Top Causes of Elevated Liver Enzymes - Lower Your AST and ALT

Top Causes of Elevated Liver Enzymes – Lower Your AST and ALT

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 is used to represent a series of test that can help to determine if your liver is functioning appropriately. 

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. 
  • 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 caused blocked “ducts” such as bile stones or direct damage to the bile ducts. 
  • 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. 

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. 

Treatment algorithm for high ast and high alt

Massively elevated AST and ALT (levels greater than 10x the normal reference range) usually indicates an acute life-threatening condition such as liver failure from medication overdose, physical trauma to the liver or massive organ failure. 

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. 

normal ranges for liver function tests

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. 

liver diseases and elevation in ast and alt

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. 

evaluation of elevated liver enzymes

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:

pathogenesis of non alcoholic fatty liver disease

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. 

Treating NAFLD and High AST/ALT

If you have liver damage from insulin resistance and obesity then you should be aggressive with your treatment. 

The following therapies have been shown to reduce (and even reverse) liver damage from NAFLD: 

  • Weight Loss: Losing weight has been shown to reduce AST and ALT levels and reverse liver damage. There’s a right way to lose weight and a wrong way, so focus on improving your diet and exercising more as opposed to simply restricting your calories. 
  • Medications: Certain medications such as metformin, GLP-1 agonists, SGLT-2 inhibitors, and carb blockers have been shown to reverse insulin resistance help with weight loss, and improve LFTs. 
  • Dietary Intervention: Insulin resistance is often caused by the over-consumption of refined sugars and carbohydrates. You can impact insulin levels by reducing the amount of sugar and refined carbohydrates you consume (2)(bread, pasta, bagels, pizza, sugary drinks, etc.). 
  • Supplements: Certain supplements have been shown to reduce inflammation and oxidative stress which is critical in the pathogenesis of NASH and NAFLD. These supplements have been shown in studies (3) to help: Vitamin E, Vitamin C, Berberine, Probiotics, and Glutathione precursors (Betaine). 
  • Exercise: Exercise helps to increase insulin sensitivity and may assist with weight loss. If you have elevated liver function tests and you are overweight make sure you don’t forget the basics like exercise. 

Treatment should then be focused on managing blood sugar, dietary changes, and specific medications/supplements. 

#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. 


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. 

medications that cause liver damage

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: 

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”. 

autoimmune hepatitis in men vs women

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. 

viral hepatitis and liver damage

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 = inability to get rid of iron adequate (treatment should focus on reducing oral iron intake and phlebotomy (18)). 

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. 


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 vegetables (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. 


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! 






















causes of elevated liver enzymes

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About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 80,000+ people have used them over the last 7 years. You can read more about my own personal health journey and why I am so passionate about what I do.

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109 thoughts on “Top Causes of Elevated Liver Enzymes – Lower Your AST and ALT”

  1. Hello Dr Childs,
    This is really informative. My wife was prescribed isoniazid for latent TB. A follow up after three months revealed that her AST is 428 and ALT 430. Her doc did hep test which was positive but she attributed it to older infection or a previous vaccine. Also an ultrasound of her abdomen was done, which turned to be normal. So the doc says if she is feeling well then not to worry. She needs to get tested for liver enzymes in two weeks time. Is this correct course of care ? Any inputs would be helpful to quell our anxiety.- Raj

  2. I just had blood work done and have elevated levels, AST 61, ALT 60. My Dr. believes that a perscribed 40 mg simvstatin is to high and may cause the elevation and has lowered it to 10 as of this email. Also I have hemochromatosis which is under control with phlebotomy treatments. So, if the lower statin isn’t the cause, what else could cause elevation?

    • Hi Ron,

      The elevation could be from the hemachromatosis, the statin or some other issue such as insulin resistance (fatty liver) but you will need further testing to confirm.

  3. Last year my AST was 21 now it is 40. Last year my ALT was 36 now it is 51. I had hip surgery 1 1/2 years ago and need to take 500mg (4) of them whenever I go to the dentist, which has been about 4x a year. I have gained about 15/20lbs due to lack of exercise. I had been drinking wine about 3/4 glasses a week. I also have Chroans disease but not on any medications nor do I have any symptoms of it. What are your recommendations?
    Thank you

  4. My alt was 988 and ast was 209. I was also having gallbladder attacks and the ultrasound confirmed gallstones. They removed my gallbladder the next day. This all just happens a few days ago. I am searching for ways to recover my liver, and also stay healthy now that my gallbladder is removed. I would love information that will help me get better. I still am unsure if removing the gallbladder will just fix everything else, but I would assume I still need to do something to help with the damage my liver showed since my numbers were so high. Any suggestions on what to do next or if I need more tests?

    • Hi Ashley,

      Actually in your case it’s most likely that your numbers will fall back to normal and there will be no lasting damage (unless there is underlying damage from some other cause such as fatty liver).

