What are the normal levels of ALT and AST. How do high or low results affect your health. What symptoms might indicate abnormal liver enzyme levels. What causes elevated ALT and AST.

Understanding ALT and AST: Key Liver Enzymes

Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) are crucial enzymes primarily found in the liver. These enzymes play a vital role in amino acid metabolism and are often used as indicators of liver health. When liver cells are damaged, these enzymes leak into the bloodstream, resulting in elevated levels that can be detected through blood tests.

What is ALT?

ALT, or Alanine Aminotransferase, is an enzyme that catalyzes the transfer of an amino group from alanine to α-ketoglutarate, producing pyruvate and glutamate. It is predominantly found in the liver and kidneys, with smaller amounts present in the heart and skeletal muscles. ALT is considered more specific to liver damage compared to AST.

What is AST?

AST, or Aspartate Aminotransferase, is another enzyme involved in amino acid metabolism. While it is also present in the liver, it can be found in significant quantities in other organs such as the heart, muscles, and kidneys. Due to its wider distribution, elevated AST levels are less specific to liver damage compared to ALT.

Normal Levels of ALT and AST

The normal range for ALT and AST can vary slightly depending on the laboratory and the specific testing method used. However, generally accepted ranges are:

• ALT: 14 – 63 IU/L (International Units per Liter)
• AST: 15 – 41 IU/L (International Units per Liter)

It’s important to note that these ranges can differ based on factors such as age, gender, and individual health status. For instance, in healthy children, plasma ALT activity is typically lower than AST until the age of 15 to 20 years. After this, ALT tends to be higher than AST until around age 60, when the activities become roughly equal.

Factors Affecting ALT and AST Levels

Several factors can influence ALT and AST levels, even in healthy individuals:

• Time of day: ALT levels can fluctuate up to 45% during a single day, with highest levels in the afternoon and lowest at night.
• Day-to-day variation: ALT levels can vary 10 to 30% from one day to the next in healthy individuals.
• Body Mass Index (BMI): A high BMI can increase ALT levels by 40 to 50%.
• Vitamin B6 status: Both ALT and AST require vitamin B6 as a catalytic cofactor. Deficiency in this vitamin can affect enzyme activity.

High ALT and AST Levels: Causes and Implications

Elevated levels of ALT and AST are often indicative of liver damage or disease. The extent of elevation and the ratio between AST and ALT can provide valuable insights into the underlying condition.

Common Causes of Elevated ALT and AST

1. Viral hepatitis
2. Alcoholic liver disease
3. Non-alcoholic fatty liver disease (NAFLD)
4. Drug-induced liver injury
5. Ischemic liver injury
6. Autoimmune hepatitis
7. Hemochromatosis
8. Wilson’s disease

Interpreting ALT and AST Elevations

The pattern of ALT and AST elevation can provide clues about the underlying liver condition:

• Viral hepatitis: ALT is typically 10-40 times the upper limit of normal (ULN), with an AST:ALT ratio <1.
• Alcoholic hepatitis: ALT is usually 2-8 times ULN, with an AST:ALT ratio >2.
• Toxic or ischemic injury: ALT can be >40 times ULN, with AST initially higher than ALT.

In cases of extreme elevation (ALT >3000 U/L), 90% are due to toxic or ischemic injury. It’s crucial to note that peak ALT levels do not necessarily correlate with prognosis, and in some severe cases, decreasing ALT may actually indicate a lack of viable hepatocytes rather than recovery.

Low ALT and AST Levels: What Do They Mean?

While much attention is given to elevated liver enzymes, low levels of ALT and AST can also be significant. Low levels are less common and may indicate:

• Vitamin B6 deficiency
• Chronic kidney disease
• Severe liver damage (in advanced stages where few functional liver cells remain)

Low levels are generally less concerning than high levels but should still be evaluated in the context of overall health and other laboratory findings.

The AST:ALT Ratio: A Diagnostic Tool

The ratio of AST to ALT in plasma can be a valuable diagnostic tool for certain liver conditions. In most liver diseases, ALT elevation is greater than AST due to ALT’s longer half-life in circulation (47 ± 10 hours). However, there are notable exceptions:

• Alcoholic hepatitis
• Cirrhosis
• Wilson’s disease
• Very early stages of liver damage

In these conditions, the AST:ALT ratio is typically greater than 2. This ratio can help differentiate alcoholic liver disease from other forms of liver injury, where the ratio is usually less than 1.

Symptoms Associated with Abnormal ALT and AST Levels

Elevated ALT and AST levels themselves do not cause symptoms. However, the underlying liver conditions causing these elevations may present with various symptoms:

• Fatigue
• Jaundice (yellowing of skin and eyes)
• Abdominal pain or swelling
• Nausea and vomiting
• Loss of appetite
• Dark urine
• Pale stools
• Itchy skin

It’s important to note that many liver conditions, especially in their early stages, may be asymptomatic. This is why routine liver function tests, including ALT and AST measurements, are crucial for early detection and management of liver diseases.

