What are AST and ALT enzymes. How do elevated levels affect liver health. What causes increased AST and ALT levels. How can you regulate these enzyme levels naturally. When should you consult a doctor for high liver enzymes.

The Significance of AST and ALT in Liver Function Tests

Liver function tests (LFTs) are crucial diagnostic tools used to assess the health of your liver. Among the various components of LFTs, two enzymes stand out as particularly important indicators: Aspartate Transaminase (AST) and Alanine Transaminase (ALT). These enzymes are primarily found in liver cells, but they can also be present in other tissues throughout the body.

When liver cells are damaged or inflamed, AST and ALT are released into the bloodstream, resulting in elevated levels that can be detected through blood tests. Understanding the implications of increased AST and ALT levels is essential for early detection and management of potential liver issues.

What exactly are AST and ALT?

AST (Aspartate Transaminase) and ALT (Alanine Transaminase) are enzymes that play crucial roles in amino acid metabolism. While both are found in liver cells, AST is also present in heart and muscle tissue, whereas ALT is more specific to the liver. When these enzymes are detected at higher-than-normal levels in the blood, it often indicates some form of liver cell damage or inflammation.

Common Causes of Elevated AST and ALT Levels

There are several reasons why AST and ALT levels might be elevated. Some of the most common causes include:

• Hepatitis B and C infections
• Non-alcoholic fatty liver disease (NAFLD)
• Alcoholic liver disease
• Medication side effects
• Autoimmune hepatitis
• Hemochromatosis (iron overload)
• Wilson’s disease (copper accumulation)
• Liver cancer

It’s important to note that temporary elevations in AST and ALT can occur due to strenuous exercise or minor liver stress, and these typically resolve on their own. However, persistent elevations warrant further investigation.

Interpreting AST/ALT Ratios: What Do They Mean?

The AST/ALT ratio can provide valuable insights into the nature of liver damage. Typically, a healthy AST/ALT ratio is less than 1, meaning ALT levels are higher than AST levels. However, this ratio can change depending on the underlying cause of liver damage.

When is the AST/ALT ratio considered abnormal?

An AST/ALT ratio greater than 1 can indicate more severe liver damage. In particular, an AST/ALT ratio exceeding 2 is often associated with alcoholic liver disease, with approximately 70% of patients showing this pattern. However, it’s crucial to interpret these ratios in conjunction with other clinical findings and not in isolation.

Non-Alcoholic Fatty Liver Disease: A Growing Concern

Non-alcoholic fatty liver disease (NAFLD) has become one of the most common chronic liver disorders in many countries, including Singapore. NAFLD occurs when excess fat accumulates in the liver cells of people who drink little to no alcohol.

What are the symptoms of NAFLD?

Interestingly, most patients with NAFLD do not experience noticeable symptoms, making it a silent threat to liver health. Some individuals may report upper abdominal discomfort or fatigue. In advanced stages, when NAFLD progresses to non-alcoholic steatohepatitis (NASH) or cirrhosis, more severe symptoms may emerge, such as:

• Jaundice (yellowing of the skin and eyes)
• Gastrointestinal bleeding
• Fluid retention in the abdomen (ascites)
• Confusion or impaired cognitive function

Given the potential for NAFLD to progress without obvious symptoms, regular liver function tests and medical check-ups are crucial for early detection and management.

When to Seek Medical Attention for Elevated Liver Enzymes

While minor, temporary elevations in AST and ALT levels may not always be cause for immediate concern, persistent or significant increases should prompt a visit to a healthcare professional. But when exactly should you consult a doctor?

Key indicators for seeking medical advice:

• AST or ALT levels more than twice the upper limit of normal
• Persistent elevation of liver enzymes over multiple tests
• Accompanying symptoms such as fatigue, abdominal pain, or jaundice
• Known risk factors for liver disease (e.g., heavy alcohol use, obesity, diabetes)

A gastroenterologist or hepatologist can perform a comprehensive evaluation, which may include additional blood tests, imaging studies (such as ultrasound or MRI), or even a liver biopsy in some cases. Early intervention can be crucial in preventing the progression of liver disease and improving outcomes.

