Liver Issues High ALT and B12

[WiseMonkey]

Hi, my stress levels have been really bad over this last week. A couple of months ago my blood test revealed that I had a slightly raised ALT, it was 48 (the cut off is 45). Until now they've been within the normal range, but even within the normal range they've been increasing. Also over the last 4 years I've had raised B12 levels (without supplementation) but the Drs never seemed worried. I've read that raised B12 levels are rare and can indicate serious issues like severe liver disease or cancers. I know I shouldn't have Googled but I did and it threw me into a terrible panic! I went back to my Dr and she admitted that she didn't know anything about high B12 levels, but said she would refer me on.

Over the last 6 years I have been on more anti-inflammatory meds than previously. I've also been on Doxepin 10 mgs for 25+ years, so I'm wondering if all these meds have finally caught up with my liver!!

Tomorrow I see the hematologist to discuss these issues and hopefully get a liver ultrasound. My last B12 level was 644 the range is (170-600). It has been up to 778 in previous tests. I do have autoimmune activity going on so am hoping the B12 is related to that. I feel sorry for my partner, he's been wonderful putting up with my high anxiety.
So here I am at 2:30 am NZ time writing this because I can't sleep. I've left off all meds and have had a glass of hot milk. Any replies would be very welcome, thanks for reading this

[Careful1]

You really don't need an ultrasound of your liver for barley elevated ALT level. Liver enzymes tend to bounce all over the place through out the day and even if both your ALT and AST were elevated it would by no means mean you have liver disease as liver enzymes can and do elevate for so many different reasons. Trust me when I tell you if you had liver damage you would certainly know it and your labs would be off in more then just the ALT area. It's the bigger picture that matters.
As far as your B12 goes I am certain there are other reasons that it can be elevated and perhaps there is no reason at all. Lab ranges are based off general population but it does not mean that every person will fall within those ranges. A person can have values higher or lower then the threshold and it be completely normal for that person. My lab shows normal B12 levels 200 to 1,000 and so my lab wouldn't even consider your result as being to high or abnormal.
You mention you have an autoimmune disorder and so as you know this can cause many different blips in labs (depending on what autoimmune disorder you have) that would in that case be expected.

You more then likely have nothing to worry about but your doing the right thing of course by following up with your doctor to make sure, just try not to make yourself sick with worry especially when it comes to your ALT. Googling symptoms is never a good idea as this as you know will just in most causes cause needless worries.

Good luck with your appointment. Let us know how everything goes 🙂

[pulisa]

My B12 level was higher than yours 4 years ago and a year ago it was the same. The haematologist made no comment (I was being tested for multiple myeloma due to other factors). i thought it was a good thing? All I can say is I'm healthy and have never been offered a referral for high B12 or any tests.

I do hope you get some reassurance tomorrow, WM. No one has batted an eyelid with me x

[WiseMonkey]

Thank you Careful1 and Pulisa, I cried when I read your replies because they are so true I'd put the high B12 levels together with the rising ALT and come up with failing liver disease, which likely isn't the case. I am a huge worry wart and often think the worse scenario, which isn't healthy for me.

I think our NZ B12 levels are very conservative as I've read that other countries levels are between 200-900. I think my levels of B12 are probably right for me. My folate levels were raised as well (for some unknown reason). I do have CFS (chronic fatigue syndrome) and IC (Interstitial Cystitis) which are both inflammatory conditions. I may even have Lupus but all the autoimmune antibody tests are negative. Sometimes this can happen. B12 can be elevated in Lupus and RA (which I don't have). I'm taking L-Glutathione (an antioxident) and Milk Thistle which are good for the liver.

Pulisa, thank-you, you are the first person I've come across who has raised B12 levels (and even higher than mine). Mine go up and down somewhat but never fall into the 'normal' range. I'm glad you are healthy and I believe I am too despite having some autoimmune blips.

[AJBliss]

My unsupplemented B12 is also elevated (637), and as far as I know, I’m healthy. My GP was very dismissive when I asked her if it’s an indication of a problem. Hopefully it’s just one of those things for you as well.

[MyNameIsTerry]

Lesley,

A little snippet from the NHS (I won't include the rest as it's all jargon for testing):

Mildly abnormal liver test results are a common and often incidental finding. In the absence of jaundice or symptoms suggestive of biliary or hepatic disease, mild to moderate elevation in the ALT (40–200) or the ALP (110–500) usually requires investigation, normally only on a routine basis.

You are only just over this and I suspect your GP would normally monitor to ensure it dropped again where no other symptoms are present.

As you know high B12 levels are on the rare side and there is no upper limit to them anyway.

ALT is affected by various meds from antibiotics to statins to some antidepressants. It could just be your levels fluctuate a bit due to those meds baring in mind they have their peaks closer to them being taken which tail off over time depending on how long their half life is. It could be timing.

I suspect if you had liver damage you would not be well. Mild damage such as short term shock would have lower levels in elevation ALT but something like severe liver damage is going to be in the high/very high range where ALT's tend to be more like 10-20x high than normal.

And from some tests that people have asked about on here worrying about cancer it has been seen (and confirmed by those who have had cancers) that the results are often high spikes which normally alert the doctors to the need for further investigation rather than just slightly over.

So, you have a load of good things in your favour here. I really would have a chat with them about your meds and whether you should stop them too because does that mean you need something else or your autoimmune disorder isn't receiving the treatment it needs? Wouldn't that end up making you worse long term?

