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Gastroenterology (Expert Forum)
Decreasing ALT, increasing AST-rejected for insurance
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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Decreasing ALT, increasing AST-rejected for insurance
by JimandTerri, Feb 11, 2004 12:00AM
i am a 51 year old self-employed male just rejected for an individual health insurance policy because of results on a lab panel including liver enzymes. However, my personal physician is not concerned about the numbers nor is there any formal diagnosis of anything or any treatment plan. I am researching to see if I need a second opinion and/or a plan to address this.
My ALT in Jan. 04 was 55, AST was 70. 7 months ago in June 03 at my annual physical, ALT was 104, AST 50, biliburin 1.2. AP and other indicators within range. So my ALT has decreased significantly, and may be within some labs normal ranges; But my AST has increased in the same time period. Any thoughts?
I am 6 ft. 4 inches tall and currently weigh 225 lbs. I have lost 30 lbs over the past 6 months; ny B/P has gone from 148/80 to 122/80; I still have borderline high cholesterol inherited from a parent. (214). I do drink daily, mostly wine and on occasion, a vodka.
I began taking n-acetyl-L-Cysteine and L-Glutamine this summer after the June test results, although I do not take as much as the recommended dosage. I take about 600 mg n-a-l-c, and 1000 mg L-Glut.
I dug around in old test results: it looks like the first time my AST was out of range was in 2002 at 51. AST was 39 in 1989; 35 in 1994. ALT has been a bit high all along: 51 in 1989, 102 in 2002, 104 in June 2003 and 55 in Jan. 2004. Biliburin was within range until 2002 when it was 1.1. No biliburin in urine. Alk P, Albumin and total protein all within ranges all these years. I do have chronically low, though steady, platelets, around 114.
I abstained from alcohol 3 days before the labs in January 04. I know understand that I may have needed to abstain longer for any impact on test results.
My 84 year old father has had some heart trouble, and I know that elevated AST can be an indicator of heart issues as well as liver. Do you have any thoughts on what my next steps should be in terms of determining whether there is a problem and figuring out what the problem is? My internist's nurse told me that the dr. didn't get very concerned unless levels were 2-3 times the upper end of the range. I have been in that category for the ALT, and appear to be moving that way in the AST.
Thank you for your assistance.
My ALT in Jan. 04 was 55, AST was 70. 7 months ago in June 03 at my annual physical, ALT was 104, AST 50, biliburin 1.2. AP and other indicators within range. So my ALT has decreased significantly, and may be within some labs normal ranges; But my AST has increased in the same time period. Any thoughts?
I am 6 ft. 4 inches tall and currently weigh 225 lbs. I have lost 30 lbs over the past 6 months; ny B/P has gone from 148/80 to 122/80; I still have borderline high cholesterol inherited from a parent. (214). I do drink daily, mostly wine and on occasion, a vodka.
I began taking n-acetyl-L-Cysteine and L-Glutamine this summer after the June test results, although I do not take as much as the recommended dosage. I take about 600 mg n-a-l-c, and 1000 mg L-Glut.
I dug around in old test results: it looks like the first time my AST was out of range was in 2002 at 51. AST was 39 in 1989; 35 in 1994. ALT has been a bit high all along: 51 in 1989, 102 in 2002, 104 in June 2003 and 55 in Jan. 2004. Biliburin was within range until 2002 when it was 1.1. No biliburin in urine. Alk P, Albumin and total protein all within ranges all these years. I do have chronically low, though steady, platelets, around 114.
I abstained from alcohol 3 days before the labs in January 04. I know understand that I may have needed to abstain longer for any impact on test results.
My 84 year old father has had some heart trouble, and I know that elevated AST can be an indicator of heart issues as well as liver. Do you have any thoughts on what my next steps should be in terms of determining whether there is a problem and figuring out what the problem is? My internist's nurse told me that the dr. didn't get very concerned unless levels were 2-3 times the upper end of the range. I have been in that category for the ALT, and appear to be moving that way in the AST.
Thank you for your assistance.
Doctor's Answer
by Kevin Pho, MD, Feb 14, 2004 12:00AM
, Feb 14, 2004 12:00AM
There are many people with benign causes of mildly elevated liver enzymes. Your doctor is correct in saying that most liver diseases present when the liver enzymes are 2-3 times the upper end of normal.
As you have mentioned, chronic alcohol use as well as many medications can elevated the liver enzymes. Other causes that should be evaluated for include hepatitis and anatomical disorders of the liver - like fatty liver.
I would recommend abstaining from alcohol for several weeks before the repeat liver function tests to ensure it isn't alcohol related. Other reasonable screening tests would be a hepatitis panel - looking for hepatitis A, B, and C, as well as an abdominal ultrasound looking for any anatomical liver disease.
If these tests are normal, then serial monitoring of the liver function is recommended.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
As you have mentioned, chronic alcohol use as well as many medications can elevated the liver enzymes. Other causes that should be evaluated for include hepatitis and anatomical disorders of the liver - like fatty liver.
I would recommend abstaining from alcohol for several weeks before the repeat liver function tests to ensure it isn't alcohol related. Other reasonable screening tests would be a hepatitis panel - looking for hepatitis A, B, and C, as well as an abdominal ultrasound looking for any anatomical liver disease.
If these tests are normal, then serial monitoring of the liver function is recommended.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
some are known to send inspectors to your family doctor and ask to see your medical file.
if you are healthy?? and do not foresee major illness in the coming years,it may be worthwhile to look into a healthplan with high deductible.
pay for the office visits and medication yourself,just insure for the big one.
of course we dont have the crystal ball.