Cholesterol Tests: What's Your Liver Function?
I've never been told my liver function results along with my cholesterol numbers before today. But now I will always ask for them. Why? Because I don't know what levels my liver normally functions at.
Today I received a call to let me know that while on Simvastatin and enjoying a meatless diet for three months, my cholesterol numbers did not change significantly. However, my liver numbers were elevated.
What the heck does that mean? I wanted to know. The nurse told me my AST was at 43, and it should be between 14 and 34. My ALT was 75, and it should be between 1 and 33.
Oh. Of course. I see.
But I did not see at all. Although I tried to gain more of an explanation, there wasn't much more she could tell me, and perhaps she had a million more phone calls to make about results more dire than mine. So after I hung up, I decided to do a little investigating of my own, because that's what I do when I don't understand something.
I will now enlighten you. Let me first explain that the blood test you receive to determine cholesterol levels while on a statin drug is also used to determine the presence of particular liver enzymes in the blood. When your liver becomes injured, these enzymes spill into the blood stream. Therefore they can be read by a simple blood test.
Here's some terminology for you along with pertinent information: AST stands for aspartate amniotransferase. It is also known as serum glutamic oxaloacetic tranaminase, or GSOT for short. The test for AST is not a specific indicator of liver injury. This is because injury to the heart, muscle, kidney and the brain may also have elevated AST numbers.
ALT stands for alanine amniotranferase. It's also known as serum glutamic pyruvic transaminase, or SGPT for short. Thank goodness for acronyms. The test for ALT is a more specific indicator of liver damage.
My doctor's office gave me a different AST and ALT "normal range" than could be found on any of the sites I visited. MedecineNet.com informed me the AST normal range fell between 5 and 40 units per liter of serum. (Serum is the liquid part of the blood.) Liverdoctor.com mentioned 0-45, and SimpleFactsProject listed it as 5-43. Likewise, the ALT numbers were: 7-59 per liter of serum, 0-45 and 5-60 respectively.
Okay, that was confusing. So I'll stick to my doctor's office's numbers. AST: between 14 and 34. ALT: between 1 and 33.
Now, here is something interesting I found on MedecineNet.com. Taking particular medications may cause liver enzymes in the bloodstream to rise. In a study using my favored pain reliever of choice, Tylenol, 33-44% of the people who took 4g. of it daily for 2 weeks had elevated ALT levels: up to three times the normal limit. The people taking the placebo drug had no change.
Other medications that may increase liver enzyme levels include ibuprofin, atorvistatin (Lipitor), niacin, fluconazole (anti-fungal mediaction) and many others. For a full list see: http://www.medicinenet.com/liver_blood_tests/page3.htm.
It's also important to stress that moderate liver enzyme elevation is entirely normal. But I want to point out my doctor became nervous seeing my numbers which, in my medical-naive opinion, do not seem extremely high. I wish I'd kept track of my liver function numbers before this came about, but I never thought to do so. But I will.
And so should you.
Today I received a call to let me know that while on Simvastatin and enjoying a meatless diet for three months, my cholesterol numbers did not change significantly. However, my liver numbers were elevated.
What the heck does that mean? I wanted to know. The nurse told me my AST was at 43, and it should be between 14 and 34. My ALT was 75, and it should be between 1 and 33.
Oh. Of course. I see.
But I did not see at all. Although I tried to gain more of an explanation, there wasn't much more she could tell me, and perhaps she had a million more phone calls to make about results more dire than mine. So after I hung up, I decided to do a little investigating of my own, because that's what I do when I don't understand something.
I will now enlighten you. Let me first explain that the blood test you receive to determine cholesterol levels while on a statin drug is also used to determine the presence of particular liver enzymes in the blood. When your liver becomes injured, these enzymes spill into the blood stream. Therefore they can be read by a simple blood test.
Here's some terminology for you along with pertinent information: AST stands for aspartate amniotransferase. It is also known as serum glutamic oxaloacetic tranaminase, or GSOT for short. The test for AST is not a specific indicator of liver injury. This is because injury to the heart, muscle, kidney and the brain may also have elevated AST numbers.