Diagnosis and Monitoring Using ALT and AST

ALT and AST tests are part of a comprehensive liver function panel used to diagnose and monitor liver diseases. Here’s how these enzymes are utilized in clinical practice:

Diagnosis

ALT is considered the best single indicator of hepatocyte injury. A level of 300 U/L is often used as a discriminant value for recognizing acute hepatic injury. However, diagnosis typically involves more than just ALT and AST levels. Other tests may include:

• Alkaline phosphatase (ALP)
• Gamma-glutamyl transferase (GGT)
• Bilirubin
• Albumin
• Prothrombin time

Monitoring

ALT and AST levels are also valuable for monitoring the progression of liver diseases and the effectiveness of treatments. For instance:

• In viral hepatitis, ALT increases before and peaks near the onset of jaundice. It then falls slowly, at an average of 10% per day, remaining elevated for 27 ± 16 days.
• In chronic hepatitis C, ALT levels may fluctuate between normal and abnormal. Interestingly, 15 to 50% of patients with chronic hepatitis C have persistently normal ALT levels.
• In cirrhosis without ongoing liver injury, ALT and AST levels may normalize, despite the presence of advanced liver disease.

Treatment Approaches for Abnormal ALT and AST Levels

Treatment for abnormal ALT and AST levels focuses on addressing the underlying cause of liver dysfunction. Some general approaches include:

Lifestyle Modifications

• Abstaining from alcohol
• Maintaining a healthy weight
• Eating a balanced, liver-friendly diet
• Regular exercise
• Avoiding hepatotoxic substances

Medical Interventions

• Antiviral treatments for viral hepatitis
• Immunosuppressants for autoimmune hepatitis
• Chelation therapy for Wilson’s disease
• Phlebotomy for hemochromatosis
• Medications to manage complications of liver disease

In some cases, such as drug-induced liver injury, discontinuing the offending medication under medical supervision may be necessary. For advanced liver disease, liver transplantation might be considered.

Prevention and Maintenance of Healthy ALT and AST Levels

Maintaining healthy ALT and AST levels is primarily achieved through liver health promotion. Here are some strategies:

1. Limit alcohol consumption: Excessive alcohol intake is a leading cause of liver damage.
2. Maintain a healthy weight: Obesity is closely linked to non-alcoholic fatty liver disease.
3. Exercise regularly: Physical activity helps maintain a healthy weight and promotes liver health.
4. Eat a balanced diet: A diet rich in fruits, vegetables, whole grains, and lean proteins supports liver function.
5. Avoid unnecessary medications: Some medications can cause liver damage when used long-term or in high doses.
6. Practice safe sex and avoid sharing needles: This reduces the risk of contracting hepatitis B and C.
7. Get vaccinated: Hepatitis A and B vaccines can prevent these forms of viral hepatitis.
8. Avoid exposure to toxins: Limit contact with chemicals like cleaning products and insecticides.

Regular check-ups and liver function tests can help detect any abnormalities early, allowing for timely intervention and management.

Future Directions in ALT and AST Research

Research into ALT and AST continues to evolve, with several exciting areas of focus:

Improved Standardization

The International Federation of Clinical Chemistry (IFCC) has recommended that laboratories add excess pyridoxal-5′-phosphate (P5P) to their enzyme reagents. This ensures accurate measurement of enzyme activity independent of vitamin B6 status. However, less than 50% of ALT assays currently incorporate exogenous P5P. Future efforts may focus on increasing this standardization.

Novel Biomarkers

While ALT and AST remain valuable indicators of liver health, researchers are exploring new biomarkers that may offer additional insights. These could provide more specific information about the type and extent of liver damage, potentially leading to earlier and more accurate diagnoses.

Personalized Reference Ranges

Given the variability in ALT and AST levels based on factors like age, gender, and BMI, there’s growing interest in developing personalized reference ranges. This could lead to more accurate interpretations of test results and better-tailored treatment approaches.

Non-Invasive Imaging Techniques

Advancements in imaging technologies may complement ALT and AST tests in the future. Techniques like elastography, which measures liver stiffness, could provide additional information about liver health without the need for invasive procedures.

In conclusion, understanding ALT and AST levels is crucial for assessing and maintaining liver health. While elevated levels often indicate liver damage, it’s important to interpret these results in the context of other clinical findings and individual patient factors. Regular monitoring, lifestyle modifications, and appropriate medical interventions when necessary can help manage liver health effectively. As research progresses, we can expect even more refined and personalized approaches to liver health assessment and management.

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.  

