- Non-alcoholic fatty liver disease caused by insulin resistance and high sugar consumption is the #1 cause of elevated AST and ALT in the US, affecting about 30% of people, but it's reversible with diet changes and weight loss.
- If your liver enzymes are slightly elevated (30-70 range), focus on finding the root cause by checking fasting glucose, Hemoglobin A1c, cholesterol levels, and BMI to determine if you have metabolic syndrome or insulin resistance.
- Clean up your diet by eliminating refined carbohydrates, sugary drinks, and processed foods while eating more fresh fruits, vegetables, and walnuts to reduce liver inflammation and improve your AST and ALT levels.
- Be cautious with Tylenol (acetaminophen) because even daily doses of 5-8 grams can damage your liver over time, making it critical to monitor your total daily intake from all sources.
- Take milk thistle as a supplement since studies show silymarin protects your liver against injury from Tylenol, alcohol, iron overload, and other causes by acting as an antioxidant and supporting hepatocyte function.
Elevated liver enzymes may act as a warning that something is damaging your liver and should never be ignored.
Learn what causes elevated liver enzymes, what symptoms you may present with, and more importantly how to treat this problem…
Liver Enzyme Made Easy (AST & ALT)
What are liver enzymes and what do they mean?
In the most simple sense, liver enzymes are used to represent a series of tests that can help to determine if your liver is functioning appropriately.ย
The standard “liver function tests” include:
- Alanine Transaminase (or ALT for short): ALT is produced in the liver cells known as hepatocytes and is a very specific marker of liver cell damage.
- Aspartate Transaminase (or AST for short): AST is not quite as specific as ALT for liver damage as it is also found in skeletal muscle, heart muscle, and kidney tissue. AST tends to rise with ALT if liver damage is present.ย
- Alkaline Phosphatase (or ALP for short): ALP is produced by the cells lining the bile ducts or the “plumbing” of the liver. A rise in ALT is commonly seen in conditions that cause blocked “ducts” such as bile stones or direct damage to the bile ducts.ย
- Gamma-glutamyltransferase (or GGT for short): GGT is found in the liver, kidney, pancreatic and intestinal tissues. If GGT is elevated along with ALP this is highly indicative of an obstruction in the plumbing of the liver or may indicate gallbladder disease.ย
If you are dealing with “elevated liver enzymes” you most likely have an issue with AST and ALT.
While ALP and GGT are still important to assess what is happening in the liver most physicians refer to AST and ALT as the “liver enzymes”.
So what do liver enzymes tell us?
Liver enzymes help us determine if there is damage to the cells of the liver or direct damage to the liver tissue itself.
If damage is present in the liver then it will react by releasing these special enzymes (AST and ALT) into the bloodstream as the cells become “leaky”.
So if you are dealing with an elevation in liver enzymes that is an indication that there is some sort of damage occurring in your liver.
And this is obviously less than ideal.
Your liver is considered a vital organ (meaning you can’t live without it) and it helps to detoxify chemicals you come into contact with, break down supplements/medications, red blood cell production, and hormone production and plays a critical role in protein synthesis and biochemical reactions.
These reactions are critical to everyday life which is why you can’t live without your liver.
In addition, we have no way to create “synthetic” livers in the event that you have permanently damaged your liver.
So it’s in your best interest to keep yours healthy.
For the purposes of this article, we want to focus on the most common causes of elevated liver enzymes so that you can determine what is causing the problem and then prevent long-term and permanent damage.
When we talk about an “elevation” in AST and ALT we really need to define what we are talking about, what kind of numbers you should be worried about, and how to address them.
The “Rise” in Liver Enzymes
There are two basic types of elevated liver enzymes:
The first is a slight or subtle increase in AST and ALT and the second is a massive increase in AST and ALT.
We are going to focus on the slight or subtle increase in AST and ALT (levels less than 100-300 times normal) because this usually indicates a chronic condition that results in low-grade inflammation and damage to the liver over time.
Massively elevated AST and ALT (levels greater than 10x the normal reference range) usually indicate an acute life-threatening condition such as liver failure from medication overdose, physical trauma to the liver, or massive organ failure.ย
While massive elevations in liver enzymes are obviously important, the subtle increase is more relevant to most people because they can do something about it.
So what does it mean to have elevated liver enzymes?
Most laboratory reference ranges include a “range” of values to indicate that you are “normal”.
If you go outside (or too high) this range then you are considered to have elevated liver enzymes.
The standard range largely depends on the laboratory but in general, is somewhere around 0-45 IU/l for ALT and 0-30 IU/l for AST.
