Slightly elevated ALT/AST: talk me off the cliff
First time I've been terrified in a long time, but I guess it comes with the fear of recurrence territory.
I'm weeping, not sleeping, having nightmares. I have a telemed appt tomorrow with my new oncologist (I've only seen him once before in November for a check up-everything was fine-all labs normal, nothing to worry about). I don't know him very well yet. My old oncologist retired in Feb. 19, and she was with me from the beginning in Sept. 11. Needless to say, we had a great relationship.
This past Tuesday I got my labs drawn, and didn't think anything of it, till I looked at them-and saw my ALT/AST levels slightly elevated-just out of normal range (ALT 57-ULN is 46-AST 46-ULN 41). All the rest of my values (albumin, bili, globulin, globulin ratio, ALP, protein) are within normal range.
I will freely admit that I have generalized anxiety disorder, greatly exacerbated by Covid lockdown. I have a scaffolding in place that I've built for years to healthily manage my anxiety: yoga classes multiple times a week, spending time with my yoga and work communities, teaching my wonderful university students, hanging with my colleagues, going to the gym every week and sitting in the spa after a workout. I also live within reach of Sedona and Grand Canyon, and go there a lot to hike and "breathe". You see where this is going-all those are closed off to me, and my anxiety has been through the roof.
Needless to say, I've been drinking more wine than I normally do and apparently that is good for me these past six weeks of lockdown. I knew that I was drinking more but until I saw the results I had no idea. I did not think it would jump my liver enzyme values that much. I had the equivalent of one or two glasses of wine during the week before my labs-I cut down because I knew it could skew labs, but I was shocked, terrified, and embarrassed that it jumped my values that much.
I should say that my ALT/AST values have been great for years; the last time they were slightly elevated was 2014 when I came back from vacation and indulging, waited a week and then got a lab test. My MO at that time asked me if I had wine, and I said yes, and she laughed and said abstain and get tested in a week or two. ALT/AST returned to normal with that second test.
This time I am twice as terrified-could it be exacerbated by my overall anxiety and then lockdown? Do you think alcohol could skew results even though I had just a little the week before my labs? Can some weeks of overindulging cause values to be increased?
I don't need a lecture-I know what I did, and chalk it up to lockdown and increased anxiety, using alcohol to temporarily mitigate it more than what was good for me. I just need a bit of reassurance and some logic. My mind is in a very, very dark place right now.
Thanks all,
Claire
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Hello,
From my understanding, it takes time for your liver to get back in "normal shape". Yes, alcohol affects enzymes. Please, don't worry! Just google some tips how to help your liver with diet. My enzymes started growing when I ate too much sweets and cakes. They were normal, but steady growing. I cut off sugar (honestly, only partially). My enzymes jumped down.
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Hi claireinaz, I know I have been drinking too much wine also!! My last liver function labs were normal, but I'm due again in June. The time before that they were off and I was also diagnosed with a fatty liver. My doctor said to decrease carbs and sugar. Hard to do especially now that I'm making my own bread!! One thing that did elevate my levels was that I was taking a lot of ibuprofen and Tylenol due to a knee injury. I was consumed with the side effects, checking every day for jaundice etc. I understand how you feel and hopefully your doctor will put your fears to bed. Let us know what he says. Best wishes, Terry
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DH is a liver transplant patient and I know very well the AST/ALT numbers from his labs from many years of labs pre-transplant and post-transplant. He was not a drinker but for many of patients they were. Both affect liver. Also having what is called "fatty liver" even if you NEVER drank can elevate them. I don't know your weight. Try to cut back on alcohol and move more even indoors with either floor exercises, walking up and down stairs, up and down the hall even in your apartment works. Even if you do it every commercial break if you are watching TV will help get you moving and may help bring some numbers down for you on your next labs. If your docs are super concerned or watching you will know. You will get a call...…..we always do if they are worried. Best wishes.
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I'm 5 8 and 130....and I'm considered "athletic"-my resting heart rate is 49-51. I walk a lot-a lot! and fast right now-do floor exercises and home yoga, but that alone isn't enough to relieve my GAD, which is why I've worked so hard to put my healthy scaffolding into place. As well, I live in the Northland-and until recently the weather has been pretty shitty, so outside exercise is unpleasant. It's not just the exercise-it's the lockdown and isolation from everything that relieved anxiety for me.
