Blood Test Result -ALT/AST?

Joe Hallatschek

Hoping there is a "wicked smart" guy or gal out there that knows about the aspartate aminotransferase and the alanine aminotransferase results in a blood test.  My AST was 64 and ALT was 74, which were both high (max normal is 40 U/L and 41 U/L). In the past , I attributed this to our triathlete lifestyle and wrote it off since it has to do with muscle damage and protein synthesis for muscle repair. However, my current Dr seems to think that it may be the result of something else. So, she has me re-taking the test.

She said it could be "fatty" liver, cirroshis of the liver, hepatitis, or any number of things. She said fatty liver should be ruled out since my body fat is like 7%. I said that since I gave up alcohol for Lent and my blood test was at the 40 day mark, that should rule out cirroshis and she said, "maybe not".  So, I'm re-thinking this and maybe I should take this a bit more serious that I have in the past.

After some on-line research, I was unable to find anything that said athletes have higher ALT & AST results. So, if there is anything that supports this, let me know!

Leslie Knight

FP doc here- we usually don't consider LFTs to be abnormal until they are 2-3 times abnormal. Yours are not. Recheck and reassurance is all that is required. Why did your doc check them anyway? Are you on a med that can affect your liver? Heavy drinker? Symptoms of hepatitis? History of diabetes? If you have no risk factors, those tests should not even be done. If you and doc want to pursue a diagnosis, consider testing for diabetes and viral hepatitis. Check bilirubin, thyroid, and alkaline phosphatase levels as well. If they go past two times normal, check iron studies (for hemochromatosis) and liver ultrasound (fatty liver). There are other more obscure tests, but that should get most of the bad stuff. Good luck.

Joe Hallatschek

@Leslie - have no idea why she tested these in addition to a lot of other things other than my last one was in 2014, which had "minor elevations" for AST/ALT. No meds affecting liver except maybe Doxycycline for rosacea. So, I will stop that for a few days before. No heavy drinking (1 beer/day plus 2/beers/day on weekend) and no symptoms of hepatitis and no history of diabetes.

Thanks for taking the time to answer. I'm off the ceiling and feeling a lot less anxiety!

Brian Quarton [OLD]

Joe, I would just back up what Leslie said and add 3 things: First, "A population-based survey in the United States conducted between 1999 and 2002 estimated that an abnormal alanine aminotransferase (ALT) was present in 8.9 percent of respondents... Furthermore, the commonly used liver biochemical tests may be abnormal even in patients with a healthy liver." So there you go. Second, "Muscle disorders (...and heavy exercise [eg, long distance running])" are causes of liver enzyme elevations, so there you go. But thirdly, correlation does not imply causation. Meaning there could be something else going on, so follow your doctors orders, but keep your crazy exercise habits in mind as a potential cause. I got my information from UpToDate.com (and medical school).

steve Beyer

Joe, Totally agree with what both Brian and Leslie have said and would just add a few things:

- AST/ALT are commonly referred to as "liver" enzymes, but this isn't entirely accurate. They're in skeletal muscle and the heart for example(as well as many other tissues), which is why your mild elevation could easily be due to exercise as both you and Brian mentioned
- Like I said your elevation is mild and could just be your "normal"....which would put you in that 8.9% Brian mentioned. Sometimes there is even a lab error.... a simple retest would determine this.
- Because it's in other tissues, any elevation needs to be correlated not only with symptoms, but other lab markers...like Leslie mentioned.
- Along that last point, I doubt very much that it's even a very early cirrhosis or hepatitis...both would give much higher AST/ALT elevations, and with cirrhosis there would be other elevations like "bilirubin" also. But a blood test for hepatitis could be done if you wanted to have the peace of mind. And as far as "fatty liver"?? You definitely don't fit the profile if you're on this board!! but additionally there would be a corresponding elevation of both cholesterol and triglycerides (with the triglycerides higher than the cholesterol...which is the hallmark finding of fatty liver).

Having said all that, I personally think your doc is getting a little overzealous in her suspicions.

Joe Hallatschek

@Brian and Steve - thanks to your posts and what Leslie wrote, I am in a much, much better place. My HDL was 108, LDL 128, triglyceride 58, and my bilirubin was .3, all good. I'll work through this and see what wonders the medical world will reveal!

Thanks!