If your AST and ALT are higher than the 45 and 35 then they are said to be “elevated”.
And this is a big issue because by definition that means that you are experiencing some sort of liver damage.
More important than just knowing that your liver function tests are elevated is figuring out why they are elevated, to begin with, and the picture behind their elevation.
We will discuss the most common causes of elevated AST and ALT below (including treatment) but first, let’s talk a little bit about lab values.
While the laboratory data shows there is a “range” for both AST and ALT you can picture the damage done to your liver on a spectrum.
On this spectrum, the higher your AST and ALT values are the more damage that exists in the liver.
This correlation exists to the point that you can almost define disease states based on the elevation of AST and ALT.
For instance:
Patients with chronic hepatitis tend to have AST and ALT levels in the 30-120 range, and those with autoimmune hepatitis tend to have levels in the 100-600 range.
Perhaps more important than these two causes is liver damage caused by a condition known as non-alcoholic fatty liver disease.
If your liver enzymes are elevated then there is a VERY high chance the damage to your liver is actually caused by your diet and a condition known as insulin resistance.
The elevation in AST and ALT observed in this condition tends to be mild (and may even be missed!).
People with non-alcoholic fatty liver disease will often have a very “modest” elevation in AST and ALT, somewhere in the 30-70 range for both.
What’s more interesting is that people with this condition tend to be completely asymptomatic, which means that this condition is really only picked up on routine screening.
Patients with this condition often tend to also be overweight and have issues with glucose regulation.
Once it is identified that you do indeed have elevated liver enzymes your Doctor should begin to do a workup to figure out the cause.
Once the cause is determined then you can focus on the treatment.
When thinking about what causes damage to the liver it’s important to focus on those conditions which are VERY common as opposed to rare conditions.
Most Common Causes of High AST/ALT
There are MANY, MANY conditions and disease states that lead to high AST and ALT but the majority of them can be boiled down to just a few conditions.
This list below is not all-encompassing but should give you a good idea of how to get started.
Emphasis should be put on #1 and #2 which will most likely account for the vast majority of slight elevations in AST and ALT in most people.
The reason you should focus on these is that they are treatable and reversible.
#1. Non-Alcoholic Fatty Liver Disease (AST and ALT levels in the 30-70 range)
This is by far the #1 cause of elevated AST and ALT in the United States with a prevalence of up to 30% (1) and it’s primarily caused by insulin resistance and almost entirely preventable!
How it happens:
As you consume sugary, especially refined sugar, your body rapidly metabolizes glucose into fats or lipids in the liver through a process known as de novo lipogenesis.
As the influx of glucose becomes more than your body is able to handle this fat begins to get stored in the liver.
As fat increases in the liver, it results in damage to the liver cells.
This damage is seen in the serum (bloodstream) as an elevation in serum levels of AST and ALT.
If the diet is not changed or if insulin resistance is not managed then this fat accumulation will eventually cause permanent and chronic damage to the liver.
This may result in complete liver failure over time.
It’s very important to find out if your elevated liver enzymes are caused by non-alcoholic fatty liver disease because it can be treated and damage can be prevented.
Those with AST and ALT caused by fatty liver disease can be diagnosed by checking AST/ALT levels in conjunction with fasting glucose, Hgb A1c, serum cholesterol, and by checking BMI.
People who have metabolic syndrome and high AST/ALT should be evaluated for diabetes and insulin resistance.ย
#2. Alcoholic Liver disease (AST and ALT in the 70-700 range)
Alcoholic liver disease used to be the #1 cause of liver failure in the United States until it was taken out by non-alcoholic fatty liver disease and obesity.
Having said that it is still an important cause of liver damage in many people.
The liver damage caused by alcohol consumption occurs after prolonged and excessive drinking (usually years’ worth of damage to the liver).
It can occur from daily drinking or episodes of binge drinking.
Consuming 30 grams of undiluted alcohol for 10 years (4) may result in a condition known as cirrhosis (permanent liver damage).
The mechanism of damage is similar to that of non-alcoholic fatty liver disease.
Overconsumption of alcohol results in direct damage to liver cells and puts an increase in demand on your body.
You can think of alcohol as a liquid carbohydrate source that must be metabolized by the liver.
This produces chronic damage and fat accumulation in the liver much like non-alcoholic fatty liver disease.
What’s interesting is that alcohol consumption, even in small amounts, can make existing liver conditions (such as non-alcoholic fatty liver disease) even worse.
Because of this, it is recommended that you stop consuming alcohol if you have elevated liver enzymes – even if it is not primarily caused by alcohol consumption.
