Does anyone know if AST/ALT 2:1 RATIO counts if ALT is normal but AST is one point above normal? AST: 31(normal is 10-30) ALT:15(normal is 6-29) Test taken 2 weeks AF. Background: Im 26 years old and have been a heavy drinker for the better part of my life since turning 21 in July 2012.The drinking gradually increased from me turning 21. Stopped drinking for a period of time when i became pregnant in Dec of 2015 but started up again OCT 16, stopped for a month in Aug 17 but started again in Sept. I know no one here is a Dr. but i'm about to have a mental break down. My next appointment for blood test is in a month. G.P didn't seem worried with my results, but i have googled that a 2:1 ration means Liver disease. Has anyone experienced similar? Im really freaking out and i'm alone all the time, so i tend to get in my own head. Any reassurance and support is welcomed
Written by
Lovelydove
To view profiles and participate in discussions please or .
The general rule of thumb is, If its normal its normal and don't worry. Forget about any ratios within normal reference ranges. Also don't worry if a test is slightly above normal. As with everything there are natural variations from day to day and from people to people, even hour to hour.
Even so, if you are a heavy drinker it may be sensible to take it easy a bit. Everything in moderation as they say. Best to try and not get to the stage where your ratio does count!
Thanks for the reply. I was fine driving home from the Dr. but when i got home the first thing i did was google my results and just bursted into tears. I do have discomfort both sides off and on with dull RUQ pain off and on. Dr thinks its gastritis, but I've read a lot of cases of normal result and having ALD. Your reply has made me feel a lot better.
The "De Ritis" ratio inversion (AST floating substantially over ALT) has a lot of false positives associated with it. The AST enzyme is found in muscle tissue too, so any exercise or exertion within a few days before the blood draw can bump AST briefly up and over ALT. A recent alcoholic binge can also create this inversion when advanced liver disease is NOT present.
This said, it may be wise not to completely ignore a 2:1 inversion, as it is a common finding with both mild/chronic alcoholic hepatitis and advanced disease. It is not a particularly reliable stand alone indicator, but something to watch.
If this continues to occur in followup labs when you haven't been exercising or binging the week before your labs, a heavy drinker might want to look at other indicators.
GGT is a good blood lab to add when alcoholic disease is a worry. Heavy drinking can bump it over normal range (10-50), but when GGT is up into triple digits AND a 2:1 De Ritis inversion occurs at the same time in more than one lab, an advanced diagnostic like ultrasound or fibroscan might be wise. GGT is a dirt cheap lab, & your doc shouldn't mind adding this to your next lab order. You have to ask for it in advance though, as it isn't included in routine labs.
Try to minimize your alcohol consumption for at least a week before your next bloods are taken, & you should see some improvement.
Im going back in a month and the Dr said she would test my ggt to help with my anxiety. It is a little worrisome because i had stopped drinking two weeks prior to that test but i also did start working out for the first time in a while those two days prior also. I hope thats the reason!
It's called a de Rios inversion when AST is elevated above the ALT
However, only when the labs are out of range does it raise an eyebrow. Alcohol and hepatic toxic substances tend to raise AST over ALT. AST is not liver specific, it can come from muscle, heart, bones, kidenys ect. Alcohol and toxic substances are metabolized in zone III of the liver. This is where mitochondrial damage takes places. Hence, why in Alcoholic liver disease or alcohol stress can cause an increase on AST. Nothing to worry about, don't put too much into one lab result. When I got sick my AST was 200+, ALT was 70 and it was from a year of using Tylenol.
Last test ALT 20, AST 18 :). Labs taken less than a week ago. I was so sick my abdomen tore because of the pressure from an inflamed liver. Time away from toxic substances does the liver a lot of good. GGT is another good test, very sensitive to alcohol damage.
I'm so glad you were able to recover!! how long did it take? i will be getting the GGT in a month and i will be 7 weeks alcohol free then. What sucks is that now that i have stopped drinking i all of a sudden have acid reflux or something similar, i hope this will go away.
Only a pleasure .. find a hobby! or better, do things later on in the day that you need to drive to. There is NO way I would ever get behind the wheel if I have had a drink, so take an evening class, get home late and no need for more than 1 or 2 quick sips of wine...???