    • Hi Ashley, I’m having the same issue after gallbladder removal. How long were you suffering from the attacks before you had it removed?

    • Very informative article, thank you! My ALT and AST levels have been rising. I was having migraines every day last week and I started having side pains when I took deep breaths. I went into the instacare to find a solution. When they ran my blood test my levels were high AST being 73 and my ALT is 121 I went to the ER the next day to get an ultrasound and with a d-dimer test was high too so they did a CT scan but everything came back fine, however, my blood test was doubled, 289 for my ALT and 147 for my AST. The ER doc recommended that I get work done again this week to see the level. Go forward 2 days and my AST is Now 389 and my ALT has lowered to 134. So it seems like they keep increasing. I haven’t heard from my PCP to figure out what to do going forward. I’m a 30-year-old female I weight 158 and I’m 5’7. My appetite has decreased immensely and I’m eating maybe one meal a day. I’m going to change my diet and maybe start working out more? Any suggestions? I know this is a year old but any feedback would be appreciated.

      • Hi Ash! I know this is a late post but I’m just wandering around here with my own questions and wanted to see if you ever got any answers? I hope so and hope you are feeling better! Thanks … Kim 🙂

    • I’ve read after gallbladder removal you need to be taking bile supplements to replace what you will be depleted off for digestion. I take Bile Builder.

  5. Hello, my name is Marc and I’m almost 49 years old. I recently was exposed to toxic mold, and after getting so sick I couldn’t hardly walk, I did months of reading information by doctors who have realized how deadly the ensuing damage (including liver damage, nervous system damage CIRS, and cancer) can be. I had 31 of 35 know symptoms all of the sudden, according to a leading doctor in the field…Dr. Richie Shoemaker. I also am a chronic alcoholic (Will start the reduction of alcohol tonight… to quit within a week. Also my father died of Graves disease. My liver levels went from 30 – 40 to 500 in six months during the exposure to the mold, and happened without warning over a couple of days of exposure after a very stressful “priming event”. I wondered if maybe I had a stroke, but wasn’t paralyzed, just too weak to get out of bed or eat much for a couple of months. I lost 25 lbs in 2 months then got better after months of a strict diet and taking curcumin and bentonite clay. But since I’ve read warnings about it having high levels of lead. Tonight I’m having bad pressure in my liver and having diabetes/ cirrosis symptoms worse than I normally do. I mainly commented because of my experience with the mold, as it is my understanding that doctors aren’t taught about it in medical school. I’m worried about how I feel at the moment and will be in the urgent Care tomorrow. Getting testing done. I know I need to get in and figure out what is going on today. God bless you and I look forward to your response.


    • I also had an exposure to toxic mold and the doctors don’t believe in it. My doctor who discovered it is a gastroenterologist turned natural health doctor. Ever since I’ve had problem after problem. It started out with Fibromyalgia. Then I Had my gallbladder removed due to stones, then got food poisoning with reactive arthritis, then diagnosed with Seronegative spondyloarthritis with chronic pain daily. That’s my new life, every day with pain. I have slightly elevated levels of ALT, AST and GGT. ALP is normal. I’ve had some issue with dehydration for years and I have to really watch it. I did gain weight and I am hoping if I get my self back in shape that things will get better.

  6. My alt/ast were normal on 2016, one year later I wanted all blood work done to see how I was since going Vegan. I have Ehlers Danlos Syndrome which can do tricky things to a body. I am 5-6”, 50yr old eating healthy and weigh 140. I do not drink at all. Was on Prozac 20mg daily during that year. I occasionally take 600mg ibuphrofen for body pain or headaches. I was just retested and they’re even a bit higher. Dr wants to do a liver biopsy which I think is invasive esp with my EDS and bleeding poor healing. I had an ultra sound of abdominal and it said liver was fine and normal size, gall bladder, bile ducts, no blockages seen, pancreas, kidneys all checked everything normal no ascites. Here is chart of some numbers, thank you for any advice
    1.0 – 2.5 (calc)
    1.6 1.8 1.5
    3.6 – 5.1 g/dL
    4.4 4.6 4.4 4.3
    33 – 130 U/L
    46 53 59
    ALT (SGPT)
    6 – 29 U/L
    14 34 44 43
    AST (SGOT)
    10 – 35 U/L
    18 38 38 46
    Bilirubin Dir
    < OR = 0.2 mg/dL
    0.3 0.2
    Bilirubin Ind
    0.2 – 1.2 mg/dL (calc)
    1.2 1.2
    Bilirubin, Total
    0.2 – 1.2 mg/dL
    1.5 1.5 1.4
    1.9 – 3.7 g/dL (calc)
    2.8 2.5 2.9
    6.1 – 8.1 g/dL
    7.4 6.9 7.2
    Standard Range
    1.0 – 2.5 (calc)
    3.6 – 5.1 g/dL
    33 – 130 U/L
    ALT (SGPT)
    6 – 29 U/L
    AST (SGOT)
    10 – 35 U/L
    Bilirubin Dir
    < OR = 0.2 mg/dL
    Bilirubin Ind
    0.2 – 1.2 mg/dL (calc)
    Bilirubin, Total
    0.2 – 1.2 mg/dL
    1.9 – 3.7 g/dL (calc)
    6.1 – 8.1 g/dL