Diagnosis of liver cancer | Canadian Cancer Society

Diagnosis is the process of finding out the cause of a health problem. Usually, diagnosing liver cancer begins when a routine test suggests a problem with the liver. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for liver cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as liver cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of liver cancer.

The following tests are usually used to rule out or diagnose liver cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risks and all the medical events
and problems you have had in the past. Your doctor will ask
questions about your history of:

• symptoms that suggest liver cancer
• scarring of the liver (called cirrhosis)
• infection with hepatitis B virus (HBV) or hepatitis C virus (HCV)
• drinking large amounts of alcohol
• smoking tobacco

Your doctor may also ask about a family history of:

• liver cancer
• risks for liver cancer
• other cancers

A physical exam allows your doctor to look for any signs of liver cancer. During a
physical exam, your doctor may:

• feel the abdomen to find out if any organs are larger than normal or if there is a
  buildup of fluid (called ascites)
• look at the eyes or skin for yellowing (called jaundice)
• check for swelling in the legs and feet from a buildup of fluid (called
  edema)

Find out more about physical exams.

A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and
platelets. A CBC is done to get basic information about your general health.

Find out more about a complete blood count (CBC).

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are working and can help find abnormalities. Blood chemistry tests used to diagnose liver cancer include the following.

Liver function tests (also called a liver panel) are a group of blood chemistry tests
that are often ordered together. While they do not diagnose liver cancer, they can tell
the doctor that there may be a problem with the liver.

Albumin is a protein made by the liver. Low levels of albumin suggest that the liver is damaged.

Bilirubin is made when old red blood cells (RBCs) break down. The liver absorbs and uses bilirubin. A high level of bilirubin may mean that the liver isn’t working properly. A buildup of bilirubin in the body can cause jaundice.

Prothrombin time (PT) is the amount of time it takes blood to clot. The liver makes proteins that the blood needs to clot (called coagulation factors). Doctors use bleeding and blood-clotting factor tests to see how well the body can clot blood. Slower clotting time may be caused by liver damage or disease.

Alkaline phosphatase (ALP) is an enzyme found in the liver and other body tissues. A high level of ALP may be a sign of liver damage.

Aspartate aminotransferase (AST) is an enzyme found in liver and heart cells. When liver or heart cells are damaged, they release AST into the blood. A high level of AST in the blood may be a sign of liver damage or disease.

Alanine aminotransferase (ALT) is an enzyme found in the liver and kidneys. A high level of ALT in the blood is often found before symptoms of liver damage, such as jaundice, develop.

Find out more about blood chemistry tests.

An ultrasound uses high-frequency sound waves to make images of parts of the body. It is used to see if the liver is larger than normal. It can also be used to see if a growth in the liver is solid or filled with fluid (like a cyst).

Find out more about ultrasound.

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

To diagnose liver cancer, a CT scan is done 4 times. This is called a 4-phase, or multiphase, CT scan. A CT scan is first done without any contrast medium. The next 3 scans are done after contrast medium is injected into a vein. The way the contrast medium flows through the liver can tell doctors if a tumour in the liver is cancerous. When doctors identify liver cancer with a CT scan, they don’t need to do a liver biopsy.

Doctors also use a CT scan to get information about the tumour’s size, shape and location. They use a CT scan to look for signs that the cancer has spread to nearby lymph nodes, tissues or organs. A CT scan also helps the doctor decide if the liver tumour can be removed by surgery.

Find out more about CT scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures.

An MRI may be used to look for signs that liver cancer has spread to nearby lymph nodes, tissues or organs.

Find out more about MRIs.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested
in a lab. A report from a pathologist will show whether or not cancer cells are found
in the sample.

In most cases, doctors use a CT scan to diagnose liver cancer. If they
can’t confirm that there is a tumour in the liver based on the imaging test results,
doctors may do a liver biopsy.

A core needle biopsy uses a large, hollow cutting needle to remove a cylinder-shaped
sample (core) from a tumour. It is the most commonly used biopsy for
liver cancer because it gives enough tissue for doctors to make a diagnosis.

Find out more about biopsies.

If doctors think someone has liver cancer, they will order a blood test to check for hepatitis viruses. Chronic infection with hepatitis B virus (HBV), hepatitis C virus (HCV) or both increases the risk of developing liver cancer.

Find out more about hepatitis viruses.

An x-ray uses small doses of radiation to make an image of parts of the body on film. It is used to see if liver cancer has spread to the lungs.

Find out more about x-rays.

Tumour markers are substances found in the blood, tissues or fluids removed from the body. An abnormal amount of a tumour marker may mean that a person has liver cancer.

Tumour marker tests are generally used to check your response to cancer treatment. They can also be used to diagnose liver cancer.

