What Does It Mean When Your ALT Is High? > Personalabs

Getting elevated alanine aminotransferase (ALT) or serum glutamic-pyruvic transaminase (SGPT) in your liver function test can be distressing. But what high ALT means depends on factors such as the medications you’re taking, underlying liver disorders, chronic drinking, and consumption of herbal medicine. 

Understanding the roles of ALT and its sudden spike in the bloodstream will provide clues on your liver health. Read more about it in the next few lines. 

What Is an ALT Lab Test? 

An ALT blood test measures the alanine aminotransferase (ALT) enzyme level to detect liver damage caused by diseases like hepatitis or lifestyle factors such as habitual drinking. The enzyme is an ideal marker for health conditions concerning the liver as it is released to the bloodstream when the liver sustains injuries or undergoes dysfunction. 

However, ALT bloodwork does not produce conclusive results on its own. Therefore, it is usually taken as part of the hepatic function panel test and comprehensive metabolic panel, along with other blood tests for other liver enzymes.  

In some cases, you might take the ALT blood test first, followed by other labwork to confirm a suspected condition or the other way around. These tests include:

• AST (aspartate aminotransferase) test
• GGT (gamma-glutamyl transferase) test
• ALP (alkaline phosphatase) test
• ALB (albumin) test
• Total bilirubin blood test

ALT Blood Test: Preparation and Results Meaning 

Measuring ALT levels is done through blood work, wherein you will have to visit a laboratory for a phlebotomist to collect your blood sample. 

Although there is no special preparation before the blood collection for an ALT blood test, you may need to fast if you take it alongside other tests. For example, if it is part of a liver function panel where a bilirubin lab test is involved, you will need to abstain from food and drinks for about 8 hours before the test. 

What Does It Mean When Your ALT Is High?

Your ALT level is considered high if it exceeds the normal range of 0 to 44 IU/L. Some laboratories may present a slightly different reference interval, but a test result of 55 IU/L or above could indicate liver problems. If the value exceeds the upper limit of the normal range, it could suggest liver disease or cirrhosis (tissue scarring).  

However, other factors could contribute to the increase of ALT in your blood – not just liver disorders. Here are common causes of high ALT:

Infections

Patients diagnosed with hepatitis, whether A, B, or C, typically have elevated ALT liver enzymes. Hence, if you got a test value exceeding the normal range of ALT and are showing hepatitis symptoms, consult your doctor to secure the proper diagnostic lab tests.

Aside from hepatitis, studies have also shown that those with infectious mononucleosis have elevated liver enzymes, including ALT. So your doctor may proceed to check for swelling in your tonsils and liver on top of common infection symptoms. 

Did you know? Hepatitis can be prevalent among older kids. That’s why it’s vital to detect hepatitis in children at the onset of the symptoms. This allows for better treatment and speedy recovery.  

Medications

Various drugs can cause high ALT levels, such as anti-seizure medications (phenytoin, valproic acid, carbamazepine, etc.), antidepressants, antipsychotics, cholesterol-lowering drugs, heparin therapy, acetaminophen, and many others. So if you’re taking these medications, make sure to let your doctor know. 

Herbal Supplement

Herbal teas and supplements can also elevate your ALT. These include kava, chaparral, ephedra, skull cap, comfrey tea, and Yohimbe. While traditional medicine may suggest that these supplements benefit your health, consult with your healthcare provider before taking them regularly.  

Alcohol and Toxins

Alcohol has been known to cause fatty liver tissues and induce inflammation. As a result, binge drinking elevates liver enzymes like ALT and causes gradual hepatic damage. Other substances like cocaine and poisonous liquid also increase ALT, as they generate high levels of hepatic toxicity.   

Diseases

Medical conditions associated with high ALT include hemochromatosis (iron overload), fatty liver disease, cirrhosis, thyroid disease, diabetes, Celiac disease, cancer, hemolysis, etc. Heart disease has also been associated with elevated ALT. 

If you have a family history of liver disease, there’s a higher chance of getting elevated ALT in your bloodwork, especially with an unhealthy lifestyle. So opt for a CMP 14 blood test to be included in your annual wellness checkup to detect liver problems early. 

