Alanine Aminotransferase (Alt)

This panel also includes an aspartate aminotransferase (AST) test. AST is another liver enzyme. As with ALT, the levels of AST in your blood rise if your liver is damaged.

What Are High ALT Levels and How to Lower Them

Alanine aminotransferase (ALT) is an enzyme found inside liver cells. Liver enzymes, including ALT, help your liver break down proteins to make them easier for your body to absorb.

When your liver is damaged or inflamed, it can release ALT into your bloodstream. This causes your ALT levels to rise. A high ALT level can indicate a liver problem, which is why doctors often use an ALT test when diagnosing liver conditions.

Several things can cause high ALT levels, including:

  • nonalcoholic fatty liver disease (NAFLD)
  • over-the-counter pain medications, especially acetaminophen
  • prescription medications used to manage cholesterol
  • alcohol consumption
  • obesity
  • hepatitis A, B, or C
  • heart failure
  • hereditary hemochromatosis, an inherited condition that can lead to liver disease due to iron overload
  • thyroid disorders
  • some muscle disorders
  • celiac disease

Rare causes

Other causes of high ALT levels that are rare include:

  • autoimmune hepatitis
  • alpha-1 antitrypsin deficiency, an inherited condition that can lead to lung and liver disease
  • Wilson’s disease, an inherited condition that can cause a buildup of copper in the body

Regardless of what’s causing your elevated ALT levels, it’s important to work with your doctor to find and address the underlying cause. But in the meantime, there are a few things you can try that may help lower your ALT levels.

Drink coffee

Several studies have found that coffee may have a protective effect on the liver and that drinking it can lower liver enzymes.

A 2017 review found that drinking anywhere from 1 to 4 cups of coffee per day can help lower ALT levels and reduce the risk of liver disease and cancer.

More recently, the results of a 2021 meta-analysis of 19 observational studies involving 222,067 people also suggested that coffee consumption was associated with lower ALT.

Another recent study into the benefits of coffee on liver health found that all types of coffee appeared to lower the risk of liver disease.

Consume more folate or take folic acid

Consuming more folate-rich foods and adding a folic acid supplement to your diet are both linked to lower ALT levels.

While the terms “folate” and “folic acid” are often used interchangeably, they aren’t quite the same. They’re two different forms of vitamin B9.

Folate is a naturally occurring form of B9 found in certain foods. Folic acid is a synthetic form of B9 used in supplements and added to some processed foods. Your body processes them in different ways, too.

While they aren’t quite identical, both folate and folic acid have benefits when it comes to liver health and lowering ALT.

Studies have linked folate deficiency to increased ALT levels and liver damage and found that folic acid appears to reduce ALT in people with liver damage.

A 2017 study found that folic acid appeared to be just as effective as, if not more than, silymarin treatment in lowering liver enzymes in children with drug-induced liver injuries from antiepileptic therapy.

To help lower ALT levels, consider adding more folate-rich foods to your diet, such as:

  • leafy greens, including kale and spinach
  • asparagus
  • legumes
  • Brussels sprouts
  • beets
  • bananas
  • papaya

You can also try taking a folic acid supplement. Most folic acid supplements contain doses of either 400 or 800 micrograms. Aim for a daily dose of 800 micrograms, which is the equivalent of 0.8 milligrams.

This is the dose involved in many studies looking at the link between folic acid and ALT levels.

Make changes to your diet

Adopting a healthier diet can help lower ALT levels and reduce your risk of liver disease.

A 2019 clinical trial compared the effects of a low sugar diet and a typical diet in adolescent boys with NAFLD. Sugar in the diet intervention group was limited to less than 3 percent of the total daily caloric intake.

After 8 weeks, those in the diet group had lower liver enzymes and a greater reduction in liver fat.

Reducing the amount of fat and carbohydrates can also help treat and prevent NAFLD, a common cause of high ALT.

To improve liver health and help lower ALT, you don’t necessarily need to make drastic changes to your diet. Start by trying to eat at least five servings of fresh fruits and vegetables per day.

