am a liver transplant patient with..." + (show)
@footballmum

Good morning
I'm not a professional by any means. I am a liver transplant patient with a incurable liver disease. I was diagnosed with primary biliary cholangitis. At the beginning they thought I had RA. Have you seen a rheumatologist yet? Elevated enzymes can be caused by RA. Maybe suggest that to your Dr first. Also remember not all liver diseases are caused by diet or alcohol. I'm a nonsmoker and non drinker, follow a healthy
Lifestyle but still required a transplant due to an autoimmune disorder. Hopefully this will be helpful.

Jump to this post

Hi and thank you for your reply!
My doctor has done multiple ultrasounds on my abdomen and apparently there are no issues with my gallblader/biliary ducts. How was your primary biliary cholangitis actually diagnosed? Are there specific blood markers that need to be done?

RA has been excluded a long time ago. But I have osteoporosis and I am on medication for that condition. According to my doctor, those meds do not cause elevated liver enzymes, and it is not listed on the package leaf as a side effect.

REPLY
2 replies
Sophie93 | @sophie93 | Feb 23 9:20am
In reply to @rosemarya "@sophie93, I am a patient and have had a liver transplant. Thus my experience is the..." + (show)
@rosemarya

@sophie93, I am a patient and have had a liver transplant. Thus my experience is the limit of my knowledge about liver enzymes. I can see that your doctor has already ruled out some of the common causes of elevated liver enzymes and I assume that you are not taking any over the counter meds or supplements and herbs without your doctor's approval because these can affect your liver function numbers and cause damage to your liver. The same can be said for drugs and alcohol.
Nearly 20 years ago, my liver enzymes were elevated and I was referred to a Gastroenterologist, and was eventually diagnosed with a rare liver disease that was (and still is) mostly unknown to most providers.specialists.

Are you under the care of a Gastroenterologist? Are you being monitored for the increasing liver enzymes?

Elevated liver enzymes
https://www.mayoclinic.org/symptoms/elevated-liver-enzymes/basics/causes/sym-20050830

Jump to this post

Hi and thank you for your reply!

At the moment I am taking a supplement which contains milk thistle in order to lower my liver enzymes, but of course, this has been prescribed by my doctor. I do not take any other supplement or over the counter medication. But I do take meds for my other condition which is osteoporosis.

My liver enzymes are monitored now every month as my doctor suggested, in order to see if they come down and what to do next.

REPLY
Sophie93 | @sophie93 | Feb 23 9:22am
In reply to @bobweller "I left you a comment in the other group. I had 2 liver transplants over 24..." + (show)
@bobweller

I left you a comment in the other group. I had 2 liver transplants over 24 years. Read my other post. With me it turned into a bile duct issue and they performed surgery repositioning my ducts from my stomach to.small intestines with a shunt. They included my pancreas ducts in this surgery.

Jump to this post

Hi
Thank you for this reply and for the reply in the other group as well. I will see it just now.

REPLY
footballmum | @footballmum | Feb 23 10:05am
In reply to @sophie93 "Hi and thank you for your reply! My doctor has done multiple ultrasounds on my abdomen..." + (show)
@sophie93

Hi and thank you for your reply!
My doctor has done multiple ultrasounds on my abdomen and apparently there are no issues with my gallblader/biliary ducts. How was your primary biliary cholangitis actually diagnosed? Are there specific blood markers that need to be done?

RA has been excluded a long time ago. But I have osteoporosis and I am on medication for that condition. According to my doctor, those meds do not cause elevated liver enzymes, and it is not listed on the package leaf as a side effect.

Jump to this post

Good morning
My PBC was diagnosed via routine blood tests. My family doctor thought it was arthritis related so sent me to a rheumatologist. The rheumatologist looked at my numbers and said no this is not arthritis and he sent me to a liver specialist so I was diagnosed when I was about 50 and I had my liver transplant in 2020.

REPLY
Mentor
Lori, Volunteer Mentor | @loribmt | Feb 23 10:16am
In reply to @sophie93 "Hi and thank you for your reply! My doctor has done multiple ultrasounds on my abdomen..." + (show)
@sophie93

Hi and thank you for your reply!
My doctor has done multiple ultrasounds on my abdomen and apparently there are no issues with my gallblader/biliary ducts. How was your primary biliary cholangitis actually diagnosed? Are there specific blood markers that need to be done?

RA has been excluded a long time ago. But I have osteoporosis and I am on medication for that condition. According to my doctor, those meds do not cause elevated liver enzymes, and it is not listed on the package leaf as a side effect.

Jump to this post

Hi @sophie93. My liver remains highly reactive to anything since having months of chemo and a bone marrow transplant. However, for months my AST and ALT were happy as larks. Then out of the blue in 3 months time between blood draws, my numbers shot up again! That required me to go back to monthly draws for a few months. Everything reversed again and my numbers are great.
The only variable was that a few months before my alarming blood draw, I had started taking a daily OTC multivitamin for women! My doctor didn’t feel that would be the issue but it was suggested I stop anyway. And my gosh, the next 3 tests were perfect!! It was the vitamin A in the multivitamin that caused my liver to flair. No where is that listed as a side effect and I only took one per day! So just because it’s not listed, doesn’t mean it can’t happen.

There is a link between having liver disease and developing osteoporosis. https://pubmed.ncbi.nlm.nih.gov/29479832/

Which leads me to wonder if there can be link between treating osteoporosis and potential for liver issues? I found this article for you that validates your thoughts.
https://www.ncbi.nlm.nih.gov/books/NBK548566/
Our livers can be very sensitive but they can also heal and regenerate quickly. It might be worth another chat with your doctor about your bone loss and liver numbers. Have you seen an endocrinologist about your osteoporosis?

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