In the past, alpha-fetoprotein (AFP) was the tumour marker used for liver cancer. Recent research shows that AFP may also be higher than normal in people who have other types of cancer, including intrahepatic bile duct cancer. Because the test does not specifically identify liver cancer, doctors no longer recommend it as a diagnostic test for liver cancer.

Find about more about tumour markers.

To make the decisions that are right for you, ask your healthcare
team questions about diagnosis.

• Kelly W Burak, MD, FRCPC, MSc(Epid)

• Vincent Tam, BSc(Hon), MD, FRCPC

• American Cancer Society
  . Tests for Liver Cancer
  . 2019
  : https://www.cancer.org/.

• American Society of Clinical Oncology (ASCO)
  . Cancer.net: Liver Cancer: Diagnosis
  . 2021
  : https://www.cancer.net/.

• Burak KW, Sherman M. Hepatocellular carcinoma: consensus, controversies and future directions: a report from the Canadian Association for the Study of the Liver hepatocellular carcinoma meeting. Canadian Journal of Gastroenterology and Hepatology. 2015: 29(4):178–184. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4444026/.

• Fong Y, Dupuy DE, Feng M, Abou-Alfa G. Cancer of the liver. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer; 2019: 57:844–865.

• Heimback JK, Kulik LM, Finn RS, et al
  . AASLD guidelines for the treatment of hepatocellular carcinoma
  . Hepatology
  . 2017
  : 67(1):358–380
  .

• National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers (Version 3.2021). 2021.

what is it? What does an increase in the level of ALT and AST in the blood mean? How to take the analysis? What can affect the increase in ALT

ALT – alanine aminotransferase. It is a specific enzyme involved in the production and breakdown of proteins. Synthesized by cells of various organs: liver, spleen, kidneys, lungs, heart muscles. Normally, a small amount enters the bloodstream. Blood ALT testing is a common diagnostic test.

Diagnosis based on ALT analysis

Detection of the level of alanine aminotransferase is carried out as part of a general biochemical blood test. Complaints for which a blood test for ALT is prescribed are:

• Increased fatigue;
• Decreased appetite;
• Occurrence of weakness in the body;
• Pain on the right side of the abdomen;
• Discoloration of urine;
• Yellowness of the skin;
• Pain in the region of the heart;
• Nausea.

It is mandatory to determine the level of aminotransferase in patients suffering from obesity, diabetes, liver disease.

Important! Blood donation is done in the morning on an empty stomach. It is not recommended to consume alcohol and fatty foods the day before the analysis.

You should also refrain from taking strong medications. The results of the study can be affected by the psycho-emotional state of a person and physical stress.

Exceeding the threshold of the norm

The upper limit of normal ALT is important in medical research. The limit for adult men is 45 units / l, for women 34 units / l. An increase in ALT in a blood test indicates an inflammatory process in the body. The following are the diseases that cause such a pathology.

1. Pancreatitis. Severe damage to the pancreas. It occurs due to the appearance of a tumor that blocks the enzyme ducts. As a result, the accumulated digestive enzymes begin to digest the pancreas itself. Possible lethal outcome;
2. Hepatitis. Liver disease. It is characterized by inflammation of the tissues of the body. It is divided into several types. Hepatitis C is considered the most dangerous. The latter often becomes chronic and can cause cirrhosis of the liver. Common causes of hepatitis are: toxic damage to liver cells (for example, alcohol), viral infection;
3. Myocardial infarction. The most severe heart disease. It is characterized by the death of some parts of the heart muscle, due to a critical decrease in blood circulation. There are many reasons for pathology. The main ones: smoking, hypertension, obesity, diabetes, sedentary lifestyle.

There are reasons for the excess of ALT in the blood test, not related to the listed diseases:

• Chemotherapy;
• Injuries involving damage to the muscles of the body;
• Taking strong drugs;
• Physical and emotional strain;
• Eating fatty fried foods,
• Taking drugs.

Important! The main recommendations aimed at reducing the likelihood of these diseases will be: proper nutrition, refraining from using drugs (including alcohol, nicotine), moderate physical activity, and reducing stressful situations in life.

DeRittis coefficient

One of the most important research methods is considered to be the comparison of the ALT level with the level of AST – aspartate aminotransferase. The latter is also an endogenous enzyme involved in the synthesis of amino acids. Aminotransferases have similar threshold levels in the blood. The diagnosis of a particular pathology depends on the balance of ALT and AST. The AST/ALT ratio is characterized by the de Rittis coefficient.

Important! The normal value of the de Rittis coefficient is 1.33-1.75 units / l.

A decrease in the rate below 1 unit / l will mean viral damage to the liver. An increase in the coefficient to 2 units / l and above, subject to an increased content of albumins, indicates myocardial infarction.