  7. This week my routine physical blood work showed elevated enzymes. First time ever. Last year in January they were normal. I quit drinking alcohol in August last year. Pretty ironic to have liver problems after quitting my red wine habit. I have increased my carb intake…hot chocolate, frozen yogurt, dark chocolate, and bread. My sugar reading was 95 which has come down from last year – it was 103 (both fasting). My Dr sent me for another blood draw 2 days after the first to rule out lab error. That came back a bit more elevated! I am scheduled for an abdominal ultrasound week after next. The fear of the unknown is freaking me out.

    • Did they figure out what was causing the elevated numbers? I have had them come back elevated during a routine blood check from my thyroid dr. I’m a bit freaked out and haven’t gotten to discuss the results with the Dr yet but like you mentioned, the fear of the unknown… I’m so worried.

      Hope yours are doing better now!

  8. Hello Dr. Child’s: First I want to thank you for such informative information especially when it’s been most difficult to obtain. Now for my story, I will begin by telling you that my pancreatic and liver enzyme tests have been elevated since 2015, the last tests on Feb 1, 2018 showed my Serum Lipase at 173 with a reference range of 14-72, and my ALT at 159 with a range of 39-117, I recently had my gallbladder removed (December 2017), it was thought that my gallstones may have contributed to my elevations but now that I’m still elevated I’m scared something bad may be going on! I am a type 2 diabetic and overweight but have changed my diet and have lost 13 pounds since my surgery. In the past I was using a lot of ibuprofen and Tylenol for fibromyalgia pain and I also had a bad reaction to nitrofurantoin I don’t know if I caused liver and pancreatic damage as I was suffering from gallstones for 2 years prior to surgery. I need some help!

  9. My husband had a whipple procedure on November 29, 2017 and is recovering well. He was to start the follow-up chemo today, Gemzar/Abraxane. When his labs were taken his liver enzymes ALT and AST were elevated. AST was 263 and ALT was 76. Oncologist said he was only going to give Gemzar today and redraw labs next Monday to see if they have come down. No meds have changed in the last 10 days. The only thing was that he is seeing a personal trainer to build up his muscles since the surgery and two months of doing nothing did a number on him. Can toxins be released from working the muscles in the body that could cause this elevation? During the whipple they removed his gallbladder and 1/3 of his stomach, and about 8″ of his small intestine. All margins and lymph nodes were negative.

  10. I never drink. But my diet for many years has been cheeseburgers. I made a life change and ate right and took a blood test. My chlroestrol went from 400 to 111. But my ast was 68 and alt was 138. This is higher is this something I should be super worrier about? Sign that my liver is working really hard to flush all this fat out?

  11. Hi Dr Child’s, I visited my gp last week as had been suffering from a fever and headaches for 3 weeks, a random blood test showed that my alt/alp was elevated to 265/147, the same test was repeated 4 days later and it had risen to 704/317. Strange thing is my fever is starting to lift though I still feel quite weak. I had bloods taken to test for possible viral infections 6 days ago but still awaiting the results. No further tests have been arranged at this point, im hoping it turns out to be an infection but will keep you posted. I should mention also that my lymphocyte count is 8.3, I rarely drink and have a bmi of 27.3

  12. I work nights and in the last 5 yrs have gained about 25 unwanted pounds. I was already 20 lb overweight!

    I am a med surg nurse who often cares for infectious febrile patients – who was stricken with an illness a little over a week ago. Sat/Sun I was tired and kept falling asleep instantly every time I laid down. Monday night a nightly fever up to 103 with shaking teeth chattering chills started then. Other than that my sx were exhaustion, loss of appetite and nausea, occasional slight pain under right rib. No diarrhea but a change in stools and malodorous – no other synptoms. This pattern if cyclical fever continued for four nights. On the 4th night I was admitted to the hospital and got an ultrasound, echocardiogram and a pan CT from chest to pelvis were performed and negative for any masses or lymphoma.

    Tested for flu, hep b hel b hep c, mono, all negative.

    The ONLY abnornalities found were a “very mild’ fatty liver and a few scattered “slightly” enlarged lymph nodes in abdomen. At the max sickness (Thursday) AST 514 ALT 902 Bili 2.3. Friday after 3 bags of IV fluid and nothing more I woke uo and felt like a million bucks. Since then I feel fine possible even better than I did before I got sick.

    Now 6 days later labs were AST 416 ALT 762 Bili 1.2. I have weekly rechecks of my labs to ensure they have normalized.

    I have a husband and two children at home. Kids are fine. My husband has also been ill this past week with a similar but much milder symptoms (much less fever and only 100.4 max). He has not had his blood drawn though.

