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Why Would Liver Enzyme Levels Be Elevated When All Other Test Results Are Normal?
Posted on
Fri, 27 Apr 2018
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Fri, 27 Apr 2018
Answered on
Wed, 4 Dec 2019
Last reviewed on
Question : Hi, GGT is 264, ALT is 102, AST is 69, triglycerides 214, everything else normal. What is going on and what do I do about it?
I am in good health, somewhat overweight but not obese, no symptoms of anything wrong. Drink on average about one drink or less per day, meaning 2 or 3 drinks some days and none other days. No medications.
Thanks!
I am in good health, somewhat overweight but not obese, no symptoms of anything wrong. Drink on average about one drink or less per day, meaning 2 or 3 drinks some days and none other days. No medications.
Thanks!
Brief Answer:
Questions so that I can advise
Detailed Answer:
Hello,
I have a few questions for you to be able to help provide specific information:
1. What was the reason that liver enzymes were checked?
2. How do these lab results compare with past liver enzyme tests? Over what time did they become elevated, and was it following use of Tylenol, any other medications (I know you are not on any medications daily) or a period of time of increased alcohol consumption?
3. Have you ever been tested for Hepatitis C (as a routine check, which is now recommended)?
4. What is your height and weight, and are you more overweight in the middle?
5. In this panel, did they check alkaline phosphatase?
6. Has your doctor checked pro time (PT) or bilirubin? These are not always on a liver enzyme panel.
7. What is the most alcohol you have drunk at one time (in a given day, not on average) in the past 6 weeks?
I'll write back with some thoughts after I hear back from you - thanks.
Questions so that I can advise
Detailed Answer:
Hello,
I have a few questions for you to be able to help provide specific information:
1. What was the reason that liver enzymes were checked?
2. How do these lab results compare with past liver enzyme tests? Over what time did they become elevated, and was it following use of Tylenol, any other medications (I know you are not on any medications daily) or a period of time of increased alcohol consumption?
3. Have you ever been tested for Hepatitis C (as a routine check, which is now recommended)?
4. What is your height and weight, and are you more overweight in the middle?
5. In this panel, did they check alkaline phosphatase?
6. Has your doctor checked pro time (PT) or bilirubin? These are not always on a liver enzyme panel.
7. What is the most alcohol you have drunk at one time (in a given day, not on average) in the past 6 weeks?
I'll write back with some thoughts after I hear back from you - thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Berger-Durnbaugh,
These tests were done for a life insurance application (denied due to these results).
I have never had these tests done before. I did not take any medications before the test. No period of increased alcohol consumption, might have had a drink or two with dinner the night before (I did not realize that might be a problem for this test).
No Hepatitis C check in at least 10 years, if ever.
Height and weight: 5' 9'', about 190 lbs. Would not say I am more overweight in the middle.
Here are a few more results from the same test that came back normal, is this what you were asking for?
EST. GFR 125
ALK. PHOS. 95
BILI. TOT. 0.8
TOT. PROTEIN 7.3
ALBUMIN 4.5
GLOBULIN 2.8
Most alcohol at one time in the past 6 weeks would be 4, I make a point to never go beyond that. I enjoy a drink or two with dinner after work (grew up in Europe, kept that habit when I move to the US), but I do not ever binge drink.
Thanks,
XXXX
These tests were done for a life insurance application (denied due to these results).
I have never had these tests done before. I did not take any medications before the test. No period of increased alcohol consumption, might have had a drink or two with dinner the night before (I did not realize that might be a problem for this test).
No Hepatitis C check in at least 10 years, if ever.
Height and weight: 5' 9'', about 190 lbs. Would not say I am more overweight in the middle.
Here are a few more results from the same test that came back normal, is this what you were asking for?
EST. GFR 125
ALK. PHOS. 95
BILI. TOT. 0.8
TOT. PROTEIN 7.3
ALBUMIN 4.5
GLOBULIN 2.8
Most alcohol at one time in the past 6 weeks would be 4, I make a point to never go beyond that. I enjoy a drink or two with dinner after work (grew up in Europe, kept that habit when I move to the US), but I do not ever binge drink.
Thanks,
XXXX
Brief Answer:
Information
Detailed Answer:
Hello,
Thanks for the additional information.
Given that the alkaline phosphatase and bilirubin levels are normal, this is not a cholestatic pattern for liver inflammation (such as coming from the gall bladder).