I'm close to being vegan and eat organic; not a sugar person (except for wine sugar, ha) or carbs, much.
I know that I should have abstained during this lockdown-I didn't-I'm not doing it anymore. But I'm still so scared. I look for reassurance here when I'm not reassuring others on these boards.
I appreciate the posts and hope more will chime in.
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Quick question for your Ladies with BC hormone +, can you drink wine? My MO told me wine increases estrogen.
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Claire, my AST numbers are always a point or to over what they should be. They got WAY high in treatment then went back to a point or two oup. Is it the very rare booze? the less rare MM? or the boatload of supplements I am on? My doc said since it's typical for me he does not worry, and in general does not worry not unless they are significantly higher than a few points up. Could you be detoxifyng anything else? Such as an antibiotic or OTC drug? The liver takes care of a lot of stuff....
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hi santabarbarian so good to see your screen name come up. I recall that I had some hip aches and sciatica (from running, Yoga) and lumbar aches from a new yoga sequence and took a lot of Advil, some tramadol, from that. My days kind of ran together but it seemed to be about 3 weeks ago, I resolved both with some yoga designed for that kind of pain. Would that have skewed enzymes? Again they are just above normal range, but with anxiety disorder everything looks like a threat.
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I also have GAD and I'll say it like I say it to myself, Girl, get a grip! You are fine! It looks like there are multiple reasons your levels may be ever so slightly elevated. You are already doing all the right things. Don't beat yourself up. Everyone has found this whole quarantine situation difficult. I've gained 10 lbs and we all know that is not good for preventing recurrence. I really recommend some free online guided meditation apps. Do a 10 minute one every time you feel your self going into a spin. It really helps. Love to you.
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Claire, so many things can elevate those enzymes...supplements/herbs included.
The best thing to do before panic sets in is to wait 2 weeks or so and redo them. Sometimes, the machines are off or how they drew your labs can affect certain values. My doctors have always said redo them before panic-ing. I'm having some issues of my own and I'm trying to breathe through them. Some days are easier than others.
Milk Thistle helps cleanse the liver and I started taking it when I went on tamoxifen but keep taking it because I do drink wine (and for my b-day this weekend, a gin martini!)
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claininaz - my BFF (has never had BC) is super fit, and has had elevated AST/ALT for a number of years. This was not the case when she was younger, but as she has gotten older the values have crept up. She has had every imaging known to man of her liver and all available explanatory lab tests, multiple times. I flew to California to be her support person (she is single) when she had a liver biopsy. Everything is totally normal except for those two values on the CMP. This seems to be idiopathic, but there is some thought in the research I have done that those who are fit, and push their muscles when they exercise, can have elevated liver values. She has regular CMP done and has experimented with exercising less, she cycles and plays soccer several times a week, and her values have dropped but are still elevated above the high end of the range. The approach her docs have taken is that she "runs hot" for this particular set of values and since there is no apparent cause, this is her normal. She does not drink at all, and eats a very healthy diet free of gluten, most sugar, few processed foods. You might try some hot water with lemon in the morning, and the milk thistle recommended in the above post - I know a number of people who have had success with that. I feel you on the anxiety this produces - I just went through a year of elevated ALP. During this time I had some pretty invasive dental work done - extraction, bone graft, screw in my jaw, platelet rich plasma infused in the bone, and finally an implant - over 18 months. The approach was super cautious since I had a history of almost 8 years of aromatase inhibitors and 6 years of Prolia, both of which can impact bone. When the ALP rose well above the high end of the range I asked my maxillofacial surgeon if all of this could drive the number up, and he said maybe immediately afterward, but not as long as mine was. I am a Murphy's Law patient, so I decided to ride it out even though my MO recommended scans, which was really nerve wracking. I had regular labs drawn before my most recent routine appt. with my MO in March and the ALP was firmly in the normal range, yay! Hoping this resolves for you quickly and it is just a blip.
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Hi Claire, my numbers were elevated last year and it turns out it was from over the counter medicine I had taken for the flu. They were normal 3 months later.0
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Hello my longtime BC friends-wallycat, SpecialK, peregrinelady-we've been through some things together, right? And many thanks to other posters, too! Every post but one was reassuring and I knew I'd find that here!