You can also try incorporating these tips into your weekly meal planning:

  • Limit fruits and vegetables served with high calorie sauces or added sugar and salt.
  • Eat fish at least twice a week, ideally those high in omega-3 fatty acids, such as salmon or trout.
  • Opt for fat free or low fat milk and dairy products.
  • Replace saturated and trans fats with monounsaturated and polyunsaturated fats.
  • Choose fiber-rich whole grains.
  • Opt for lean animal proteins, such as skinless chicken or fish.
  • Swap fried foods for baked or roasted ones.
  • Snack on nuts, which have various health benefits and have been shown to lower liver enzymes in people with NAFLD.

Alanine Transaminase (ALT)

Alanine transaminase (ALT) is an enzyme that mainly exists in your liver. An ALT blood test is often included in a liver panel and comprehensive metabolic panel, and healthcare providers use it to help assess your liver health. High levels of ALT in your blood may indicate that you have damage to your liver and/or a liver condition.

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Overview

What is alanine transaminase (ALT)?

Alanine transaminase (ALT), also known as alanine aminotransferase, is an enzyme that’s mainly found in your liver, though it exists in other parts of your body.

An enzyme is a type of protein in a cell that acts as a catalyst and allows certain bodily processes to happen. There are thousands of enzymes throughout your body that have important functions.

What is an ALT blood test?

An alanine transaminase (ALT) blood test measures the amount of ALT in your blood. ALT levels in your blood can increase when your liver is damaged, so healthcare providers often use an ALT blood test to help assess the health of your liver.

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Since many types of liver problems can cause ALT levels to increase, healthcare providers don’t use the test alone to diagnose conditions. An ALT blood test is most often included in a blood test panel, such as a liver enzyme panel (HFP or LFT) or a comprehensive metabolic panel (CMP). A blood panel measures several aspects of your blood with one sample and can provide more detailed information about your overall health.

Common names for an ALT blood test include:

  • Alanine transaminase (ALT).
  • Alanine aminotransferase.
  • SGPT.
  • Serum glutamic-pyruvic transaminase.
  • GPT.

How is alanine transferase (ALT) different from aspartate transferase (AST)?

Aspartate transferase (AST) is another enzyme that’s commonly measured along with AST in a liver function panel or comprehensive metabolic panel. Both of these enzymes can leak into your bloodstream when certain cells in your body are damaged.

AST and ALT are both commonly considered liver enzymes, but there are greater amounts of AST in other parts of your body, such as your heart, skeletal muscles and pancreas. Because of this, ALT is considered to be more directly tied to your liver health, but healthcare providers use both measurements to assess the health of your liver.

Why do I need an ALT blood test?

The purpose of an ALT blood test is to help evaluate the health of your liver. If cells in your liver are damaged, it can cause ALT to leak into your blood, so an ALT blood test can help find liver issues.

Your healthcare provider may order a blood panel test that includes an ALT test for you to help screen for, monitor or help diagnose liver conditions.

Screening

Screening means checking for potential health issues before you experience symptoms. Your healthcare provider will likely recommend screening with a liver panel blood test that includes an ALT test if you have risk factors for liver disease, which include:

  • Heavy alcohol use.
  • Family history of liver disease.
  • Diabetes.
  • Obesity.
  • Injecting drugs using shared needles.

Since ALT tests are often included in routine blood panel tests that assess your general overall health, such as a comprehensive metabolic panel (CMP), you may have an ALT test even if you don’t have risk factors for liver disease.

Monitoring

If you have a liver condition, your provider may order an ALT test, often as part of a panel, to monitor your condition to see if it’s improving, worsening or staying the same with or without treatment. Your provider may also have you undergo an ALT test and liver enzyme panel test if you’re taking a medication that can affect your liver health.

Diagnosing

Your provider may use an ALT test for diagnostic purposes when you’re experiencing signs and symptoms of possible liver problems. While providers can’t diagnose a condition based solely on ALT levels, it can be an important part of the diagnostic process.

Signs and symptoms of liver conditions include:

  • Nausea and/or vomiting.
  • Belly (abdominal) pain.
  • Itchy skin.
  • Jaundice (a yellowing of your skin and the whites of your eyes).
  • Tiredness (fatigue).
  • Appetite loss.