    Understandably we are frustrated not having answers and hearing oh well it must be a virus but its going away so who cares. Do you have any ideas for us?

  13. I recently went for routine blood work and AST was 163, ALT was 420. 2 years ago it was 31 and 33. I am scared because I don’t drink alcohol at all and run marathons! My doctor is doing Hepetitis testing.. but I have never done any risky things in life (no drugs of any kind). What is going on with me?

  14. Good info, thank you. I had Whipple surgery for a PNET a year ago. A few days after surgery, my liver enzymes spiked (they were normal before that). They have since come down a lot, but still aren’t within normal range (currently AST 66, ALT 75, Alk phos 216). These numbers have been pretty consistent now for several months. I have been taking Protonix since the surgery. We reduced my Protonix dosage, but the numbers remained elevated. Having gone through a major surgery and recovery, I am anxious to put this behind me. CT scans show slightly fatty liver but no lesions or anything suspicious. Is a biopsy necessary with these mild elevations? I feel fine and have no symptoms of any liver damage. Thoughts?

  15. I went for an annual checkup today. I’ve been eating a whole food plant based diet almost 6 months. If you look at my labs I’m in worse shape than before! My cholesterol was always great, but the LDL went from 66 to 103. I’m also concerned because my AST liver level is at 40. The others aren’t elevated. The doctor said it wasn’t bad because the others are low. Not really helping me to stay calm tho, I’m super concerned. I did just have a septum/turbinate surgery 5 weeks ago. I spent over 2 weeks on steroids, pain meds, and antibiotics. Maybe that’s what makes the liver levels go up? The doctor didn’t seem concerned or to have answers. ugh.

  16. Hey Dr. Childs and everyone else,

    I’m a 27-year-old woman recently cleaning up my act after some problems with heroin/IV drug use. I had bloodwork done and my ast/alt levels are alarmingly high. It’s the weekend and I have to wait to get an appointment for follow up. Any feedback about this would be so appreciated. I’m scared.
    I was tested for Hepatitis about 3 months ago and the results were negative. I’ve only used heroin for 6 months and I would use with my husband and no one else. Clean needles every time. I entered into a treatment program last week and they ran a standard blood test with this result. I’m so scared of these numbers. My counselor said that they are indicative of chronic infections of some sort.
    I’ve been to Latin America twice within the last 3 months – the first time I returned home I was really sick. Montezuma’s revenge. Had blood work done at the hospital and everything came back normal other than low potassium levels.
    With the blood work done this week, alt/ast results are the only out of range results.
    Any ideas? Is it possible that these numbers are outrageous because I received a Hep vaccine before my most recent trip abroad?

    Any feedback is so greatly appreciated.

  17. Hi, thanks for the information. I currently got diagnosed with autoimmune hepatitis disease. I’m just trying to seek information to understand it better. My levels had gone back to normal but they are going up gradually! I’m also trying to find information on Diet plans.

  18. Hi Dr. Child’s
    I have hemochromatosis but have never had elevated AST/ALT. I recently started taking omeprazole (250 mg 2x a day). Could that be causing higher levels? I also wonder if it could single beginning CFH (because I feel like I have other symptoms but have been diagnosed with asthma)? Thank you for your time.

  19. Good Morning,
    As I am reading this article I am in the hospital because of elevated enzymes. I was admitted on Tuesday because I had severe pain in my right upper abdominal area and my AlT was 694 and my AST was 894. They did an MRI and saw a slightly enlarged fatty liver. The next day the did an ERCP to see if a bile duct was blocked they found nothing. The morning after the procedure both of my levels doubled. My levels just slowly started coming g down between yesterday and this morning. The levels are both still in the 1000’s and no one has a clue. I’m in the hospital just waiting. I am very afraid and confused. Any thoughts?

    • I had the same symptoms. Went to ER bc I had severe upper right pain..liver enzymes were 1300 and 900. They did 3 CT scans, ultrasounds, MRIs, doppler and many blood tests. They couldnt find any disease or virus. They could never figure out what was wrong with me. I am suppose to have a liver biopsy soon.

  20. I’m a 33-year-old otherwise healthy female. After visiting our small town ED for viral symptoms of severe vomiting, diarrhea, extreme abdominal pain, pain in back and shoulders. Treated as normal for a virus with Zofran and fluids. Labs showed low mag (dehydrated), but astonishing high liver enzymes. ALT 2,000. AST 1,400. CRP 50. FERRITIN 3,000! We were all suddenly shocked as I’ve never had these issues and had enzymes checked several times postpartum 5 months ago. They were WNL. CT showed “slight inflammation of the liver and surrounding lymph nodes”. Hepatitis panel pending. After 24 hrs of treatment with fluids, and gastroenteritis meds I was discharged after my ALT dropped to 350 and AST dropped to 500. Follow up in 1 week for enzyme check.
    I live in a small town and they’ve never seen this before but they mentioned viruses can cause such extreme values and hopeful for no long-term damage considering the trend downward.

