What are the common causes of elevated AST and ALT levels. How should primary care doctors approach asymptomatic patients with high liver enzymes. What diagnostic tests are recommended for evaluating abnormal liver function results.

Understanding AST and ALT: Key Liver Enzymes

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are important enzymes primarily found in liver cells. When liver cells are damaged, these enzymes leak into the bloodstream, causing elevated levels in blood tests. While both are indicators of liver health, ALT is considered more specific to liver damage than AST.

ALT is located mainly in the liver and kidneys, with smaller amounts in the heart and skeletal muscles. The normal range for ALT is typically 14-63 IU/L, though this can vary slightly between laboratories. AST, on the other hand, is found in various tissues including the liver, heart, skeletal muscles, kidneys, and brain.

Key Facts About ALT:

• Half-life in circulation: 47 ± 10 hours
• Concentration in liver: 3000 times higher than in serum
• Best discriminant value for acute hepatic injury: 300 U/L
• Daily fluctuation: 10-30% in healthy individuals
• Diurnal variation: Up to 45%, with highest levels in the afternoon and lowest at night

Common Causes of Elevated AST and ALT

Elevated liver enzymes can result from various conditions affecting the liver. Understanding the potential causes is crucial for proper diagnosis and management.

Viral Hepatitis

Viral hepatitis is a common cause of significantly elevated liver enzymes. In acute viral hepatitis:

• ALT typically increases 10-40 times the upper limit of normal (ULN)
• AST:ALT ratio is usually less than 1
• ALT increases before and peaks near the onset of jaundice
• ALT levels decrease slowly, averaging 10% per day
• Elevated ALT persists for an average of 27 ± 16 days

In chronic hepatitis C, ALT levels may fluctuate between normal and abnormal. Interestingly, 15-50% of patients with chronic hepatitis C have persistently normal ALT levels.

Alcoholic Liver Disease

Alcoholic liver disease presents a distinct pattern of liver enzyme elevation:

• ALT is typically 2-8 times the ULN
• AST:ALT ratio is often greater than 2
• ALT values rarely exceed 10 times the ULN in uncomplicated alcoholic hepatitis

Toxic and Ischemic Liver Injury

Toxic hepatitis and hepatic ischemia can cause extreme elevations in liver enzymes:

• ALT levels often exceed 40 times the ULN
• AST:ALT ratio is typically greater than 1 in the early stages
• 90% of cases with ALT > 3000 U/L are due to toxic or ischemic injury
• Both AST and ALT peak within the first 24 hours of admission and then fall rapidly

Other Causes

Several other conditions can cause mild to moderate elevations in liver enzymes:

• Cirrhosis
• Non-alcoholic steatohepatitis (NASH)
• Cholestatic liver disease
• Fatty liver
• Hepatic neoplasms
• Hemochromatosis
• Wilson’s disease
• Autoimmune hepatitis
• Primary biliary cirrhosis
• Sclerosing cholangitis
• Alpha-1 antitrypsin deficiency

In these conditions, ALT levels are typically less than 120 IU/L. Patients with cirrhosis rarely have ALT levels higher than twice the normal range, and some may even have normal values if there’s no ongoing liver injury.

Medications and Liver Enzyme Elevation

Certain medications can cause elevations in liver enzymes. The most common culprits include:

• Sulfonamides
• Statins
• Isoniazid

When evaluating a patient with elevated liver enzymes, it’s crucial to conduct a thorough medication review, including over-the-counter drugs and supplements.

Interpreting AST:ALT Ratio

The ratio of AST to ALT can provide valuable diagnostic insights:

• Most liver diseases: ALT elevation > AST elevation (due to ALT’s longer half-life)
• AST:ALT ratio > 2 suggests:
  • Alcoholic hepatitis
  • Cirrhosis
  • Wilson’s disease
  • Very early liver damage

It’s important to note that both AST and ALT require vitamin B6 (pyridoxal-5′-phosphate, P5P) as a catalytic cofactor. Pyridoxal-5′-phosphate deficiency is common in alcoholic liver disease and renal failure, which can affect enzyme measurements.

Diagnostic Approach for Asymptomatic Patients with Elevated Liver Enzymes

When a primary care physician encounters an asymptomatic patient with elevated AST and ALT levels, a systematic approach is crucial for proper diagnosis and management.