What Should I Do if My ALT Is High? 

Seeing an elevated ALT in your test results can be alarming, especially if it’s far off the upper limit and if the other parameters also go beyond the normal range. But you can lower this liver enzyme (along with the others) through the following ways:

1. Get Tested for the Cause of Increased ALT

Finding the root cause of your elevated ALT, whether it’s a disorder or a medication, is imperative for the right course of action in normalizing it. In addition, be mindful of symptoms you may have been experiencing, especially those related to liver problems. These could include abdominal pain and swelling, appetite loss, fatigue, dark urine, pale stool, vomiting, itchy and easily bruised skin, and jaundice (yellow eyes and skin). 

Your doctor will assess your symptoms and request appropriate liver function tests. Once the condition is diagnosed, you will be given proper treatment. You will most likely take another ALT test, among others, to see if you already have low ALT levels within the normal range. 

2. Limit Cholesterol and Avoid High-Carb Foods

Changing your diet typically tops the lifestyle changes that improve your liver health. In the case of high ALT, shifting to a low carbohydrate diet has a beneficial impact on normalizing the liver enzyme’s production. 

In a 2015 study, high carbohydrate intake of fructose-rich food and beverages significantly increased ALT. On the other hand, a low-carb diet decreases the enzyme twice as a low-fat diet.  

While carbohydrates seem to trigger the spike in liver enzymes, fat, specifically bad cholesterol, doesn’t do any favor. High cholesterol overloads liver function, increases ALT, and even promotes the risk of liver cancer. That said, it’s best to avoid fatty foods such as whole-milk dairy, red meat, and those smothered in oil. 

Think you have high cholesterol? You will know for certain when you take the comprehensive lipid profile blood test. Doing so allows you to have a base record of your lipid levels, helping you assess your risk for heart and liver disease. 

3. Drink a Cup of Coffee a Day

Coffee comes with plenty of health benefits. However, it can be subjective depending on your physical and mental state. But in the case of liver function, studies have shown that drinking coffee aids in preventing high serum ALT.

Moreover, a 2015 study says that drinking coffee reduces your risk for liver cancer and chronic liver disease, bordering cirrhosis. So secure one cup of coffee daily, especially in lieu of alcohol. If you have anxiety disorders, consult your doctor first, as too much coffee can aggravate the condition. 

4. Be More Physically Active

Exercise promotes liver health and allows you to lose weight. By being physically active for about 30 minutes daily, you improve your metabolism, which involves the oxidation of fatty acids. This helps ease liver function and, by extension, prevents injuries that lead to increased liver enzymes in the blood. 

Consistent physical activity is particularly helpful for those with fatty liver. In a 2018 review, evidence shows that regular exercise aid liver functions in people with nonalcoholic fatty liver disease (NAFLD), from damage reduction to improved insulin resistance. 

5. Avoid Alcohol and Smoking

It’s no secret that alcohol can cause severe liver damage if consumed habitually. Heavy drinkers are prone to alcoholic liver disease and alcoholic hepatitis. On top of that, alcohol is also the most significant risk factor for liver cirrhosis. 

Smoking is another habit you should shake off if you plan to lower your serum ALT. According to an article published in the Journal of Hepatology, cigarette smoking aggravates liver problems and contributes to the impediment of hepatic treatment. This remains true with secondhand smoke. 

If you’re having trouble leaving these unhealthy habits behind, seek help from professionals and support from your social circle. 

6. Rethink Taking Supplements, Drugs, or Herbal Medicines

As herbal teas and vitamin supplements (iron and vitamin A) can cause liver toxicity, make sure to avoid them if you have elevated liver enzymes. Likewise, consult your doctor regarding taking prescribed medications and be sure not to take them beyond the recommended dosage. For example, acetaminophen (a drug for fever and pain) can induce acute liver damage if taken in large amounts. 

Other Frequently Asked Questions 

Which is worse: high AST or ALT?

Liver enzymes AST and ALT are often compared to better understand liver health. Getting high lab values for both AST and ALT indicates the severity of the liver problem. Generally, if AST is significantly elevated than an already high ALT, it could suggest cirrhosis, which can lead to liver failure. 