Natural Ways to Regulate AST and ALT Levels

For individuals with mildly elevated liver enzymes or those looking to maintain liver health, several lifestyle modifications can help regulate AST and ALT levels naturally:

Exercise and physical activity

Regular exercise plays a vital role in improving liver health. Physical activity can enhance insulin sensitivity, reduce inflammation, and help manage weight – all factors that contribute to liver function. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with strength training exercises.

Dietary modifications

A liver-friendly diet can significantly impact AST and ALT levels. Consider the following dietary changes:

• Reduce sugar intake: Excessive sugar consumption can lead to fat accumulation in the liver
• Limit saturated and trans fats: These fats can contribute to inflammation and liver damage
• Increase fiber intake: Fiber helps remove toxins from the body and supports digestive health
• Consume foods rich in antioxidants: Berries, leafy greens, and nuts can help protect liver cells from damage
• Include folate-rich foods: Avocados, spinach, and legumes support liver function

Maintain a healthy weight

Obesity is a significant risk factor for non-alcoholic fatty liver disease. Losing excess weight through a combination of diet and exercise can help reduce liver fat and improve enzyme levels.

Limit alcohol consumption

For those who drink alcohol, moderation is key. The recommended limits are up to one drink per day for women and up to two drinks per day for men. However, individuals with existing liver conditions may need to avoid alcohol entirely.

The Role of Supplements in Supporting Liver Health

While a balanced diet should be the primary source of nutrients, certain supplements may offer additional support for liver health. However, it’s crucial to consult with a healthcare provider before starting any supplement regimen, as some may interact with medications or have unexpected effects.

Potential liver-supporting supplements:

• Milk thistle: Contains silymarin, which may have protective effects on the liver
• N-acetyl cysteine (NAC): An antioxidant that supports glutathione production in the liver
• Vitamin E: May help reduce inflammation in non-alcoholic fatty liver disease
• Omega-3 fatty acids: Can help reduce liver fat in people with non-alcoholic fatty liver disease

Remember that supplements should not be used as a substitute for a healthy lifestyle or medical treatment. Their effectiveness can vary, and more research is needed to fully understand their impact on liver health.

Advanced Diagnostic Techniques for Liver Health Assessment

While AST and ALT levels provide valuable information about liver health, they are just one piece of the puzzle. Modern medicine offers a range of advanced diagnostic techniques that can provide a more comprehensive picture of liver function and structure.

Imaging technologies

Non-invasive imaging techniques can reveal important information about liver size, texture, and potential abnormalities:

• Ultrasound: Uses sound waves to create images of the liver, helpful in detecting fatty liver disease and tumors
• Computed Tomography (CT): Provides detailed cross-sectional images of the liver, useful for identifying liver tumors and assessing liver damage
• Magnetic Resonance Imaging (MRI): Offers high-resolution images and can be particularly helpful in characterizing liver lesions
• Fibroscan: A specialized ultrasound that measures liver stiffness, useful for assessing fibrosis and cirrhosis

Liver biopsy

In some cases, a liver biopsy may be necessary to definitively diagnose liver conditions. This procedure involves removing a small sample of liver tissue for microscopic examination. While more invasive than blood tests or imaging studies, a liver biopsy can provide crucial information about the extent and nature of liver damage.

Genetic testing

For certain inherited liver diseases, such as hemochromatosis or Wilson’s disease, genetic testing can be invaluable. These tests can identify specific genetic mutations associated with these conditions, allowing for early intervention and management.

By combining these advanced diagnostic techniques with traditional liver function tests, healthcare providers can develop a comprehensive understanding of an individual’s liver health and tailor treatment plans accordingly.