Initial Evaluation

1. Confirm the elevation: Repeat the liver function tests to rule out laboratory error or transient elevation.
2. Detailed history:
   • Alcohol consumption
   • Medication use (prescription and over-the-counter)
   • Herbal supplements
   • Risk factors for viral hepatitis
   • Family history of liver disease
3. Physical examination: Look for signs of chronic liver disease or systemic conditions that might affect the liver.

Further Diagnostic Tests

Based on the initial evaluation, the following tests may be recommended:

• Complete blood count
• Hepatitis B surface antigen
• Hepatitis C antibody
• Iron studies (serum iron, total iron-binding capacity, ferritin)
• Ceruloplasmin (to rule out Wilson’s disease in younger patients)
• Antinuclear antibodies and smooth muscle antibodies (for autoimmune hepatitis)
• Abdominal ultrasound (to assess liver structure and rule out biliary obstruction)

In cases of persistent elevation without a clear cause, consider referral to a hepatologist for further evaluation, which may include a liver biopsy.

Management Strategies for Elevated Liver Enzymes

The management of elevated liver enzymes depends on the underlying cause. Here are some general strategies:

1. Address modifiable risk factors:
   • Advise alcohol cessation if applicable
   • Encourage weight loss in overweight or obese patients
   • Optimize control of diabetes and other metabolic conditions
2. Discontinue or modify medications that may be causing liver enzyme elevation
3. Treat underlying conditions (e.g., antiviral therapy for viral hepatitis)
4. Monitor liver enzymes periodically to track progress
5. Consider hepatitis A and B vaccination if not previously immunized

For mild, asymptomatic elevations without a clear cause, close monitoring may be appropriate. However, persistent or worsening elevations warrant further investigation and possible referral to a specialist.

Special Considerations in Liver Enzyme Interpretation

When interpreting liver enzyme results, several factors should be taken into account:

Body Mass Index (BMI)

A high BMI can increase ALT levels by 40-50%. This is particularly relevant in the context of non-alcoholic fatty liver disease (NAFLD), which is closely associated with obesity and metabolic syndrome.

Age and Gender

ALT levels can vary with age and gender. In healthy children, plasma ALT activity is typically lower than AST until 15 to 20 years of age. After this, ALT tends to be higher than AST until around age 60, when the activities become roughly equal.

Diurnal Variation

ALT levels can fluctuate up to 45% during a single day, with highest levels occurring in the afternoon and lowest levels at night. This variation should be considered when interpreting results and planning follow-up tests.

Laboratory Variability

Different laboratories may use different methods and reference ranges for liver enzyme tests. The International Federation of Clinical Chemistry (IFCC) has recommended standardizing aminotransferase assays by adding excess pyridoxal-5′-phosphate to enzyme reagents. However, less than 50% of ALT assays currently incorporate this recommendation.

Prognosis and Follow-up

The prognosis for patients with elevated liver enzymes varies greatly depending on the underlying cause. It’s important to note that:

• Peak ALT levels do not necessarily correlate with prognosis
• In fulminant hepatic necrosis, decreasing ALT may indicate a lack of viable hepatocytes rather than recovery
• Regular follow-up and monitoring are essential, especially in cases of chronic liver disease

Primary care physicians play a crucial role in the early detection and management of liver diseases. By understanding the nuances of liver enzyme interpretation and following a systematic approach to diagnosis and management, they can significantly improve outcomes for patients with liver-related issues.

In conclusion, elevated AST and ALT levels in asymptomatic patients require careful evaluation and a tailored approach to management. While many cases may be benign or easily treatable, some may indicate serious underlying liver conditions that require prompt intervention. Continuous medical education and adherence to up-to-date guidelines are essential for primary care physicians to provide optimal care in these cases.

Alanine Aminotransferase or ALT is increased in liver disease

Alanine Aminotransferase (ALT)

Alanine aminotransferase is an enzyme involved in the transfer of an amino group from the amino acid, alanine, to alpha-ketoglutaric acid to produce glutamate and pyruvate. ALT is located primarily in liver and kidney, with lesser amounts in heart and skeletal muscle. Increased ALT activity is more specific for liver damage than increased aspartate aminotransferase (AST) activity. ALT is seldom increased in patients with heart or muscle disease in the absence of liver involvement. In healthy children, plasma ALT activity is lower than AST until 15 to 20 years of age. Thereafter, plasma ALT activity tends to be higher than AST activity until age 60, when the activities become roughly equal. The half-life of ALT in the circulation is 47 +/- 10 hours.

