Blood Test Results - Slightly high ALT AST

blood
#1

Heya,

I decided to hope back into keto (last time i did in 2016 for about 3-4 months) since it really helped me keep my daily calories intake low (as i stay satiated for longer).

Been into it for three weeks, diet is like this:

Morning:
1 Brazilian Nut (for the selenium) + handful of pumpkin seeds (for the zinc)

Morning + Lunch:
3 egg omelette in coconut oil, cheddar cheese, tomatoes + spring onion, red chili powder and some chicken stock powder (vegetarian)

sometimes i had coffee with mct oil

Dinner:
3 egg omelette in coconut oil, cheddar cheese, tomatoes + spring onion, red chili powder and some chicken stock powder (vegetarian)
and some chicken with some cheddar cheese

My weigh dropped in the 3 weeks from 89kg to 86kg (kinda fast - not at 2.2lbs/week, but im assuming water weight loss accounted for most of the drastic drop).

Before that for about a month or two I was going all out carb crazy. Fast food nuggets and fries (dipped in sauces - i absolutely loved the sauces) and Sprite almost every night, and instant noodles with jasmine rice.

After 3 weeks of keto, I got my blood tests and everything seems fine except:

TG to HDL ratio which is kinda high
ALT 80
ASH 55

Doc asked me to introduce more vegetables. And was concerned at the liver agitation and mildly elevated levels, but he didnt think further tests were necessary.

I dont know what has caused that. I dont drink alcohol, take no medicines. One factor could be exercise but studies indicate strenuous exercise only and I do only 3 exercises using a barbell
3x10 standing curls (for biceps)
3x10 standing overhead press
3x10 bent over pulls

And the above isnt even something I do every day, maybe every other day and half of those. Sometimes its even 1 set. So that surely isnt strenuous exercise right?

Could it be exercise? Could it be a recovering liver from all the fast food and instant noodle abuse?

Blood test: https://i.imgur.com/Neyv5IC.jpg

(Eric - The patient needs to be patient!) #2

Your TG will come down with strict keto and your HDL may rise as well. That takes time but also the measurements can be off depending on how you approach the blood draw. You should fast 12 to 14 hours and only have water and electrolytes. Try not to go longer than 14 hours and less than 12.

Eat your normal diet for 3 days before the blood draw. Do not fast into the blood draw fast. If you skip breakfast that is said to be okay but make sure to have 2 meals.

What were your previous AST and ALT readings? You may have developed NAFL (non alcoholic fatty liver). NAFL goes away with strict keto. My liver function and biomarkers have improved with less vegetables and lower carbs. I had slight NAFL disease and from a bio marker standpoint I do not have that anymore.

Medicines can affect livers a lot. So it may not be diet alone.

I would stay the course and give it 3 months and test again. But if you are on meds you might want to research their affects on liver.

(Bob M) #3

I doubt it’s exercise, as I exercise and my ALT and AST are lower. I’d give it another test in 6 months or so. Fasting and keto should help bring them down.

#4

Thank you for the reply, daddyoh and ctviggen.

As for my fast, I had my normal omelette at 8PM and had the blood drawn at 9:30AM next day. Only had water in between (or i think i avoided that too, cant remember).

Dont have previous numbers for liver AST ALT, I never gave them any attention sadly. What are the biomarkers for NAFL? Which test should I ask the doctor for?

So if exercise isnt it, I suspect it was my diet prior to the keto that might have caused a lot of liver agitation?

The doctor kept repeating “the livers job is to detoxify, so you are taking stuff which is causing the liver to work harder” and I couldnt think of anything except the chicken salt (which comes under “processed” and maybe the coconut oil?) Ive got some humus too which lasts forever (ie super processed with preservatives), I wonder if that could be the cause too.

When I asked to come in after 2 weeks, he said “no need, a liver recovering from damage takes months, just add vegetables to your diet”. Which made me think that my binge on instant noodles (indomie) for the past two months, might have caused some damage and its actually falling down from a worse off number. I never had liver issue symptoms either But it doesnt make sense, my wife who has staple is indomie never had issues (gotta get her blood tested too now that I think about it).

Ive set the calendar for my next blood test after 90 days.

(Bob M) #5

What I believe is true is that anything that affects the liver will increase these values. I even started a “liver protocol”, taking a bunch of vitamins, and these values went UP, not down. So, I stopped that.

Like you, I don’t know what my values were when I was high carb, so there’s no way for me to know how high these went. I do know that my first test after about 1.5 years of low carb, these were relatively low, though they are even lower at my last tens (5+ years into low carb/keto). They do seem to go up and down, though.