The primary treatment for alcoholic liver damage is to stop consuming alcohol, in some cases, this is enough to completely reverse the condition or at least stop further damage.
#3. Prescription Medications (Low-grade elevation of AST/ALT)
Certain prescription medications can also cause liver damage.
Remember:
Medications must be metabolized by the body and that metabolism usually occurs in the liver.
As your body breaks down certain medications it creates byproducts that can still remain active and some may even be toxic.
If these metabolites are left in the body they can cause local injury to the liver or injury to other tissues.
The perfect example is Tylenol (5).
In small doses, your liver can metabolize it without issues, but once doses become excessive Tylenol metabolites can cause serious damage to your body and even result in acute liver failure.
In the case of Tylenol, even daily doses of 5 to 8 grams per day may lead to liver damage over time.
This is very important to consider because Tylenol is available over the counter and commonly used for aches and pains.
Other medications that may cause liver damage include:
- Statin medicationsย (6)
- Tylenol (7) (acute ingestion or chronic doses of more than 4 grams per day over time)
- Oral Testosterone (8) (due to first-pass metabolism)ย
- Chronic daily steroid use
- Certain antibiotics (nitrofurantoin, minocycline)
- And many more…ย (9)
If you are taking a medication that is causing liver damage (and it isn’t necessary to take) then the treatment is to discontinue or reduce the dosage of medication.
#4. Certain Supplements (Low-grade elevation of AST/ALT)
Even some supplements have been shown to cause acute liver damage and cause a rise in liver function tests.
The supplements that tend to cause issues are hard to pinpoint exactly.
Most of the information we have stems from case studies of patients who were taking very suspect types of “fat burners” and combining them with many different weight loss supplements.
Some case studies (10) show that these types of supplements can cause acute liver damage in certain susceptible individuals.
This shouldn’t be enough to cause alarm among most people, however.
The people who experience these side effects tend to do so when they use poor-quality supplements that likely contain actual hormones and medications in them.
Not all supplements are regulated in the same way that the pharmaceutical industry is, which means that you can get more (or less) than you are expecting.
Some weight loss supplements have even been shown to contain toxic doses of actual thyroid hormone (11).
You can avoid all of these potentially dangerous side effects simply by purchasing high-quality supplements that ship from the United States (don’t purchase supplements overseas) from reputable companies and suppliers.
Also, please avoid supplements with “too good to be true” advertising, especially in the weight loss area.
You can read more about how to safely and correctly use supplements such as fish oil, berberine, and CLA to augment weight loss therapies in my other guides.
Using these types of non-gimmicky supplements can actually help with weight loss – provided they are used correctly.
#5. Autoimmune Hepatitis (AST/ALT in the 100 to 600 range)
While autoimmune hepatitis is not as common as the other 4 listed above it’s still worth mentioning.
Autoimmune disease is on the rise in the United States and is, therefore, a very important cause of diseases.
The term autoimmune means exactly as it sounds – auto attack by the immune system on your body or tissues.
In autoimmune hepatitis (12), your immune system creates antibodies that circulate in the body and target your liver as the “enemy”.
This results in inflammation and chronic damage which can lead to irreversible damage in some cases.
Who is at risk of developing this condition?
It turns out, like most autoimmune diseases, that women get this disease much more frequently than men.
What causes it?
While the exact mechanism and trigger are unknown it is felt that the etiology of autoimmune hepatitis is multifactorial.
What this means is that the disease can be “triggered” or “turned on” by certain environmental factors such as exposure to toxins or infection.
Autoimmune diseases tend to occur in individuals with a genetic predisposition, meaning not everyone is at risk.
#6. Viral Hepatitis & Other Viral Diseases (AST and ALT depend on the degree of the damage)
An elevation in liver function tests will prompt an immediate workup for basic viral hepatitis by your physician.
A history of intravenous drug use, old tattoos, or high-risk behavior may increase the risk that your liver damage is caused by a viral infection.
Hepatitis B and Hepatitis C, both of which are viral infections, may lead to chronic and long-term damage to the liver.
Hepatitis A (13) (spread via the fecal-oral route) on the other hand tends to be more acute in nature with an acute spike in AST and ALT in a short period.
This should be compared to chronic Hepatitis B and C (14) which tend to cause a slower and more long-term elevation in liver function tests.
But these aren’t the only viruses that cause liver damage.
CMV and EBV (15) (both of which are very common) may also cause an acute spike in liver enzymes.
The damage from CMV and EBV tends to be short-lived however and shouldn’t cause long-term damage.
In addition, the rise in liver enzymes is almost always associated with other systemic symptoms such as fatigue, malaise, sore throat (in the case of EBV), and fever.