ALT activity in the liver is 3000 fold higher than in serum. Measurement of serum ALT activity is a good indicator of hepatocyte injury.

X ULN = times upper limit of normal, Protime prolongation is number of seconds above ULN

• The best ALT discriminant value for recognizing acute hepatic injury is 300 U/L.
• ALT increases before & peak near onset of jaundice in viral hepatitis. Activity falls slowly, an avery of 10% per day. ALT remains elevated 27 +/- 16 days.
• ALT levels fluctuate between normal and abnormal in hepatitis C. 15 to 50% of patients with chronic hepatitis C have persistently normal ALT.
• In uncomplicated alcoholic hepatitis, ALT values are almost never >10 times the upper reference limit.
• Extremely elevated ALT levels are common in toxic hepatitis and hepatic ischemia secondary to circulatory collapse and heatstroke. 90% of cases with ALT >3000 U/L are due to toxic or ischemic injury. AST is usually higher than ALT and both enzymes peak in the first 24 hours after admission. After peaking, both levels fall rapidly; AST faster than ALT.
• Peak ALT levels bear no relationship to prognosis and may fall with worsening of the patients condition. In fulminant hepatic necrosis, decreasing ALT may signify a paucity of viable hepatocytes rather than recovery.

Patients with cirrhosis, non-alcoholic steatohepatitis, cholestatic liver disease, fatty liver and hepatic neoplasm typically have slightly raised serum ALT levels (<120 IU/L). Patients with cirrhosis seldom have ALT levels higher than two times normal. Cirrhotic patients without ongoing liver injury the values may have normal values.

Other causes of elevated ALT include hemochromatosis, Wilson disease, autoimmune hepatitis, primary biliary cirrhosis, sclerosing cholangitis and alpha-1 antitrypsin deficiency. The medications most commonly associated with elevated ALT are sulfonamides, statins and isoniazid.

The ratio of AST to ALT in plasma may help in the diagnosis of some liver diseases. Most liver diseases are associated with greater elevation of ALT than AST because of the longer circulating half-life of ALT. Exceptions include alcoholic hepatitis, cirrhosis, Wilson disease and very early liver damage. In these disorders the AST to ALT ratio is generally greater than 2.

Both AST and ALT require vitamin B6 (pyridoxal-5′-phosphate, P5P) as a catalytic cofactor. Pyridoxal-5’-phosphate deficiency is common in alcoholic liver disease and renal failure.  In an attempt to standardize aminotransferase assays, the International Federation of Clinical Chemistry (IFCC) recommended that laboratories add excess P5P to their enzyme reagents so that these assay accurately measure enzyme activity independently of vitamin B6 status. Unfortunately, less than 50% of ALT assays incorporate exogenous 5P5.

In healthy individuals, ALT levels can vary 10 to 30% from one day to the next.  ALT levels can fluctuate 45% during a single day, with highest levels occurring in the afternoon and lowest levels at night.  A high body mass index can increase ALT levels by 40 to 50%. 

Reference range is 14 – 63 IU/L.

Specimen requirement is one SST tube of blood.  ALT is stable at room temperature for 3 days and refrigerated for 3 weeks.  Hemolysis causes moderate increases in ALT levels.  

Abnormal liver enzymes | Christian Healthcare Ministries

Health & Wellness

By Dr. Jacobson, D.O.

A member wrote:

I’ve been doctoring a sharp, knife-like pain and burning in my sternum area for five months. My blood work shows high liver enzymes: AST [aspartate transaminase] of 561 and ALT [alanine transaminase] of 469. I’ve never consumed alcohol, smoked or taken drugs of any sort. In the last few days, my stools have been soft and a yellowish-orange color. All other tests—CT [computed tomography], MRI [magnetic resonance imaging], MRCP [magnetic resonance cholangiopancreatography], and ultrasound of my abdomen—showed nothing. Additional blood work results were good. Can you help me please?

Dr. Jacobson’s response: I summarize the history you’ve provided as follows: mid-chest pain; recent stool changes, soft and light in color; elevated liver (hepatic) enzymes with AST slightly higher than ALT; additional normal lab work; and no unusual radiology reports.

The first concern would be to address the chest pain and to rule out the most serious and immediate threats to your health. The pain’s duration—five months—and the sharp, stabbing character as a practical matter rule out a cardiac (heart) cause. It may, or may not, be related to the bowel and liver problems you describe. Most likely, it’s coming from the rib cage and sternum area; it’s called atypical chest pain, though it’s the most common type.

