The ALT test measures alanine aminotransferase, an enzyme concentrated in liver cells that leaks into the blood when hepatocytes are injured. Practitioners use it as the most liver-specific enzyme on a standard panel and an early marker of fatty liver in clients with insulin resistance. Herbal products, some medicines and hard resistance training can raise it, so check these first.
| Test type | Measured in a blood sample |
|---|---|
| Measurements required | ALT only |
| Sample and collection | Blood draw at a collection centre |
| Preparation | This test doesn't need fasting on its own. |
| Turnaround | 3 to 5 business days |
| Available through | Liver Function Tests, part of the Baseline Health Check. Also in: Full Body Health Check, Weight Management Test. |
| Pricing | Included in the $99 Baseline Health Check |
| Results | Returned in the Vively practitioner platform, beside your client's other markers |
What are the ALT reference and optimal ranges?
| Typical lab reference | Vively optimal | |
|---|---|---|
| Men | 5 to 40 U/L | 10 to 30 U/L |
| Women | 5 to 35 U/L | 10 to 20 U/L |
Labs differ, so read the client's result against the range on their report (RCPA guidance). The optimal range is a target for long-term liver health, not a diagnostic cut-off.
Check a client's ALT result
Enter the value from your client's lab report to see where it sits against the typical lab range and the Vively optimal range.
A guide only, not a diagnosis. One result is a starting point: read it with symptoms, history and a repeat test. Labs differ, so check the result against the range on your client's report. Nothing you enter is stored or sent.
How do you arrange ALT testing through Vively?
- Get verified. Practitioners with a recognised qualification or membership (ATMS, NHAA, ANTA, Dietitians Australia, NSA, CMA or Ahpra registration) can request free practitioner access.
- Choose a panel. Log in to the practitioner platform and pick a panel that includes ALT, or build your own. It is included in the $99 Baseline Health Check.
- Client collects. Your client collects at a partner collection centre, with their request on their phone or printed.
- Review results. Results come back to you in the practitioner platform, beside your client's other markers, ready for the follow-up consult.
Which Vively panels include ALT?
Log in to the practitioner platform to view a panel in full, or build and save your own from 100+ tests and panels.
- Baseline Health Check74 markers across 11 lab groups$99
One fasting blood draw.
Full Blood CountUrea, Electrolytes & CreatinineLiver Function TestsCalcium, Phosphate & MagnesiumLipid StudiesDiabetes & Glycaemic StudiesIron StudiesThyroid Function Tests+3 moreLog in to view this panel - Weight Management Test27 markers · Heart & metabolicPrice on sign-upALTTotal CholesterolLDL CholesterolHDL CholesterolNon-HDL CholesterolTriglyceridesFree testosteroneSHBG+19 moreLog in to view this panel
- Log in to view this panelFull Body Health Check87 markers · Health checksPrice on sign-up
Why does the optimal range sit there?
Our optimal ceilings sit well under lab limits, because those limits were built from populations with many undiagnosed fatty livers, which pushed them up.
Prati and colleagues (Annals of Internal Medicine, 2002) re-derived limits in lean, healthy, low-risk adults: about 30 U/L for men, 19 U/L for women. The American College of Gastroenterology guideline (Kwo, 2017) gives 29 to 33 U/L and 19 to 25 U/L.
Published links tie very low ALT to frailty in older adults, and the enzyme needs vitamin B6 as a cofactor. That evidence is thinner.
What should ALT be read with?
- ContextALT above AST with high triglycerides and HOMA-IR
Typical fatty liver (MASLD) and insulin resistance pattern.
- ContextAST above ALT with high GGT and MCV
Alcohol pattern; in known fatty liver it can also signal fibrosis, which the GP can assess with a FIB-4 score.
- ContextALT and AST raised after hard training, normal GGT
Muscle source more likely; repeat after a quiet week.
- HighHigh ALT with high ferritin and transferrin saturation
Iron overload or fatty liver; needs GP review.
- HighHigh ALT with high bilirubin or low albumin
More significant liver involvement; GP review.
What can affect a ALT result?
- Herbal and supplement products, including concentrated green tea extract, turmeric or curcumin products, kava and some bodybuilding products.
- Medicines such as statins, methotrexate, amoxicillin-clavulanate and regular high paracetamol intake.
- Hard or unfamiliar resistance training, which can raise ALT for up to a week.
- Alcohol, rapid weight loss and very low calorie diets.
- Untreated coeliac disease and hypothyroidism.
When should you refer the client to their GP?
- ALT above three times the upper limit, or above twice the upper limit on repeat.
- Any raised ALT with jaundice, dark urine, pale stools, abdominal pain, easy bruising or confusion.
- ALT above range for six months or rising across tests.
- A rise after starting a herbal or supplement product: pause the product and involve the client's GP.
How should a client prepare for a ALT test?
Copy or print this to send to your client.
Preparing for your ALT test
- This test doesn't need fasting on its own.
- If your practitioner has requested the Baseline Health Check, fast for 8 to 12 hours before a morning collection (water is fine).
- Avoid heavy or unfamiliar resistance training, such as a new weights program, for three days before your test.
- Take your pathology request to any of 4,000+ collection centres. Bring it printed or on your phone.
- Keep taking prescribed medicines as usual unless your doctor tells you otherwise.
- Results usually take 3 to 5 business days and come to your practitioner. Book your results appointment for after that.
How do practitioners use ALT with clients?
ALT responds to metabolic change: more fibre and whole foods, less added sugar, fructose and alcohol, and modest weight loss in clients with central adiposity usually bring it down over two to three months. Ask about every supplement and herbal product before reading a rise, including ones you did not prescribe.
ALT FAQs
Can a naturopath, nutritionist or dietitian order ALT through Vively?
Yes. Add it to a client panel on the Vively practitioner platform. It is part of Liver Function Tests in the $99 Baseline Health Check, and is also in Full Body Health Check and Weight Management Test. No account yet? Request free access.
Can a client have fatty liver with a normal ALT?
Yes. Many people with fatty liver, and some with fibrosis, have an ALT inside the lab range, especially where the upper limit is 35 to 40 U/L. A value above our optimal range with high triglycerides, high fasting insulin or a large waist is worth discussing with the client's GP, who can consider imaging or a FIB-4 score.
What should I do if ALT rises after starting a herbal product?
Pause the product, let the client's GP know, and retest in four to six weeks. Herb-induced liver injury is uncommon but documented for products such as green tea extract, kava and some turmeric preparations. If ALT is above three times the upper limit or the client has symptoms, refer straight away.
Can hard training raise ALT, and how do I tell muscle from liver?
Yes. Hard or unfamiliar resistance training can raise ALT for up to a week. If ALT and AST are both raised after training with a normal GGT, a muscle source is more likely, so repeat after a quiet week. A persistently raised GGT or a rising ALT points back towards the liver.
How do I read ALT and AST together?
ALT above AST with high triglycerides and HOMA-IR is the typical fatty liver (MASLD) pattern. AST above ALT with a high GGT and MCV suggests alcohol. In known fatty liver, AST rising above ALT can signal fibrosis, which the client's GP can assess with a FIB-4 score.
References
- RCPA Manual. Alanine aminotransferase.
- Pathology Tests Explained. Alanine aminotransferase (ALT).
- Prati D, Taioli E, Zanella A, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Annals of Internal Medicine. 2002.
- Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: evaluation of abnormal liver chemistries. American Journal of Gastroenterology. 2017.