When you stop drinking or insulting your liver your liver goes through a phase called PAWS. This is when the immune system revs up to heal the damage that has been done to the liver. Normally, you'll see globulin in the labs and total protein increase. Things can get worse before they get better. My certainly did, I took over a year to start feeling good again. Many leading hepatologist believe the liver can take up to 18 months to heal. I still have issues with my abdominal separation from when I was sick, but the bad issues are now gone. Fibroscan was a 4.8.
In no way am I happy that you had to go through this terrible ordeal, but your experience has really helped calm me. It's so good to read a story with a great outcome! Im feeling pains that weren't there when I was drinking, so that's been scary. Im only in my first month of healing, so I have a ways to go. Your story gives me hope that I haven't done anything too irreversible. I have completely changed my diet and will look for recipes with beets and artichokes! I was a picky eater before this whole ordeal and didn't care what i put in my body as long as it tasted good. I'm surprised at how easy it was for me to change my whole lifestyle, fear is a powerful motivator!
With AST only moderately elevated (high-normal/1 point over), your workouts most likely was what bumped your AST.
In heavy drinkers it may take GGT 4 to 6 weeks to normalize with abstinence, so a slight elevation may remain early in recovery. It should not be hanging up in triple digits (double or more normal) after a month clean & sober.
Thanks for your replies! I will be 7 weeks alcohol free when they draw more blood so hopefully i''ll get good results! I wish my Dr would have told me this!
It would be wrong to say don't worry, but at 31 and 15 .. there is no problem YET. You are 26, so you need to take it easy on the booze ... easy to say, sometimes hard to execute. ps - my GGT is 500+, so when yours comes back like 80-200 and is OVER the norm ... don't panic .. Seriously Lovely - you are just fine - enjoy Valentines!!! J.
Your right! I need to just admit to myself that i'm not just a heavy drinker, but an alcoholic. I'm an all or nothing type of drinker, so I know I must quit forever. My Dr recommended AA, but as of right now alcohol scares the living daylights out of me and I don't know how they would feel about an 18 month old accompanying me ;p. Thanks for the insight and I hope you enjoy your Valentine's Day as well!!
You sound sensible, AA is probably not the answer (but I never tried)? so just chill and follow your instinct for now. You know too much is not good, so moderate it. I wish every 26 year old had the same attitude! Keep well Dove! Jx
I appreciate you saying that! The truth is that this whole experience knocked some sense into me haha! I wish I had the strength to moderate but i'm not so sure. Thanks for your replies! I needed the reassurance!
Take milk thistle and drink more coffee and limit alcohol. Coffee as well as milk thistle will protect liver disease from drinking too much. You’re probably okay but do yourself a favor and don’t drink so much.
Coffee and milk thistle will not protect the liver from the effects of drinking too much. Many UK hepatologists actually advise against taking milk thistle as it can skew liver numbers and there is no proven scientific evidence it has any beneficial effects. We have forum members who have been told to absolutely not take milk thistle as some hep doctors actually believe it to be harmful. Coffee is good for the liver but isn't any type of shield to prevent damage from alcohol. The only thing that can prevent damage from alcohol is cutting alcohol out altogether.
I was taking milk thistle, but i started developing dull RUQ pain so I've stopped to see if thats the cause. I do drink coffee every morning and am going to up the amount once i get some more decaf. Im done drinking, it's not worth the anxiety. I Also add some powdered turmeric to my coffee, so hopefully that helps!
On the coffee note, they say caffeine might actually have something to do with the positive effect it has on the liver. Also, drink water, remember your kidneys need water and hydration always will help with healing. Cocoanut water is great for that. Milk thistle has selenium in it, I you want some eat artichokes. Supplements are hit or miss because many have fillers in them that come from China. I was taking something called clear lungs and found out it had death cap roots in it. Highly liver toxic, after that I stopped taking any supplements. Beets are your A+ liver friend. They restore glutathione, the lover's and bodies largest antioxidant. Which, is also used to detoxify metabolites in the liver through the P53 pathway. Eggs have choline, without choline the liver is more susceptible to damage. Choline is needed for the liver to rebuild itself.
The Choline you can get from eggs, they have the largest amount of it. You can also get supplements, but best to stay away from those if you have liver issues as those supplements can have nasty fillers. The beets are for glutathione, which is the largest anti-oxidant found in the liver that helps repair damaged liver cells. I'm sure they have a powder, but I just drank straight beet juice or bought beets and ate them in a salad.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Fatty Liver / Early Liver Disease Questions
please expert comments...
Abnormal liver results 
ALT AST Fluctuate 
Still concerned about my liver!