The changes in stool are characteristic of someone who has a biliary system issue. Bile—which assists in the breakdown of fats—is dark green and gives the stool its brown color. Manufactured in the liver, bile is normally stored in the gallbladder. Released in response to a meal containing long-chain fats, bile moves in a duct that travels through the pancreas into the small intestines. Blockage of the bile ducts anywhere in this system can result in light-colored stools similar to your description.

Abnormal liver enzyme levels may also provide a clue as to the cause. ALT, AST and alkaline phosphatase are three of the most commonly-tested enzymes, but there are others, including bilirubin levels. The latter two are typically elevated when something outside the liver is blocking the bile system. However, if all other lab tests are normal, it’s most advantageous to look at the AST and ALT values.

You report that AST and ALT are only mildly elevated, and AST is slightly higher than ALT. In this scenario, causes that should be considered include:

• acetaminophen (generic for Tylenol) or other drug toxicity,
• autoimmune hepatitis, especially in females 30-50 years old
• non-alcoholic fatty liver disease, especially in presence of obesity, diabetes, elevated cholesterol and hypertension
• iron overload (genetic hemochromatosis)
• viral hepatitis—usually higher levels of ALT and AST in the acute stage
• ischemia (lack of blood supply to the liver)
• cirrhosis of the liver—usually from chronic alcoholism
• rhabdomyolysis (a by-product of massive muscle breakdown)
• hemolysis (breakdown of blood cells)
• Budd-Chiari syndrome (The liver veins can become blocked, preventing drainage. This syndrome can vary from extremely severe to no symptoms at all.)
• Wilson’s disease (A rare inherited disorder in which copper accumulates in the liver, brain and other organs. It may be accompanied by a brown ring, or copper deposits, along the edge of the cornea and may require a liver biopsy to diagnose).
• Other conditions outside the liver such as thyroid disease or celiac

The list of possible causes for elevated liver enzymes is long, and it can be difficult to ascertain the cause. The likely diagnosis usually becomes more apparent after standard lab tests and imaging such as you described.

As your diagnosis is still elusive, however, I would make sure that your physician(s) has taken a thorough look into possible auto-immune disorders and has considered performing a liver biopsy. The best route might be to take all of your records to a university-based hepatologist—a gastroenterologist who has sub-specialized in the study of disorders of the liver, pancreas, gallbladder and biliary tree.

References

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – . Record No. T316452, Abnormal Liver Function Tests – Approach to the Patient; [updated 2018 Dec 02, cited West Chester, OH, May 21, 2020]. Available here. Registration and login required.

Vagvala, S.H. and O’Connor, S.D. (2018), Imaging of abnormal liver function tests. Clinical Liver Disease, 11: 128-134. doi:10.1002/cld.704

What is astral projection? Facts and theories

Astral projection is the supposed act of going out of the body during sleep, but is it real?

Tags:

supernatural

Mysticism and psychics

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What is astral projection? This phenomenon was shown in the 2016 blockbuster “Doctor Strange” and the sequel “Doctor Strange in the Multiverse of Madness”, where the superhero has the ability to separate the physical body from the spiritual one and participate in battles. But still, astral projection is not just another trick invented by filmmakers, but a spiritual practice with a long history.

Surveys show that between 8 and 20 percent of people say they have experienced something like an out-of-body experience at some point in their lives—the feeling that the consciousness, spirit, or “astral body” is leaving the physical body. While most experiences occur during sleep or under hypnosis, some claim they can experience it simply by relaxing.

Background

The idea that people can leave their body during sleep is ancient. Countless people, from New Ageers to shamans around the world, believe that it is possible to communicate with the cosmic mind through visions and vivid dreams experienced during astral projection, also known as out-of-body experiences.

The idea of ​​astral projection comes from a 19th century mystical system called Theosophy, which states that we have seven bodies, from the lowest physical to the highest spiritual and mental bodies.

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The Theosophical Society was founded in New York in 1875 by Helena Blavatsky, who claimed to have traveled the world, studied with Tibetan gurus, contacted the dead, and learned to reach higher planes from Hindus and Buddhists.

Theosophy teaches that there are seven human bodies, the third of which is the astral. The astral body can leave the physical and etheric bodies and travel through the astral planes. Theosophy had a profound influence on artists and scientists in the 19th and early 20th centuries.

