What Are The Normal AST/ ALT Levels For A Healthy Liver?

Posted on Mon, 20 Apr 2015

Question: Is your AST/ALT ratio relevant if the numbers are well within normal levels? For instance an ALT of 10 and an AST of 20. I drank a lot in my 20s but now i have kids and want to make sure my liver's healthy! I also worked out right before the test which i think can affect AST?

Answered by Dr. Amitkumar Maheshwari (2 hours later)

Brief Answer:
Do the serum GGT level along with AST/ALT

Detailed Answer:
Welcome to HCM
This is Dr Amit. Let me help you in this case
Your ALT( alanine transaminase) and AST(aspartate transaminase) both are within the normal range. Only raised AST/ALT ratio is not significant for the alcoholic liver disease.
So I will advise you to do Gamma glutamyl transferase (GGT) which is sensitive liver marker for chronic alcoholism.
Raised GGT level along with the AST/ALT RATIO greater than 2 is significant for alcoholic liver disease. And AST level is affected mainly by cardiac problem and muscle injuries. Exercise rarely cause significant change in the level of AST
Hope I have given satisfactory answer to your question
Feel free to ask if you have any other doubts
Regards

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Amitkumar Maheshwari (2 hours later)

So if these and all other liver panel tests, including GGT are within normal range the AST/ALT ratio is insignificant? ,

Answered by Dr. Amitkumar Maheshwari (3 hours later)

Brief Answer:
Carry out abdomen ultrasound

Detailed Answer:
Welcome to HCM
This is Dr Amit. Thanks for the follow up query.
Previously it was considered significant if the AST/ALT RATIO is greater than 2 suggesting of alcoholic liver disease and other diseases affecting the liver function like alcoholic hepatitis.

It has been also noted that patients with non alcoholic steohepatitis (NASH) also shows AST/ALT ratio greater than 1.5 or two. As there is significant overlap between AST:ALT ratios in different conditions.this ratio cannot be relied on exclusively when making a diagnosis

So it is recommended now that elevated AST/ALT RATIO along with elevated GGT is considered significant for the alcoholic liver disease.

If the GGT is normal and AST/ALT is high then it is not that much significant as compared to raised GGT along with raised AST/ALT RATIO but to rule out such possibility I will advise you to carry out abdomen ultrasound to see the gross picture of liver whether there are any changes related to alcoholic cirrhosis like change in the size of liver, formation of fibrosis etc.
Hope I have given satisfactory answer to your question. Feel free to ask if you have any other doubts
Regards

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Above answer was peer-reviewed by : Dr. Raju A.T