ALT Liver test information : by Ray Sahelian, M.D. ALT SGPT alt ast elevated alt liver test

ALT Liver Test by Ray Sahelian, M.D. ALT SGPT ALT AST - Elevated ALT liver test

An initial step in detecting liver damage is a simple blood test to determine the presence of certain liver enzymes in the blood. Under normal circumstances, these enzymes reside within the cells of the liver. But when the liver is injured, these enzymes are spilled into the blood stream. Among the most sensitive and widely used of these liver enzymes are the aminotransferases.They include GGT, aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT). These enzymes are normally contained within liver cells. If the liver is injured, the liver cells spill the enzymes into blood, raising the enzyme levels in the blood and signaling the liver damage. Alanine aminotransferase, or ALT, is a potential marker for liver damage often seen among heavy drinkers and patients with hepatitis C, and also in those who eat lots of fast foods or junk foods.

ALT test

ALT is an enzyme produced in hepatocytes, the major cell type in the liver. The level of ALT in the blood (actually enzyme activity is measured in the clinical laboratory) is increased in conditions in which liver cells are damaged or die. As cells are damaged, ALT leaks out into the bloodstream. All types of hepatitis (viral, alcoholic, drug-induced, etc.) cause hepatocyte damage that can lead to elevations in the serum ALT activity. The ALT level is also increased in cases of liver cell death resulting from other causes, such as shock or drug toxicity. The level of ALT may correlate roughly with the degree of cell death or inflammation, however, this is not always the case. An accurate estimate of inflammatory activity or the amount cell death can only be made by liver biopsy.

Fast food elevates ALT levels
Eating fast foods for one month elevates ALT liver enzymes. Researchers in Sweden followed 12 men and six women in their twenties, all slim and in good health, who are two meals per day at McDonalds, Burger King or other fast-food restaurants for a one month period. The men and women were asked not to exercise. The goal was to increase body weight by 10 to 15 percent. Levels of ALT increased after only one week, and quadrupled on average over the entire period. In the majority of the volunteers, ALT rose to levels that would normally reflect liver damage. Two of the individuals had liver steatosis, or fatty liver, in which fat cells build up dangerously in the liver. This study shows that high ALT levels can be due to unhealthy food intake alone.

Tylenol use and ALT liver test
More than a third of healthy adults starting Tylenol (acetaminophen) at the maximum recommended daily dosage of 4 grams will exhibit ALT elevations. The lead researcher is Dr. Paul B. Watkins, from the University of North Carolina in Chapel Hill. Dr. Watkins's study involved 145 healthy adults who were randomized to receive Tylenol alone, Tylenol plus opioid in one of three combinations, or placebo for 14 days. In all of the Tylenol groups, the Tylenol dosage was 4 g/day. No ALT elevations greater than three times the upper limit of normal were seen in the placebo group. By contrast, the incidence of such elevations ranged from 31% to 44% in the four groups receiving Tylenol. As noted, treatment with opioids did not further increase the ALT elevation seen with Tylenol. Serum acetaminophen levels were usually not measurable at the time of the elevation. JAMA 2006;296:87-93.

Folic Acid and ALT liver test

Low folic acid levels may raise ALT levels in the blood. High homocysteine level is also associated with higher ALT levels.

ALT, a marker for general health?
Doctors, and the public at large, should pay more attention to blood levels of the liver enzyme alanine aminotransferase (ALT), according to recommendations from the American Association for the Study of Liver Diseases (AASLD). Dr. Adrian Di Bisceglie, chair of the public policy committee for AASLD, and professor of internal medicine at St. Louis University believes the liver enzyme ALT is a marker for general health. Dr. W. Ray Kim and associates at the Mayo Clinic College of Medicine in Rochester, Minnesota studied 6792 residents of Rochester who had their ALT measured at least once in 1995. Abnormally high ALT levels were documented for 907 subjects. Kim's group observed an increased risk of death for subjects with elevated levels of ALT. Elevated levels of ALT enzyme increased the risk of death by 63 percent. The increased death risk included not only death from liver disease, but from all other causes as well.

ALT AST
ALT / AST (alanine aminotransferase / aspartate aminotransferase). Elevated ALT and AST.

ALT liver enzyme questions
Q. This Q & A was is on your web page:
   Q. My question pertains specifically to fish oils. I read that fish oil supplements, even the new FDA approved medical grade fish oil can elevate liver enzymes. Is this true to any degree? And if so, why would they be toxic to the liver, assuming the supplements are pure.
   A. We have seen no evidence that reasonable amounts of fish oil capsules, one to three a day, cause liver problems or are toxic.
      Q. My question is: Is there an upper limit? Your answer is confined to 1 to 3 capsules a day. I started on 9 grams of fish oil a day. I also have been eating canned wild salmon every day. My cholesterol went from 200 to 145, my HDL went from 55 to 85 and my LDL went from 130 or so to 45. Also my BP went from 120/80 to 100/65 and pulse went from 66 BPM to 50. However, my ALT and AST levels went from around 25 to 60. Someone told me that fish oil capsules are toxic due to the way they are processed and suggested that my liver was taking a beating from them. I did not find much on the internet but I did find a study wherein rabbits had raised ALT and AST levels from fish oil and an article that promoted fish oil for the heart but cautioned that if one was going to use fish oil as therapy, one should have their ALT and AST levels checked regularly. I also found your web page where the question was asked. Can too much fish oil negatively affect the liver? Ten grams does not seem a lot to me. After all it is a fat, not a vitamin. You get that much saturated fat in a hamburger. But it seems coincidental that I began on fish oil, my ALT liver enzymes went up and there are claims out there that fish oil does just that.
          A. We could not find any good human research regarding the influence of high fish oil dose on liver enzymes such as ALT and AST. We do not feel it is necessary to take more than 3 or 4 fish oil caps a day, and at that level there would be much of a problem, especially if a person takes a day or two off a week.
               Q. I had just completed 10 months straight of 20 hours a week of intense workouts and had began eating tuna and/or salmon every day and taking 6-9 fish oil capsules a day. My heart numbers drastically improved but my ATS and ALT levels went up from the 20’s to the 60’s. I just had them tested again after 6 weeks of 2 hours of exercise a week while keeping the fish and fish oil up at the same levels. They returned to the 20’s. I had read that extreme over-exercise could also raise ATS and ALT. Apparently that was the cause. P.S. For the first test my mercury level was at 7.5 while eating tuna almost daily. For the second test I switched exclusively to salmon, but kept eating the same total amount of fish and my mercury level went to 2.2.