Amylase and Lipase high

Hi All,

My Amylase and Lipase are consistently showing up as higher than their range in my blood tests. They were first highlighted on a check up and repeating those two a month ago, they were still at same level. Does any of the rapamycin takers in the forum has this problem. It might not be related but other than taking rapamycin, I can’t think of anything. I don’t have any major medical problem and my other blood markers are good except a little bit high cholestrol.

I have been taking rapa every week for 6mg for around 18 months and I had couple of month breaks. 46y old male.

Amylase 121 U/L (range 28 - 100)
Lipase 73 U/L (range 13 - 60)

Regards,
Kemal

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I’m not going to give you medical advice - but I can tell you in general my approach to such issues.

First, these are minor lab abnormalities, and by definition, normals for these tests are established as 95% of the population being between these ranges. As a secondary issue - save your money and just check Lipase for pancreatic inflammation, amylase adds nothing and is of historical interest, back when lipase wasn’t widely available (lipase is specific to the pancreas, amylase is from pancreas/parotids/other salivary glands/ovary).

The only mechanism I’d see for Rapamycin relating to this is if one were to have elevated triglycerides due to Rapamycin - which can happen - but unless the triglycerides are >500, rare to see any change in pancreas enzymes.

I’d usually just look at a fasting insulin level, hba1c, c-peptide for the endocrine aspect of the pancreas to make sure those are normal, and if no signs of pancreatic insufficiency from the exocrine function (digestive enzymes) - I’d usually not head into checking that in most cases.

If a patient is thin - an ultrasound to make sure the pancreas is normal, if overweight, then will usually need a CT.

Generally - unless something else is present on the history or exam - if all those things are normal, I’d not usually be chasing things further.

I’d also make sure no evidence of fatty liver with excessive visceral fat, no significant toxins/supplements that could inflame the pancreas - including ethanol. Some people will head into whether there is a heavy metal or organic pollutant exposure.

Overall, minor abnormalities in isolated labs rarely yield a specific diagnosis and are generally simply followed over time. However, it would be important to see a physician who is boarded in family med or internal med to make sure there isn’t something underlying these minor abnormalities - but above would be my general approach to this issue.

Hopefully that helps.

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Hi Dr Fraser,

Many thanks for your detailed answer, much appreciated indeed for you well thought answer. I am listing some more info below just to see if this relates to rapamaycin at the end but I am definitely not expecting any diagnosis, though you answer was very helpful.

I’ve got my new results today and amylase is now measured at 205 U/L which is even ~70% higher than initial test that was done back in September last year. I am getting concerned to be honest. I was referred to a gastroenterology team to look into my results.

I stopped using rapamycin and to be honest I had around a month break since the initial test anyway.

I’ve come across this article: Evidence for Rapamycin Toxicity in Pancreatic β-Cells and a Review of the Underlying Molecular Mechanisms | Diabetes | American Diabetes Association

I would appreciate if you can let me know your thoughts about it.

Btw I am overweight; 178cm, 88kg. My liver markers are good but I was told that I had first stage NAFLD. It could be due to weight I gained and lost past few years and bad diet. My hba1c is normal. My lipids and cholesterol are just over the upper limit so no concern there either.

I live in UK and these things take a very long time so I might just see someone at private and perhaps get a CT scan as well.

I was focused on pancreas but apparently saliva glands also does this enzyme.

Hi Kemal,
Again - will not give you specific advice, but happy to give you my general approach to such issues. First, just go with Lipase.
I’d not have rapamycin anywhere near the top of my list of things to pursue. Not impossible, but really not in the doses we take. People can have idiopathic reactions to anything - but would be way down my list.
In regard to assessing insulin sensitivity, HbA1C is only abnormal once “the wheels have fallen off” your metabolism. Fasting insulin and a C-peptide will let you know if you are getting insulin resistant and really need to worry. Fasting sugars of >90 mg/dL (you can convert to SI units) are concerning for pre-diabetes - but the Insulin being up and C-peptide being up are the best approach.
Take a listen to some of the podcasts on Visceral Fat, as you will have fatty infiltration of your pancreas as part of this. This can cause abnormal enzymes, but usually in the setting of at least some pancreas dysfunction.
There are plenty of worries with Cholesterol being “just over the upper limit” - I’d encourage you to read my blog on this topic on my website.
The one thing you don’t want to be ignoring in this situation is the possibility of a growth in the pancreas or some other structural issue being the cause. A CT scan would be a common approach to looking at this. In the U.S. there is an easy ability to essentially self order almost everything - albeit sometimes with a physician simply assisting the ordering at low cost. You’ll have to sort out if your GP will order this or if they think another route is more appropriate. I defer to them, in your case. I’m well familiar with socialized medicine and there are parts that are great, and I am licensed in AU and have my FACRRM and FRACGP (and Generalist Emergency Medicine) there.

Hi Dr Fraser,

Many thanks for your answers, and appreciate the detail & guidance. I will hopefully get to the bottom of this and will update the forum so everyone can benefit.

Regards,
Kemal

I had elevated Lipase in 2017. It was 60. Then a month later it was rechecked - 42. Amylase was 73. Did not check since. Will recheck in couple months. At that time I was on Rapamycin for 7 years.

Hi Lara,

That would be great, and help a lot considering you have been using rapa such a long time. Many thanks.

Regards,
Kemal

Kemal, an Ultrasound scan for abdomen may be helpful to start with and could be easier to obtain than a CT scan. It will show your liver as well as pancreas. It was very helpful in my situation.

Re Rapamycin: you said you stopped it. Most likely your lipase reading is not connected to Rapamycin. There could be a cyst or a lesion on your pancreas or liver (US test will show), and Rapamycin would usually slow its progression in case you have it. Instead of stopping it, you could just minimize the dose to 1-2 mg per week. It may help you to lose some weight. I was also taking Bromelain enzyme for healthy digestion.

Many thanks Lara for the advice.

I’ve had an abdomen ultrasound as part of the full check up where this was highlighted back in last September. But maybe they missed it but I guess there was not anything major seen. I’ve chased my GP today actually, and they will hopefully be back to me in another week or so. I feel perfectly fine though so I don’t feel alarmed at the moment but would be good to understand why these are showing up high for the third time in a row.

I think I will go private and have a CT or MRI scan if things go slow with the GP which is the case in the UK. Just to have peace of mind.

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