Dear Mainstreet Doctor,
I applied for life insurance and was denied because of a high AST (54), ALT (51), and GGTP (271). I went to the doctor and hepatitis was ruled out. Since then I applied for life insurance through another company at a higher rate and the test came back, levels were AST (49), ALT (47) and GGTP (156) and LDH (253). The doctor is running another blood test. I have consumed alcohol for 15 years at a rate of 12-15 beers a week. I am 34, and am in good shape. I run 30 miles a week and exercise 3 times a week. I did take Celebrex for a short time for pain in my foot. When I was denied the life insurance policy I stopped taking Celebrex and stopped drinking. My doctor seems to be a little slow with the blood tests results and analysis. Should I be impatient with this or should I be worried? Also, am I taking the proper steps to help remedy the problem?

Dear Matt,
There are many causes of elevated liver enzymes. Since most drugs and chemicals are metabolized through the liver, think of elevated liver enzymes as an indication that something is poisoning the liver. For example, some drugs you take, including over-the-counter medicines or herbs, could potentially damage the liver. Tylenol (acetaminophen) is the classic one that if taken in higher than recommended doses, can cause liver damage. Celebrex, as well as other non-steroidal anti-inflammatory drugs (including ibuprofen over-the-counter) have been reported to cause elevation of liver enzymes. Alcohol is one of the most common causes of elevated liver enzymes, even at 2 drinks or beers per day. If the use of alcohol is excessive and prolonged, it can eventually lead to serious liver damage, cirrhosis and death. Other toxins to the liver may be chemicals, solvents, or insecticides that people work with on the job. This doesn't happen as much anymore since precautions are usually taken when working with these chemicals. Along with alcohol, the most common cause of elevated liver tests in the North America is Hepatitis C. Next is Hepatitis B. Fortunately, you've already been tested for these and do not have those serious diseases. Less commonly, abnormal liver enzymes could be an indication of a disease process, transient or serious, that has affected the liver. Some of these would include gallbladder disease, other viruses, any severe acute illness, or chronic diseases, and of course, cancer. In your case Matt, the alcohol would be my first consideration for the elevated liver tests. It looks like the tests have improved slightly since stopping the alcohol and the Celebrex. Continue to follow the liver enzymes and they should continue to gradually improve unless the liver was too damaged by the alcohol already. If the tests don't continue to improve then further testing would be indicated. It appears that you are a person who is interested in healthy habits, so congratulations on stopping the alcohol. Let me know how things go.

Best wishes,
Donald Ebersole MD for mainstreet doctor

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