High AST And Normal ALT 

Are you having a high AST with normal ALT?
My name is Dr. Terranella, and if you don't know, those are typically referred to as liver enzymes. And in this video, we're going to look at the question of what's going on in people that have high AST with normal ALT.
We look at what is going on in people with high AST levels and normal ALT levels. AST, as you may or may not know, stands for aspartate aminotransferase, and ALT stands for alanine aminotransferase. These are both liver enzymes that are commonly measured in blood tests when you want to evaluate your liver function.
When there's liver damage or injury from a toxin or even drinking too much alcohol, these enzymes are released into the bloodstream from the damaged cell. The cell bursts open, and it leads to higher than normal or elevated liver enzyme values. In the case of high AST levels with normal ALT levels, it's important to note that AST is not exclusively found in the liver. It's also found in other tissues, such as the kidney, heart, and muscle.
So, high AST levels in the presence of normal ALT levels, depending on how low or normal that ALT is, could be indicating a problem more with other tissues and not the liver itself. And it's not always necessarily a problem either.
There are several possible reasons for high AST levels with normal ALT. The first, most common, and most likely is from muscle damage or increased exercise that can result in muscle damage. Every time we exercise, we're damaging our muscles to some degree. Depending on how intense it is, you may get more or less of that muscle damage, and that can result in those muscle cells bursting open and spilling out some of the AST enzyme into the bloodstream. So, if you have really high AST levels and your ALT is pretty much normal, less than 25, then this is most likely the problem.
Of course, there are other problems, like kidney issues and heart issues, that can also cause this. But more than likely, if you're having those problems, you're going to see other problems related to those specific organs. Maybe you have creatinine or other indicators of a kidney issue, and maybe you have other elevated enzymes indicating a heart issue. No one test is going to give you 100% accuracy on what's going on, but at least this gives you a general idea. The second possibility is from the liver itself actually causing issues because these enzymes are found in the liver. Alcohol use is probably one of the more common reasons that can lead to liver damage and result in elevation in AST.
However, elevations in AST that are a result of consuming alcohol are usually accompanied by a corresponding ALT and even GGT elevation.
So, in short, if you have high AST levels with normal ALT levels, this could simply be from exercising too much. I wouldn't assume that unless the timeline definitely matches and you don't have any other reason to think that there's something going on with your liver, heart, or kidneys.
Whatever the cause, it's usually a good idea to get a second follow-up test when you're away from the exercise or the offending culprit, so that you're sure that you don't actually have this on an ongoing basis. I hope this helps you better understand what could be going on in people with high AST and normal ALT.

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