Q. How can high ALT be managed?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Jul 29, 2020 and last reviewed on: Aug 20, 2020

Hi doctor,

I have blood work done with ALT marked high. The number was 32 and my AST is 29. A year ago my ALT 6 and AST 22. My question is:

1. Should I be concerned about current numbers

2. Is the jump in numbers from last year a bigger concern ? I went online and did the ratio calculations and last year's results are 3.7 and this year is 1:1.



Welcome to icliniq.com.

Well there is obvious surge in liver enzymes than previous year, but thankfully they are just at the upper limit of the normal. This minor elevation of ALT and AST but seemingly within normal limits is not an alarming sign. Therefore, I want to assure you not to worry. But we just need to monitor it for a while to make sure it is not inclining in coming few months.

It seems it is your weight with accompanying some fatty deposition within the liver, which has been causing this distrubance of LFTs. The condition is called fatty liver disease. The one reason is weight and the other reason is alcohol intake. I want to know if you have any history of taking alcohol? If you do not use alcohol then it is highly possible that your weight is causing all this. Your Body mass index (BMI) is 27.5 which is just an 2.5 higher than expected i.e. 25 kg/m2.

For now I suggest you to try to lose some weight. like 10% of your current body weight i.e., target of 68 kg. If not possible then at least try to reach 70 kg in coming 3 months. I see this is decent goal. Just repeat a complete LFTs in 4 weeks time and let me know. If you have been using some herbal medicine, or any allopathic medications or any new treatment for any reason kindly let me know. I have seen your reports (attachment removed to protect patient identity) and they all are normal , but want to know whether you have any diabetes or cholesterol issues. Kindly upload those tests as well if you have.

Thank you doctor,

I was looking over more of my bloodwork. I also noted my GGT numbers also had a significant rise but still in normal range. A year ago was 10 and current level is 34. I am having a very weird symptom of after having a bowel movement. I am experiencing pain in liver area that also burns under center of chest. Sometimes middle back ache . It is subsided after an hour or so but until it does I cannot get comfortable.



Welcome back to icliniq.com.

The raised GGT again signifies that it is related to fat deposition within the liver. You did not mention about the pain in your previous thread so I did not correlate your upper limit of normal values of ALT, AST, and GGT with this pain. Because fatty liver disease tend to cause painless, completely asymptomatic elevation of the liver enzymes. Given pain, the scnerio can change however, and therefore I would need following information before establishing something conclusive out of it.

Do you take alcohol? Any herbal medicines? Or any OTC or prescription medicine in regular use? Did you have any of your ultrasound abdomen? The pain ever occurred before? Similar pain in past I mean? Any weight loss? Let me know the answers, I would be in better position to tell what you should do now. The possibilities are still on top fatty liver disease, alcohol related liver disease, gall bladder stones or gall bladder functional pain.

Hi doctor,

Thank you so much.



Welcome back to icliniq.com.

You can contact me any time you want.

Thank you doctor,

No alcohol, no herbal supplements, no prescribed drugs. Slight pain before on and off but more of a very dull ache. No weight loss. I have gained weight in the last month of COVID lockdown probably 10 lbs. This came on after a big meal of pasta. Pain lasted a good week or so but I could sleep. The initial attack was a night of discomfort feeling very full across my upper rib cage. When I eat I get full fast but it subsides.



Welcome back to icliniq.com.

So as far as I understand the pain is mild, more of a dull ache like and does bother your sleep. This means pain is not as predominant feature of your overall scenario. Given no alcohol intake, no recent medicine, and recent gain in weight, the high possibility is fatty liver disease unless excluded otherwise. Since you have liver enzymes just at upper limit of the normal, I suggest you to simply reduce weight for now and just monitor the liver function tests every monthly.

A 7 to 10 % weight reduction of your current body weight would make these liver function tests improved. If you have difficulty with that at least control weight as it should not go above current value. Your current Body mass index BMI is 27.5. Less than 25 is normal. And that is what your target is. If your liver function test would not improve in one month time, would definitely suggest you some more blood work.

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