It’s worth mentioning viral infections because they are an important cause of liver damage, but they are generally caught and treated appropriately in most patients.
#7. Copper and Iron Overload Syndromes (AST and ALT depend on the degree of the damage)
Another sinister cause of liver damage and thus elevated liver enzymes is an overload of certain metals in the body.
Overload syndromes such as Iron overload (also known as hemochromatosis (16)) and copper overload (also known as Wilson’s disease (17)) result in the deposition of high levels of metals in specific tissues which results in damage to these tissues over time.
While iron and copper deposit in more than just the liver, they definitely can and do cause liver damage if they are deposited there.
The prevalence of Hemochromatosis is estimated to be around 1 in every 200 to 500 people which is fairly high.
Generally, those people who have Hemochromatosis are often asymptomatic and the diagnosis is made by finding a slight elevation in liver function tests with abnormal serum iron levels.
As long as it is caught early the damage can be mitigated.
Wilson’s disease is much less common and more difficult to diagnose but still worth mentioning as it is an overload disease that can cause liver damage.
Tips to Naturally Treat and Improve Liver Function
Regardless of the cause of liver damage in your body, there are several steps that you can take to improve liver function and perhaps impact your liver enzyme levels.
If you aren’t sure where to start then you can consider following these guidelines.
And remember:
The #1 cause of elevated liver enzymes in the United States is non-alcoholic fatty liver disease which is caused by obesity and insulin resistance.
It’s also one of the most treatable causes of liver damage.
Find the Root Cause
Whenever possible your main goal should be to find the source and cause of your elevated liver enzymes.
Once you know the source you can direct your treatment to that specific problem.
For example:
The root cause of non-alcoholic fatty liver disease = insulin resistance and obesity (which should be your target treatment).
The root cause of alcoholic fatty liver disease = alcohol intake.
The root cause of iron overload syndrome is the inability to get rid of iron adequately (treatment should focus on reducing oral iron intake and phlebotomyย (18)).ย
You should never “ignore” elevated liver enzymes because they indicate something wrong in your body!
I also recommend keeping an eye on your AST and ALT levels with a goal to try and get both to less than 20 IU/l.
Take inventory of Supplements and Medications
Make sure you are only taking those medications and supplements that are absolutely necessary for your body.
Supplements AND medications must be processed through the liver which can increase demand on your body.
Some medications you may need to continue even if they are potentially causing increased demand but the same may not be true with all supplements.
You should also try to avoid sketchy weight loss supplements or supplements that come from overseas.
Taking supplements such as B12, a multivitamin, fish oil, etc. should not be an issue.
Clean Up Your Diet
That means eating more fruits and vegetables!
Even if your liver issues are not caused by insulin resistance you can bet that eating excess sugar or refined carbs will definitely NOT be helping your issue.
Remember:
Once the liver is slightly damaged it becomes susceptible to other potential causes of damage.
If you have non-alcoholic fatty liver disease you can be sure that excess alcohol consumption is NOT going to help your liver out.
Stick to these tips:
- Consume plenty of fresh and whole fruits and vegetablesย (19) (a rich source of antioxidative vitamins like B carotene and Vitamins C & E)
- Avoid refined carbohydrates (bread, pasta, bagels, etc.)
- Avoid refined sugars (especially sugary drinks such as flavored coffee, and sodas)
- Avoid alcohol 100%
- Avoid fast food
- Consume walnuts (a rich source of a-linoleic fatty acid)
Certain Supplements
While some supplements may potentially be damaging to the liver, others may offer considerable help.
One such supplement is Milk Thistle.
In various studies, milk thistle has been shown to work as an antioxidant in the liver, protect the liver against genomic injury, increase hepatocyte protein synthesis, and decrease the activity of tumor promoters (20).
In animal studies (21), silymarin (the active ingredient in milk thistle) has been shown to reduce liver injury caused by Tylenol, iron overload, alcohol, and other causes.
With this in mind, milk thistle may be considered in many individuals with elevated liver enzymes.
Conclusion
Abnormalities in liver function tests should never be ignored.
If you have been identified as having an elevation in liver enzymes then you should go to work to find the root cause.
Whenever possible address and treat this condition and try to lower your AST and ALT levels as much as possible with treatment.
Now I want to hear from you:
Are you suffering from an elevation of AST and ALT?
Do you know why?
Leave your comments below!