Although originally a private, quasi-religious meditation practice, like many New Age beliefs, it has become commercialized. Astral travel can become big business, and there are many books, seminars, and other materials that promise to teach people to leave their physical body and access other dimensions. But does astral projection work?

Is astral projection real?

If astral projection is real, why couldn’t science prove it?

Astral travel practitioners insist that the experience must be real because it seems so vivid and some of the experiences are similar even for people from different cultures. But it is not surprising that many people who try to experience an astral projection experience similar experiences, as they are told in advance what to expect from an astral projection.

This may be a profound experience, but the fundamental problem is that there is really no way to scientifically measure whether a person’s spirit “leaves” or “enters” the body. The simplest and best explanation for out-of-body experiences is that the person is simply fantasizing and daydreaming. Since there is no scientific evidence that consciousness can exist outside the brain, scientists reject astral projection.

Why hasn’t astral projection been scientifically proven?

Some argue that leading scientists are limited in their view of the world and refuse to even look at evidence that does not fit their narrow world view. However, in science, those who refute the prevailing theories are rewarded, not punished. Evidence of the existence of psychic powers, astral projection, or alternate dimensions would earn dissenting scientists a place in the history books, if not a Nobel Prize.

The scientific verification of astral travel should be fairly simple. For example, you can hide ten unknown objects in different places, and then ask the person to project their consciousness into each place and describe exactly what is there. Either the descriptions match or they don’t.

According to researcher Susan Blackmore, author of Out of the Body: A Study in Out-of-Body Experiences, people who claimed to have had astral experiences scored higher on measures of hypnotizability and, in several surveys, on absorption rates, a measure of a person’s ability to turn on something full attention and immerse yourself in it. People who have an out-of-body experience are more imaginative, suggestible, and fantasizing than others, although they have low levels of drug and alcohol use and no overt signs of psychopathology or mental illness.

There are other possible causes of OBEs and astral projections. In 2017, a study published by The Atlantic analyzed about 210 patients with vestibular disorders. The vestibular system in the inner ear is responsible for providing the body with a sense of balance, and problems associated with this system can lead to feelings of dizziness and disorientation. In a survey of patients, it was found that about 14% reported out-of-body experiences compared to 5% of those surveyed without any form of vestibular problems.

Although practitioners of astral projection insist that their experiences are real, all their evidence is anecdotal—in the same way, a person who takes psychostimulant substances may be sincerely convinced that he interacted with God, dead people, or angels while in changed state. Astral projection is a fun and harmless pastime that can feel profound and, in some cases, even life-changing. But there is no evidence that out-of-body experiences occur outside the body and not inside the brain.

Read Astral Exit Online (Full and Free) by Osborne Phillips

This book will teach you how to exit your body – simply, freely and safely. In this guide to astral travel, you will find a clear, step-by-step description of both simple and complex methods of working with the astral. You will learn how you can live, create, study and simply relax in the astral plane, make new friends and meet elementals – inhabitants of the astral world.

Contents:

• Preface 1

• 1 – What is the astral? 1

• 2 – Cosmos and soul 2

• 3 – Physical and astral training 4

  • Place setting 4

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• 4 – Awareness and manifestation of the astral body 5

• 5 – Fact and fiction 6

• 6 – Astral substance: strength and lightness 8

• 7 – Open communication channels 9

• 8 – Entrance to the astral light 10

• 9 – Astral travelers, astral inhabitants 12

900 65

10 – Friends and helpers 13

• 11 – Exploring space 15

• 12 – Time and space 16

• 13 – Love and sex in the astral plane 18

• 14 – Healing in the astral plane 20

• 15 – Your astral potential 22

• 16 – Projection help 24

• 17 – Astral and animals 25

• 9000 2 18 – Light that brings protection 26

Osborne Phillips

EXIT TO THE ASTRAL

Foreword

Whoever you are, wherever you are, a wonderful life awaits you, or rather, many wonderful lives. And you don’t have to die to live them. This is part of the miracle. The opportunity to live with a sense of wonder awaits you now, at this very moment – and it is in no hurry. She is with you always.

Get out there and act!

Perhaps you spend most of your days at your desk, and your infrequent dreams are full of anticipation of a vacation and counting the money that the desired freedom will cost.

Perhaps you are a housewife who is in a secret struggle to keep the widest horizons of the imagination open for both you and your partner – until the children are older.

