Daniele Jesus/Getty Images
- To lower ALT levels, you can drink coffee, improve your diet, get more folic acid or folate, lower your cholesterol, and avoid alcohol or smoking.
- High ALT levels can indicate a liver problem, as these liver enzymes do not function properly and leak into the bloodstream.
- This article was medically reviewed by Rudolph Bedford, MD, gastroenterologist at Providence Saint John’s Health Center in Santa Monica, CA.
- Visit Insider’s Health Reference library for more advice.
If you have high ALT levels — a liver enzyme known as alanine aminotransferase — it may be due to a liver problem. Here’s what you need to know about these liver enzymes and how to lower your ALT levels naturally.
What is ALT?
ALT is an enzyme in your liver cells that helps convert proteins from the foods you eat into energy. If your liver cells are inflamed or injured, they may leak higher amounts of these enzymes, which causes them to be released into your bloodstream.
Your ALT level can be measured through an ALT blood test. For males, the normal amount ranges from 29 to 33 units per liter (IU/L) of blood. For females, the range is 19 to 25 IU/L.
Some of the common causes of a high ALT level include:
- Nonalcoholic fatty liver disease, an accumulation of extra fat in your liver cells that isn’t caused by drinking alcohol
- Drinking excessive amounts of alcohol, such as more than three drinks a day
- Being obese
- Side effects of over-the-counter pain medications (like Tylenol) or cholesterol-lowering medications (like statins)
- Hepatitis A, B, or C
- Heart failure
Fortunately, an elevated ALT level is usually temporary and doesn’t indicate a serious liver problem.
"If you have an elevated liver enzyme test, step one is to give it some time and repeat it," says hepatologist Zachary Henry, MD, an associate professor in the Division of Gastroenterology and Hepatology at the University of Virginia. "Sometimes these levels go up and down, and it may have just been a red herring."
But, if you do have persistently high ALT levels, the following lifestyle changes may help lower them and improve your liver health overall.
1. Drink more coffee
"Coffee is a fascinating drink for the liver," Henry says. In fact, drinking up to four cups a day can help lower your ALT levels, according to a 2017 review.
A large 2014 study found that both caffeinated and decaffeinated coffee lowered levels of abnormal liver enzymes. Of the 27,793 adult participants, those who drank at least three cups of coffee a day had lower ALT levels than participants who didn't drink coffee.
One caveat is that you should drink coffee without sugar and cream since these can have a detrimental effect on your liver. "It's best to drink it black," Henry says.
2. Improve your diet
Studies have found that eating a healthy, well-balanced diet can help lower your ALT level. After 10 men in Japan ate low-calorie lunches for a month that were high in vegetables and low in animal-based proteins, their ALT levels were lowered by 20.3%, according to the results of a small 2013 study.
There are no specific foods or beverages that will lower your ALT level, Henry says. But a healthy diet is important, especially if the cause of an elevated ALT level is nonalcoholic fatty liver disease.
The American Liver Foundation recommends that you eat more of these foods for a healthier liver:
- Fruits and vegetables
- Lean meats
- Fish containing omega-3 fatty acids, such as salmon and trout
- High-fiber foods like whole-grain breads, rice, and cereal
- Fat-free or low-fat milk and other dairy products
On the other hand, you should avoid eating the following:
- Foods high in sugar, fat, or salt
- Fried foods
- Raw or undercooked shellfish like clams or oysters
- Foods containing partially hydrogenated vegetable oils
3. Get more folic acid
Folic acid is a form of vitamin B-9 found in supplements and in its natural form as folate in some foods. It's essential for the production, growth, and function of red blood cells.
A folic acid deficiency may lead to a higher ALT level. A 2011 study of 480 participants with mild hypertension found that a daily dose of 800 milligrams of folic acid may help lower ALT levels, especially for men and people with elevated ALT levels.
However, Henry warns that you should always consult with your doctor before taking folic acid or other supplements to make sure there are no perceived health risks. Instead of taking folic acid supplements, he recommends eating foods that are high in folate. These include:
- Leafy, dark green vegetables like spinach, kale, and brussels sprouts
- Beans
- Peanuts
- Sunflower seeds
- Whole grains
- Liver
4. Lower your cholesterol
A large 2018 study suggests that high cholesterol levels are associated with elevated ALT levels.
While lowering your cholesterol level may not necessarily also lower your ALT level, making lifestyle improvements like eating a healthy diet and exercising regularly are still important.
"Patients who have fatty liver disease frequently have comorbid medical conditions like high cholesterol, and we certainly want good control of those conditions because of the increased risk of heart disease," Henry says.
5. Avoid alcohol and smoking
It's a well-known fact that drinking alcohol can damage your liver, leading to serious health issues like cirrhosis.
A large 2010 study found that normal ALT levels were elevated by 6% for those who drank about two alcoholic drinks each day, and 10.4% for those who had four drinks daily.
Smoking cigarettes should also be avoided since it can harm your liver in several ways. For example, it produces potentially toxic chemicals that could cause liver inflammation and scarring of your liver tissue. Researchers have found that for people who don't drink alcohol, smoking may be a significant risk factor for developing nonalcoholic fatty liver disease.
Takeaways
While making these lifestyle changes may help lower your elevated ALT level and improve your health overall, it's important to see a doctor if the level continues to be high after follow-up ALT tests. Your doctor may recommend additional bloodwork and an ultrasound of your liver, or may refer you to a specialist, to determine why your liver is injured or inflamed.