Scientific References
#1. https://www.ncbi.nlm.nih.gov/pubmed/21875310
#2. https://www.ncbi.nlm.nih.gov/pubmed/25527677
#3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2387293/
#4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321494/
#5. https://www.ncbi.nlm.nih.gov/pubmed/900673
#6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983981/
#7. https://www.ncbi.nlm.nih.gov/pubmed/900673
#8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897047/
#9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3940315/
#10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076034/
#11. http://online.liebertpub.com/doi/abs/10.1089/thy.2013.0101?journalCode=thy&
#12. https://emedicine.medscape.com/article/172356-overview
#13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88961/
#14. https://www.ncbi.nlm.nih.gov/pubmed/21108341
#15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2932915/
#16. https://www.ncbi.nlm.nih.gov/pubmed/23418762
#17. https://www.ncbi.nlm.nih.gov/pubmed/10470603
#18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149125/
#19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4027841/
#20. https://www.ncbi.nlm.nih.gov/pubmed/9468229
#21. https://www.ncbi.nlm.nih.gov/pubmed/20564545
Could you explain a possible link between elevated liver enzymes and SIBO?
My AST has been mildly high for the last several years, usually 1 to 8 points above the normal range. One doctor suggest it could be related to high EBV scores, but I do not test postive for a current infection. Usually the ALT is on the high end of normal, but occasionally mildly elevated (1-7 points). My recent hepatic score for AST was 55 (highest it’s ever been) and ALT normal. I started taking a new timed released CoQ10 product to raise my baseline serum levels of this supplement to get the benefits associated with CoQ10 supplementation, so this higher elevation (of 55) coincided with the introduction of this supplement. Ultrasound of liver shows no fatty liver disease or other pathology (all lower abdomen organs were viewed as normal, pancreas, gall bladder, kidneys (two small stones only). Do you think the CoQ10 could be responsible? I also have been working out at the gym more aggressively, which my doctor said could raise an AST level, due to muscle/skeletal strain. Can you comment on my situation? Do you have any thoughts or suggestions? I take milk thistle and phosphatidyl choline for liver health daily.
My liver enzymes are extremely high. I did abuse acetaminophen when I was a teenager and in my early 20s. Iโm 48 and my liver enzymes have been high for the past few years. The cause of the high enzymes has not been determined by my doctor.
Does anyone know if vaccines can contribute to liver enzymes rising?
From 2/21/18 to5/15/19
AST went from 66-232 ,ALT 2-22-18 16 ALT11/21/18 & 5/15/19- 10.
Hi Dr. Childโs.
I happened upon your article, while researching elevated liver enzymes.
This is frightening to me, as my husband passed away 4 years ago due to non-alcoholic cirrhosis of the liver. Pretty sure due to many years on methotrexate and prednisone for arthritis.
I am a 72 year old female.
Six months ago my ALT was 21
and my AST was 21 as well.
Last week my AST was 37
and my ALT was 152.
My only prescription medication is 10 mg lisinopril daily.
I also take 81 mg aspirin daily.
I do however take 12 vitamins daily, adding recently (April, 2019) potassium.
I do not drink alcohol nor have I ever used drugs.
My nurse practitioner told me to stop some of my vitamins and I will have a new bloodwork done in 2 weeks.
My question is, she had me stop turmeric and milk thistle…. they are specifically for the liver. I am very confused about that.
I have been on the KETO diet for 13 months, and just stopped it.
I want to see another doctor, but donโt know what type of doctor I should see for this?
I donโt want to put this off as I know I need to find the reason behind this.
I am a nervous wreck. I hope you can give me some advise.
Thanks for your valuable time.
My annual exam revealed elevated AST (41) and ALT (81) compared to last year’s exam, AST (22) and ALT (17). I have been Whole Foods Plant Based low Sugar,Oil, Salt for a little over a year. I have never had elevated liver enzymes before. I have been doing diet and lifestyle to improve my lipid readings. My total cholesterol dropped from 268 to 245, my LDL from 186 to 173, and my HDL unfortunately dropped too, from 62 to 53. I am getting further tests but I am baffled. I had been taking HCTZ but was switched to olmesartan because the HCTZ was causing constipation and raised my triglycerides. I thought going plant based was going to heal everything -not bring on another issue. My BMI is 23. What should I be looking at as the culprit for the rise?
I am a 48 yr old male. My liver damage was created by high stress, alcohol abuse (binge drinking) and poor diet.
1st test results before any treatment:
AST 41
ALT 100
After initial treatment of ozone therapy. (Major Auto-Hemotherapy)
Results:
AST 44
ALT 41
After 2nd treatment
AST 26
ALT 41
Needless to say, I’m going back for more!
Hi Manny,
That’s great! Thanks for sharing.