I appreciate it's a trigger though so don't feel bad or kick yourself over any of this as we've all reacted in these ways in our time. You've got support on here to talk about and your partner seems a great bloke so I'm sure he will be trying to take your mind of this worry and get it back onto enjoying your life together.

Try to stay away from medical sites. With your autoimmune issues you want a doctor's knowledge anyway and it's only going to open the door to your subconscious "what ifs" and you'll just end up clicking on more links when all this might just be an incidental finding that you would other wise never know of and have may have had off & on all your life for all know as could the rest of us as it's part of natural cycling in the body.

[WiseMonkey]

Lesley,

A little snippet from the NHS (I won't include the rest as it's all jargon for testing):



You are only just over this and I suspect your GP would normally monitor to ensure it dropped again where no other symptoms are present.

As you know high B12 levels are on the rare side and there is no upper limit to them anyway.

ALT is affected by various meds from antibiotics to statins to some antidepressants. It could just be your levels fluctuate a bit due to those meds baring in mind they have their peaks closer to them being taken which tail off over time depending on how long their half life is. It could be timing.

I suspect if you had liver damage you would not be well. Mild damage such as short term shock would have lower levels in elevation ALT but something like severe liver damage is going to be in the high/very high range where ALT's tend to be more like 10-20x high than normal.

And from some tests that people have asked about on here worrying about cancer it has been seen (and confirmed by those who have had cancers) that the results are often high spikes which normally alert the doctors to the need for further investigation rather than just slightly over.

So, you have a load of good things in your favour here. I really would have a chat with them about your meds and whether you should stop them too because does that mean you need something else or your autoimmune disorder isn't receiving the treatment it needs? Wouldn't that end up making you worse long term?

I appreciate it's a trigger though so don't feel bad or kick yourself over any of this as we've all reacted in these ways in our time. You've got support on here to talk about and your partner seems a great bloke so I'm sure he will be trying to take your mind of this worry and get it back onto enjoying your life together.

Try to stay away from medical sites. With your autoimmune issues you want a doctor's knowledge anyway and it's only going to open the door to your subconscious "what ifs" and you'll just end up clicking on more links when all this might just be an incidental finding that you would other wise never know of and have may have had off & on all your life for all know as could the rest of us as it's part of natural cycling in the body.

Hi Terry, thanks for taking the time to reply My big concern in regards to my ALT levels is that they had been rising over the last 3-4 years, even when they were within the normal range (ie from 11 then to 24, then to 26, then to 24, then to 36, then to 48) so I'm a bit scared of what the next reading may be!! It seems to be a trend.

I saw the hematologist today mainly about the B12 levels and he was very reassuring that although mine are raised, they are fine. High B12 is quite rare but he thinks it could be to do with transport molecules (transcobalamin 11) and how it moves B12 around the body. It could be an inflammatory immune response. B12 has an association with neutrophils. All of my complete blood counts are great so there is no problem. He said if there was anything serious going on, then something would show up in the 'complete blood count'. He was most reassuring. Sorry this is rather technical.

Regarding the ALT's he didn't think there was an issue as all the other liver readings are stable and within normal levels. The rise could also be an inflammatory immune response.

We talked about the anti-inflammatory meds and it's better for me to take paracetamol. He didn't have a problem with me continuing the low dose 10mg Doxepin (a tricyclic antidepressant) which helps with sleep and inflammation in those with CFS). He also thinks I could try stopping it and see what happens, as it could have become a psychological crutch. A this low level Doxepin is not addictive.

I'm going to use this time to clean up my diet. I don't drink alcohol any more and I've cut out sugar. I will continue with the vitamin C and milk thistle which are both good for the liver

[Hypo84]

ALT fluctuactions wiithin the normal range are irrelevant.

[pulisa]

Thank you Careful1 and Pulisa, I cried when I read your replies because they are so true I'd put the high B12 levels together with the rising ALT and come up with failing liver disease, which likely isn't the case. I am a huge worry wart and often think the worse scenario, which isn't healthy for me.

I think our NZ B12 levels are very conservative as I've read that other countries levels are between 200-900. I think my levels of B12 are probably right for me. My folate levels were raised as well (for some unknown reason). I do have CFS (chronic fatigue syndrome) and IC (Interstitial Cystitis) which are both inflammatory conditions. I may even have Lupus but all the autoimmune antibody tests are negative. Sometimes this can happen. B12 can be elevated in Lupus and RA (which I don't have). I'm taking L-Glutathione (an antioxident) and Milk Thistle which are good for the liver.

Pulisa, thank-you, you are the first person I've come across who has raised B12 levels (and even higher than mine). Mine go up and down somewhat but never fall into the 'normal' range. I'm glad you are healthy and I believe I am too despite having some autoimmune blips.

I have to admit that my B12 levels were 900+..I thought it was because I love Marmite/vegemite! Folate levels are above the normal range too but neither are considered significant here in the UK and that's good enough for me. I have Raynauds but I doubt whether this is a factor.

Glad to hear that you have been reassured. You certainly take good care of yourself! x

[WiseMonkey]

I have to admit that my B12 levels were 900+..I thought it was because I love Marmite/vegemite! Folate levels are above the normal range too but neither are considered significant here in the UK and that's good enough for me. I have Raynauds but I doubt whether this is a factor.

Glad to hear that you have been reassured. You certainly take good care of yourself! x

Pulisa, Raynauds is an autoimmune condition so this could be the reason your B12 is/was elevated x