Normal levels of ALT/AST in the body:

• Alalnin aminotransferase: men – up to 45 U/l, women – up to 34 U/l;
• Aspartate aminotransferase: men – up to 41 U / l, women – up to 31 U / l.

Self-interpretation of tests

Often, patients, having read medical information, try to independently decipher a blood test for ALT levels. After receiving the results in the laboratory, some people, seeing the deviation of indicators from normal values, self-diagnose serious diseases in themselves.

Doctors know that exceeding ALT thresholds is not always a sign of pathology. Results from different laboratories may differ from each other. It depends on the equipment, on the research methods, on the materials used in the analysis. Also, other factors can influence the results, whether it is the patient’s wrong lifestyle, medication, emotional state, and others.

Only a doctor can correctly decipher the results of research. He also prescribes medication.

To date, physicians do not use ALT analysis as a means of accurate diagnosis. An excess of ALT in a blood test indicates only the possibility of a disease. To make a final diagnosis, additional studies are used, specialists of a narrow profile are involved: urologists, cardiologists and others.

Normalization of ALT levels with folk remedies

After the examination, a patient with a high ALT level is prescribed medication. But for prevention, the doctor may recommend herbal medicine. The following are examples of the use of folk remedies to reduce the level of alanine aminotransferase.

• Milk thistle decoction. To prepare a teaspoon of chopped herbs, pour a glass of boiling water, wrap and let it brew for 20 minutes. Then filter the infusion. Take a decoction in small sips, half an hour before meals twice a day, for three weeks;
• Herbal collection. Immortelle, St. John’s wort and celandine are mixed. The proportion of herbs is 2-2-1 respectively. The collection is poured with 1 liter of hot water, wrapped and infused for 12 hours. Then you need to strain the infusion. Take half a cup 4 times a day for two weeks;
• Dandelion infusion. For cooking, take 200 g of crushed dandelion flowers. Pour 100 ml of vodka. The remedy is insisted during the day. Take 2 tablespoons three times a day for three weeks;
• Decoction of corn stigmas. To prepare the product, dried crushed stigmas are taken. Pour 200 ml of boiling water and leave for 15-20 minutes. Take the infusion twice a day in a glass. The course of treatment can be six months.

Important! Folk remedies are not a cure! They are used for the prevention of diseases and general strengthening of the body.

The level of development of modern medicine allows diagnosing most known diseases with accuracy. One of the generally accepted research methods is a biochemical blood test. It contains many indicators, one of which is the level of alanine aminotransferase.

Exceeding the normal level of ALT indicates the possibility of developing serious diseases in the body. But only a doctor can accurately determine the disease. We strongly recommend that you do not engage in self-diagnosis, and even more so self-treatment. If you experience anxiety symptoms, contact the clinic immediately. They will conduct all the necessary examinations and help you cope with the problem.

Biochemical analysis of blood for enzymes reveals many hidden pathologies of internal organs. Doctors have long been using it for early diagnosis of diseases. One of the first enzymes that began to be determined for diagnostic purposes are ALT and AST. Now this study is gradually being replaced by tests for other enzymes in the blood, which are more specific to individual organs. But this analysis remains a good old classic and is still widely used today. So what is it – ALT and AST in a biochemical blood test? What do these indicators mean? What diseases can indicate?

Normally, enzymes work inside the cell, regulating a wide variety of biochemical reactions, and they enter the blood as a result of its destruction. This does not mean that they are completely absent in the blood, they are present, but in minimal quantities. The thing is that in the body of a healthy person, natural cell death occurs daily, this is a normal process of self-renewal.
. As a result of this programmed cell death, few enzymes enter the bloodstream. However, they can appear in the blood in much higher concentrations – in the event that pathological mass cell death occurs. It is on this feature that the possibility of the diagnostic application of a biochemical blood test for enzymes is built.

International units (IU) are used to assess AST and ALT activity. For one in this system, such an amount of enzyme is taken that accelerates the conversion of 1 μmol of substrate per minute. When conducting analysis in Russia, the Reitman-Frenkel method is considered unified, but there are other methods, some of which are even more accurate. To decipher the analysis, the methodology used is not of fundamental importance: the figures obtained in various research options are almost identical.

Blood AST

The enzyme AST (aspartate aminotransferase) promotes the transfer of the amino group from aspartic acid to alpha-ketoglutaric acid. There are two forms of it – mitochondrial and cytoplasmic, which can be distinguished by special analysis. Normally, only cytoplasmic can be detected in the blood.

Serum AST activity in healthy individuals ranges from 10 to 30 IU/l. This enzyme is found in the heart, liver, muscles and some other tissues. An increase in its activity may indicate when deciphering a blood test for the pathology of one of the above organs. AST values ​​are most strongly elevated in heart diseases, in particular, in such a form of coronary artery disease as myocardial infarction.