I have just received bloodwork with a ALT of 201 and AST of 641. I am post breast cancer treatment, have been on a ketogenic diet since January 2019 and do not drink alcohol. I do use the swerve sweeteners (erthyitol and monk fruit) but do not eat fruit either. I did have heavy chemo from 4/17 to end of September and have 9 lymph nodes that were removed. Also, I had 40 radiation treatments which all ended in January of 2018, so I’ve been out of treatment for 1 1/2 years. My wbc is very low…2.9, which has been this way for years…even before treatment and despite lots of medicinal mushrooms. My oncologist is redoing the bloodwork just to make sure it’s correct and I have a whole body CT scheduled for Monday. Based on your article, I would suspect autoimmune hepatitis or EBV or overload of metals. I also drink exogenous ketones as I get kicked out of ketosis fairly easy, even eating a net carb count of 20 or lower. I’m a 45 year old mama of three young children and I want to stay alive…trying my hardest! I meditate, lift weights, walk, eat organic and free range and only put healthy and pure foods into my body. I just don’t know what to do anymore.
So kinds freaking out as my 14 year old son has his liver enzymes checked because its required before he can take a certain oral medication and his dermatologist called & said his enzymes were really high and he needs to get seen at his regular doctor asap. His ASL is 661 and his ALS is 199.
I’m waiting for his doctor to call me hopefully 1st thing tomorrow morning but im baffled because he’s 14, healthy, not overweight, eats great & has had no issues other than occasional headaches.
Thoughts?
Hello Dr. Childs:
Very information discussion on liver enzymes. I am 64-year-old male and have taken OTC nicotinic acid in the amount of about 1,200 โ 1,500 mg per day for probably 25 years for cholesterol. I do not drink and am not overweight. I discontinued niacin a week ago.
In May my AST=50 and ALT=27. A retest in July showed AST=59 and ALT=19. One year ago AST=29 and ALT=37. I will be retested in early October. My GGT levels have always been high, around 100. All other blood work items are normal and I have no liver disease symptoms I am aware of.
I have become concerned while waiting. Based on the AST/ALT results, do you know how likely it would be for me to have a significant liver damage?
Thanks! Dave
Hello, Dr. Childs.
Thank you for your informative article.
What would you recommend for those of us with elevated ALT and AST levels caused by pharmaceutical drugs for rheumatoid disease? We are told we are not able to stop taking these drugs that cause liver damage. Thank you.
Does anyone know if alt at 206 from alcohol can be reversed…
Does anyone know if an alt of 206 of alcohol abuse can be reversed…. plz anyone…
Hello, I have been diagnosed with non alcoholic fatty liver disease and hypothyroidism over the past year my liver enzymes has been increasing with both Alt and AST in the 60โs I am negatative for all hepatitis disease. My doctor wants an abdominal ultrasound and wants to refer me to a GI doctor. Iโm am freaking out .
Dear Dr Childs, I became ill 2.5 years ago. Previous normal LFTs. I was a nurse and a patient vomited over me, I also had taken Nitrofuradantoin for one week several months before. After the former incident I was ill for 2 weeks , like gastric flu, but after this felt tired and lethargic but nil specific. Three months later ALT 1850 AST 1450 Bil 226.No alcohol , no drugs. After biopsy showing no significant fibrous, focal !bridging necrosis and lymphatic infiltration with few plasma cells, diagnosed with likely acute onset AIH. Also at same time diagnosed stage one Papilory Bladder cancer (Turbt Sept 2018). I have been on Prednisolone (now 2.5mg) and Azathioprine since then. The later continually at 50mg , Refused to take higher dose due to previous cancer. My LFTs came to ALT early 40s AST early 30s. After 5 months Six months ago I lost 3 stone now ALT 22-24. AST 30-35. My immunoglobulins are lower end of normal. I will be seeking to coming off medication in the next six months. My concerns are now AST about 5-6 points higher than ALT, Donโt see Gastroenterologist for six months . He suggest no biopsy prior to reducing/ discontinuing meds. Could this AST be due to fibrous ? Iโm just into overweight range still loosing weight 5 10 208 lbs at present I would value your thoughts please re AST level.
