Elevated liver enzymes
 

So back in January, I did my initial class 1 medical, and my ALT and AST were up the roof. ALT was around 210, the upper limit is 40. I later realised that it was due to me taking what I thought were supplements, but were in fact a prescription drug. I stopped taking them and my levels have been coming down dramatically. My test results last month showed my ALT was 44, only 4 out of the limit, and my AST was entirely within.

However, I did what I hoped would be my final test on Monday, and my ALT suddenly rose to 53, and while my AST was still within limits, it went up as well. This got me pretty worried. In the past 3 weeks between the 2 tests, I cannot think of anything I did to make it go up. I'm only 19, never drink or smoke, no drugs of any kind other than the ones that got me to this situation. I do regular exercise and eat at home whenever possible. The only thing is that I have eczema, which got pretty bad in the past few weeks, and I stopped exercising for 1 week when I had some family visitors.

My question is, can there be any reason for my levels to not only stop going down, but suddenly come up? Could my eczema or my 1 week's lack of exercise have something to do with it? I'm very worried because I'm only 19 and I haven't even started my career, yet this could potentially erase my chances at becoming a pilot. Any help would be deeply appreciated.

I think there are a few other markers that need to be elevated for them to tie it to alcohol, and I also believe that those markers are pretty sensitive. A common cold or other type of infection can raise those. At lest that was my experience. I've ran into this in the past, and all the doctors say that one or two of these markers slightly elevated do not mean that there is something major happening. I want mine all within range, but my doctor says thats just were my body is at. I do take milk thistle time to time just for my own gratification.

DS,

Noting from your post that you exercise and was taking supplements, if you don't mind can I ask what kind of supplements were you taking?
I'm acutally concerned if taking whey protein or L-Glutamine might elevate liver enzymes for HBsAg positive carriers. Any lights on this matter from experts would be appreciated.

AvE
 

I was taking a particular brand of Omega-3 fish liver oil capsules. Normally I believe they are classified as supplements, but this particular brand LOVAZA is classified as a drug. I did a search on their website and the first on the list of possible side effects is elevated liver enzymes.

Thanks DS,

anyone else out there with info on side effects of taking Whey Protein or L-Glutamine supplements while being HBsAg positive. Specially concerned if it elevates the liver enzymes which might show different results during PCR test for HBsAg and subsequently affect first class medical.

DS

The liver is like a a washing machine which cleans away not only the products of metabolism but also food, drugs and other things we imbibe. Normally is is only ticking over, and is like a derated aero engine. If you damage or poison it, these markers will rise but it still works. If you poison or damage it further it can't cope and you get liver failure.

All you can say is that your liver has been unhappy, and I am afraid this site is unlikely to help you much more. You really need to go and see a liver specialist. It is quite possible you have had an infection or other illness, or you may have some inherent disease. Many are self limiting but rather than worry, go see a doctor. Clearly it isn't alcohol as you don't drink!

I wouldn't worry about fluctuating numbers as this is common and the tests are not that accurate. You clearly have an unhappy liver but the slight rise in one number may be irrelevant and your doctor will follow them over a longer period

However this does highlight the issue of self poisoning with over the counter supplements, vitamins, chemicals, food additives and the like. Unlike the drugs your doctor gives you these have often never been tested and the actual ingredients are unknown and of variable quality. It is a free world and you can take what you like but caveat emptor

Normally as a "one off", elevated figures in the labs don't mean too much, but having said that, your readings are quite high.

If you were my patient, (and obviously you're not :-) ), I'd be a little concerned about the level of those readings. I'd be questioning you about liver "risk factors," and then maybe repeating the blood test again, (probably within a week). If they were still that high, I'd be asking for an expert opinion. Maybe a few other investigations (Ultrasound scan and more blood tests), may be useful.

Reassuringly, your levels seem to have returned to near normal.

Thanks for all your help. Like Radgirl said, this does highlight the danger of taking any non-prescribed substances, even "supplements". Right now I'm keeping a log of what I'm doing and what I'm eating everyday so that if my next test is still off I can see what may be the cause. My levels have come down drastically since January so I'm pretty sure it was the supplements but now I'm trying to look into whether eczema may affect the liver as well.