In such patients, the activity of AST in the blood serum is increased by about 2-20 times. Changes in the biochemical analysis of blood begin after about 6-8 hours, but the maximum AST values ​​are increased by the end of the first day. Then the analysis gradually approaches the norm and reaches the initial normal values ​​on the 5-6th day. If a second infarction occurs during this period of time, a new jump in the rise in AST activity will be observed.

Often, an altered activity of an enzyme in the blood shows a myocardial infarction even earlier than an ECG. Therefore, a biochemical blood test is very important for early diagnosis. In addition, it, like the ECG, makes it possible to differentiate a heart attack from an attack of angina pectoris: indicators of AST activity with it are almost never elevated. Also, this analysis allows you to monitor the dynamics of recovery, to draw prognostic conclusions.

ALT in blood serum

Normally, the activity of ALT (alanine aminotransferase) in human serum is in the range from 7 to 40 IU / l. This enzyme accelerates the reaction of transport of the amino group from alanine to alpha-ketoglutarate. It is found in the greatest amounts in the liver, but is also found in other internal organs, such as:

• heart;
• pancreas;
• spleen;
• lungs;
• skeletal muscles, etc.

Most often, serum ALT levels are elevated in hepatitis, cirrhosis and other liver damage. Such changes are detected when deciphering the analysis in all such patients.

An increase in ALT activity in the blood in hepatitis A appears 10-15 days before the first signs of jaundice, and in hepatitis B – many days before the full clinical picture of the disease. In the usual course, the indicator reaches a maximum at the 2-3rd week, and normalizes after 30-40 days. The prolongation of the period of increase in ALT activity indicates a chronic process and therefore is an unfavorable prognostic sign. If a new burst of enzyme activity is observed during the disease, this means that a relapse has occurred.

In addition, ALT activity may be increased in hemolytic disease in newborns. Their blood ALT levels are elevated to about 50 IU/L or more. These changes are explained by the fact that in such children there is a significant overload of the liver with a violation of its functions. Also, the influence of hemolysis products leads to the fact that the liver in children cannot perform the function of protein synthesis in full.

The formation of high-density lipoproteins also suffers, as a result of which cholesterol in the blood of sick children is also elevated. In addition, in children with hemolytic disease, blood clotting is impaired, which is explained by a decrease in the synthesis of prothrombin in the liver. The degree of damage to this organ in hemolytic disease in newborns reflects precisely the activity of ALT in the blood. Children with the highest ALT numbers are at greater risk of death.

ALT and AST total score

When deciphering a biochemical blood test, it is the total assessment of the activity indicators of ALT and AST that is very important. A comprehensive study provides more complete information about the depth and localization of the lesion, makes it possible to make more accurate predictions of the course of the disease, and determine the severity of the pathological process. During the decoding of the blood test, the Ritis index is calculated, that is, the ratio of the activity of the AST enzyme to ALT. Normally, it should be equal to 1.33. With liver diseases, this index decreases, with heart pathologies it increases.

The enzymes ALT and AST have different half-lives (ALT has about 50 hours, while AST has only 20 hours), which allows us to draw correct conclusions about the age of the disease. When diagnosing hepatitis, the degree of AST activity allows you to judge the depth of the lesion (the higher the activity, the stronger the damage), but you can pay attention to this indicator only in the case of elevated ALT, because it is this enzyme that indicates the pathology of this organ.

Interestingly, with alcoholic liver damage, the Ritis index increases, as with heart disease. This is due to the fact that the depth of pathological changes is very high.

Of great importance is the detection of other enzymes, together with a blood test for ALT and AST . It is very important to determine the activity of LDH, MDH, alkaline phosphatase and others.
In addition, other blood parameters must be taken into account. We have already mentioned that with hemolytic disease in newborns, a decrease in the level of albumin, prothrombin, an increase in cholesterol and a number of other changes are detected in the blood. Therefore, when deciphering the results, all of them should be evaluated as a whole. This applies not only to children, but also to adults.

A blood test for ALT and AST shows whether there is a pathology of the internal organs. When deciphering the results in case of deviation from the norm, doctors suggest, first of all, heart pathology with an increase in AST and liver disease with an increase in ALT. Careful consideration of the obtained figures allows not only to answer the question of whether there is a pathology or not, but also to assess its severity, nature, and make a prognosis. Of course, only an experienced doctor can do all this, so patients are not recommended to try to interpret the results of the analysis themselves.

Good day to all my readers! Today we will talk about elevated AST and ALT levels in the numbers of a biochemical blood test. People are interested in what this means, especially since the analysis itself is new, carried out not so long ago. It is especially important on Mondays, when people get tests, I have already understood this from my own practice.

