Test Results....HELP! I don't understand them!

[sillygirl1122]

Hi Everyone,

I hope that you are all doing. I have some questions, so please bare with me.

How long does it take elevated AST and ALT levels to come down due to fatty liver? What about from a medicine reaction? Is there a difference? Here is why I ask. On February 8th of this year, I fell down our hard wood stairs from the top, all the way down to the bottom and landed on my head. Although conscious, I couldn't talk and had no idea who or where I was. I went by ambulance to the hospital and spent the entire day having tests run. I don't remember any of it. I was ultimately diagnosed with a severe concussion and a traumatic brain injury. I'm still having some residual memory problems and problems with speech and remembering words. It's been really scary.

Anyways, once I got home from the hospital, we noticed that my AST and ALT were elevated. I'm going to give you a timeline of the elevations and what I have done to get the numbers back down. I am terribly confused as to the reason for the increase. I did have an ultrasound and was found to have moderate to severe fatty liver. Since then, I have lost 60 pounds, been walking 5 miles a day and eating a very healthy liver diet. Depending on which lab reference range I look at, sometimes I am in range, and sometimes I am out.

Here's where the confusion lies. I was taking a medication at the time of my hospital stay that is known to potentially elevate liver enzymes (specifically ALT and AST). I don't know if my liver enzymes have come down from the weight loss, healthy eating and exercise, or from removal of the medication (perphenazine), both of which I started at the beginning of March. I wonder if the time frame of my enzymes coming down can help us decipher drug toxicity, from NASH, which is what my doctor diagnosed me based on elevated liver enzymes and fat in my liver (but with no biopsy). I am so confused and this has scared me to death. I have a wonderful hubby and two wonderful teenage girls. I want to be around for them and I can't seem to get any definitive answers.

I am going to list you a timeline and would love your opinion if you could give it. Thank you so much!

Robin

All liver enzymes always normal and within limits before this time.

1/23/14 Started taking perphenazine for anxiety

2/8/14 Fall down the stairs, head injury and elevated liver enzymes.

ALT 72 AST 58 (both high)

2/27/14 Followed up on liver enzymes with my PCP and they were even higher.

ALT 108 AST 63 (Still taking perphenazine, having no idea that it could affect my liver.)

3/5/14 Liver ultrasound showing moderate to severe fatty liver with no other remarkable findings. STOPPED TAKING PERPHENAZINE.

At this point, my PCP said that I had fatty liver, specifically NASH as indicated by the elevated numbers and fat seen on the ultrasound. No biopsy. No elevated enzymes in the past. No watching the enzymes to see if they would come down, just NASH. I wasn't even having any pain or discomfort. Several doctors have told me that she jumped the gun in her diagnosis. She has even admitted this now, but I've heard NASH, and I can't get it out of my head. Doc won't do liver biopsy because it's too dangerous. ???

3/6/14 Starting eating a liver friendly diet, exercising and losing weight. Lost 60 pounds between February and October.

4/21/14 ALT 59 AST 37 (AST 3 points over top of range, AST now normal)

7/21/14 ALT 51 AST 33 (both within range)

I had my blood drawn again on (11/3/14) and found out the numbers yesterday. Needless to say, I am now REALLY confused. At the lab used at my doctor's office, the ALT range is 0 to 56. Therefore, my ALT came into range between April and March. The test I took a couple of cays ago had a much lower ALT range. My ALT number came back at 36 (way lower than it was three months ago), but was classified high as their lab limit is 32. AST still within limits and GGT is 11.

I don't understand. I am now back out of range, but my numbers are so much lower, even after just a few months. Are these numbers good in that they are lower, or bad in that they are now out of the new range given by the new lab?

ARGH!!!! HELP!!!!

Can any of you sort any of this out based on the numbers and dates I've given you? All other blood tests are normal and I am now at 60 inches and 130 pounds. My BMI is somewhere around 21.6. GGT was 11. No diabetes, but glucose was a point high (101) in July. No high blood pressure. In fact, it's very low. On Prevastatin 40mg/day and have been for several years for high cholesterol. Cholesterol is great and Prevastatin has never affected my enzymes before.