Test Details

Who performs an ALT blood test?

A healthcare provider called a phlebotomist usually performs blood draws, including those for an ALT blood test, but any healthcare provider trained in drawing blood can perform this task. The samples are sent to a lab where a medical laboratory scientist prepares the samples and performs the test on machines known as analyzers.

Do I need to fast for an ALT blood test?

If your ALT test is part of a comprehensive metabolic panel (CMP), you’ll likely need to fast for 10 to 12 hours before your CMP blood test. Fasting means not eating or drinking anything other than water.

It’s not as common, but if you’re only getting an ALT blood test, you don’t need to fast.

In any case, your healthcare provider will give you instructions when they order the bloodwork. Be sure to follow their directions.

Do I need to do anything to prepare for an ALT blood test?

Many different types of medications and supplements can affect your ALT levels, so it’s important to tell your healthcare provider about any drugs or dietary supplements you’re taking before you get the test. In some cases, your provider may have you stop taking a medication before the test. Only stop taking medication if your provider tells you to do so.

Intense exercise can also affect your ALT levels, so tell your provider if you frequently do demanding physical workouts before you get the ALT test.

What should I expect during my ALT blood test?

You can expect to experience the following during a blood test, or blood draw:

  • You’ll sit in a chair, and a healthcare provider will check your arms for an easily accessible vein. This is usually in the inner part of your arm on the other side of your elbow.
  • Once they’ve located a vein, they’ll clean and disinfect the area.
  • They’ll then insert a small needle into your vein to take a blood sample. This may feel like a small pinch.
  • After they insert the needle, a small amount of blood will collect in a test tube.
  • Once they have enough blood to test, they’ll remove the needle and hold a cotton ball or gauze on the site to stop any bleeding.
  • They’ll place a bandage over the site, and you’ll be finished.

The entire procedure usually takes less than five minutes.

What should I expect after my ALT blood test?

After a healthcare provider has collected your blood sample, they’ll send it to a laboratory for testing. Once the test results are back, your healthcare provider will share the results with you.

What are the risks of an ALT blood test?

Blood tests are a very common and essential part of medical testing and screening. There’s very little risk to having blood tests. You may have slight tenderness or a bruise at the site of the blood draw, but this usually resolves quickly.

When can I expect the results of my ALT blood test?

In most cases, you should have your test results within one to two business days, though it could take longer.

Results and Follow-Up

What do the results of an ALT blood test mean?

Blood test reports, including alanine transaminase (ALT) test reports, usually provide the following information:

  • The name of the blood test or what was measured in your blood.
  • The number or measurement of your blood test result.
  • The normal measurement range for that test.
  • Information that indicates if your result is normal or abnormal or high or low.

What is the normal range for an ALT blood test?

The normal range for alanine transaminase (ALT) varies from laboratory to laboratory. One common reference range for an ALT blood test is 7 to 56 U/L (units per liter). ALT levels are typically higher in people assigned male at birth than in people assigned female at birth.

Since ranges can vary depending on the laboratory, it’s important to check your test result report to see what your specific lab’s reference range is.

What does it mean if my alanine transaminase (ALT) is high?

High levels of ALT in your blood can be due to damage or injury to the cells in your liver. An increased ALT level may indicate the following conditions:

  • Alcohol-induced liver injury.
  • Fatty liver disease (too much fat in your liver).
  • Hepatitis (liver inflammation).
  • Cirrhosis (scarring of the liver).
  • Taking medications that are toxic to your liver.
  • Liver tumor or liver cancer.
  • Liver ischemia (not enough blood flow to your liver, which leads to death of liver tissue).
  • Hemochromatosis (having too much iron in your body).
  • Mononucleosis (“mono”).
  • Certain genetic conditions can affect your liver.
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Although it’s less common, elevated ALT levels can also indicate injury to cells in other parts of your body, since ALT isn’t solely found in your liver.

It’s important to know that having a high ALT test result doesn’t necessarily mean you have a medical condition. Less than 5% of people with elevated ALT levels have severe liver conditions. Other factors can affect your ALT levels. Your provider will take into consideration several factors, including other blood test results and your medical history, when analyzing your results.