How quickly can ALT levels drop?

On average, ALT decreases significantly after treatment and lifestyle changes in about four weeks. This depends on how consistent you are with the necessary adjustments. For example, if you have given up alcohol, your ALT could start to drop in a week and continue to do so with continuous abstinence. 

Can ALT levels go down on their own?

Unless you change your diet, start exercising, and eliminate unhealthy habits like heavy drinking and smoking, serum ALT levels will not decrease. Additionally, if the elevation of the liver enzyme is due to a severe liver disorder, failing to address and avail of proper treatment will only contribute to high ALT remaining unchanged. 

Bottom Line 

When your ALT levels are elevated, it’s certainly high time to check your liver. Doing so allows you to seek proper treatment and employ the necessary lifestyle adjustments, such as changing your diet, getting tested for a particular disorder, and being physically active. If symptoms of liver damage are observed, consult your doctor immediately. 

Aspartate Aminotransferase (AST) Test (aka SGOT): High vs. Low Levels

Written by WebMD Editorial Contributors

• Why Would I Need This Test?
• How Do I Prepare?
• What Happens During the Test?
• What Are the Risks?
• What Do the Results Mean?
• Will I Take Other Tests?
• More

The aspartate aminotransferase (AST) test is a blood test that checks for liver damage. Your doctor might order this test to find out if you have liver disease and to monitor your treatment.

Your liver is an organ that has many important jobs.

It makes a fluid called bile that helps your body digest food. It also removes waste products and other toxins from your blood. It produces proteins, as well as substances that help your blood clot. Alcohol or drug use and diseases such as hepatitis can damage your liver and keep it from doing these jobs.

AST is an enzyme your liver makes. Other organs, like your heart, kidneys, brain, and muscles, also make smaller amounts. AST is also called SGOT (serum glutamic-oxaloacetic transaminase).

Normally, AST levels in your blood are low. When your liver is damaged, it puts more AST into your blood, and your levels rise.

A high AST level is a sign of liver damage, but it can also mean you have damage to another organ that makes it, like your heart or kidneys. That’s why doctors often do the AST test together with tests of other liver enzymes.

Your doctor can order an AST test if you have symptoms of liver damage, such as:

• Yellow skin or eyes, called jaundice
• Tiredness
• Weakness
• Swollen belly
• Stomach pain
• Appetite loss
• Itchy skin
• Dark-colored urine
• Light-colored poop
• Swelling in your legs and ankles
• Bruises

Other reasons to have this test:

• You’ve been exposed to the hepatitis virus.
• You drink a lot of alcohol.
• You take medicine that’s known to damage the liver.
• You have a family history of liver disease.
• You have obesity.
• You have diabetes or metabolic syndrome.
• You’ve had nonalcoholic fatty liver disease.

Your doctor might also want you to get this test to see if treatments you take for liver disease are working.

The AST test is also part of a comprehensive metabolic panel — a blood test your doctor does as part of a routine exam.

You don’t need any special preparation for the ALT test.

Tell your doctor what drugs or supplements you take. Some medicines can affect the results of this test.

A nurse or lab tech will take a sample of your blood — usually from a vein in your arm. They will first tie a band around the upper part of your arm to make your vein fill with blood and swell up. Then they will clean an area on your arm with an antiseptic and put a needle in one of your veins. Your blood will go into a vial or tube.

The blood test should only take a couple of minutes. After your blood is drawn, the lab tech will take off the band and pull out the needle. They’ll put a piece of gauze and a bandage where the needle went in to stop the bleeding.

The AST blood test is safe. Risks are usually minor, and can include:

• Bleeding
• Bruising
• Infection
• Pain when the needle is inserted
• Fainting or feeling dizzy

You should have the results in about a day. They are given in units per liter (units/L). Normal ranges are:

• Males: 10 to 40 units/L
• Females: 9 to 32 units/L

Your exact range may depend on which lab your doctor uses. Talk with them about the specifics of your case.

