ALT Liver Test, elevated information, measures liver damage and health problems, natural ways to reduce levels

April 20 2016 by Ray Sahelian, M.D.


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 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 interpretation

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, role of junk foods
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 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.


Role of pesticides, toxins, pollutants
The prevalence of abnormal alanine aminotransferase levels in the US adult population is approximately 40%, even after excluding known risk factors for abnormal liver enzymes, such as alcohol abuse and viral hepatitis. Dr. Matthew Cave of the University of Louisville, Kentucky evaluated 4,500 adults, analyzing blood and urine specimens for levels of 196 toxicants. He found at least one of 111 chemical pollutants in more than 60% of subjects. Abnormal ALT levels were defined as greater than 30 U/l for men and greater than 19 U/l for women. Approximately 70 million U.S. adults have elevated ALT not explained by traditional risk factors such as alcohol and hepatitis C. And while some of these cases, and perhaps the majority, may be explained by obesity and the metabolic syndrome. Some of them may be due to environmental pollution. Dr. Matthew Cave found several chemicals associated with an increased risk for abnormal liver enzymes. These included lead, mercury, thallium, organochloride pesticides and dibenzofuran.


Medications that elevate levels
Examples of medications that may cause elevations of liver enzymes include the statins (used in treating high blood cholesterol levels) some antibiotics, some antidepressants, and some medications used for treating diabetes, tacrine (Cognex), aspirin, and quinidine.


J Physiol Pharmacology. 2014. Thymoquinone and curcumin prevent gentamicin-induced liver injury by attenuating oxidative stress, inflammation and apoptosis. The present data indicated that thymoquinone and curcumin significantly prevented the gentamicin-induced elevations of serum AST, ALT and LDH activities as well as tumor necrosis factor alpha (TNF-α) and total bilirubin levels.


ALT level and body fat
Alanine aminotransferase is used as a surrogate marker for nonalcoholic fatty liver disease (NAFLD), which is frequently observed among obese subjects. ALT concentrations have a strong association with visceral fat accumulation.


Natural supplements for liver health
There are many substances, herbs and supplements that could be helpful in protecting liver tissue from damage. The most well known is milk thistle plant which contains silymarin. Milk thistle has been used for centuries to treat liver ailments. AcetylCysteine  is another nutrient that could help liver tissue particularly in those who take acetaminophen.


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

Low folic acid levels may raise ALT levels in the blood. High homocysteine level is also associated with higher 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 elevated (alanine aminotransferase / aspartate aminotransferase).

Checking blood levels
I recently tested as having a AST level of 132 but a normal ALT level. How long should I wait to have another test? Doctor wants me to wait two months but thatís a long way to go if there's something wrong with me.
   I can't comment on any particular case, but in general it is a good idea to repeat blood studies since a different result can occur next time the AST level is tested.


Fish oils
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 20ís to the 60ís. 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 20ís. 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.


I'm 46 yrs old and in excellent shape. I work out 5 days a week. I recently had my blood tested and my alt came in at 85 which is down from 95 from when I was last tested in Feb. All my other vitals including ast were good. I used to be a heavy drinker, and have laid of the alcohol the last month prior to my blood work hence the drop from 95 to 85. I also have a hypothroid, and I'm taking 175 mgs of Synthroid. My question is should I be alarmed by this? and also how long will it take for my alt levels to drop to the normal range? should I abstain from alcohol until it drops to normal levels? Once it does can I resume drinking socially?
    I can't give you specific personal advice just to say that one has to evaluate the whole person, including all symptoms, sign, physical exam, medical history, use of medications, supplements, results of other tests, etc, rather than make a decision based on one lab result of one specific number.