Drake I joined a gym in the middle east and it included a program design by a Personal trainer.

I went for three sessions with him before he brought the supplements out.

I didn't take them but did take photo's of the ingredients. Usual pilot thing of having to check before you take.

On web searching them I was quite shocked about what they contained

Amphetamines
Steriods
Pain killers.

Which individually were pretty nasty and bad for you.

But combined they were down right dangerous. One of them the combination of ingredients was dangerous stand alone never mind mixing it with the others.

Anyone got a link to CAA acceptable liver function test limits?

Google "liver enzymes elevated causes" look at the one on the Mayo Clinic (this is a top US hospital) there is a long list of causes including:

mono, hepatitis a,b& c, thyroid issues, bacterial infection (such as lyme), alcohol etc

Like others posted when it comes to issues with your liver get it checked out by a liver specialist to avoid long term damage to your liver.

Well, finally have some good news! Did another test on Saturday, this time at a different lab. My alt and ast are back to normal limits! 38 and 25 respectively. Hopefully the doctor will accept the report even if I did it at another medical institution. I guess the moral of this story is: If it ain't broke, don't fix it! Keep yourself healthy by doing exercise, eating healthy and sleeping well. Natural ways of keeping fit are way better than taking any kind of pill.

Correct.

You will find once you get into flying that pretty much everything needs to be checked out before you take it with an aviation doctor. Even herbal remedies which claim to be natural are banned.

melatonin is an example.

Avoid blood tests :-)

Ask for a full set of blood tests, especially ferritin, and iron levels.

It could be hereditary hemochoromatosis (iron overolad). The iron deposits land in the liver and cause enzymes to shoot up.

The good news is that if the test comes back positive, the treatment is very simple and effective, giving up about 500 ccs of blood, at first frequently, then afterwards every few months (in some countries like Canada, it can be done through regular blood donations if you otherwise qualify).

If treated early you can expect a normal, healthy lifespan. The weird thing is that it is a very common disease (1 in 200 in folks of northern European, UK or Irish stock), but not frequently picked up by doctors as the symptoms are initially so vague. As it progresses people with the disorder get varied vague complaints and are often labeled as hypochondriacs, but it is a very real and treatable condition.

Mildly elevated LFT's in the absence of a known major cause of liver disease are unlikely to fail you a Class 1 medical, but it might need to be monitored, and ultimately finding a cause is a good thing.

A few thoughts.

1. treat excess alcohol with disdain ! Also have a look at how much coffee you drink.
2. Keep you BMI well under 25 if you can - fatty liver is the most common modern cause of liver injury
3. See a skilled physician with knowledge of liver disease - there is a list including many of the things noted above, that need to be thought about and excluded.If its your transaminases elevated you won't have a bile duct cause.
4 if you have been born or raised in a Hepatitis prone area like Asia or India, you may have caught hep B or Hep A years ago and its catching up with you. Another scenario would be Hep b or C post past blood or sexual contact, and not picked up.
5 occasionally liver disease can be due to autoimmune processes or exogenous substances , and this is quite specialised .Dont take anything that isn't normal food! If you have joint pains or rashes of other medical symtpoms that may offer a clue to the physician.

Hi guys, I've been bodybuilding for the last 3 years, around 10 crap meals in the 3 years, ZERO alcohol, ZERO drugs or cigarettes, on suppliments (Whey Protein, Casein Protein, Fish Oil, Multi-vits, Arginine, Beta-alanine, caffeine). I have a really high ALT and ALS readings still now, at one point the ALT was around 260. I've been having blood tests and trying to sort it out recently. I paid for a private consultant appointment where he came to the conclusion that i may have something called "Stentohepatitis - Non Alcoholic". He said its basically where your metabolic rate is permanently really high and its making your liver work overtime to keep up with your body to filter everything through. I'm still currently working on sorting this high reading out at the moment, if i have any advances i will keep you posted!

I'm about to start looking into becoming a pilot as well, would this actually be any issue when i came to get my medical sorted out?

Thanks in advance, Sam.