Higher-than-normal AST levels can be caused by:

• Chronic (ongoing) hepatitis
• Cirrhosis (long-term damage and scarring of the liver)
• Blockage in the bile ducts that carry digestive fluid from the liver to the gallbladder and intestine
• Liver cancer

Very high AST levels can be caused by:

• Acute viral hepatitis
• Damage to the liver from drugs or other toxic substances
• A blockage in blood flow to the liver

Your doctor might also compare your AST and ALT levels. If you have liver disease, usually your ALT level will be higher than your AST level.

These other conditions not tied to your liver can also raise your AST level:

• Burns
• Heart attack
• Intense exercise
• Muscle injury
• Pregnancy
• Pancreatitis
• Seizures
• Surgery

Some diseases or medicines you take can cause a “false positive” result on the AST test. This means your test is positive, even though you don’t have liver damage. Any of these can cause a false positive result:

• Diabetic ketoacidosis (Your body can’t make enough insulin, which helps sugar enter your cells.)
• Some antibiotics, such as erythromycin estolate or para-aminosalicylic acid (Paser)

AST is usually done as part of a group of liver function tests called a liver panel. It’s often ordered with a test for alanine aminotransferase (ALT), another liver enzyme.

ALT is more accurate than AST at detecting liver disease. It can more accurately show whether the problem is in your liver or in another part of your body, like your heart or muscles.

Your doctor can compare the amount of ALT to AST in your blood to find out whether you have liver damage or a problem with another organ, such as your heart.

Your doctor might also do other tests of enzymes and proteins your liver makes, such as:

• Alkaline phosphatase (ALP)
• Bilirubin
• Total protein

Talk with your doctor to make sure you understand all of your liver test results. Also find out how these results might affect your treatment.

Top Picks

When the liver goes wrong: a gastroenterologist named 4 common reasons why ALT and AST are elevated in the blood

• Health

However, the growth of these main “liver” markers in the blood test does not always indicate problems.

April 25, 2022

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A biochemical blood test is considered one of the main ways to find out if the liver copes with the load of “wrong” nutrition, alcohol, and medication. This will be told by such indicators in the analysis as ALT (alanine aminotransferase) and AST (aspartate aminotransferase) – these liver enzymes are among the first to respond to malfunctions of the organ.

– If there is an increase in both ALT and AST, this means that the liver cells are destroyed and the enzymes from them enter the blood. (…) An increase in AST and ALT means that an inflammatory process is taking place in the liver and its cells are being destroyed. If the indicators are above the norm, you need to contact a gastroenterologist, – gastroenterologist Maria Lopatina wrote in her telegram channel, adding that the upper limits of the norm may differ in different laboratories and one must focus on those established where the analysis was taken.

The doctor named the 4 most common causes of increased liver values.

Chronic viral hepatitis

With an increase in ALT and AST in the blood, viral hepatitis B and C are always excluded first. This is very important, as they can be asymptomatic, while destroying the liver. Mandatory tests: HBsAg – hepatitis B and Anti-HCV – hepatitis C.

Non-alcoholic fatty liver disease

When fatty liver cells destroy them, ALT and AST in the blood rise and steatohepatitis develops.

Fatty liver disease is suspected if:

• Waist circumference ≥94/≥80 cm in men/women;

• Blood pressure 130/85 mmHg And more, or the person is taking antihypertensive drugs;

• Fasting glucose level of 5.6 mmol/l or more, or the person is taking hypoglycemic drugs;

• Serum triglycerides more than 1.7 mmol/l;

• High-density lipoprotein (HDL) level less than 1.0/1.3 mmol/l in men/women.

Drug-induced liver injury

All drugs that we take by mouth pass through the liver. The more drugs we take, the more likely it is to be damaged. This group includes both herbal preparations and dietary supplements. Liver damage can occur immediately or after several weeks.

Alcohol

According to Russian clinical guidelines, a safe dose for the liver in women is 20 grams of ethanol per day, for men – 40 grams. Regular excess of this dose leads to the development of alcoholic hepatitis and an increase in ALT and AST.