What is ALT and AST

ALT analysis in most cases comes with AST. For them, the norm is the same. These abbreviations indicate the presence in the blood plasma of the enzymes alanine aminotransferase (ALT) and aspartic aminotransferase (AST).

Their activity is considered in arbitrary units, since it is difficult to accurately determine their concentration in the blood even with modern devices. They are counted by enzymatic activity. I will not describe how the calculation is going on, this is not necessary for us, ordinary people.

These enzymes work inside the cells of our body.
Their role is to transfer groups of atoms from one amino acid to another. That is, they perform transport functions. The second name of these enzymes is transaminases. ALT is an alanine transaminase, AST is an aspartic transaminase.

These enzymes are present in all cells, some more, others less. Liver cells have the highest concentration of ALT, and heart cells have more ACT enzymes

. In other tissues, the indicators are also different.

These enzymes enter the blood only from the destroyed cells. This means that an increased level of AST and ALT enzymes in the blood indicates that the process of cell destruction is underway in the body. If ALT analysis is elevated
, which means the liver is experiencing certain problems, you need to pay attention to this and take measures to improve it.

If AST is elevated
, it means there are some problems in the heart. You need to pay attention to this body.

AlAT levels in the blood

for women up to 31 U

for men up to 41 U

Norms of AST in the blood

for women up to 31 U

for men up to 41 U

These are, so to speak, average values
for the average person leading a normal life. The norm is not an ideal, but with these indicators people live and feel more or less tolerable.

How much can the indicator increase

If, according to the results of the analyzes, you have some kind of excess, then it is important to imagine how much it has deviated from the norm.

If the indicator is 2-5 times higher than normal
, then this is a moderate increase – it will probably need additional analysis after a while to track the dynamics.

If 6 to 10 times higher
, then this is an average increase – consultation with a doctor is recommended.

If more than 10 times normal
, then this is a high increase – you need to contact a specialist.

Reasons for increasing AST and ALT

viruses, various hepatitis – drug and alcohol, heart attacks, pancreatitis. In general, any health problems are reflected in these indicators.

Therefore, a comprehensive health assessment is required
, and it can only be given by your attending physician, or a specialist who deals with you on the problem that you turned to him with.

Increased ALT or AST for no reason

Check your medicines
, probably among them there is one that can have a side effect on the liver. This is the most common reason for this kind of increase. Most often, ALT can increase from taking statins – cholesterol-lowering drugs.

Also, experts advise to consult a hepatologist or a gastroenterologist
. Doctors will prescribe drugs to protect the liver (hepatoprotectors) and treat the gastrointestinal tract.

Increased ALT during pregnancy

Sometimes you have to deal with the fact that ALT can be elevated in a woman during pregnancy. This is acceptable, and if a woman is under the supervision of a doctor, then there should be no cause for concern. Plus, if you feel relatively normal, then the indicator should be considered only as a signal of pregnancy, no more.

Video – why is the alt analysis increased?

Friends, I am publishing this video solely for your familiarization with the information given by the specialist. All phone numbers and contacts of clinics in the video have nothing to do with me.

Terminals

Elevated levels of AST and ALT on a biochemical blood test indicate that the process of cell destruction is underway in the tissues of the heart and liver.

Avoid exposure
drugs, alcohol, fatty and fried foods. Visit a hepatologist and gastroenterologist who will prescribe you recovery procedures.

But I repeat once again, it is not worth drawing any terrible conclusions from this analysis
. Do not scare yourself and loved ones ahead of time. It is necessary to find out the cause of the increased indicators by additional examinations, and even then, if they are prescribed by your doctor. If the specialist does not see a reason for concern, then you do not need to worry.

In the comments you often write your test results, but I will not give you any recommendations. There is an excess of the norm, but what caused it, I will not tell you.

How to lower your ALT levels
– pay attention to oatmeal jelly. I talked in detail about the recipe for cooking here, follow the link and cook. Indicators should, if not return to normal, then go down. Oats have a good hepatoprotective effect.

Increase in the level of ALT and AST in the blood

1. ALT and AST: what is it? What does an increase in the level of ALT and AST in the blood mean? How to take the analysis?

2. Reviews Increased blood ALT and AST levels

ALT and AST: what is it? What does an increase in the level of ALT and AST in the blood mean? How to take the analysis?

ALT (alanine aminotransferase) and AST (aspartate aminotransferase) are special proteins (enzymes) that are contained inside the cells of the body and are involved in the metabolism of amino acids (substances that make up proteins). These enzymes are found only in the cells of various organs and enter the blood when damage or destruction of cells (diseases, injuries). An elevated level of ALT and AST indicates the presence of a disease of one or another organ (most often hepatitis, pancreatitis, heart attack).

The content of ALT and AST in different organs is not the same, therefore, an increase in one of these enzymes may indicate a disease of a particular organ.