ALT stands for alanine amniotranferase. It's also known as serum glutamic pyruvic transaminase, or SGPT for short. Thank goodness for acronyms. The test for ALT is a more specific indicator of liver damage.
My doctor's office gave me a different AST and ALT "normal range" than could be found on any of the sites I visited. MedecineNet.com informed me the AST normal range fell between 5 and 40 units per liter of serum. (Serum is the liquid part of the blood.) Liverdoctor.com mentioned 0-45, and SimpleFactsProject listed it as 5-43. Likewise, the ALT numbers were: 7-59 per liter of serum, 0-45 and 5-60 respectively.
Okay, that was confusing. So I'll stick to my doctor's office's numbers. AST: between 14 and 34. ALT: between 1 and 33.
Now, here is something interesting I found on MedecineNet.com. Taking particular medications may cause liver enzymes in the bloodstream to rise. In a study using my favored pain reliever of choice, Tylenol, 33-44% of the people who took 4g. of it daily for 2 weeks had elevated ALT levels: up to three times the normal limit. The people taking the placebo drug had no change.
Other medications that may increase liver enzyme levels include ibuprofin, atorvistatin (Lipitor), niacin, fluconazole (anti-fungal mediaction) and many others. For a full list see: http://www.medicinenet.com/liver_blood_tests/page3.htm.
It's also important to stress that moderate liver enzyme elevation is entirely normal. But I want to point out my doctor became nervous seeing my numbers which, in my medical-naive opinion, do not seem extremely high. I wish I'd kept track of my liver function numbers before this came about, but I never thought to do so. But I will.
And so should you.
Well, what does it mean for you? I guess you'll have to question the doctor when you follow up and just to note, wikipedia and other web sites aren't the doctors. They didn't graduate from med school and there are many variables that affect each person differently(that's usually why the doctor is better than any website;) They can confuse you even more and by the way, that's why they monitor patients levels while on certain meds and we all know (or should know) that certain foods or other drugs effect meds too. Just saying.
ReplyDeleteWell, both true and not true. Certainly we can find a lot of misinformation on the web. I came across some less than credible sources while researching ALT and AST. But some websites are maintained by doctors, and sometimes doctors place information on Wikipedia as well. Also, even if you decide to skip the web altogether, you can go from one doctor to another and receive differing information. I have. There's nothing wrong with checking out websites, as long as you use good judgment. In fact, sometimes it's a great way to understand what questions you will need to discuss with your doctor! I do feel, however, we must do our own research and be advocates for our own health. No doctor is infallible. Thanks for your post!
ReplyDeleteWell said and with that said: people don't believe the first thing you read and become your own strongest advocate concerning your own health. Remember, doctors are human too. Find one who works with you and for you. They can't cure everything nor can a pill!! Good luck!!
ReplyDeleteHi Kim,
ReplyDeleteThis is not about the liver, it's about the kidney. I had to go to a renologist because over the course of several years, I had consistently shown a high creatine level in my blood. Because many medical records can now be combined, I had the lab results for the last ten years. I started out, based on my numbers, with stage 3 kidney disease. But the doctor and I, during the history portion of the examination, saw that there was significant drop in creatine levels at around the same time I started going to the gym on a steady basis. Creatine leaches from decaying muscles, so as the muscles became used and actually started to develop new growth, the creatine levels dropped. Based on the upward swing of the health indicators, he considered that I was at a stage 2.
Significantly, the overall decrease of kidney function likely stemmed from the NSAIDs I had once taken daily for arthritis relief. Artificial hips helped that. They also helped me with being able to work my muscles again.
Interesting thoughts about the kidneys, Dave. My doctor's office never mentioned anything about my creatine levels. Guess after my next lab work I'll have to ask them about that.
ReplyDeleteAnd as for your response, Anonymous, I agree wholeheartedly. If you like a holistic approach, find one that believes in alternative medicine. If you feel that's a bunch of malarky, go with a doctor who prefers a different approach.
I'm so glad you're contributing to the discussion, posters. It's important to have many differing opinions and thoughts. Only then can people figure things out for themselves.