  21. I am 42 and have Hypothyroidism. I recently had some blood work done and my liver enzymes were elevated. I started testosterone injections two months ago to try to increase libido. Can Hypothyroidism or testosterone injections influence liver enzymes?

  22. In Oct of 2017, I went to the ER with severe stomach pains, nausea, and vomiting. Blood work was completed and my AST was 17 and ALT was 25. After a colonoscopy and endoscopy (as a follow up) I was diagnosed with GERD. I had another blood test done last week and my AST was 150 and ALT 199. I was instructed to follow up with Primary and Endocrinologist. I am in recovery from Alcoholism. It’s been 8 years since my last drink. I am also overweight. Curious as to the spike in levels.

  23. Just found your blog. Thanks for the info. My recent annual labs (4/27/18) showed elevation liver enz. from 2017 values (U/L). AST went from 23 to 38 & ALT went from 21 to 50. In late January I started Meloxicam (15 mg/QD)for hip OA. In Early Feb. 500 mg Tylenol was started PRN (never more than 4 grams QD) to replace my long-term Ibuprofen (never more than 2400 mg QD). Meloxicam & Tylenol were stopped beginning of May. How long should I wait before having liver enzymes rechecked? Is it safe to start taking Ibuprofen again? Do not drink alcohol. Weight is 106 at 5ft., BMI is ideal. Age is 71. Thanks. 5/5/18

  24. Hello, just got lab results back with an elevated GGT of 121 and slightly elevated ALT of 48. I have arthritis of the hip and have been taking anywhere from 220-660 of Aleve 2 times per day. I am in the process of further evaluation but feeling this may be the culprit. Really concerned about what I can take now so just suffering from the pain until we have more answers.

  25. I was on an antibiotic in Dec. of 2017 that the doctors think attacked my liver. I spent 6 days in hospital having blood work, a CAT scan, an Ultrasound and an MRI. My alanine Aminotransferase was over 1,100, my Alkaline Phosphatase was over 400 and my Bilirubin was around 100. I get my blood tested every 2 weeks now and my results are up and down. In the most recent (Friday, May 11, 2018) my AA is 626, my AP is 171 and my Bilirubin is 54. Both the Bilirubin and AA results are higher than last time. I have had no treatment, the gastroenterologist says this is not unusual to see results fluctuate. I am tired all the time, have trouble eating almost anything and feel nauseous and bloated. When in the hospital I was told I also have gallstones and elevated cholesterol levels. I cut out all chips, cakes, cookies, doughnuts etc. from my diet and have tried to eat much more healthily. Is there anything else I can or should be doing?

  26. My levels are ridiculously high. Current Doctor confirmed no hepatitis and yet my blood work contradicts the doctor’s findings. Any ideas?
    Here are the values that are high and outside the normal range:

    Alkaline Phosphatase 289 IU/L H 39-117
    ALT 926 IU/L HH 0-44
    AST 271 IU/L H 0-40
    BUN 26 mg/dl H 6-24
    BUN/Creatinine 28 mg/dl H 9-20
    LDL Cholesterol 113 mg/dl H 0-99
    Sodium 146 mmol/L H 134-144
    Triglycerides 191 mg/dl H o-149

    I also suffer from fatigue on a grand scale. I stop moving and I immediately fall to sleep.I’m starting to experience mild chest and peripheral pains. Any help you can provide would be greatly appreciated.

  27. My elevated liver enzymes (Total Bili 2.60,
    Alk Phos 135,
    AST 232,
    ALT 452) are being caused by Opdivo (immunotherapy drug). I am on Prednisone to combat the effects of the Opdiivo (which has been stopped).
    Any other recommendations?

    • It is now July 6th, and I have been on Milk Thistle for about 6 weeks. Total Bili 1.20, Alk Phos 128, AST 127, ALT 138. It is an OTC drug which you can get at Walmart. A 2 month supply is about $8.00. I have had no side effects which is reason enough to try it. To everyone above who is looking for a way to lower your liver enzyme levels, this could be the most harmless route to try. Recommended dosage is 525 MG/day. Each pill is 175 mg.
      Please post any comments you might have on any drugs or whatever you have tried in regards to his subject and your results, and good luck to all!

  28. Hello, I was reading over this thread and realize it hasn’t been active for a while, however, I have a question. I am 30/F with a history of elevated liver enzymes. My AST is generally the culprit although ALT has been high as well in the past. This has been going on for about 6 years, I have had bloodwork done testing everything done by a gastro dr and nothing was found along with 2 ultrasounds and a biopsy this year. The only thing found on biopsy was sight irritation at liver ports not of clinical significance. I just had bloodwork the other day as the dr wants to test my liver enzymes every few months and my AST was 61. Does this sound like a good course of action or is there something else I should do? Also about 2 years ago I got a positive speckled ANA following a miscarriage and have had nothing found on bloodwork from a rheumatologist, not sure if there is any relation but thought it was worth mention. If you could please offer any advice/thoughts you may have it would be greatly appreciated, thank you!