Or your work just involves endless trips, and you really want to finally find time to take a good look at some of the places that flashed past you and realize those fleeting impressions that somehow managed to hook you. Or maybe you’re an astronomer who doesn’t have enough of a far-off view of the affairs of cosmic glory. Maybe you are confined to a hospital bed or a wheelchair, or you are serving a prison sentence. Or maybe you are just a dreamer who wants his dreams, with all their fantastic events and incredible outcomes, to be something more than just dreams.

You are tired of wanting and waiting for freedom.

Whoever you are, let’s go free!

Another kind of freedom?

Perhaps this is another kind of freedom that you are looking for. You may have already read a number of books on religion, philosophy, psychology or the occult sciences – on any of these subjects or on all at once – and you want to be able to see what lies deeper and beyond conflicting points of view, get your own experience of interaction with the invisible, come to your own conclusions on this matter.

Is there life after death? You may have asked yourself this question as well.

What about reincarnation – does it exist, and if so, according to what rules does it exist?

What is “I”? Who am I? How did I get like this? Who and what can I become?

What help do I need? How can I provide it for myself? What help do others need? How to provide it?

And how can I solve all these problems while continuing to live the way I live now?

You can get answers to all these questions and new knowledge in the form that your life experience allows. You will understand what you learn, because all this will be in your native language – in terms and concepts that are natural to you.

This book: what is it for?

It is not the intention of this book to teach the reader any particular religious or philosophical system, although if you have knowledge of any of the systems, you can gain insight through the book regarding the fundamental truths of your system. This book is intended to initiate you into the great art of the psyche, astral projection. This art is naturally yours by birthright, since you were born as a human being.

This is as natural as the desire to live. Like sleep and dreams. As natural as the impulse of self-expression in dance, music, acting, any kind of creativity that involves the creation of an image.

This is as natural as the belief that we must somehow be able to fly without special apparatus – like we fly in dreams, when free flight gives us a feeling of deep happiness and inner fullness of life.

Your options

Discover how much you get from astral projection. It shows the reality of such things that seem transcendent for a person in terms of sensation, knowledge and understanding. It reveals the mysteries of the past and the future. It will elevate you to unimaginable heights of sexual ecstasy due to the extreme fullness of sensations at the appropriate moments. It will give you the strength and the way to know the wonders of the visible world and look into your own soul. You will discover a great potential for action, you will be able to help other people overcome seeming limitations. Astral projection will open the future for you. You will be able to experience the infinite levels and dimensions of the astral world, learn the various ways of organizing life and see territories arranged differently than our planet, potentially endless, providing an inexhaustible source of information and experience.

1

What is the astral?

Range of the astral world • Etheric vision • Your astral senses • Astral frontiers • Soul and body: built-in fuses • Astral substance: one and only • Astral whole

The astral world or plane represents a very wide spectrum of reality. In its highest manifestations, it brings us closer to supersensory perception, the highest forms of spirituality and releases the energy of thought. At its lower levels, it is so close to the physical universe that it is not easy to point out the dividing line unambiguously. It includes our astral bodies, our souls – components of the individual psyche.

Ether vision in ordinary consciousness

The lower levels of the astral world are sometimes called “ether”. Very many people can, without leaving their physical bodies at all, use “etheric vision” – the ability and power to see colors, shapes and living beings, albeit of a lower, but still astral level. With practice, you will almost certainly develop the power of this vision. This is a matter of skill. It has nothing to do with sharpness or other aspects of your physical vision. And it has nothing to do with human virtues. Sometimes people who claim to be able to see non-material beings and non-material phenomena are treated as if they were saints or extraordinarily spiritually gifted. In fact, the only virtue required to realize etheric vision is mindfulness and open-mindedness.

Definitely, the level of someone’s involvement in the astral (the ability to feel it and be aware of these sensations) is determined by the state of inner readiness. But this state can also be developed, and our possibilities increase in proportion to the knowledge of what we are striving for.

Feelings and sensations in the astral consciousness

When you are outside the limitations imposed by the body, you continue to hear, see and feel everything that surrounds you. Each manifestation of being is real and tangible at its native level. What you feel, responding to reality, is transformed by you into your usual representation – into visual images, sounds, smells, tactile sensations. If you travel astrally on the level of the material world, you will see it as it is at that very moment – if you so desire; although you will most likely want to perceive the past of the world and its possible future – that is, something that is difficult to get from ordinary, earthly travels.