My Husband is 49 has high blood pressure was started on lisinopril 5mg 6 months after first dose was seen by Dr. she did
blood work called said everything was fine. One year later my Husband went back in and his blood pressure was elevated again so they raised the lisinopril to 10 mg and did blood work called my Husband two days later to tell him his liver enzymes were elevated slightly and his cholesterol was at 288 he had all good blood work up until taking the meds. His Dr asked him to start eating healthy but no mention of the meds he is on . I called them back and asked if it could be the lisnopril raising his enzyme levels and possibly his cholesterol and I had complete silence . So I am trying to get my Husband in to see a different Dr.
hello yes my liver has the AST at 54ug/l so am trying to exercise again and being on vegetable regime but now I realize about sugar,bread and pasta
Hi,
I’m a 71 year old male and have, always, had normal HS CRP, Alt and Ast. I’m an avid jogger/walker, doing 36 miles/week. Have been for over 40 years. Had my yearly physical and, to my surprise, my HS CRP (3.5), Alt (168) and Ast (112) are elevated. Rest of blood work is normal (Cholesterol ratios, glucose, insulin all good). I did get the Pfizer COVID vaccine and had a recent small shin cut that got infected. It got a little red but has healed without getting an antibiotic. Can any of this have a sudden affect on these levels being elevated? Have read that “inflammation” can, temporarily, cause these readings? Do I need to be worried? Thanks.
I have a question, I just had my bloods done and my ALT is up to 102. I received a text from my doctor saying it was high and probably due to alcohol. She was not aware of the fact I was 7 weeks into a VLCD and had not drank alcohol during this time and been in Ketosis. Can Ketosis cause your ALT to rise as the liver is working hard to convert the fat into energy, I’m know in week 10 and have lost 44lbs and still in ketosis, they took my blood again yesterday to retest. I have been on 80mg Statin which the doctor halved 2 weeks ago , my sugars were back into the normal range and Cholesterol was good.
Thanks
Thanks
Hi Charlie,
If anything, the keto diet should improve your LFTs, not worsen them. I would say it’s more likely related to a prescription (probably the statin, in this case) medication or a supplement rather than the diet itself.
Great article-been following you for awhile, always learn something so thank you for what you are doing!
I am 44 and health is what I am all about. Exercise daily, eat only organic, clean, drinks maybe two glasses of wine a week. On armor and cytomel for hypo. Just got bloodwork back and have AST 49 and ALT of 35. Functional practitioner ordered ultrasound of gallbkadderer/liver. I’m super confused why my levels would be out of range and have been on Google definitively too much
The only thing that was off thyroid wise over the last six months is we tried sustained release but it put me back into hypo because I wasn’t absorbing so went back to old formulation. Bumped Cytomel to three and armor 75.
I don’t know-it’s weird?? Would love to hear your thoughts!
Thank you:)
My liver enzymes have been elevated in the last 3 months (went from AST 15 to 53 & ALT 18 to 86). I tried to think of any changes made in that time and the only thing I can come up with was I started taking a supplement called Estrobalance that contains DIM (as well as turmeric and black pepper extract). Could that cause elevated enzymes? Thanks!
My son who is 26 and while in Aruba dor a vacation, experienced upper right stomach pain. On coming back they did blooodwork and an ultrasound. Ultrasound was fine but bloodwork showed elevated ATP of 138 and AST of 44. A week later they repeated bloodwork and found ALT now 153 and AST of 78. Any idea what might be causing it. He is also a Hodgkin s survivor and has been in remission for over 5 years. MRI next week but we are all freaking out. Thanks.
Hi my liver enzymes are elevated my AST is 61 I have a fatty liver. Iโm overweight. I donโt know what. To do. To lower my AST. I canโt seem to loose weight. Iโve tried. Iโm 84 years old. In good health. Can you help me. I need guidance
Hi Diane,
I would check out this weight loss program: https://www.restartmed.com/hormone-mastery/
HI DR. WESTIN, I AM A 58 YEAR OLD WOMAN 155 LBS AND HAVE JUST FOUND OUT THAT MY AST IS 226 AND MY ALT IS 79. LAST YEAR THEY WERE BOTH AT 20. I HAVE DRANK MORE ALCOHOL THAN USUAL BUT I ALSO GOT INJURED WITH A HERNIATED DISC AND WAS ON TYELENOL AND DUAL ACTION ADVIL FOR ABOUT 2 WEEKS PRIOR TO MY LABS. WOULD THIS BE WHY MY LEVELS ARE SO HIGH? AND CAN I REVERSE THIS?
Dr. Westin,
I was recently treated for Transaminitis caused by the Nitrofurantoin I was taking for postcoital prophylaxis. (ALT 530; AST 590)
My Ferritin was 407. Since D/C the medication, most of my levels have trended down. My ferritin is remaining elevated at 230. Do you have any recommendations?
Dr Westin, This was a very informative artical. Learned a lot.
Based on all the causes you have described, in my case, I think I have an alcoholic Liver enzymes. I do drink daily.
My Comprehensive Metabolic Panel results had 4 categories which were ‘H” compare to normal range.