  29. I’m currently about to have a liver biopsy to determine the cause of my high and continuously rising ALT and AST levels. I don’t drink at all or take any acetaminophen or herbal supplements. I don’t take any of the known prescription meds that can cause liver enzyme elevations. I don’t have NASH or NAFLD. I’m not obese (in fact I am underweight with a BMI of 16), and have no diabetes, metabolic syndrome, or dyslipidemia. All of the various forms of hepatitis have been ruled out, as have hemochromatosis and Wilson’s disease. My ultrasound was negative although I did have minimal fibrosis on a fibroscan, which was thought to be “normal” for my age of 55. My ALT is 398 and my AST 175. My hepatologist says that biopsy is the only definitive test left that may show a cause. I’m thinking that there must be some other systemic problem which is damaging my liver. Malnutrition? I had a gastric bypass for severe GERD due to a massive hiatal hernia that had collapsed the lower lobe of one of my lungs. I also had Barrett’s esophagus and gastric adenomatous polyps and polyps in the jejunum, which was also removed in the RNYGB. I’m wondering if malnutrition from short bowel syndrome could be causing my liver problems, in spite of my special, high-nutrient diet and vitamin supplementation.

    • Did your biopsy show anything? I also have elevated liver enzymes and had weight loss surgery (duodenal switch) I had a biopsy and nothing was found.

    • Did your liver biopsy an answer? Are your levels normal? My Dr is thinking towards it. Thank you for your time.

  30. Hi I’m 26 and I had a high AST at 61 and high LD, as well as high Cholesterol and low Vitamin D. My Doc, waited two months and retested me. Now my AST is 17… He didn’t check the other ones. He also did not test me for Hep A B or C which I am pretty upset about because I thought that was standard. Should I go back for the third time and get tested for Hep? Why would it be so high then normal? :/ Any thoughts? Thank you 🙂

  31. Hello, I had a traumatic horse accident on 6/3 … 11 days ago. I was struck in the chest… fracturing ribs 3 and 4. I was admitted as a trauma 1 patient. My liver enzymes were elevated alt 104, ast 96.

    My question how long does it take enzyme levels to return to normal in a healthy adult.

    I’ve been taking Tylenol for pain… should I stop?


  32. Hello, Doctor. I broke two ribs (right side) about one year ago. I sit for hours on the computer for my job. I am still having tenderness in that area. What is the best test to determine if my ribs healed correctly? I just had lab work done that shows a jump in my ALT from 21 in 2016 to 68 now (2018). My AST is 94 (on baseline for comparison from past like the ALT). While I have “fatty liver” my hgb A1c is 5.6, so insulin resistance/diet does not seem to be my issue. A liver ultrasound a week ago shows a lesion on my liver..not uncommon. Now my doctor wants an MRI, but I don’t like the idea of the contrast dye, and the doctor wants the dye. Shortly after my broken ribs an ultrasound was done but did not show any organ damage. Is it possible there was damage to my liver in my 2017 fall and this was overlooked? If so, will the MRI show a puncture/tear to the liver? Or, if this were the case wouldn’t I have much more pain than I do now (i.e., the tenderness I feel around my right lower rib cage and some sensation of discomfort or tightness on that side when breathing very deeply? Any insights would be most appreciated here as I am trying to determine whether or not to scratch the MRI and try other less invasive testing/blood work before dye injections that are becoming more and more questionable. Thank you so much.

  33. My ALT was 36 in 4.2018, it is now 39. My PCP does not seem concerned. I am because I take Diltiazem XL for my hard to control BP.I believe this med is the cause. Not sure what other XL BP med I’ll be able to safely take.

  34. I have been monitoring my blood work for around 10 years. The numbers below are an average over the years.

    Albumin Level=4.8
    ALK Level= 52
    ALT Level= 52
    AST Level= 24
    Billi Total= 1.9

    However my last blood test showed my ALT was elevated to 74. I was dehydrated when I had my blood work done. Could that be a cause in the ALT elevation?
    My Trigs are also elevated at 234. Diabetes does run in my family. My doctor suggested I might have AIH.

  35. My AST is 117 and ALT is 49. My last test in December 2017 was 20 and 15. I had an ultrasound in December and it came back normal. My bilirubin was 2.5 in December and now 2.3. I very rarely drink alcohol. I am extremely fatigued and dizzy for the past week. I am waiting on my Dr. to follow up (It has been a week since my tests).

  36. Recently had lab work done, was told one of my liver enzymes was elevated & had been for 3 years. Last 4 months, nauseous, some vomiting,extremely tired, sweaty, could I have some liver issues? 2 1/2 years ago, I had a knee implant. I feel I could be allergic to the implant so am searching to my not feeling well. My Ortho surgeon does not think it is necessary for testing so I am searching as to what could be wrong with me. I do not drink or smoke, but am overweight, 82 years old.