Can you give me any insight? Does this sound like I have NASH or a reaction to a toxic medication? I'm so scared and confused! I am hoping that in a little more time, my ALT will be at 32 and be within range, but until then, I feel like I am a ticking time bomb. I need to be here for my kiddos and hubby. I am a recovering alcoholic of almost 8 years and haven't had so much as a sip. My doctor said that my past drinking has NOTHING to do with this.

Is the elevated ALT an indication of continued liver disease, such as inflammation and/or fibrosis? I just want to get it stabilized.

Any idea how I should interpret this new set of liver results, specifically the ALT? I would really appreciate your words of wisdom!

Thank you for your help!

Robin

[Bolly]

Hi Robin, thats a long post and I'm not going to answer it in detail as it might only confuse you more.

Your ALT results are now pretty much normal. Dont get hung up over a few units different between labs. We're talking 08 here, and ALT levels out of normal range can shoot up to 1,000s of units, so yours is looking ok. My labs normal range has an upper of 40 - so you see they are all different.

An elevated ALT can be indicative of more than liver disease or liver inflammation. On its own, with everything else normal, it can elevate due to exercise or a mild infection. For more serious stuff other liver function results would be out of range too.

How long will it take to get lower? How long have you been overweight and how long has it taken to get to your current BMI. I dont know how long, but that fat has probably been settled in nicely for a while and may take a while to shift from your liver, perhaps longer than from your midriff, but keep going and keep healthy and you doing the right things.

Statins taken long term are known to damage the liver, so perhaps work out a nutrition plan that might mean you can, with doctors advice, come off the statins. While you are taking any meds, statins included, it will affect your blood results. As a hepatologist in the UK said at a recent presentation i went to , ALL meds are toxic!

[Hidden]

The ultrasound did show something to match the high LFTs. You have now got them within range, so another Ultrasound would be advised to see if its cleared up.

Unfortunately LFTS do not measure any Fibrosis, but significant Fibrosis should throw other bloods out and could show on ultrasound. AST that is over 2x higher than ALT usually indicates a serious Liver issue

your are nowhere near that, so your not in immediate danger im sure

The thing with medical issues is there is no guarantee (something i find stressful) Other tests to help would be a Fibroscan and a biopsy.

Ive also heard statins are bad for the lover especially in drinkers

[MisterX]

1) Keep at the new diet, well done with that by the way.

2) Bear in mind that the liver is constantly working, being damaged and regenerating so LFT numbers can fluctuate for a number of reasons in the normal course of events. It can take time for damage to reverse once the cause of the damage has been removed but removing the cause is the most important thing. The liver can function normally even if significantly damaged.

3) Your numbers look fairly good. Clearly there was something of a small spike but that has now come down to more or less normal range. LFT number values are not absolute - you can't compare numbers from different labs on an absolute basis, but only in comparison to that labs normal range (Took me a while to get used to that too!), so you have to stop comparing the actual numbers between labs, but it's ok to compare whether they are in or out of range.

4) The cutoff for normal is not hard and fast, a few points over or under is within a reasonable margin. Your numbers look pretty good so clearly what you have done has been good.

5) At this stage, with those numbers - unless your doctors suggest otherwise - I'd say get on with your life, keep off the booze and embrace getting fit and healthy. Very well done.

6) Dates - FYI (and just FYI) - Outside the US everyone uses DD/MM/YEAR format.

Cheers and best of luck.

[sillygirl1122]

I got my AST/ALT results back on Friday afternoon from the lab I usually use and they were great. AST was 21 and ALT was 24. Shew.....that scared me!!! Still eating right, still exercising and still confused if NASH or medication caused my enzymes to go up in February. Regardless, they are down now. In NASH, do they fluctuate? Should I be having other symptoms? I know I have fat in my liver and will be rescanned at the beginning of the year. My doctor said that with the 60 pounds that I've lost, there's no way that my liver fat hasn't decreased significantly. She said that with it being moderate to severe fatty liver when I was diagnosed in February of this year, that it could be another year before the fat is completely gone. Even she is now saying that maybe it wasn't NASH, as I never had a biopsy, never had any pain, yet definitely had fat in my liver because I was 60 pounds overweight. With eating healthy and exercising, the weight literally just fell off. Does this sound like NASH? I am so confused. If it is NASH, will my enzymes continue to fluctuate? Can I live a long life?