I had my telemed appt yesterday. It was very short (almost felt rushed) but okay. MO opened by saying that all my labs were fine, EXCEPT my AST/ALT. Right. He then jumped right into "I want you to have an ultrasound of your liver, and"...blah blah. I stopped listening for about a second because he didn't ask or even give me a chance to share diet, OTC drugs, supplements, anything.
So I had to jump back in and tell him this happened once six years ago, and we retested in two weeks after I cleaned up my alcohol intake, and they dropped to normal. Then he said, not unpleasantly, "okay, if that is what you want to do, we can retest in a month and and see if they drop first." I explained that I had been drinking more than usual, because of pandemic anxiety-and probably too close to the lab draw. I had to share with him that I had been taking more advil than normal and a few tramadol because of lumbar pain due to some different yoga poses I'd been learning (he said advil shouldn't make a diff but I wonder). Finally he slowed a bit and said exercise can cause #s to rise, etc.
I did tell him I didn't want to unnecessarily go into a medical facility just yet, for obvious reasons. I live right next to the Navajo Nation and they have, per capita, the highest rate of Covid and deaths in the country. It's just terrible there, effing tragic, and our med center treats most of the cases.
Finally I had to gently push him to tell me why he would want an US. He said I might have fatty liver, and he wanted to rule it out. I did a bunch of research on NAFLD, and it turns out it wouldn't be impossible for me to be develop it but most of the time it happens with obesity, diabetes, and eating a high fat high sugar diet. I'm not any of those. The protocol for reversing it or keeping it from getting worse is diet, losing weight, no alcohol, and exercise. And I'm doing all of that except alcohol (my BMI is already 20).
Interestingly I began to look at those of us on AIs and fatty liver, and a lot of research points to the fact that ER+ early stage BCers on AIs, not just Tamoxifen, are more at risk for developing this disease, and we have a lower survival rate if we do. Yikes.
The positive take away was that he didn't mention the c word at any time in the conversation.
Altogether the conversation felt very odd. He was rattling off words and if I had just said "okay" to the US, I think he would have told me his scheduling team would contact me and he would have ended the call right then and there. Proof again that we have to continue to be proactive in our health care.
Right now I feel about 80% confident it was alcohol that elevated my values just beyond ULN. I'll post when I retest. I feel like an ongoing lab experiment.
And if on the off-chance it is FLD, then I have to weigh if I want to continue on an AI and risk permanent liver damage, or stop the AI and risk recurrence. Either way feels like a crapshoot. Well, we know how to live with those odds, right?
Claire in AZ
PS I take lipotropic complex that has milk thistle in it rx'd by my naturopath, and just added 800 mcg of folic acid to my daily supplements. It is supposed to support liver function, too.
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I didn't want to ask and I honestly don't know, nor do I care, but when someone says "too much" or "over-did" alcohol, I take it with a grain of salt...I mean, two weeks of binge drinking (binge drinking, period, is not good) should not affect a healthy liver. Livers regenerate. I'm not saying alcohol can't affect labs but in my head, I can't accept it can do that with just a week or two of over-indulging.
Claire, I did not realize you were still on AIs.
I agree, when I was a BMI of 19, diligent exerciser, blah, blah...I had little room for improvement. I have plenty of room now, LOL.
https://pubmed.ncbi.nlm.nih.gov/30679317/
https://www.ncbi.nlm.nih.gov/books/NBK548490/
https://academic.oup.com/omcr/article/2017/11/omx0...
So it could be any combination of things that happened....the pain meds plus the booze plus the AIs or anything combined there.
Your numbers are not hugely elevated. If it were over 100 or so points, it would be more worrisome but a few points ...well...it could be anything or nothing (no sh#t) and who knows when or how often they recalibrate their machines....Do update us in 2 weeks!!
Best to you. Stay focused and not in fear...we are ALL going through the quarantines and worries of covid and none of us is alone. We WILL get through it!!
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Claire, just FYI, advil doesn't affect the liver anywhere near as much as tylenol does. I have liver mets & am allowed ibuprofen but acetaminophen is out of the question for me.
