# Elevated liver enzymes



## Chainstay (Mar 13, 2004)

With my annual physical I had the regular blood tests. My AST (aspartate transaminase) level tested at 149 U/L where 10-40 is the normal range. This was 3 days after a tough century which I hammered in less than 5 hours and had leg cramps for the last 1/2 hour. On a retest 2 weeks later it tested at 66. This was the day after a regular 2 hour ride with high heart rate hill sprints. 

High AST levels are associated with liver disease or cell injury in the heart, muscle, kidney, brain or lung. I am otherwise very healthy and have been riding strong all year. My one concern is heart damage because heart disease runs in my family. I am 52 with good cholesterol and tri-glyceride levels.

Anyone else with experience or opinions on liver enzymes post exercise?

My doctor has scheduled a third blood test and this time I'm going to sit on my ass for a few days prior.


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## physasst (Oct 1, 2005)

Chainstay said:


> With my annual physical I had the regular blood tests. My AST (aspartate transaminase) level tested at 149 U/L where 10-40 is the normal range. This was 3 days after a tough century which I hammered in less than 5 hours and had leg cramps for the last 1/2 hour. On a retest 2 weeks later it tested at 66. This was the day after a regular 2 hour ride with high heart rate hill sprints.
> 
> High AST levels are associated with liver disease or cell injury in the heart, muscle, kidney, brain or lung. I am otherwise very healthy and have been riding strong all year. My one concern is heart damage because heart disease runs in my family. I am 52 with good cholesterol and tri-glyceride levels.
> 
> ...


I would be very surprised if these results had anything to do with your heart. It is most likely due to skeletal muscle breakdown during your workouts, I would still have your doctor perform an EKG, it's a rather simple, inexpensive test, and it could help put your mind at ease. Granted, lack of findings on an EKG do not absolutely exclude cardiac problems, but the probablility will decrease significantly. I think you should probably rest for a few days before your next test. I think it is probably nothing to become too alarmed about.


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## MikeBiker (Mar 9, 2003)

Here is a list of common causes of slightly high (<5x) AST levels. If I were you, I would guess the last on the list as the cause.

<table bordercolordark="black" bordercolorlight="black" class="in" align="center" border="0" cellpadding="3" cellspacing="0" width="100%"> <tbody><tr><td valign="top">Alcohol

</td> </tr> <tr> <td valign="top"> Cirrhosis

</td> </tr> <tr> <td valign="top"> Hepatitis B (chronic)

</td> </tr> <tr> <td valign="top"> Hepatitis C (chronic)

</td> </tr> <tr> <td valign="top"> Steatosis/steatohepatitis

</td> </tr> <tr> <td valign="top"> Medications/toxins

</td> </tr> <tr> <td valign="top"> Acute viral hepatitis

</td> </tr> <tr> <td valign="top"> Less common hepatic causes

</td> </tr> <tr> <td valign="top"> Autoimmune hepatitis

</td> </tr> <tr> <td valign="top"> Hemochromatosis

</td> </tr> <tr> <td valign="top"> Alpha1-antitrypsin deficiency

</td> </tr> <tr> <td valign="top"> Wilson's disease

</td> </tr> <tr> <td valign="top"> Nonhepatic causes

</td> </tr> <tr> <td valign="top"> Celiac disease

</td> </tr> <tr> <td valign="top"> Hemolysis

</td> </tr> <tr> <td valign="top"> Myopathy

</td> </tr> <tr> <td valign="top"> Hyperthyroidism

</td> </tr> <tr> <td valign="top"> Strenuous exercise

</td></tr></tbody> </table>


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## Thorn Bait (Feb 3, 2004)

Notice that heart is not on that list... I've never checked an AST to evaluate someone for a heart attack. It has such poor specificity as to be worthless. Be sure to follow up and ensure return to normal...


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## coonass (Feb 4, 2004)

FWIW, 
There is an over-the-counter Herb: Milk Thistle (Silymarin) which helps detoxify the liver; I've been taking it for about 5-6 years now without complications...
http://www.naturalfacts.com.au/milkth.html
http://www.umm.edu/altmed/ConsHerbs/MilkThistlech.html


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## Chainstay (Mar 13, 2004)

*The EKG was normal*



physasst said:


> I would be very surprised if these results had anything to do with your heart. It is most likely due to skeletal muscle breakdown during your workouts, I would still have your doctor perform an EKG, it's a rather simple, inexpensive test, and it could help put your mind at ease. Granted, lack of findings on an EKG do not absolutely exclude cardiac problems, but the probablility will decrease significantly. I think you should probably rest for a few days before your next test. I think it is probably nothing to become too alarmed about.



Thanks for your post

I will "follow up and ensure a return to normal liver enzyme levels". I asked her in our first meeting if a stress test would be advisable and she said that "the exercise you are doing goes well beyond a stress test and if I was not experiencing any symptons like shortness of breath or chest pains I was fine". Shortness of breath?, at maximum heart rate? duh


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## physasst (Oct 1, 2005)

Thorn Bait said:


> Notice that heart is not on that list... I've never checked an AST to evaluate someone for a heart attack. It has such poor specificity as to be worthless. Be sure to follow up and ensure return to normal...


