High Alanine Aminotransferase (ALT) Causes & Health Effects

Alanine aminotransferase (ALT) is commonly tested as a marker of liver health. High levels often point to liver damage or disease. Read on to find out what can cause your levels to increase.

What Does it Mean When Your ALT is High?

Alanine aminotransferase or ALT (also known as SGPT) is an enzyme your body needs to break down food into energy [1, 2].

Healthy liver cells store most of your ALT, but small amounts are also found in the muscles and blood. When liver cells are damaged due to illness, injury, or medication, they release ALT, increasing its blood levels [3].

Therefore, ALT blood levels are a marker of liver health: low levels typically indicate a healthy liver, while high levels suggest liver damage [4].

However, a result that’s higher than normal, doesn’t necessarily mean that you have a health condition that needs treatment. If your blood tests reveal you have elevated ALT levels, speak with your doctor about what the results might mean. Your doctor might recommend further testing to determine what the underlying cause of the elevated ALT is.

What is Considered a High Level?

The normal range is around 7-35 U/L in women and 7-40 U/L in men. There may be some lab-to-lab variability in ranges due to differences in equipment, techniques, and chemicals used.

Causes of High ALT Levels

Causes listed below are commonly associated with high ALT. Work with your doctor or other health care professional for an accurate diagnosis. Your doctor will interpret your ALT result, taking into account your medical history, signs and symptoms, and other test results.

1) Liver Disease

ALT levels increase in response to liver diseases, such as [5]:

• Fatty liver or non-alcoholic fatty liver disease (NAFLD). Fatty liver affects approximately 35% of the US population and often occurs alongside diabetes and obesity [6].
• Viral hepatitis. Usually results in extremely high ALT levels [7, 8, 9, 10].
• Autoimmune hepatitis [11, 12]
• Liver cancer

However, not all people with liver disease will have high ALT (e.g. fatty liver, autoimmune hepatitis), nor can ALT levels be used to predict disease severity [13, 14, 15].

Liver diseases increase ALT levels. However, ALT levels are not proportional to liver damage. In addition, some people maintain normal ALT levels despite liver damage.

2) Alcoholism

Excessive alcohol consumption is the most common cause of liver disease in the Western Hemisphere [16].

In multiple studies from around the world (1.1 million Korean participants, 46k English men, 24k Americans, 6k Koreans, and 125 Italians), ALT levels increased with daily alcohol consumption [17, 18, 19, 20, 21, 22].

Alcohol breakdown takes a significant toll on liver health by causing free radical damage and increasing levels of inflammatory markers (TNF-α). Long term, excessive alcohol consumption leads to liver cell death, which releases ALT from the liver into the bloodstream [23, 24, 16].

Limited drinking may not increase ALT levels in normal-weight individuals due to its ability to improve insulin sensitivity, which seems to reduce ALT, according to trials on almost 14k people [25, 26].

Heavy drinking worsens liver health and increases ALT as a result.

3) Liver Damage due to Drugs, Supplements, and Toxins

There are many drugs that can increase ALT by causing liver damage, but this usually only happens in a small percentage of the people taking the drug.

But while the percentage is small, it adds up when we look at it on the population level. In fact, over-the-counter and prescription drugs are among the most common causes of elevated ALT. The same applies to natural products and supplements.

That’s why it’s important to tell your doctor about all of the drugs and/or supplements you are taking.

Drugs and supplements that can increase ALT include:

• Non-steroidal anti-inflammatory drugs (e.g. ibuprofen) [27, 28]
• Cholesterol-lowering drugs (e.g., statins) [29]
• Acetaminophen (Tylenol, Panadol) overdose [27, 30]
• Antibiotics [27]
• Opioids [30]
• Chemotherapy drugs [31]
• Vitamin A (retinoids) [32, 33]
• Kava [34]
• Cocaine (intoxication) [35]
• Methamphetamines [36]

ALT can also increase when there is liver damage due to toxins such as lead, mercury, or pesticides [27, 37, 38].

Many drugs and supplements can increase ALT by causing liver damage, but this usually only happens in a small percentage of users. Toxins that cause liver damage also increase ALT levels.

4) Anorexia

ALT is often abnormal in anorexia, occurring in almost half of all people with the disorder. Weight loss and fasting can cause mild elevations in ALT (2-3x normal), while further elevations (4-30x normal) can happen in more severe cases with starvation [39].

5) Obesity

ALT is often elevated in people who are obese [40, 41, 42].

Stomach fat is more dangerous than general obesity and often accompanies conditions such as diabetes and liver disease. Waist circumference and stomach fat more accurately predicted elevated ALT than the measurement of body mass index (BMI), as seen in multiple studies of over 17,000 adults, adolescents, and children [43, 44, 45, 46, 47, 48, 49, 50].