Glucose = 105 mg/dl
AST =108 U/L
ALT = 147 U/L
Anion Gap = 12 mmol/L
In your expert opinion, do you consider a dangerous stage?
What is your advise and other then giving up alcohol, what else can I do to bring my liver enzymes to normal level?
Thank you very much for your help.
Hi Paranv,
Yes, I would consider any state which increases liver enzymes to be potentially dangerous. Alcohol avoidance is pretty much the best thing that you can do.
Two recent lab results (beginning of Feb and end of Feb) showed good numbers followed by spiked numbers. Initially, the thought was Amiodarone being Rx’d early in Feb. After stopping this Rx, the numbers were still spiked plus bilirubin spiked at the end of Mar. Researched other changes and found two things: 1) started using Gatorade regularly after January; 2) started about the same time eating lots of Mariani dried fruit. Those seem to be more likely the cause, but further testing to come.
When I went for a checkup, I was informed my ALT was 81, with AST 41, and was told to return in two weeks for another blood test. My research revealed the main culprits are alcohol and obesity, neither of which apply to me. What I did was cut out all vitamins, then returned for another test the other day. We’ll see what the results reveal. Depending, my next move might be to do a liver cleanse.
Hi Chuck,
Obesity, alcohol, and insulin resistance are the most common causes but there are many other potential causes beyond those that can be looked at.
For those who eat well, no fatty liver, etc etc ran lots of test with nothing left but the elevated enzymes and the abnormal hormones, both changed in the same period (in this case 2 years), could it be that improving the hormonal situation the liver inflammation (AST 40, ALT 80) may improve too?
Hi Norbert,
It would depend on which hormones you are referring to. Which ones were abnormal?
I meant TSH and FT4. TSH from 4.0 to 6.9 / FT4 from 1.0 to 0.6 in the same time (2 years) as AST/ALT rising. Before this I had always (2008-2020) TSH 3.0-4.0 and normal liver enzymes.
So: no root cause found for elevated liver enzymes for now: could the thyroid be affecting the liver or it’s always the reverse? (sorry for the simplistic concept)
Hi Norbert,
It’s possible for the thyroid to impact liver function but only in extreme cases such as thyrotoxicosis. It’s not something that would really sneak up on you like fatty liver from insulin resistance could.
Hi My name is Cheryl and I am a 57 African American female. I recently started a diabetes medication called Mounjaro for diabetes in November 2022. Recently I had a bout with diverticvulitis and my doctor has had me on a strenuous dosage of antibiotics (metronidazole 500 mg, levofloxacin 750mg as well as a 5 day dosage of potassium Cl 20 meq because my potassium levels bottomed out at 2.5. I also take Rosuvastatin 10 mg for my high cholesterol. I was wondering if my diverticulitis could be the cause of my elevated AST and ALT levels. I had labwork done on yesterday 02/21/23 and it showed my AST at 53 and my ALT at 49. I have never had any issues with these levels up unitl now. Previouusly my AST level ranged around 27 and my ALT level ranged around 26.
Hi Dr Childs,
I have been on a short course of injectable Trenbolone Enanthate, and I just had bloods done and all my levels are fine except for my AST, itโs supposed to be under 41 and itโs at 80. Is there a possibility it is from the steroids? I was also sick with food poisoning in the 10 days prior to having my bloods done, so I donโt know if that might be the cause of my higher AST levels. If you are able to give me some advice I would really appreciate it. Thanks, Ben
Hi Ben,
Yes, trenbolone can cause an increase in liver enzymes. If there’s any concern, you can always recheck to see if the reduction fades after a period of time. If it persists then that’s likely a sign it’s related to the androgen use.
I just had my second ast test.. always been normal but in feb 2025 it was 43
a monthlater march 27 it was still 43.. My sugar a1c was 6.3 in feb and march it was 6 i have started a detox for my liver stopped eating so much sugar and i have stopped my 10 carmel macheiatos i drank everyday sugar coffe lattes.. i weigh 110 lbs .. could it be high due to all the sugar intake … i am not on anything.. taking a multi vitamin and milk thistle now
Hi Donnell,
Yes, it could certainly be attributed to your intake of sugar.
Hi doctor I am a 37 year old woman I had a chronic etopic pregnancy and was tested and told my liver enzyme and bilirubin is high ast and alt Iโve 1600 and bilirubin 159
I have done all the test MRI , ultrasound and blood work and nothing can be traced I do not drink though I am obese โฆ I did do a biopsy and awaiting the result
The etopic surgery has been done but the number is not dropping โฆ. I would really need your input