Saturated fat is supposedly very good for the liver, as is choline (eggs, other things). Don’t worry about those, and the recommendation to eat vegetables is most likely wrong. If you LIKE vegetables, eat them, but they won’t help your liver. Also, polyunsaturated fats (seed oils, like soybean, sunflower, canola, etc.) don’t help the liver.

If you can wade through this guy’s site, he has a lot of good information about the liver:

(Eric - The patient needs to be patient!) #6

Also NSAID - LIke tylenol and ibuprofen (and many other over the counter) can harm the liver. The best test is a sonogram that looks for fat. There is evidence that NAFLD can be reversed quickly (<month or two) of strict keto.

AST and ALT are supposedly good markers. There are others but I am not conversant in those. My liver fat was spotted on a sonogram and that corresponded with higher AST and ALT.

Carb heavy diet leads to NSFLD and especially foods high in fructose. Fruit, some vegetables, corn sweeteners and more.

(Bacon is a many-splendoured thing) #7

In addition to enzyme levels, a scan or biopsy will reveal droplets of fat stored in the liver. Such fat is the first to go when we lower our carbohydrate, and most especially when we cut out sugar. One study, performed on obese children at a clinic in San Francisco, showed improvement in liver enzymes in one week, merely from reducing the fructose load.

The fructose moiety of the sucrose molecule is what does the damage, because it is metabolised by the same pathway as ethyl alcohol, a pathway that is easily overwhelmed. A fatty liver is the result. Starches also put strain on the liver, because all that glucose needs to be turned into triglycerides and packaged for storage in the adipose tissue.

A well-formulated ketogenic diet with plenty of saturated and monounsaturated fat in it (think butter/ghee, tallow, lard, bacon grease) will give your liver a break and allow it to recover. Get re-tested once you’ve been ketogenic for about six months, and you should have decent numbers again.

(Bob M) #8

This is supposed to be another good test for the liver, and is the one Ivor Cummins recommends:

https://labtestsonline.org/tests/gamma-glutamyl-transferase-ggt

I’ve only had this done once (I paid for it), but I got a relatively low score here, too. That was a recent test, only after hearing Ivor recommend it. He also recommends testing for ferritin, though that’s more of an iron test.

(Bacon is a many-splendoured thing) #9

Ferritin level is one of the markers of inflammation.

(Bob M) #10

I did not know that. The Ivor podcast was about iron, and I do not believe they tied that into inflammation, though they may have.

I must not be inflamed, as I got (8/9/19) a CRP of 0.4 mg/L, a ferritin of 47 ng/mL, a GGT of 12 U/L, ALT of 10 U/L and AST of 13 U/L, which are are relatively low. Hmm…some of these are almost too low and near the bottom of the range.

#11

my Ferritin looks ok.

Right now I have cut down to three posibilities:

  1. Liver getting better from getting of junk food

  2. Chicken salt ( Maize Maltodextrin, Southern Ocean Sea Salt, Cane Sugar, Yeast Extract, Natural Vegetable Flavours, Canola Oil, Extra Virgin Olive Oil, Turmeric Ground Madras (Colour))

  3. My non stick frying pan releasing toxins in my daily omelette routine. Thinking of switching over to

  4. Eating 1xbrazil nut + half handful of pumpkin seeds?

Cant think of any other reason why my liver would be mildly stressed, sigh … cant wait for my next blood test.

(Bob M) #12

See if you can get a GGT test done. That supposedly is the best test.

I’d try not to stress about it, and see how much fasting you can do. Otherwise, just wait for a while. If you’re taking any medication or vitamins, see whether you can stop taking them too.

#13

I am piggy backing onto this conversation as I am getting a lot of pressure from my doctor.

3/2019: Month after starting Keto:
Alkaline Phosphatase: 38
AST: 38
ALT: 12
Total Cholesterol: 236
HDL: 76
Chol/HDL Ratio: 3.1
Triglycerides: 73
LDL: 145

3/2020: year later
Alkaline Phosphatase: 79
AST: 60
ALT: 30
Total Cholesterol: 305
HDL: 109
Chol/HDL Ratio: 2.8
Triglycerides: 35
LDL: 189

The fact that my blood pressure dropped from 140/80 to 110/60, lost a little over 20 pounds, (didn’t start Keto for weight loss just a nice side benefit), haven’t taken asthma medication for over a year, workout everyday, two meals a day (now due to isolation 1 meal a day basically)

I said no to the medication for cholesterol, but don’t know what to say about the liver issue. The only medical items I find is that ALT is the more important number and that is normal but rising. I do not drink, I do not take any medication. I have search for medical paperwork, the ones I do find are way beyond me. Everything I do read seems to say I have liver damage. So if you have an update to this conversation or anyone else can point me in the right direction to medical paperwork that is understandable I would appreciate it.