It is common that in a general analysis, a check-up or in periodic medical check-ups of adults, the measurement of transaminases is requested, in addition to other parameters such as glucose, cholesterol or hemoglobin.
In fact, most of our readers surely know that high levels of transaminases can indicate more or less serious health problems, generally related to liver problems. What they probably don’t know is what scope it has or what consequences it can have.
In this post we are going to try to make it clear what transaminases are, when they should be monitored and paid more attention and if it is possible to control them safely. And for this we are going to have the help of Juan Antonio Latorre, dietician-nutritionist in A Coruña and Full Academician of the Spanish Academy of Nutrition and Dietetics.
What are transaminases (ALT/GPT and AST/GOT)?
“They are intracellular enzymes, of a protein nature that act as biological catalysts in multiple metabolic reactions, participating in the metabolism of proteins, carbohydrates and fats, in the synthesis and degradation of nitrogenous compounds and in the detoxification mechanisms of drugs and toxins,” says the expert.
Transaminases are present in other tissues such as skeletal muscle or the kidney, but the relationship they have with the liver is especially important, specifically the ALT type (also called GPT), because it is more concentrated in this organ than in the rest of the tissues and can be a specific marker of hepatocellular damage.
What does it mean to have high transaminases?
It means that there may be cellular damage, especially due to liver damage, if it is ALT-type transaminases. This can lead to consequences that vary depending on the cause and persistence over time.
«Mild and transient elevations are very common and do not usually have clinical consequences. However, high and/or persistent elevations may reflect liver diseases that require monitoring,» indicates the dietitian-nutritionist.
Normal values and how to interpret them without getting scared
There is no single answer to this question because, as the expert indicates, «the reference intervals are not universal, they depend on the analytical method and the laboratory. For the correct interpretation, the specific reference range that appears in the laboratory report itself can be used.»
In any case, Latorre states that normal values for men are below 40-50 U/L; and for women they are usually less than 35 U/L.
When do you worry? and what to do
“When the elevation is less than two or three times the upper limit of normal, it is a relatively common finding and, if it does not persist in subsequent controls, it often normalizes when the triggering factor is corrected.”
On the contrary, if the rise is very high or persistent over time, it requires urgent medical evaluation.
Common causes of having high transaminases
The most common cause or trigger is what is called metabolic dysfunction-associated steatotic liver disease (MASLD) or, in other words, “extra fat accumulation in liver cells not caused by alcohol related to metabolic syndrome, obesity and insulin resistance.”
Other common causes are alcohol consumption, viral or autoimmune hepatitis, hepatotoxic medications and supplements, or intense physical exercise.
Symptoms of having high transaminases
One of the difficulties of having high transaminases is, precisely, that “they frequently occur without symptoms, and if they appear it is due to the disease that is causing them,” says Latorre.
In any case, the expert points out that the most common symptoms are tiredness or a feeling of fatigue, discomfort in the right area of the abdomen and, in advanced stages, yellowing of the skin and eyes (jaundice).
How transaminases are studied
«The evaluation of an elevation of transaminases is proposed in a stepwise manner. The first step is to confirm the alteration by repeating the analysis and expanding the liver profile to define the pattern of involvement,» explains the expert, for whom a detailed clinical history is an essential part of the study for diagnosis.
It is important that the history specifically review alcohol consumption, use of drugs and supplements, history of infections, and the presence of metabolic factors such as overweight, diabetes, or dyslipidemia. “Based on these data, selective tests are requested, such as viral studies or other specific analyses, and liver ultrasound is very frequently incorporated as an initial imaging test, especially when the alterations persist or there are clinical data that suggest structural involvement,” he clarifies.
How to lower high transaminases safely (step by step)
Medication is key, but it is also important to take into account what other diagnostic tests indicate.
What medications are used and what doctor can parents take them?
Treatment is not aimed at normalizing the analytical figure in isolation, but rather at correcting the cause that is causing the liver injury: eliminating alcohol, adjusting or suppressing hepatotoxic drugs or controlling diabetes, hypertension, dyslipidemia and weight.
On the other hand, medication varies depending on the cause, from specific antiviral treatments to immunosuppressive drugs, diabetes controllers, obesity and dyslipidemia…
This medication can be prescribed by primary care physicians, specialists in the digestive system, internal medicine or endocrinology depending on the clinical context.
Are other tests done if transaminases are high?
Depending on the suspected cause and the pattern of elevated liver enzymes, it is common to incorporate imaging tests to visualize the state of the liver. Liver biopsy is reserved for selected cases in which diagnostic doubts persist or it is necessary to specify the degree of fibrosis.
Food for high transaminases: what to prioritize and what to limit
As with medication, the diet to prioritize or restrict depends on the cause. For example, «in hepatic steatosis associated with metabolic dysfunction, dietary intervention constitutes a central therapeutic component. Improved diet quality is associated with reduced liver fat, improved insulin sensitivity, and decreased metabolic inflammation, with clinically relevant decreases in ALT and AST and, often, progressive normalization of values.»
Therefore, the initial assessment must include the patient’s nutritional status, but also dietary habits, level of physical activity and alcohol consumption.
«A Mediterranean-type eating pattern, which prioritizes vegetables (the base of the plate), whole fruit, legumes, whole grains, olive oil, fish and nuts, is related to less fat accumulation in the liver and better cardiometabolic health. Adequate intake of good quality proteins such as legumes, fish, eggs and lean meats also plays a relevant role, as it contributes to preserving muscle mass and improving liver metabolism, especially in people with insulin resistance. Moderate coffee consumption (2-3 cups/day) is associated with lower ALT levels and lower risk of fibrosis,” concludes Latorre.
Regarding foods to restrict, the expert emphasizes the reduction of:
- Added sugars, especially fructose,
- refined flours
- Ultra-processed products
- Foods with industrial trans fats and saturated fats
The ALDI Council
Take care of your liver with a healthy diet that includes vegetables, fruits, legumes and whole grains. Avoid alcohol and maintain a healthy weight.
Juan A. Latorre. Full academician at the Spanish Academy of Nutrition and Dietetics. Graduated in Human Nutrition and Dietetics from the San Pablo-CEU University. He holds a doctorate in Pharmacy Cum Laude from the University of Valencia and a master’s degree in Food Science and Engineering from the Polytechnic University of Valencia. He is an adjunct professor at the Isabel I University in the Degree of Human Nutrition and Dietetics. He also has a consultation in a private nutrition center in A Coruña and is a collaborator in the multidisciplinary consultation of the Dietary Council in the Nephrology Service of the Hospital da Costa de Burela.