What does it mean if my alanine transaminase (ALT) is low?

Having a lower than normal ALT result is uncommon and usually isn’t a cause for concern. However, a lower than normal ALT level could indicate a vitamin B6 deficiency or chronic kidney disease.

If your ALT result is lower than what’s considered normal, your healthcare provider will likely have you retake the test or undergo further testing to make sure nothing is causing your low level.

Should I be worried if I have high or low alanine transaminase (ALT) test results?

If your ALT test result is high or low, it doesn’t necessarily mean that you have a medical condition that needs treatment. Other factors can affect your levels, including:

  • Exercise: Intense or extreme exercise can cause a temporary increase in ALT levels.
  • Medications: Several medications and supplements can affect ALT levels, including over-the-counter pain medications such as acetaminophen.
  • Sex: Scientists believe hormonal differences contribute to sex differences in ALT levels.
  • Menstruation: ALT levels can increase or decrease during your menstrual cycle.
  • Age: ALT levels tend to decrease with older age.
  • Heritage: Research shows that people who have Mexican-American heritage are more likely to have elevated levels of ALT.
  • Body mass index: Several studies have revealed an association between ALT levels and body mass index (BMI), which may change the interpretation of test results in people who have obesity.

In addition to the above factors, when analyzing your ALT results, your healthcare provider will take into consideration many aspects of your health and situation, including:

  • Your medical history.
  • How high or low your ALT results are.
  • Previous ALT results.
  • The results of other tests usually taken alongside ALT.
  • If you’re experiencing symptoms.

Do I need follow-up tests if my ALT results are abnormal?

It’s common for healthcare providers to recommend follow-up tests if you have an abnormal ALT level.

Follow-up testing may include:

  • Repeat ALT blood tests.
  • Other blood tests.
  • Imaging tests.
  • A biopsy.

Additional testing may be immediate if you have significantly elevated ALT levels and/or are experiencing symptoms of a liver condition.

Every person and situation is unique, so there’s no single follow-up testing plan that works for everyone. Together, you and your provider will determine the best plan.

When should I call my doctor?

If you’re experiencing symptoms of liver damage, such as jaundice or belly pain, call your healthcare provider.

If you’ve been diagnosed with a liver condition and are experiencing new or concerning symptoms, contact your provider.

If you have any questions about your alanine transaminase (ALT) results, don’t be afraid to ask your provider questions.

A note from Cleveland Clinic

Seeing an abnormal test result can be stressful. Know that having a high level of alanine transaminase (ALT) doesn’t necessarily mean you have a medical condition and need treatment. Many factors can affect your ALT levels, and 1 in 20 healthy people will have results outside of the normal range. Your healthcare provider will let you know if you need to undergo further tests to determine the cause of the abnormal level. Don’t be afraid to ask your provider questions. They’re there to help you.

What Is an Alanine Aminotransferease (ALT) Test?

The alanine aminotransferase (ALT) test is a blood test that checks for liver damage. Your doctor can use this test to find out if a disease, drug, or injury has damaged your liver.

Your liver does a lot of important things for you:

  • It makes a fluid called bile that helps your body digest food.
  • It removes waste products and other toxins from your blood.
  • It produces proteins and cholesterol.

Diseases such as hepatitis and cirrhosis can damage your liver and prevent it from doing its many jobs.

Why Is ALT Important?

This enzyme is found mainly in your liver. Smaller amounts of ALT are in your kidneys and other organs, too.

Your body uses ALT to break down food into energy. Normally, ALT levels in the blood are low. If your liver is damaged, it will release more ALT into your blood and levels will rise. (ALT used to be called serum glutamic-pyruvic transaminase, or SGPT).

Doctors often give the ALT test along with other liver tests.

Why Would My Doctor Order This Test?

Your doctor might recommend ALT if you have symptoms of liver disease or damage, such as:

  • Stomach pain or swelling
  • Nausea
  • Vomiting
  • Yellow skin or eyes (a condition called jaundice)
  • Weakness
  • Extreme tiredness (fatigue)
  • Dark-colored urine
  • Light-colored poop
  • Itchy skin

Here are some reasons you might get this test:

  • You’ve been exposed to the hepatitis virus.
  • You drink a lot of alcohol.
  • You have a family history of liver disease.
  • You take medicine that’s known to cause liver damage.