  37. Is it possible that sudden onset of celiac disease could cause ALT/AST levels to increase to 140-142? If so, will levels return to normal after strict gluten free diet or does this mean patient has acquired autoimmune hepatitis?

  38. Hello Dr. Childs,
    I am a breast cancer survivor and am taking Letrozole. My liver function levels have been gradually increasing over the past year, with my most recent levels AST 40/ALT 76. I have been on Letrozole for a year and can’t help but think it may be responsible for the increased liver enzyme levels. Are you familiar with Letrozole (Femara) and its effect on the liver?

  39. Excellent article. Do you have any further ideas on how to determine the cause of low-grade elevation? Specifically when trying to distinguish between (or a mix of) supplement use and metal overload? Thanks.

  40. Three weeks ago I was in the emergency room with pain from under my right shoulder blade around to under my right breast. It felt like someone was trying to cut through my ribs with a hot knife. After many tests, the doctor came to the conclusion that I had internal shingles. I have had shingles twice before but never internal. A week after dx my ALT was 61 and my AST was 41. One week later ALT was 83 and AST was 68. I have never had elevated results before. My glucose is 83 and I am not diabetic. I try to keep my weight within normal range and walk almost every day. I do not eat much bread, potatoes, sugar or fried foods. I think the internal shingles attacked my liver. I am waiting for my insurance to authorize a CT scan. Do you have any experience with this type of situation? Any advice?

  41. Hi, I have been diagnosed with focal nodular hyperplasia after taking HRT for 6 months. I no longer take this medication but still have raised liver functions results they initially reduced but have now gone up again. The tumor is 9.6 cm long and caused discomfort whilst sitting (I work in a call center) and also becomes painful when walking even a short distance now feels like a stitch in my side and breathlessness. What advise could you offer me as I feel very uncomfortable and not sure I can relieve any of these symptoms through diet. Thank you.

  42. Dear Dr. Childs,

    I had a blood test done and my AST was 82 U/L, my ALT was 132 U/L and my Cholesterol Ratio was 3.6 U/L. I had an ultrasound done on my liver and they found two Nodules (Hemangioma) They want to do a C-Scan but I am cautious about how much radiation my body gets. I feel fine and have no pain. My liver doesn’t have fatty deposits, I am not overweight and I don’t drink much. This is the first test I ever had like this.

    What do you suggest that I do next?

  43. Hi Dr, I am a healthy 32yr old white woman who has never had elevated liver enzymes until now. I had routine blood work done and everything looked good except my alt was 182 and ast 74. My dr wants a redraw in 3 months. I do not drink or do drugs and am a little concerned waiting. I am 5’2 and weight 180. I completed a course of Accutane 11 months ago(all my levels were normal then) I wonder if my weight or past Accutane could be the cause.

  44. I have a daughter who took minocycline and had a major reaction which later found out it caused the autoimmune disease, it attacked her liver, spleen and caused her to be hospitalized with a severe rash all over her body and the affects to her organs. She is a college basketball player and has been working out strenuously for her conditiong and weightlifting with her team. Her liver has become swollen and has discomfort. Her doctor said her liver enzymes were slightly elevated, but the swelling is continuing even with ice applied. She is to see a GI doctor here, but wondering why is this happening and what could be the cause? I need help and answers. She wants to be healthy and normal as her normal can be. She never feels really good.

  45. Great resource. I have elevated ALT since my last test a year ago and have narrowed down the culprit to vitex extract supplement, too much sugar and simple carbs in my diet (soda too), and taking Tylenol for pain too often.
    I am stopping the supplement and they Tylenol for now and am drastically changing my diet to include more fresh fruits and veggies. Looking forward to my next test in 6 months being normal.

  46. Hello Dr Childs,

    I have had mildly elevated liver enzymes for many years. 2 years ago I had a biopsy (I have had every test!) and there was nothing found at all. It is just my ALT and AST effected. They were 104 and 89 respectively when I was last tested. This gives me a lot of anxiety. I did have weight loss surgery 9 years ago and wonder if it is somehow related. The abnormal liver tests started 4 years ago. I do not have a gallbladder either. I would like to get to the bottom of this before any more damage is done and don’t know where else to turn!