I mean ultimately the liver metabolizes and detoxifies most everything but some substances are more hepatotoxic. Tylenol is pretty evil. Doesn;t take much to OD on it and totally destroy a liver unless you can get to a hospital asap and administer the antidote.
I hope you have found some calm in your life and can manage the GAD in ways that support the rest of your health.
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Glad your MO listened to you. I think any time something happens with our bodies, we need to ask ourselves, what I have I done differently? Usually, there is an explanation. Unfortunately, with our past history it is so difficult not to go to recurrence. I have done it several times myself. You would think it gets easier the farther out from diagnosis you are, but it doesn’t. At least not for me with a high BCI. Claire, are you planning on ten years for the AI?0
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I'm interested to see if future labs come back into range Claire.
My friend is a stage III who had a liver biopsy last year and was found to have the non alcoholic fatty liver disease. She's still doing fine. Taking metformin. She has told me she is convinced it's from the Arimidex. She is still taking that and has been since 2014.
I once heard a fellow patient in the BS office tell the girl at the desk she would not live in a world without wine. I tend to agree. I over indulge at times too. I drink way more than they claim is safe. Safe to me is zero! Not doing it. I do take a day or several off in between. My BMI is over (25) what it should be and with the lock down I am struggling with some weight gain.
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If you think you've taken too much tylenol, the supplement NAC can sometimes help (used in hospitals in very high doses---probably IV).
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wallycat,
I spent way too much time researching liver enzymes and alcohol and found that even a few weeks of binge drinking can raise enzymes, and take some weeks to return to normal.
2014 I had three bottles of wine one night with dinner shared with my husband and got my labs done a week later (If and when I drink it’s usually one night a week, Friday). That elevated my enzymes. If my liver is working harder processing AIs, I figure it could happen. At least my former MO thought so.
My husband says at 61 I probably don’t process alcohol like I used to... and he’s probably right.
I just probably won’t have many more glasses of wine in my future for a longwhile. Too terrifying anymore.
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wallycat,
I spent way too much time researching liver enzymes and alcohol and found that even a few weeks of binge drinking can raise enzymes, and take some weeks to return to normal.
2014 I had three bottles of wine one night with dinner shared with my husband and got my labs done a week later (If and when I drink it’s usually one night a week, Friday). That elevated my enzymes. If my liver is working harder processing AIs, I figure it could happen. At least my former MO thought so.
My husband says at 61 I probably don’t process alcohol like I used to... and he’s probably right.
I just probably won’t have many more glasses of wine in my future for a long while. Too terrifying anymore.
Peregrinlady, I am not sure (about AIs). I haven’t checked research to see if even more than 10 years is better. Since ILC tends to recur later, I think my MO is definitely supports the 10 year plan, and I’m already 8 years on them anyway.
I haven’t had any real visible side effects, other than hip joint pain from time to time which could also be arthritis. But this new liver thing could be one of those side effects that are revealed only by a lab test.
I hope not. I do know that women who develop fatty liver on AIs and are ER + have a lower rate of survival than those who don’t. So there’s that.
Btw wallycat thanks for linking those. I saw them yesterday but others might find them helpdul
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Claire, I do agree with you that 1) as we age, our parts work harder to maintain us (sadly) 2) work-load for liver is cumulative, so between pain meds, AIs, and any amount of alcohol, it probably hit a tipping point.
Forgive my arrogance, but unless you're pounding down the booze (no judgement since stress has done unreal things to me as well) for months on end, I suspect this was an incidental finding that is not reproduceable if you repeat the labs. I'm crossing fingers I'm right.
For the record, I think since my DH's metastatic dx, I'm probably getting some wine-creep myself.
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For now, since I can't do anything else, I'm going to shelve my ongoing research (or try) and concentrate on a healthy lifestyle and manage my anxiety. I have to wait a month before testing anyway, so I cant do anything but wait and hope for the best second time around.
Thanks all!