The ALT test can be done as part of a blood panel during a regular exam. If you’ve already been diagnosed with liver disease, your doctor can use the ALT test to see how well your treatment is working.

How Do I Prepare?

You don’t need any special preparation for the ALT test. Your doctor might ask you to stop eating or drinking a few hours before the test.

Tell your doctor what prescription drugs or supplements you take. Some medicines can affect the results of this test.

What Happens During the Test?

A nurse or lab tech will take a sample of your blood, usually from a vein in your arm. They will first tie a band around the upper part of your arm to make your vein fill with blood and swell up. Then they will clean the area with an antiseptic and place a needle into your vein. Your blood will collect into a vial or tube.

The blood test should take only a couple of minutes. After your blood is taken, the lab tech will remove the needle and band, then put a piece of gauze and a bandage over the spot the needle went in to stop the bleeding.

What Are the Risks?

The ALT blood test is safe. Risks are usually minor, and can include:

  • Bleeding
  • Bruising
  • Infection
  • Slight pain when the needle is inserted
  • Fainting or feeling dizzy

What Do the Results Mean?

You should get your results in about a day. A normal ALT test result can range from 7 to 55 units per liter (U/L). Levels are normally higher in men.

Slightly high ALT levels may be caused by:

  • Alcohol abuse
  • Cirrhosis (long-term damage and scarring of the liver)
  • Mononucleosis
  • Drugs such as statins, aspirin, and some sleep aids

Moderately high ALT levels may be because of:

  • Chronic (ongoing) liver disease
  • Alcohol abuse
  • Cirrhosis
  • Blockage of the bile ducts
  • Heart attack or heart failure (when your heart can’t pump enough blood to your body)
  • Kidney damage
  • Muscle injury
  • Damage to red blood cells
  • Heat stroke
  • Too much vitamin A

Very high ALT levels can be caused by:

  • Acute viral hepatitis
  • An overdose of drugs such as acetaminophen (Tylenol)
  • Liver cancer
  • Sepsis

What Other Tests Will I Take?

ALT usually is done as part of a group of liver function tests called a liver panel.

This panel also includes an aspartate aminotransferase (AST) test. AST is another liver enzyme. As with ALT, the levels of AST in your blood rise if your liver is damaged.

Comparing ALT with AST levels gives your doctor more information about the health of your liver. The ALT-to-AST ratio can help your doctor figure out how severe the liver damage is and what might have caused it.

To find out what type of liver disease you have, your doctor might also test the levels of other enzymes and proteins found in your liver, including:

  • Albumin
  • Alkaline phosphatase
  • Bilirubin
  • Lactate dehydrogenase (LDH)
  • Total protein

Talk to your doctor to make sure you understand all of your liver test results. Also find out how these results might affect your treatment.

Show Sources

American Association for Clinical Chemistry: “ALT.”

Mayo Clinic: “Liver Disease: Definition.” “Liver function tests.”

Medscape: “Alanine Aminotransferase.”

National Heart, Lung, and Blood Institute: “What To Expect With Blood Tests.”

Nemours Foundation: “Blood Test: Alanine Aminotransferase (ALT, or SGPT).”

University of Rochester Medical Center: “ALT.”

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Alex Koliada, PhD

Alex Koliada, PhD

Alex Koliada, PhD, is a well-known doctor. He is famous for his studies of ageing, genetics and other medical conditions. He works at the Institute of Food Biotechnology and Genomics NAS of Ukraine. His scientific researches are printed by the most reputable international magazines. Some of his works are: Differences in the gut Firmicutes to Bacteroidetes ratio across age groups in healthy Ukrainian population [BiomedCentral.com]; Mating status affects Drosophila lifespan, metabolism and antioxidant system [Science Direct]; Anise Hyssop Agastache foeniculum Increases Lifespan, Stress Resistance, and Metabolism by Affecting Free Radical Processes in Drosophila [Frontiersin].
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