What Does It Mean When They Are Elevated

While going for a series of routine blood tests can be overwhelming, it is still important to understand the test results and what they could mean for your health. Out of which, one such common blood test to undergo is the liver function test (LFT).

The purpose of a Liver Function Test is to examine the various liver enzymes levels in your body. Liver enzymes are produced by liver cells. When infected or inflamed, these injured liver enzymes will leak into the bloodstream – resulting in a condition otherwise known as elevated liver enzymes.

While liver enzyme levels may be temporarily elevated and do not pose much of a concern, it’s crucial to know that they may signal some underlying issues as well. Let’s take a look at the elevation of two enzymes, ALT and AST, and what you can do to regulate these enzyme levels.

What is the AST and ALT?

When there are high levels of ALT and AST, it signals that the liver is infected and inflamed, hence releasing both enzymes into the bloodstream at a rate higher than usual

Possible causes include hepatitis B and C, side effects from medication, non-alcoholic fatty liver disease (NAFLD) and alcohol.

As one of the most common chronic liver disorders in Singapore, NAFLD is a possible cause of an abnormal ALT and AST. Most patients with NAFLD do not have symptoms. In some patients, they may experience upper abdominal discomfort or tiredness. Look out for signs of severe liver condition such as jaundice and gastrointestinal bleeding if it has progressed to liver hardening.

If persistent increments in your AST and ALT levels are observed without any visible health issues, it’s best to consult a professional gastroenterologist for further evaluation. This can come in the form of screening for liver disease or an ultrasound of the liver, if necessary.

What is considered to be an abnormal AST/ALT ratio?

The AST/ALT ratio tells you the relative concentrations of the enzymes aspartate transaminase (AST) and alanine transaminase (ALT) in your blood.

A typical AST/ALT ratio would be less than 1. Sometimes, minor increments in AST/ALT ratio levels can be observed after vigorous exercise or suggest signs of skeletal muscle injury. But, an average of 70% of patients with alcoholic liver disease have an AST/ALT ratio of more than 2.

How do I regulate my AST and ALT levels?

But not to worry, lowering your AST and ALT levels can be achieved by changing lifestyle habits. For instance, cultivating a habit of regular exercise would improve insulin sensitivity and reduce liver inflammation.

Another way to keep your AST and ALT levels in check is to review your diet. Consider reducing your sugar intake and animal fat consumption. These foods can over-work your liver cells. Instead, consume foods rich in folate and the water-soluble B vitamin. Folate is key in helping your liver function at its best, so include foods such as avocado and spinach as part of your diet.

Conclusion

When it comes to protecting your liver, it’s crucial to keep your AST and ALT levels in check to be aware of potential infections or diseases you might have contracted. If your AST and ALT levels have been persistently high, consult a professional as soon as possible to steer clear of any dangerous developments.

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Alanine aminotransferase (ALT) – take a blood test, prices in Moscow at SM-Clinic

Method of determination IHLA

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Alanine aminotransferase (ALT) is one of the basic enzymes found in all cells and tissues of the body without exception. The maximum concentration is observed in the liver and kidneys, followed by the heart muscle and skeletal muscles. With lesions of these organs, an increase in ALT in the blood is observed, which makes it possible to diagnose a disease or damage, clarify its degree and monitor the process in dynamics. The analysis is carried out simultaneously with the determination of aspartate aminotransferase (AST), and the ratio of these indicators allows us to identify a possible cause of damage to the liver tissue.

In the SM-Clinic laboratory, you can take a biochemical blood test to determine the level of alanine aminotransferase (ALT) in the blood. After receiving the result, you can sign up for a consultation with a specialist who will prescribe additional diagnostics and help determine the treatment tactics.

Synonyms

Serum glutamate pyruvate transaminase, serum glutamate pyruvate transaminase, SGPT, ALaT, Alanine aminotransferase, Serum glutamic-pyruvic transaminase, SGPT, Alanine transaminase, AST/ALT ratio.