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Sounds like a good plan. I, too, have had to contemplate no alcohol after diagnosis. I can go for a while without, but I don’t want to binge afterwards. I have settled on only one drink at a time when I do drink and usually only once or twice a week. I have also abstained for a few weeks at a time. It is difficult, especially when your spouse drinks, but I feel much better when I don’t drink and it is the only time I can lose weight!0
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Peregrinelady,
I have always abstained for at least 3 weeks before any lab draw. This time I cut it too close and I'm paying for it now, but today I got up and gave thanks for that lab report. It has made me examine how much covid wine I was really drinking, and how I was using it temporarily to relieve anxiety. Pre-covid my drinking habits were way more normal than what my drinking habits of the last couple months have been. Since I can't change the lab report, I can flip it and be grateful that perhaps it got my attention and made me realize an unhealthy (temporary) habit. I mean, since we will all have to live with the uncertainty of Covid for some time anyway, I have to train myself to find grace in the uncertainty and not harm myself while doing so.
Here's one link to research from USC regarding some weeks of binge drinking and liver damage: ""We sometimes think of alcoholic liver damage as occurring after years of heavy drinking. However, we found that even a short period of what in humans would be considered excessive drinking resulted in liver dysfunction".
https://www.ucsf.edu/news/2017/01/405561/binge-drinking-may-quickly-lead-liver-damage
I seem to be susceptible to even shorter durations of binging and elevated liver enzymes.
Okay, enough-I can become anxious just ruminating on all this! The alcohol-free day awaits.
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Yes, it is always beneficial to find the lessons in life, no matter how old we are getting. Enjoy your day!0
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Just a minor point - Advil affects the kidneys, not the liver. Tylenol is the only OTC NSAID that affects the liver, and only if taken in large doses over a long period of time. I found out all this by taking naproxen and then ibuprofen for years, which contributed to kidney cancer. So now, after a nephrectomy, I am ONLY allowed Tylenol (acetaminophen). I was told I'd have to go over the established daily maximum to harm my liver, and I have a fatty liver already.
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Alice: that is amazing. I didn’t know naproxen and ibuprofen can contribute to kidney cancer! A family member of mine is being tested for microscopic colitis. That too can be caused by naproxen and ibuprofen use. Wow thank you for sharing this info
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I didn't want anyone else to learn the way I did! 😀
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I wonder if the ibu and naprox kidney relationship is due to genetics; DH has been taking ibuprofen for nearly 30 years, daily....so far, nothing odd with his kidneys.
I took Ibu for an abscessed tooth (pain) during holidays when there were no dentists and I still think it contributed to "colitis" which has since resolved but seemed to take forever--much longer than the time I took the pain med.
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Alice yes. I’m glad you shared that info!
Wallycat: wow interesting about the colitis. Thanks for sharing that info tii
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Got the follow up test results today: my AST dropped to normal levels (from 46 in May-upper limit range is 41) to 37-yay. \
However, ALT dropped, but not enough to get me back in the "green" range so I'm still petrified. It dropped from 57-upper limit range is 46--to 48.
And my bilirubin went up from May--it was 1.1, and now it's 1.4 - upper limit range 1.3. My bilirubin has fluctuated during my regular checkups, though-in 2018 it was 1.6 and previously 1.5, 1.4, etc.
I checked the Mayo Clinic website and their ranges for the above and I'm well within their normal ranges. Sonora Quest is my lab though and shows a different range, but should I tell myself I'm okay because I am within range at Mayo? I think Mayo is a trusted source...?
Everything else on the repeat liver test was good; in most cases like ALP, protein, albumin/globulin ratio all dropped even from last month though they were in normal range last month too. I haven't heard from the doc yet, since I accessed these online just today. I am disappointed in the bilirubin and the ALT, which dropped, but not enough to keep me from jumping off the cliff with anxiety about a met in my liver.
I have been hiking (did 6 miles, 2 hours, at 9800 feet elevation last week) and walking a lot, went back to the gym, but none of that is like I'm training professionally. Would any of that cause just my ALT level to drop more slowly? It is dropping, but not as much as I hoped after abstaining from alcohol for four weeks. I eat clean anyway, and in my previous posts have shared BMI 20, I don't smoke, I exercise regularly--every day--now back to weight machines at the gym--I don't eat fried foods or meat except for fish. Lots and lots of organic veggies.
I know that bilirubin can fluctuate with stress and god knows I've been stressing over this.
What the h*ll is going on with me? Help, please.
I'm hyperventilating, and hypervigilating (if that is a word).Claire
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