I agree, where do you practice at, and what is your specialty? Just curious


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## Thorn Bait (Feb 3, 2004)

physasst said:


> I agree, where do you practice at, and what is your specialty? Just curious


Internal Medicine - Tucson AZ.


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## physasst (Oct 1, 2005)

Thorn Bait said:


> Internal Medicine - Tucson AZ.


Jealous, great year round riding right?...


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## saccycling (Sep 30, 2004)

I had a enzyme level of 2500. The doctors were surprised I was still alive. My problems were do to the fact that I drank like a fish. Three months after quitting drinking all my enzyme levels returned to normal.


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## Joop Zoetemelk (Nov 6, 2005)

*Ibuprophren?*

Did you take ibuprophren after the centrury? These can damage liver cells which will cause increased blood AST levels (similar to alcohol). 



Chainstay said:


> With my annual physical I had the regular blood tests. My AST (aspartate transaminase) level tested at 149 U/L where 10-40 is the normal range. This was 3 days after a tough century which I hammered in less than 5 hours and had leg cramps for the last 1/2 hour. On a retest 2 weeks later it tested at 66. This was the day after a regular 2 hour ride with high heart rate hill sprints.
> 
> High AST levels are associated with liver disease or cell injury in the heart, muscle, kidney, brain or lung. I am otherwise very healthy and have been riding strong all year. My one concern is heart damage because heart disease runs in my family. I am 52 with good cholesterol and tri-glyceride levels.
> 
> ...


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## coonass (Feb 4, 2004)

*Don't leave out Acetaminophen (Tylenol)*



Joop Zoetemelk said:


> Did you take ibuprophren after the centrury? These can damage liver cells which will cause increased blood AST levels (similar to alcohol).


Increase your knowledge of the OTC items you consume that contain Acetaminophhen or you'll destroy your liver:
http://www.wtvr.com/Global/story.asp?S=280645
http://www.sunsetchiro.com/issues/tylenol.html
http://www.relieve-migraine-headache.com/tylenol.html


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## Chainstay (Mar 13, 2004)

*Elevated liver enzymes revisited*



Chainstay said:


> With my annual physical I had the regular blood tests. My AST (aspartate transaminase) level tested at 149 U/L where 10-40 is the normal range. This was 3 days after a tough century which I hammered in less than 5 hours and had leg cramps for the last 1/2 hour. On a retest 2 weeks later it tested at 66. This was the day after a regular 2 hour ride with high heart rate hill sprints.
> 
> High AST levels are associated with liver disease or cell injury in the heart, muscle, kidney, brain or lung. I am otherwise very healthy and have been riding strong all year. My one concern is heart damage because heart disease runs in my family. I am 52 with good cholesterol and tri-glyceride levels.
> 
> ...




Well when I finally got around to re-doing the blood test my AST level had actually increased. My doctor scheduled some more blood tests and an abdominal ultrasound, testing for a number of different liver diseases from various forms of hepatitis to Cirrhosis and cancer.

As it turns out I basically have a fatty liver. It's very common in obese and diabetic people and in heavy drinkers. None of this applies to me. It is not serious in this form but can progress to more serious liver conditions.

Here are a couple of links if you are curious.

http://www.liverfoundation.org/db-select/articles/CatNonAlcy/1/1/ascend/Validated
http://www.medicinenet.com/fatty_liver/index.htm

I am considering taking milk thistle. Although I am not generally a supplement fan, it appears to have a good track record. See earlier post. Beyond that I will reduce my alcohol consumption and keep my weight down by riding a lot.


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## physasst (Oct 1, 2005)

*yep*



Chainstay said:


> Well when I finally got around to re-doing the blood test my AST level had actually increased. My doctor scheduled some more blood tests and an abdominal ultrasound, testing for a number of different liver diseases from various forms of hepatitis to Cirrhosis and cancer.
> 
> As it turns out I basically have a fatty liver. It's very common in obese and diabetic people and in heavy drinkers. None of this applies to me. It is not serious in this form but can progress to more serious liver conditions.
> 
> ...


ALSO, with NASH, which is what I am thinking they diagnosed you with....PLEASE...PLEASE be careful with acetaminophen as well. Always make sure to tell your providers, ER and such that you have this so we can avoid hepatotoxic drugs.


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## Kram (Jan 28, 2004)

Besides that, stir-fried fresh ginger is yummy!


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## physasst (Oct 1, 2005)

Chainstay said:


> NASH is with inflamation. It's NAFLD which in some cases progresses to NASH



yep, but most people don't get diagnosed until it is NASH, which is why I was thinking it probably was.


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## Chainstay (Mar 13, 2004)

*It's not NASH*



physasst said:


> ALSO, with NASH, which is what I am thinking they diagnosed you with....PLEASE...PLEASE be careful with acetaminophen as well. Always make sure to tell your providers, ER and such that you have this so we can avoid hepatotoxic drugs.



NASH is with inflamation. It's NAFLD which in some cases progresses to NASH


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