  47. Will try my best to make this long story short.
    I’m 20 years old, female, and have had a history of elevated ALT and AST levels for about 7 years. When I was 13, my ALT was in the 3000s and AST in the 1000s. Shortly after, I found out I had gallstones and had my gallbladder removed. I got my levels checked twice a year after that, sometimes they are perfect and other times they are in the hundreds. In 2016 and 2017, they spiked back up to the thousands, but they always come back down to the normal range. Doctors have performed multiple tests and have found absolutely no reason for the constant spike in levels. This past August (2018) my ALT and AST were 15 and 16 and all my other levels were perfect (Iron, Copper, GTT, everything). Last month, I had an episode of extreme nausea, vomiting, and massive headache and went to the ER. My ALT was in the 8000s and AST in the 5000s. They admitted me overnight and gave IV fluid for my liver. My hepatologist cannot figure out what is going on. Three weeks ago, I got my levels tested again, and they were perfect. Then last week, I had another episode of nausea and headache (no vomiting) and got my levels tested–3000s and 2000s. The next step is a liver biopsy, but I fear they will find nothing, as they’ve done ultrasounds and a fybroscan which showed absolutely no scarring or damage to the liver and a normal fat level. Any insight would be great, as I am so young and have been tested for multiple viruses and diseases, everything has come back negative. I don’t take any medicine at all and do not drink alcohol.

  48. Can taking thyroid medicine (perhaps higher dose than needed) cause AST and ALT to raise? Mine have gone up 6 points each since starting on NDT 10 months ago. My TSH is suppressed to .02 for last 6 months on 130 NDT T3 and T4 are middle to high range. Thanks

    • Hi Kristine,

      It is possible? Yes, but unlikely. Liver damage doesn’t typically occur until you are in a state of thyrotoxicosis or nearing a thyroid storm which should be accompanied with other symptoms.

  49. Hi. My daughter is 11. She has been having frequent dizzy spells. Her pediatrician did labs and everything including A1C was normal except Liver Enzymes were slightly elevated and her T3 level also. She was adopted as a baby from Guatemala. Not sure if that culture is prevalent to some type of illness. I have researched Wilson’s disease and some of the symptoms are the same. We are waiting on an GI consult but are worried. Do you have any thoughts on this? Her dizzy spells are almost daily. She said her forehead gets tight, like she has a band around it, and then the dizziness starts. This scares us!

  50. Hello. For the first time ever I had elevated AST and ALT levels show up on a blood test. Here’s the story: I have routine bloodwork done every 6 months since being put on pravastatin about 6 years ago. Liver function has always come back at normal levels. I have always been a social alcohol drinker sticking to weekends and occasions but never having an “everyday” habit. I had smoked in the past but quit nearly 10 years ago. Other than the prescribed statin the only drug I take is a daily low dose aspirin. I had open heart surgery to repair an aneurysm/valve replacement about 2 years ago. That all being said, my previous levels of liver enzyme have always been normal. In fact, my latest blood results from November 2018 showed AST/ALT both in the low 20s. This past weekend I experienced what I would call debilitating stomach pain. However, I would characterize it as feeling like severe gas pain. It was accompanied by brief cold sweats and not much else by way of symptoms. Took some gas X and everything seemed to subside in a relatively short time although it left my body feeling sore. Not wanting to take any chances based on my medical history I visited the ER for peace of mind. EKG was normal so no signs of heart distress. Good news. However, blood tests while I was there revealed an AST of 285 and an ALT of 205 – bilirubin at 2.7 and a bump in lipase to 71. After CT scan both liver and pancreas were noted as “unremarkable” with the only thing of note being “possible” tiny gall stones. It’s also worth noting that at the time of this ER visit I had not had a drop of alcohol in more than three weeks. Obviously, this sudden spike in liver enzymes has me concerned. I plan to continue my abstinence from alcohol and make changes to my diet. My questions are these: Can liver enzymes really go from normal to extremely high in just 3.5 months? Could the spike be temporary or event-driven based on the pain I was experiencing? Could tiny gall stones have that affect? I will follow up with my GP but any insight you can offer would be appreciated.

  51. 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.

  52. My liver enzymes are extremely high. I did abuse acetaminophen when I was a teenager and in my early 20s. I’m 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.

  53. Hi Dr. Child’s.
    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 don’t know what type of doctor I should see for this?
    I don’t 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.

  54. 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?

  55. 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)
    AST 44
    ALT 41

    After 2nd treatment
    AST 26
    ALT 41

    Needless to say, I’m going back for more!

  56. 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.

  57. 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.

  58. 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 – 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

  59. 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.

  60. 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 60’s I am negatative for all hepatitis disease. My doctor wants an abdominal ultrasound and wants to refer me to a GI doctor. I’m am freaking out .

  61. 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, Don’t see Gastroenterologist for six months . He suggest no biopsy prior to reducing/ discontinuing meds. Could this AST be due to fibrous ? I’m just into overweight range still loosing weight 5 10 208 lbs at present I would value your thoughts please re AST level.

  62. 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.

  63. 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

  64. 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.

  65. 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.


    • 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.

  66. 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:)

  67. 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!

  68. 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.

  69. Hi my liver enzymes are elevated my AST is 61 I have a fatty liver. I’m overweight. I don’t know what. To do. To lower my AST. I can’t seem to loose weight. I’ve tried. I’m 84 years old. In good health. Can you help me. I need guidance


  71. 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?

  72. 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.

  73. 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.

  74. 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.

  75. 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?

      • 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.

  76. 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.


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