Also, given that all of the liver enzymes (AST, ALT, GGT) are elevated, the problem seems to be from the liver (and not due to muscles, cardiac, or other sources).
Although elevated, the elevations are not so high that I would suspect a toxin or viral hepatitis as the cause.
The most likely cause of the elevations, particularly given that your triglycerides are high, is non-alcoholic fatty liver disease. Alcohol may be contributing to the problem too. Some people have no problem with a couple of drinks, others can get an angry liver from it. Who gets NAFLD can have a genetic component, so while you are not severely overweight, it's clear that your liver is unhappy.
So here is what I recommend:
1. Decrease simple carbohydrates (anything with sugar or made with white flour) while increasing vegetables. You may want to consider consulting a dietician for dietary help, but the general idea is to decrease simple carbs. Increasing exercise is generally helpful too.
2. Cut out alcohol and replace with other (non sugar, non-artificial sweetener) beverages for now. Avoid Tylenol (acetaminophen aka paracetamol). Make an appt. with your doctor for further testing. This should include a Hepatitis Panel, CBC, Ferritin and transferrin, and protime or INR.
3. It can take several weeks for the liver cells to regenerate, so no need to recheck immediately, but they should be rechecked in 1-2 months to make sure there is a downward trend. If your elevated labs are not going down, an ultrasound of the liver is the next step.
I think with a bit of weight loss (gradual), decreasing simple carbs (which also affects triglycerides), and cutting out alcohol, you should see improvement in your labs in several weeks.
Information
Detailed Answer:
Hello,
Thanks for the additional information.
Given that the alkaline phosphatase and bilirubin levels are normal, this is not a cholestatic pattern for liver inflammation (such as coming from the gall bladder).
Also, given that all of the liver enzymes (AST, ALT, GGT) are elevated, the problem seems to be from the liver (and not due to muscles, cardiac, or other sources).
Although elevated, the elevations are not so high that I would suspect a toxin or viral hepatitis as the cause.
The most likely cause of the elevations, particularly given that your triglycerides are high, is non-alcoholic fatty liver disease. Alcohol may be contributing to the problem too. Some people have no problem with a couple of drinks, others can get an angry liver from it. Who gets NAFLD can have a genetic component, so while you are not severely overweight, it's clear that your liver is unhappy.
So here is what I recommend:
1. Decrease simple carbohydrates (anything with sugar or made with white flour) while increasing vegetables. You may want to consider consulting a dietician for dietary help, but the general idea is to decrease simple carbs. Increasing exercise is generally helpful too.
2. Cut out alcohol and replace with other (non sugar, non-artificial sweetener) beverages for now. Avoid Tylenol (acetaminophen aka paracetamol). Make an appt. with your doctor for further testing. This should include a Hepatitis Panel, CBC, Ferritin and transferrin, and protime or INR.
3. It can take several weeks for the liver cells to regenerate, so no need to recheck immediately, but they should be rechecked in 1-2 months to make sure there is a downward trend. If your elevated labs are not going down, an ultrasound of the liver is the next step.
I think with a bit of weight loss (gradual), decreasing simple carbs (which also affects triglycerides), and cutting out alcohol, you should see improvement in your labs in several weeks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, much appreciate your helpful reply.
I was concerned the results were a sign of some serious illness. If it is just a matter of better diet, exercise, and less alcohol I can deal with it, so this is very reassuring. I will take your advice to schedule an appointment with my doctor and follow up on this.
Thanks,
XXXX
I was concerned the results were a sign of some serious illness. If it is just a matter of better diet, exercise, and less alcohol I can deal with it, so this is very reassuring. I will take your advice to schedule an appointment with my doctor and follow up on this.
Thanks,
XXXX
Brief Answer:
Your welcome - have a good night
Detailed Answer:
Hello,
Your welcome. I can't say with absolute certainty that it is NAFLD without ruling everything out with the other tests mentioned, but it is the most likely thing that is going on.
Best regards,
Bonnie Berger-Durnbaugh, MD
Your welcome - have a good night
Detailed Answer:
Hello,
Your welcome. I can't say with absolute certainty that it is NAFLD without ruling everything out with the other tests mentioned, but it is the most likely thing that is going on.
Best regards,
Bonnie Berger-Durnbaugh, MD
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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