Both anorexia and obesity can increase ALT levels.

6) Gallstones and Biliary Disease

ALT can increase due to gallstones and gallstone induced inflammation of the pancreas (pancreatitis) [51, 52].

In a study of 424 patients with inflamed gallbladders (cholecystitis), those without gallstones had moderately raised ALT levels (82. 5 U/L), and those with gallstones had noticeably raised ALT levels (95 U/L) [53].

Gallstones also cause pancreatitis by blocking the bile duct and forcing the bile back into the pancreas [54].

The ALT levels of patients with pancreas inflammation due to gallstones was 200 U/L on average, in a study of 543 people [55].

Gallstones can increase ALT levels, especially in people who also have pancreatic inflammation.

7) Muscle Damage

Since small amounts of ALT are stored in muscle cells, muscle injury and disease can also cause ALT to leak into the blood and raise its levels [56, 57, 58].

In a study with 16 patients with various muscle injuries, extreme exercise and seizures increased ALT levels [59].

In another study, almost 88% of 232 patients with muscular dystrophy, an inherited disease where muscles weaken and waste away, had high levels of ALT [57].

Muscle damage due to surgery or burn injury also increases ALT [60, 61].

Muscle-wasting diseases, muscle injuries, damage due to surgery, burns, or intense exercise can all increase ALT levels.

8) Heart Attack or Heart Failure

ALT levels can increase after a heart attack or heart failure, due to a shortage in the supply of oxygen to the liver [62, 28].

9) Hypothyroidism

Underactive thyroid gland (hypothyroidism) is often associated with being overweight, fatty liver, and higher ALT levels [28].

10) Other Infections and Diseases that Affect Liver Function

ALT can also increase in health conditions that are not typically associated with the liver but can affect liver function, such as:

• Mononucleosis [63]
• Dengue fever [64, 65]
• HIV [66, 67]
• Celiac disease – liver injury due to untreated celiac disease is called celiac hepatitis and is usually successfully treated with a gluten-free diet [68]
• Hemochromatosis, a genetic disorder that causes iron to build up in cells [69]

11) Abnormal Destruction of Red Blood Cells

Abnormal destruction of red blood cells (hemolysis) can falsely increase ALT levels [70, 71, 72].

Other causes of elevated ALT include heart attack or heart failure, hypothyroidism, and hemolysis (abnormal destruction of red blood cells).

Health Effects of High ALT Levels

There are several large population studies that have found a link between higher ALT levels and health conditions such as diabetes, heart disease, or and other metabolic issues. However, there is no proof that any of these associations are causal. It is much more likely that they are all results of underlying issues such as obesity and chronic inflammation.

1) Diabetes

In a meta-analysis of 17 studies involving over 60k participants, higher ALT levels were associated with a higher risk of type 2 diabetes. However, the association was modest, and scientists think it may not be clinically relevant (i.e. may be due to publication bias) [73].

In a 5-year study with 724 participants, elevated ALT levels slightly improved the prediction of future development of diabetes, in addition to other factors, such as BMI, fasting blood sugar, and family history [74].

2) Metabolic Syndrome

Metabolic syndrome describes a number of interconnected symptoms that increase the risk of heart disease and diabetes. These include high blood pressure, high cholesterol, high blood sugar, high triglycerides, and insulin resistance [75].

In a meta-analysis of 5 studies with over 29k participants, the risk of developing metabolic syndrome increased by 14% for every additional 5 U/L of ALT in the blood [76].

In another study with over 28k people, those with the highest ALT levels were more likely to suffer from metabolic syndrome than those with the lowest levels [77].

Higher ALT levels may be associated with a higher risk of developing type 2 diabetes and metabolic syndrome.

3) Heart Disease

According to a meta-analysis of 29 studies with 1.23 million participants, ALT levels were not associated with heart disease [78].

In another meta-analysis of over 1 million participants, lower ALT levels were associated with a higher risk of heart disease [79].

4) Stroke

In a meta-analysis of 29 studies with 1.23 million participants, higher ALT levels were associated with a moderately increased likelihood of stroke [78].

In a study with 280k Asian participants, men with elevated levels of ALT were more likely to suffer a stroke than men with low ALT, though this association was less prominent in women [80].

Elevated ALT is likely not associated with heart disease, but appears to be associated with a modestly increased likelihood of stroke.

5) Mortality

In a meta-analysis of 19 studies with 9.24 million participants, Asian participants in the top third for ALT levels were 43% more likely to die from any cause than those in the bottom third. This association was not seen in North American participants [81].