Indications for analysis

Blood biochemistry with an analysis of the ALT level is performed for a general assessment of the state of the liver as part of preventive examinations, as well as if the patient has symptoms that indicate damage to the organ:

• pain in the right hypochondrium or in the area of ​​the solar plexus;

• loss of appetite;

• bitterness in the mouth in the morning;

• occasional nausea and vomiting after eating;

• yellowish color of the skin and whites of the eyes;

• darkening of urine, lightening of stools;

• skin itching;

• weakness, fatigue.

The analysis is also relevant for an increased risk of liver disease:

• after hepatitis or with a possible, but unconfirmed infection4

• with alcohol abuse;

• with hereditary predisposition;

• when taking hepatotoxic drugs;

• with diabetes mellitus or metabolic syndrome.

With already identified diseases, the study of ALT levels is necessary to monitor the state of the liver in dynamics and monitor the effectiveness of treatment.

Study description

A study on the level of ALT is carried out using a UV kinetic test, venous blood is taken for analysis.

Preparation

Blood for analysis is given strictly on an empty stomach in the morning. The last meal should be no earlier than 8 hours before the visit to the laboratory. Half an hour before the procedure, you can not smoke and overstrain physically. Drinking alcohol and playing sports are prohibited at least a day before blood donation.

Interpretation of results

Units of study of the level of alanine aminotransferase in the blood – a unit per liter (U / l).

Reference values ​​

Normally, the amount of ALT in the blood is small. The maximum allowable level depends on the age and sex of the patient.

Analytical result

The most common causes of elevated ALT levels in the blood are:

• viral hepatitis in acute and chronic form;

• taking hepatotoxic drugs or poisoning with hepatotoxic substances;

• impaired blood supply to the liver, accompanied by oxygen deficiency;

• violation of the outflow of bile;

• cirrhosis of the liver;

• tumors and metastases in the body.

A relatively small deviation from the norm may be associated with intense physical activity the day before, as well as with the intake of certain drugs, including dietary supplements. If the patient is undergoing continuous therapy, he needs to warn the doctor about this, who will evaluate the results of the analysis.

Additional examinations in case of deviation from the norm

As a rule, ALT activity is measured simultaneously with the level of AST, which also increases with liver damage, but not so much. The ratio of the activity of these two indicators is an important marker of diseases of the hepatobiliary system. In addition to AST, to clarify the diagnosis, you will need to donate blood to:

• total alkaline phosphatase;

• GTG;

• serum albumin;

• total and direct bilirubin;

• general blood analysis;

• markers of viral hepatitis and other tests.

Additionally, it is advisable to undergo an ultrasound of the liver and gallbladder, as well as sign up for a consultation with a general practitioner, surgeon, infectious disease specialist or gastroenterologist, depending on the results.

If you need to donate blood for alanine aminotransferase (ALT), you can check the price of the test, as well as the cost of other services for the diagnosis and treatment of diseases on the website of the SM-Clinic in Moscow or by calling the contact center. Monitor the condition of your liver, be examined regularly.

• Christopher Higgins. Deciphering clinical laboratory tests. Knowledge Lab, 2022

• Schiff Eugene R, Maddrey Willis S, Sorrel Michael F. Schiff’s disease of the liver. Vascular, neoplastic, infectious and granulomatous diseases. GEOTAR-Media, 2010

• Karpishchenko Anatoly Ivanovich, Kuznetsov Valery Valentinovich, Moskalev Alexander Vitalievich Clinical laboratory diagnostics of diseases of the liver and biliary tract. Management. GEOTAR-Media, 2020

What else is ordered with this analysis

Gamma-glutamyltransferase is one of the enzymes responsible for biochemical transformations in the liver and biliary tract. With bile stasis, inflammatory processes, malignant tumors, GGT activity increases, which is one of the important criteria for making a diagnosis.

