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 control cholesterol
- alcohol consumption
- hepatitis A, B, or C
- heart failure
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 to lower your ALT levels.
A small, hospital-based cohort study from 2013 looked at people living with chronic hepatitis C. It found that those who drank filtered coffee every day were three times more likely to have normal ALT levels than those who didn’t.
A 2017 review further suggests that drinking anywhere from one to four cups of coffee a day can help to lower ALT levels and reduce the risk of liver disease and cancer.
While the terms folate and folic acid are often used interchangeably, they’re aren’t quite the same. They’re two different forms of vitamin B-9. Folate is naturally occurring B-9 found in certain foods. Folic acid is a synthetic form of B-9 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.
A 2011 short-term, randomized controlled trial found that taking 0.8 milligrams of folic acid a day was helpful for lowering serum ALT levels when combined with medication. This was particularly true for participants with ALT levels over 40 units per liter (IU/L). For reference, typical ALT levels range from 29 to 33 IU/L for males and 19 to 25 IU/L for females.
A 2012 animal study similarly found that consuming more folate resulted in lower ALT levels and a decreased risk of liver damage. The results showed that ALT levels decreased as folate levels increased.
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.
Adopting a low-fat, moderate-carbohydrate diet can help to both treat and prevent NAFLD, a common cause of high ALT.
A small 2013 study found that swapping just one meal a day for a veggie-heavy, low-fat meal can help to lower ALT levels over the course of a month. An earlier study similarly found that eating a diet lower in calories and carbohydrates was effective for lowering ALT levels in overweight adults with insulin resistance.
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 a day.
You can also try incorporating these tips into your weekly meal planning:
- avoid 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
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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