Takeaway

ALT is most commonly increased in response to liver disease or liver damage, caused by alcohol, drugs, supplements, or toxins. Other causes of high ALT include obesity, anorexia, biliary disease, muscle damage and disease, heart attack, hypothyroidism, and infections and diseases that can impair liver function.

Higher ALT levels have been linked with adverse health effects such as diabetes, heart disease, stroke, and metabolic syndrome. However, these associations are likely a result of common underlying issues such as obesity and/or chronic inflammation.

Want to Learn More?

This post is part of a series about ALT. Find out how to naturally lower your levels in the next part.

Learn more about the functions of ALT and why doctors order the test here. If your ALT levels are abnormally low, read this post.

ALT Characters Table | NO BS Marketplace

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Alt characters, or special characters, are symbols like ¿ © « ¤ ™ which can be created using Alt codes on computers that run Microsoft Windows operating systems.  

These codes are generally typed onto a keypad along with the Alt key to create the special characters. Keyboards have limited space, so Alt codes enable the creation of characters and symbols that don’t already have designated keys.

When performing a technical SEO audit, you may wonder if special characters have an effect on your rankings. 

Generally, special characters in meta tags do not have an effect on SEO. So, if a word or phrase needs its tilde, umlaut, or another accent to be understood, then keep the special character in place.

If you’re looking for a specific symbol and its code, follow the guide below. 

Character	ALT Code*	Character	ALT Code*	Character	ALT Code*	Character	ALT Code*	Character	ALT Code*
[backspace]	Alt 8	E	Alt 69	q	Alt 113	ó	Alt 162	®	Alt 0174
[tab]	Alt 9	F	Alt 70	r	Alt 114	ú	Alt 163	¯	Alt 0175
[line break]	Alt 10	G	Alt 71	s	Alt 115	ñ	Alt 164	²	Alt 0178
¤	Alt 15	H	Alt 72	t	Alt 116	Ñ	Alt 165	³	Alt 0179
¶	Alt 20	I	Alt 73	u	Alt 117	ª	Alt 166	´	Alt 0180
§	Alt 21	J	Alt 74	v	Alt 118	º	Alt 167	¸	Alt 0184
[paste]	Alt 22	K	Alt 75	w	Alt 119	¿	Alt 168	¹	Alt 0185
[space]	Alt 32	L	Alt 76	x	Alt 120	¬	Alt 170	¾	Alt 0190
!	Alt 33	M	Alt 77	y	Alt 121	½	Alt 171	À	Alt 0192
“	Alt 34	N	Alt 78	z	Alt 122	¼	Alt 172	Á	Alt 0193
#	Alt 35	O	Alt 79	{	Alt 123	¡	Alt 173	Â	Alt 0194
$	Alt 36	P	Alt 80	|	Alt 124	«	Alt 174	Ã	Alt 0195
%	Alt 37	Q	Alt 81	}	Alt 125	»	Alt 175	Ä	Alt 0196
&	Alt 38	R	Alt 82	~	Alt 126	¦	Alt 179	Å	Alt 0197
‘	Alt 39	S	Alt 83		Alt 127	ß	Alt 225	È	Alt 0200
(	Alt 40	T	Alt 84	Ç	Alt 128	µ	Alt 230	É	Alt 0201
)	Alt 41	U	Alt 85	ü	Alt 129	±	Alt 241	Ê	Alt 0202
*	Alt 42	V	Alt 86	é	Alt 130	°	Alt 248	Ë	Alt 0203
+	Alt 43	W	Alt 87	â	Alt 131	•	Alt 249	Ì	Alt 0204
,	Alt 44	X	Alt 88	ä	Alt 132	·	Alt 250	Í	Alt 0205
–	Alt 45	Y	Alt 89	à	Alt 133	€	Alt 0128	Î	Alt 0206
.	Alt 94	è	Alt 138	ˆ	Alt 0136	Ô	Alt 0212
3	Alt 51	_	Alt 95	ï	Alt 139	‰	Alt 0137	Õ	Alt 0213
4	Alt 52	`	Alt 96	î	Alt 140	Š	Alt 0138	Ö	Alt 0214
5	Alt 53	a	Alt 97	ì	Alt 141	‹	Alt 0139	×	Alt 0215
6	Alt 54	b	Alt 98	æ	Alt 145	Œ	Alt 0140	Ø	Alt 0216
7	Alt 55	c	Alt 99	Æ	Alt 146	‘	Alt 0145	Ù	Alt 0217
8	Alt 56	d	Alt 100	ô	Alt 147	’	Alt 0146	Ú	Alt 0218
9	Alt 57	e	Alt 101	ö	Alt 148	“	Alt 0147	Û	Alt 0219
:	Alt 58	f	Alt 102	ò	Alt 149	”	Alt 0148	Ü	Alt 0220
;	Alt 59	g	Alt 103	û	Alt 150	–	Alt 0150	Ý	Alt 0221
<	Alt 60	h	Alt 104	ù	Alt 151	—	Alt 0151	Þ	Alt 0222
=	Alt 61	i	Alt 105	ÿ	Alt 152	˜	Alt 0152	ã	Alt 0227
>	Alt 62	j	Alt 106	¢	Alt 155	™	Alt 0153	ð	Alt 0240
?	Alt 63	k	Alt 107	£	Alt 156	š	Alt 0154	õ	Alt 0245
@	Alt 64	l	Alt 108	¥	Alt 157	›	Alt 0155	÷	Alt 0247
A	Alt 65	m	Alt 109	P	Alt 158	œ	Alt 0156	ø	Alt 0248
B	Alt 66	n	Alt 110	ƒ	Alt 159	Ÿ	Alt 0159	ü	Alt 0252
C	Alt 67	o	Alt 111	á	Alt 160	¨	Alt 0168	ý	Alt 0253
D	Alt 68	p	Alt 112	í	Alt 161	þ	Alt 0254	©	Alt 0169