ALT (ALAT, alanine aminotransferase) is an enzyme found mainly in the cells of the liver, kidneys, muscles, heart (myocardium – heart muscle) and pancreas. When they are damaged, a large amount of ALT comes out of the destroyed cells, which leads to an increase in its level in the blood.
AST (AST, aspartate aminotransferase) is an enzyme that is also found in the cells of the heart (in the myocardium), liver, muscles, nerve tissues, and to a lesser extent in the lungs, kidneys, pancreas. Damage to the above organs leads to an increase in the level of AST in the blood.

What are the norms for the content of ALT and AST in the blood?

ALT and AST levels are determined using a biochemical blood test. In order to obtain reliable results of the study, it is recommended to donate blood for biochemical analysis in the morning, on an empty stomach (it is recommended not to eat anything for at least 8 hours before taking the analysis). Blood is usually taken from a vein. Normally, the blood levels of ALT and AST in men and women are not the same. In women, this level normally does not exceed 31 U/l. In men, normal ALT does not exceed 45 U / l, and AST 47 U / l.

In children, the level of ALT and AST varies depending on age, but should not exceed for ALT – 50 U / l, for AST – from birth to 5 days up to 140 U / l, up to 9years – up to 55 IU / l.

It is important to take into account the fact that the norms and reference values ​​​​of ALT and AST transaminases vary depending on the equipment that the laboratory has, therefore, only a doctor who knows the norms of the laboratory can interpret the results of the analysis.
Do not self-medicate before taking medication
Be sure to consult with a specialist.

Choose a reliable doctor in an area of ​​Moscow that is convenient for you.

Why is ALT elevated?

High ALT indicates diseases of those organs in the cells of which it is contained in the greatest quantities. The following main causes are distinguished:

1. Hepatitis and other liver diseases (liver cirrhosis, fatty hepatosis – replacement of liver cells with fat cells, liver cancer, etc. )
   In viral hepatitis A, B, C, D and E, as well as other forms of hepatitis (medicated, alcoholic hepatitis, etc.), many liver cells are destroyed, resulting in ALT from the liver cells into the blood. Other symptoms of hepatitis are: pain and discomfort in the right hypochondrium, jaundice (yellowing of the skin of the body, sclera of the eyes and mucous membranes), bitter belching, bloating, constipation, diarrhea, etc. In a biochemical blood test, against the background of hepatitis, in addition to ALT, as a rule , there is an increase in the level of bilirubin (blood pigment). Often, an increase in ALT precedes the onset of other symptoms of the disease. The degree of elevation of ALT blood levels in hepatitis is generally proportional to the severity of the liver disease.
2. Myocardial infarction is necrosis (death) of a section of the heart muscle, as a result of which ALT and AST are released into the blood. Thus, with myocardial infarction, the level of both enzymes in the blood increases. Other symptoms of myocardial infarction are: acute pain in the region of the heart, radiating to the left side of the body (left side of the neck, inner surface of the left arm, etc.), prolonged pain (lasting more than 30 minutes), shortness of breath, feeling of weakness, fear of death, dizziness, etc.
3. Other heart diseases (myocarditis, heart failure, etc.), occurring with the destruction of myocardial cells (heart muscle) are also accompanied by an increase in ALT in the blood. Other symptoms of these diseases are: shortness of breath, palpitations, low blood pressure, etc.
4. Extensive injuries with muscle damage, as well as burns, are the cause of an increase in ALT in the blood.
5. Acute pancreatitis – inflammation of the pancreas tissue. With pancreatitis, the level of ALT in the blood rises. Other symptoms of the disease are: pain around the navel, diarrhea, bloating, weight loss, etc.

Why is AST elevated?

An increase in the level of AST, as a rule, indicates diseases of the heart, liver, pancreas, etc. The following main causes are distinguished:

1. Myocardial infarction is the most common cause of elevated AST levels in the blood. At the same time, AST, as a rule, is increased several times, while the level of ALT is slightly increased. Other symptoms of myocardial infarction: an attack of acute prolonged pain in the region of the heart, weakness, shortness of breath, dizziness, etc.
2. Other heart diseases (myocarditis, rheumatic heart disease – inflammation of the heart in rheumatism), as well as conditions after a recent operation, are the cause of an increase in the level of AST in the blood.
3. Liver diseases (viral hepatitis, alcoholic, drug, toxic hepatitis, liver cirrhosis, liver cancer, etc.) are often the cause of an increase in the blood level of both enzymes.
4. Major injuries, burns.
5. Acute and chronic pancreatitis.

Decreased levels of ALT and AST in the blood.

An excessive decrease in the level of ALT and AST in the blood is a serious condition and often indicates the presence of severe liver damage (cirrhosis, etc.