Unexplained Elevated Liver Enzymes

Male, age 28

Hey there

I've been dealing with this protracted mystery about my health for almost 6 months now, have seen 5 doctors on it, and everyone is stumped as to what is causing my elevated liver enzymes. Hoping for some helpful insight here if possible. Here's my timeline:

March 15 - Got a standard blood panel done during my yearly checkup. No symptoms. AST: 178, ALT: 229. Immediately retests for Lead exposure and Hep A, B, and C. All are negative. All other elements of my blood test are completely normal. Doctor thinks it's caused by alcohol (I was having 2-3 drinks per day at the time). Says to abstain from drinking 8 weeks and get retested.

May 10 - After 8 weeks no drinks, I retest. AST: 40 ALT: 73. Still outside normal range but much better. Doctor says to stop drinking for 6 more weeks and retest.

June 19 - 6 more weeks no drinks, AST and ALT levels actually RISE to 51 and 95, respectively. At this point my doctor becomes extremely hard to contact and I don't know what to do next. I go on vacation the next day and decide to have 1 drink per day. Eventually the doctor requests an abdominal ultrasound to check for other causes. I have 1 drink per day for the next 3 weeks and stop again around July 12th.

July 3 - Ultrasound doesn't find anything out of the ordinary except a 3mm polyp/stone on my gallbladder. Write-up: "There is a 3 mm echogenic focus in the gallbladder that does not appear to move. It could represent an adherent stone or a small echogenic polyp. Wall thickness is normal at 2 mm. The size of the spleen is at the upper limits of normal."

July 8ish: My Dr Falls to give me a response or advice for my Ultrasound. I read that my anxiety medication, Lexapro can be hepatotoxic, so I wean myself off of it.

July 28: After still no response from my doctor, I decide to switch doctors. My new doctor is much more responsive and orders another hepatic panel. AST goes up to 71 and ALT goes up to 135. She refers me to a specialist. Throughout this time, I've been taking CBD gummies and sodas for anxiety. I read that they can affect liver enzymes, so I cut out CBD here.

July 31: I move out of my sketchy, cheaply built old condo complex (including this on the off chance there was something environmental at work)

August 10: GI specialist orders tests for Celiac IGA, Alpha 1 Anitrypsin Phenotype, Ceruloplasmin, Ferritin Serum/Plasma, Iron Binding Panel, Smooth muscle antibody, anti-mitochondrial antibody, and another hepatic function panel. AST 56 ALT 117. All other tests are normal except Ceruloplasmin, which shows 18.7 mg/dL, just outside of the normal low range of 20. She orders a 24 hour urine test to check for copper excretion/Wilson's disease.

August 21: 24 hour urine test comes back normal

August 28: Another hepatic function test. AST 41 ALT 89.

That's where things stand right now. The next plan is to abstain from alcohol another month and recheck then. I've weaned myself off of all medications and other substances that could be causes my enzymes to be elevated and included any environmental concerns of note here, as well.

All labs have been normal, the only other notable thing is that ALP (Alkaline Phosphatase) has been weirdly ticking town every time I've taken a hepatic function test in the last 6 months, and is now at 31 U/ L. The specialist says low ALP isn't really related to anything bad of note though that we haven't already tested for.

Please hit me with any thoughts or ideas of what you think could be causing these enzymes to still be elevated 6 months later. Seems unlikely alcohol would be the cause due to the rise in enzymes between May 10 and June 19 without any drinking for 14 weeks at that point. I work in wine and it's very important to be able to even just have a glass of wine with dinner again. Any help is greatly appreciated, thanks so much!

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