Determining the ethanol content in 100 ml of a drink is very simple: the percentage of alcohol in the drink must be multiplied by 0.8. Thus, 100 ml of 40% vodka contains 40×0.8=32 grams of ethanol, and 100 ml of 12% wine contains 12×0.8=9.6 grams of ethanol.

The doctor specifies that there are other reasons for the increase in ALT and AST in the blood, but these four are the most common.

Read also

When an increase in the indicator is not a cause for alarm

It happens that an increase in the level of “liver” indicators may not be associated with a problem in the work of our main “filter”. According to gastroenterologist Maria Lopatina, this may be the case if only the AST index is elevated.

– AST is found not only in the liver, but also in the heart, muscles, kidneys, brain and pancreas. If AST levels are elevated and ALT is normal, causes that are not related to damage to liver cells should be ruled out. For example, active training for all muscle groups, the doctor clarifies.

But if the liver values ​​are below normal in the blood test, in most cases this is not a cause for serious concern. According to the gastroenterologist, a decrease in their level can occur during pregnancy, starvation and a reduced content of vitamin B6.

What other indicators of a blood test can be used to understand that something is wrong with the liver, read HERE.

Signs of liver problems that can be seen in the mirror

According to doctors, the liver does not hurt in the usual sense of the word, especially at first – specific symptoms of the disease appear when things have gone too far. As the head of the MIBS outpatient department, gastroenterologist Iyri Alaya said, liver diseases are often accompanied by various digestive disorders:

• Increased flatulence;

• Feeling of fullness in the stomach;

• Rapid satiety after eating;

• Loss of appetite;

• Dryness and bitterness in the mouth;

• Attacks of nausea and vomiting;

• Constipation or diarrhoea.

And the most famous sign of liver problems is yellowness of the skin, mucous membranes and sclera, which indicates an increase in the level of bilirubin (bile pigment) in the blood.

Text author: Anastasia Romanova

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Increased ALT and AST in liver diseases

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3. ALT and AST Elevated in Liver Disease – Liver Disease Examination

Alanine Aminotransferase (ALT)

The study of the activity of ALT and AST in the blood serum is extremely important for the diagnosis of liver diseases. The rise in their activity is directly proportional to the degree of necrosis of the liver tissue.

The activity of ALT in the blood serum in the first place and most significantly changes in liver diseases. An increase in ALT activity by 1.5-5 times compared with the upper limit of the norm is considered as moderate hyperenzymemia, 6-10 times as moderate hyperenzymemia, and more than 10 times as high. The degree of rise in ALT activity indicates the severity of necrosis of the liver cells, but does not directly indicate the depth of violations of the actual functions of the liver.

In acute hepatitis, regardless of its etiology, ALT activity increases in all patients. At the same time, the ALT level rises 10-15 days before the onset of jaundice in viral hepatitis A, and for many weeks in viral hepatitis B. In a typical course of acute viral hepatitis, ALT activity reaches a maximum at the 2-3rd week of the disease. With its favorable course, the ALT level normalizes in 30-40 days. Usually, in acute viral hepatitis, the level of ALT activity ranges from 500 to 3000 IU/L.

A repeated and progressive increase in ALT activity indicates a new necrosis of liver cells or a relapse of the disease. Prolongation of the period of elevated ALT activity is often an unfavorable sign, as it may indicate the transition of acute hepatitis to chronic.

In acute alcoholic hepatitis, AST activity is higher than ALT, but the activity of both enzymes does not exceed 500-600 IU/L.

Chronic hepatitis is characterized by moderate and moderate hyperenzymemia. In latent forms of liver cirrhosis, an increase in ALT activity may not be observed.

In patients with toxic hepatitis, infectious mononucleosis, intrahepatic cholestasis, cirrhosis, liver metastases, AST activity is higher than ALT.

An increase in ALT activity can also be detected in carriers of hepatitis B surface antigen that do not have clinical manifestations, which indicates the presence of apparently asymptomatic active processes in the liver.

Aspartate aminotransferase (AST)

AST also rises in acute hepatitis and other severe lesions of hepatocytes. A moderate increase is observed in obstructive jaundice, in patients with liver metastases and cirrhosis.