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Norilsk Nickel is looking for an alternative to the EU – Kommersant

MMC Norilsk Nickel hopes to redirect supplies of metal to Asia, which some European clients refused in 2023. In 2022, the impact of geopolitics on the geographic structure of Norilsk Nickel’s sales was weak, with the exception of palladium – its purchases by the EU countries were sharply reduced, increasing imports from South Africa. This year the company will be forced to increase sales of nickel and copper to Asia, for which it has prepared a new logistics scheme. Analysts do not see this as a big problem, since it is in Asia that the main future demand for these metals is concentrated.

Photo: Mikhail Kichanov, Kommersant

Photo: Mikhail Kichanov, Kommersant

Some European clients of Norilsk Nickel refused to purchase its products in 2023, while others reduced volumes, company president Vladimir Potanin said on March 31. According to him, the company will sell all the volumes not redeemed by the Europeans in the market of Southeast Asia. This is the first time that Norilsk Nickel’s top management has acknowledged a significant reduction in demand in Europe.

Back in February, Sergey Malyshev, senior vice president of finance at the company, said that Norilsk Nickel managed to renew contracts for 2023 with “the majority of clients, including large ones.”

“We live in a strange world. Europeans and other consumers are very interested in our metal: it is high-quality, logistically accessible, but due to known circumstances, some companies decide not to buy our metal because of an emotional assessment of the current situation, – said Vladimir Potanin (quote from Interfax).- Some even refuse existing contracts to their own detriment, others refuse traditional volumes, replacing them with others that are obviously less profitable.” Mr. Potanin expressed confidence that the company “will have the strength to return” to the European market, when “the period of instability that has now come will be over. ”

Vladimir Potanin, President of Norilsk Nickel, March 31:

“We will fight to maintain our position in these markets (in the EU). Let’s not be capricious and behave like quarreling children in the sandbox. But everything that our traditional partners will not take, we will supply to the markets of Southeast Asia and other countries of the world.”

Since Norilsk Nickel sold metal contracted in the previous year in 2022, the influence of geopolitics on the geographical structure of sales remained moderate. At the end of 2022, the share of Europe in the company’s revenue decreased from 53% to 43%, and Asia increased from 27% to 31%. The most redistributed supplies of palladium, which is usually transported by aircraft: the ban on flights from Russia to the EU immediately and directly affected its logistics.

According to Eurostat, Russian palladium shipments to the EU fell by 25% in 2022 to 520,000 troy ounces, while purchases of this metal from South Africa increased by 38. 4%, to 350,000 troy ounces.

This metal is primarily used in the automotive industry for the production of autocatalysts. Palladium imports from South Africa hit a record since 2018 with 697,000 troy ounces shipped to Europe and rose despite South African mining being hit by power outages in 2022. Russia is increasing palladium supplies to China: according to Chinese customs statistics, they increased by 32.4%, to 245,000 troy ounces.

Norilsk Nickel’s supply chain for other metals is also changing.

Norilsk Nickel’s Logistics Director Ravil Nasybullov said on March 27 that a significant portion of the company’s copper exports had been diverted to the port of Tangier in Morocco, from where it was then shipped to Asia. Nickel still goes through the port of Rotterdam. Prior to the outbreak of hostilities in Ukraine, almost all of the company’s products were shipped from Murmansk to the European market.

The growth of Asia’s share in Norilsk Nickel’s revenue looks quite logical, says Boris Krasnozhenov from Alfa-Bank.