Deadline

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RUB 285

Urgent analysis + RUB 525

Aspartate aminotransferase is a special enzyme that is found in most cells of the body and normally has a relatively low activity. The highest concentration of the substance is found in the tissue of the liver and cardiac muscles, slightly less in the kidneys and skeletal muscles.

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Clinic

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Urgent analysis + RUB 525

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Alanine aminotransferase (ALT, AlAT) is synthesized intracellularly, and normally only a small part of this enzyme enters the blood. If the liver is damaged (with hepatitis, cirrhosis of the liver), this enzyme enters the bloodstream.

ALT levels can also rise with myocardial infarction, which is always accurately detected by tests.

An increase in ALT greater than an increase in AST is indicative of liver damage; if the AST index rises more than the ALT rises, then this, as a rule, indicates problems with myocardial cells.

An increase in ALT activity can be caused by taking certain drugs (mostly due to toxic effects on the liver).

A decrease in ALT activity in blood plasma is possible with renal failure, pyridoxine deficiency, after repeated hemodialysis procedures, during pregnancy.

Aspartate aminotransferase (AST, AsAT) is synthesized intracellularly, and normally only a small part of this enzyme enters the blood. With damage to the myocardium, the liver, this enzyme enters the bloodstream. Therefore, an adult blood test will quickly show the presence of the enzyme.

An increase in AST that exceeds an increase in ALT is characteristic of damage to the heart muscle; if the ALT index is higher than the AST, then this, as a rule, indicates the destruction of liver cells.

Total bilirubin is considered to be a breakdown product of myoglobin, cytochromes and hemoglobin in some cells of the spleen, liver and reticuloendothelial system. It is one of the nodal components of bile. Contains bilirubin in the form of fractions in the blood serum. Fractions can be direct (conjugated or bound) and indirect (unbound or free) bilirubin, together making up total bilirubin. The definition of direct and total bilirubin is traditionally used, which shows the amount of free bilirubin that is practically insoluble in water.

Indications for use:

• Liver diseases;
• Hemolytic anemia;
• Clinical signs of jaundice.

Glucose is considered a key indicator of active carbohydrate metabolism, and determining its actual level in the body is a mandatory step in the process of diagnosing complex diseases, such as diabetes. The indicator of glucose concentration is regulated by hormones, which is why an analysis for hormones is needed here. So, insulin, which is the main hormone in the pancreas, in case of its own deficiency, affects the increase in glucose, so the cells starve. For adults, a certain range of 3.9 is considered normal.-5.8 mmol / liter, while the indicator can increase during pregnancy or after 60 years.

Cholesterol (cholesterol) is an organic compound and an essential component of active fat metabolism. It is used for the process of building cell membranes, participates in the actual synthesis of sex hormones and vitamin D, and is a precursor of bile in the liver.

In the blood, cholesterol can be contained in the form of total cholesterol, as well as low or high density lipoproteins. The procedure for the synthesis of cholesterol occurs in individual liver cells, it is slightly produced in the adrenal glands, skin layers and intestinal walls. Partially, cholesterol comes with all kinds of foods. Paid blood tests will help to find out its level.

The total protein is an organic polymer composed directly of various amino acids. Proteins are involved in most biochemical reactions of the body as catalysts, are responsible for the transport of various substances and active drugs, and are also involved in providing high-quality immune protection. The generalized (total) concentration of proteins in the blood is determined by the existing concept of “total protein”.

The procedure for determining the protein index is used to diagnose a variety of diseases of the kidneys, liver and oncological diseases called a blood test for protein.

Creatinine is the end product of the breakdown of creatine, which is released during muscle contraction, transported by the blood to the kidneys and excreted from the body through the urine. Due to the fact that creatinine is excreted through the kidneys, an increase in its content in the blood is an indicator of renal failure (such an increase indicates a violation of the filtration and excretory function of the kidneys).