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Liver & Pancreas Disorders Message Board

Liver & Pancreas Disorders Board Index

Liver enzymes can be misleading. They can go sky high (over 1000) in alcoholic or viral hepatitis, or acetaminophen poisoning; but they can also be within the normal range, even with advanced fibrosis if inflammation is low, as when an alcoholic with liver damage stops or reduces his drinking. They are a great indicator of how much damage was done the week before the blood draw for the test, but a poor indicator of how much total damage (fibrosis) is present from past injury.

The enzymes are produced when liver cells are damaged, and a healthy liver can spike very high enzymes when inflamed because it has a lot of cells giving off enzymes after inflammation occurs. A severely damaged liver may be 50% scar tissue (fibrosis), with only 50% of the healthy cells a normal liver might have. This damaged liver will produce elevated enzymes when inflamed too, but there may not be enough cells left to produce the really high enzyme levels a healthy liver can. Does this make sense?

Moderately high enzymes can mean a healthy liver that is mildly inflamed, or a severely damaged liver that is very inflamed and screaming as loud as it can. The damaged liver simply can't scream as loud as a healthy liver can because it doesn't have nearly the number of cells the healthy liver does.

Now lets look at those "normal" numbers... AST normal = 35, and ALT normal = 55. Notice the normal for AST is about a third lower than normal for ALT. As liver enzymes rise and fall depending on how inflamed the liver is, these ratios should remain about the same. If you've been on a real bender, both these would shoot up, but the ratio shouldn't change all that much. AST might be 350, and ALT 550. Sky high enzymes, but the AST still about a third lower than ALT.

This rule isn't absolute, and one enzyme may rise faster than the other when an insult occurs, and one may return back to normal slower than the other once the inflammation stops, so this ratio may not follow in lock-step as enzymes rise and fall, BUT... Generally speaking, an AST equal to or above ALT over a series of tests done over many months time MAY mean something isn't quite right. The higher the AST is over ALT, the greater the indication of trouble, and when AST is double or more over ALT, this becomes a very strong indicator of alcoholic cirrhosis.

Now your ratio is only 1/1, and this is only one test so I wouldn't waste a perfectly good panic over this, but you do need to WATCH THIS in any further testing you have done. A stubbornly high AST floating over your ALT for any length of time, or a separation in this ratio from 1/1 towards 2/1 is a BAD SIGN!

Hopefully, with your moderation in drinking, all will be normal with your next test, and the AST will be back down below the ALT where it belongs.

Make sure they test for albumin, platelets and ferritin with your next test too... Albumin and platelets can rise and fall with hydration, so if you have a "fasting blood draw" in the morning when you may be a bit dehydrated, albumin and platelets should be in the middle of the normal rage with someone your age. If you're well hydrated, they may come out a bit below the middle of normal range, but they should not be "low normal", especially in a morning blood sample. Low, low normal, or falling albumin and platelets over a series of tests is another BAD SIGN.

Ferritin (stored iron) much over 100 is another BAD SIGN if you like to drink. Iron builds up in livers of long term drinkers over time, and when it reaches a certain point, inflammation can ramp up with remarkable swiftness and cause problems. Dumping excess iron is easy if you are eligible to donate blood and aren't afraid of needles. The ones they use at the blood bank are BIGGER than the ones they draw blood with at your doctors lab, but just one donation can drop your ferritin by 30 points.

If a blood donation simply ain't gonna happen, then avoid vitamins with iron, restrict your red meat consumption, and drink coffee with breakfast and ice tea with lunch. Coffee and tea inhibit iron absorption from food.

The ultrasound looks great! Alcoholic livers usually get very LARGE and fatty, sometimes doubling in size, so this is a good sign.

I'm not a doctor by the way... I'm a drinker! (an old and wise one) But I work in the medical profession, and have studied well up on alcoholic liver disease to be sure I wasn't getting into trouble myself.

I'm clean and sober now, but not so much by choice... I believe it was iron that got me in the end. Ferritin crept up and eventually started inflammation that had me on the wagon to avoid serious problems with my health. By the time I figured out what was going on, I was scared straight.

Liver disease is a long slow decline into a very bad end, and once it reaches a certain point, there's no stopping it or turning back. I wouldn't risk having my liver go over a cliff for anything in the world. Surprisingly, I found there was life after alcohol, and it's not all that bad. You might want to consider a "reality check" and see what you think from the other side of the bar.

Best of Luck to you!

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