Alanine aminotransferase (ALT) is an enzyme found inside liver cells. Liver enzymes, including ALT, help your liver break down proteins to make them easier for your body to absorb.
When your liver is damaged or inflamed, it can release ALT into your bloodstream. This causes your ALT levels to rise. A high ALT level can indicate a liver problem, which is why doctors often use an ALT test when diagnosing liver conditions.
Several things can cause high ALT levels, including:
- nonalcoholic fatty liver disease (NAFLD)
- over-the-counter pain medications, especially acetaminophen
- prescription medications used to manage cholesterol
- alcohol consumption
- hepatitis A, B, or C
- heart failure
- hereditary hemochromatosis, an inherited condition that can lead to liver disease due to iron overload
- thyroid disorders
- some muscle disorders
- celiac disease
Other causes of high ALT levels that are rare include:
- autoimmune hepatitis
- alpha-1 antitrypsin deficiency, an inherited condition that can lead to lung and liver disease
- Wilson’s disease, an inherited condition that can cause a buildup of copper in the body
Regardless of what’s causing your elevated ALT levels, it’s important to work with your doctor to find and address the underlying cause. But in the meantime, there are a few things you can try that may help lower your ALT levels.
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Consume more folate or take folic acid
Consuming more folate-rich foods and adding a folic acid supplement to your diet are both linked to lower ALT levels.
While the terms “folate” and “folic acid” are often used interchangeably, they aren’t quite the same. They’re two different forms of vitamin B9.
Folate is a naturally occurring form of B9 found in certain foods. Folic acid is a synthetic form of B9 used in supplements and added to some processed foods. Your body processes them in different ways, too.
While they aren’t quite identical, both folate and folic acid have benefits when it comes to liver health and lowering ALT.
Studies have linked folate deficiency to increased ALT levels and liver damage and found that folic acid appears to reduce ALT in people with liver damage.
A 2017 study found that folic acid appeared to be just as effective as, if not more than, silymarin treatment in lowering liver enzymes in children with drug-induced liver injuries from antiepileptic therapy.
To help lower ALT levels, consider adding more folate-rich foods to your diet, such as:
- leafy greens, including kale and spinach
- Brussels sprouts
You can also try taking a folic acid supplement. Most folic acid supplements contain doses of either 400 or 800 micrograms. Aim for a daily dose of 800 micrograms, which is the equivalent of 0.8 milligrams.
This is the dose involved in many studies looking at the link between folic acid and ALT levels.
Make changes to your diet
Adopting a healthier diet can help lower ALT levels and reduce your risk of liver disease.
After 8 weeks, those in the diet group had lower liver enzymes and a greater reduction in liver fat.
Reducing the amount of fat and carbohydrates can also help treat and prevent NAFLD, a common cause of high ALT.
To improve liver health and help lower ALT, you don’t necessarily need to make drastic changes to your diet. Start by trying to eat at least five servings of fresh fruits and vegetables per day.
You can also try incorporating these tips into your weekly meal planning:
- Limit fruits and vegetables served with high calorie sauces or added sugar and salt.
- Eat fish at least twice a week, ideally those high in omega-3 fatty acids, such as salmon or trout.
- Opt for fat free or low fat milk and dairy products.
- Replace saturated and trans fats with monounsaturated and polyunsaturated fats.
- Choose fiber-rich whole grains.
- Opt for lean animal proteins, such as skinless chicken or fish.
- Swap fried foods for baked or roasted ones.
- Snack on nuts, which have various health benefits and have been
shownto lower liver enzymes in people with NAFLD.
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There is no specific medical treatment for high ALT. Treatment, if any, depends on what’s causing the increase.
Of the 10 percent of people in the United States estimated to have high ALT, less than 5 percent have serious liver disease.
For most causes of high ALT, treatment involves lifestyle changes, such as exercise, a modified diet, and reducing alcohol intake.
Depending on the results of your liver panel and your medical history, your healthcare professional may recommend checking them again at a later date.
If they’re very high or if you have risk factors for liver disease or other symptoms, your doctor may recommend further testing or an appointment with a liver specialist to help diagnose the underlying cause of your high ALT.
Depending on what your healthcare professional suspects, they may recommend any of the following:
- blood tests to check for other conditions, such as hepatitis B and C as well as diabetes
- liver ultrasound
- abdominal CT scan
- thyroid stimulating hormone (TSH) test
- creatine kinase (CK) test
- lipid panel
- iron studies to rule out hereditary hemochromatosis
Contact a doctor if a blood test shows you have high ALT. Based on the results of your liver panel, the doctor will advise you on the next steps.
A high ALT level is usually a sign of some type of liver issue. It’s important to work with your doctor to find the underlying cause of your elevated ALT, even if you don’t have any symptoms.
Lowering your ALT will require treating the cause, but certain dietary changes can help.
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