Wondering why you have a small increase in AST and ALT liver enzymes?

Often you go to the doctor and tell them how you're feeling, they run some routine tests and usually nothing is too serious, so you go home wondering if you just complained for nothing.  I call that the "pat me on the head and send me home" visit.  Another time, you might find that your AST and ALT liver enzyme levels are climbing but still "subclinical" (meaning, we're not going to do anything about it).  Are you wondering what you can do to lower these levels?

Well, would it surprise you to know that I successfully lowered these levels despite continuing liver problems such as Non Alcoholic Fatty Liver?  There were two actions I took, both of which independently lowered my levels at different times.  I believe these levels are the canary bird in the coal mine of liver health and overall health.  I don't think we fully understand what they are indicating though and more basic research is needed into what causes these increases.  The article at the end is very helpful because it translates what little is known about this effect into clinical practice, so with a bit of insightful chatting with your doctor, you can put it to use right now.

Photo by: Matthew Henry

For me, the AST/ALT increase comes together with liver pain, so I can hardly ignore it.  An increase by as much as 1.5x the normal level is already painful to me.  The first action I took was to stop (with doctor's consultation) all my medications and most of my supplements.  After a couple of months, I added back those I felt were essential.  For example, I get migraines if I take none of the preventatives, but at the end of this process, I decided to take only one of the previous 3 preventatives.  I'd been taking those for many years without problems, but now it was a matter of not adding to a burden.  I stopped taking any topical hormones also.

TMI Alert!  What happens to one's period under these conditions is important to women.  I get hormonal migraines and that time, it was the worst I'd had in years.  Nothing stopped it.  There was a large increase in blood flow followed by hormonal anal fissures. (that sounds terrible, but it's not very rare or dangerous) I hadn't had such a bad period in a very long time.  Many of the drugs I take are "downers" and migraines are very much a product of an overactive nervous system.  The type of migraine I have started out as migraine with aura (in my 20's), and developed into a hemiplagic type by my late 30's.  In case anyone is thinking it, no, meditation doesn't help much, this seems to be a physical process.  

I can only guess why I had such unique feminine effects that time.  Certainly, my nerves were too raw, and certainly my liver was belabored with too much of some enzymes and not enough of others (estrogen and many other hormones are processed by the liver).  Then a while later, after the adding back (of drugs) process, my enzyme levels started to climb once more, very slowly and I was worried but not very much.  Plus I felt like I'd done all I could.   

It was around then that found out I had one of the two genes for Celiac disease and coincidentally I had been gluten free for a while, about two weeks.  I often did that to recover from bad periods, or just when I felt that my body wasn't functioning well.  I was never strict about it until later.

So I splurged on a weekend and had a local "New York Style" pizza (wheat crust) with my husband.  And it wasn't worth the pleasure.  Within a day I was doubled over and bedbound.  My husband had no ill effects so it wasn't a food poisoning thing.  It took nearly a week to recover from that glutening.  I should have immediately gone to my doctor and gotten a Celiac test.  But for one thing, it was just the one event and I'd been keeping gluten free for a while, and for another thing, it was in the middle of the Christmas holidays.

So my husband and I spent the holiday season in 2017 cleaning our kitchen to the Celiac standard of gluten free, banished anything that was irreparably glutened, and gave away foods that we will never use to a donation box at the grocery store.  This was a long process I may write about later.  The point is, I went fully gluten free at that point, and that finally stopped the rising liver levels.

After the holidays, I went to see my doctor who did a belated Celiac test which we both knew, would only tell us something if it was positive.  It was negative so, no new information.  Based on my reaction to the pizza (and other events in my recent past), he decided I had Non Celiac Gluten Sensitivity (NCGS), and I continued to maintain a strict gluten free diet. 

Because for me, there could be many reasons that cause a rise in AST/ALT levels (there are some signs that I have out of control reactions to common viruses like CMV and EBV), I thought I'd write about my experiences and give you a place to start if you're trying to figure out what is going wrong with your liver and if there is anything you can do about it.

The usual narrative goes like this:  you have fatty liver, it's because you're obese, lose weight before you get a disease.  My narrative is a bit different, I became obese because of ignored medical problems such as my thyroid and gynecological problems, I am seeking ways to heal my body, it's my experience that a sick body can't lose weight.

Too often we are told that "it's out of range but it's nothing until it gets much higher" when dealing with liver enzymes (subtext: lose weight).  A doctor may not know or have the time to explain the possible reasons why AST/ALT might be climbing.  But good self care is about vigilance and making reasonable changes. Like many things, it's what you do in between visits when your doctor isn't watching, that determines some of your outcomes.  And, gluten-related disease is one of the possible causes of this liver enzyme condition. 

So take a moment to read the article at the end and discuss the underlying reasons with your doctor now, proactively.  This isn't about finding new drugs to use, it's about preventing bigger problems later on.  Doctors are still the best trained to know what potential problems you're facing, especially if you've seen them for a long time. It might take a bit of a nudge to get them to tell you about it, though. This is reasonable.  They don't want to make you worry about things that may never happen. Show your doctor that you are being proactive and they might open up a bit. If not, then check the resources article of my blog, there are a few things you can do on your own. 

Mildly Elevated Liver Transaminase Levels: Causes and Evaluation.
Am Fam Physician. 2017 Dec 1;96(11):709-715.  Free full text here.

If you lowered your AST and ALT levels too, please comment and let us know how you did it.


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