From the Guidelines
If you're experiencing elevated liver enzymes, I recommend temporarily discontinuing any potentially hepatotoxic substances, including Creatine, and consulting with your healthcare provider for proper evaluation, as elevated liver enzymes can be indicative of underlying liver damage or disease, and prompt investigation is necessary to determine the cause and prevent further liver injury. According to the American College of Radiology 1, hepatocellular predominant liver chemistry is seen when aminotransferases are elevated much higher than ALP, and an increase in ALT is directly linked to hepatocyte injury. The most common causes of fatty liver disease, which can lead to elevated liver enzymes, are nonalcoholic fatty liver disease (NAFLD) and alcohol-induced liver disease 1.
When evaluating elevated liver enzymes, it's essential to consider various potential causes, including medications, alcohol consumption, fatty liver disease, viral hepatitis, or other health conditions 1. Your doctor should perform blood tests to monitor your liver function and determine the underlying cause. The American Society of Clinical Oncology recommends monitoring patients for abnormal liver blood tests, including AST, ALT, and bilirubin, before each infusion and considering weekly monitoring if grade 1 LFT elevations occur 1.
In cases of elevated liver enzymes, it's crucial to identify the underlying cause to provide appropriate management and prevent further liver injury. If the cause is identified as NAFLD or alcohol-induced liver disease, lifestyle modifications, such as weight loss, exercise, and alcohol cessation, may be recommended 1. In some cases, liver biopsy may be necessary to determine the extent of liver damage and guide treatment decisions 1.
It's also important to note that individual responses to substances like Creatine can vary, and some people may experience adverse effects, including elevated liver enzymes 1. If you decide to resume Creatine after medical clearance, start with a lower dose and monitor for any symptoms like abdominal pain, fatigue, or yellowing of the skin or eyes, which could indicate liver issues. Regular follow-up with your healthcare provider is necessary to ensure that your liver function returns to normal and to prevent further liver injury.
From the Research
Elevated Liver Enzymes
- Elevated liver enzymes are a common scenario encountered by physicians in clinical practice, and evaluation of such a problem in patients presenting with no symptoms can be challenging 2
- Alterations of liver enzymes could be a normal physiological phenomenon in certain cases, but it may also reflect potential liver injury in others, necessitating its further assessment and management 2
Causes of Elevated Liver Enzymes
- The most common causes of enzyme alteration can be classified into three patterns: hepatocellular, cholestatic, and isolated hyperbilirubinemia 2
- Autoimmune hepatitis (AIH) is a severe liver disease that can cause elevated liver enzymes, and it arises in genetically predisposed individuals worldwide 3
Diagnosis and Management
- Diagnosis of AIH is made clinically applying diagnostic scores, and it responds favorably to steroids and pharmacologic immunosuppression 3
- A step-wise algorithm can be used to interpret abnormal elevation of liver enzymes in asymptomatic patients, and initial investigations should be suggested based on the pattern of enzyme alteration 2