High alanine aminotransferase (ALT) often point to liver damage or disease. Read on to find out how to naturally lower your levels and protect your liver–both in the short and long run.
How to Lower ALT Levels Naturally
1) Engage in Moderate Exercise
Exercise significantly decreased ALT levels in 1787 participants (meta-analysis and 2 other studies) with liver disease. Individuals with high starting BMI were particularly likely to see a major decline in ALT [1, 2, 3, 1, 2].
Exercise most likely reduces ALT levels in children and teens as well. In a study of 2,844 adolescents, those with “low” fitness had higher ALT levels than those with “adequate” fitness, suggesting that improving fitness with exercise could decrease ALT levels .
2) Lose Weight
In a 15-month study with 31 overweight patients, exercise and diet led to weight loss, which was directly correlated to decreases in ALT .
In a study of 2,153 healthy participants, treatment with the diabetes drug metformin for 3 years lowered ALT levels. This effect was dependent on weight loss, indicating that metformin stimulated weight loss, which in turn lowered ALT levels .
While evidence of weight loss directly lowering ALT levels is sparse, losing weight may slow and even reverse liver diseases such as non-alcoholic fatty liver disease, supporting the hypothesis that weight loss improves liver health .
3) Eat a Low-Carb or Gluten-Free Diet
While a low-calorie diet likely reduces ALT through weight loss, low-carb diets lower ALT levels independent of weight loss .
For example, in a study of 259 overweight diabetic patients, those who ate a modified Mediterranean diet (35% carbs, 45% fat) had lower ALT levels after 6 months than those on the American Diabetes Association diet (50% carbs, 30% fat) .
Furthermore, in a study with 52 overweight, insulin-resistant patients, the low-carb diet (40% carbs, 45% fat) lowered ALT levels more than the low-fat diet (60% carbs, 25% fat) even though both diets had the same number of calories and participants lost the same amount of weight .
However, in a study of 59 obese women, participants on the low-fat and low-carb diets saw a similar reduction in ALT levels (33% and 41%, respectively). Both groups also lost a comparable amount of weight (5.5% and 5.7%, respectively), indicating weight loss was probably the intervening factor .
In cases of undiagnosed celiac disease, a gluten-free diet is likely the most effective way to lower ALT levels. In 2 studies with 171 and 158 patients with celiac disease, ALT levels decreased in 95 to 100% of individuals with high levels after eating a gluten-free diet for 6 months [14, 15].
4) Consume More Vitamins and Antioxidants
Antioxidants and vitamins may improve liver health and ALT levels by reducing oxidative damage and inflammation (turning white blood cells into the anti-inflammatory type) .
In a 2015 meta-analysis of 5 studies with 401 patients with a non-alcoholic fatty liver disease, supplementation with vitamin E reduced ALT levels by an average of 29 U/L .
Vitamin E supplementation also reduced ALT levels in patients with a non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, and chronic hepatitis C, according to another meta-analysis of 8 studies with 119 patients with various liver diseases .
In a study of 247 patients with non-alcoholic liver disease, 800 IU of vitamin E per day (approximately 530 mg) decreased ALT levels after 96 weeks of treatment and improved liver health (biopsy) .
Vitamin E did not significantly reduce the ALT levels of children with liver disease (non-alcoholic fatty liver disease) in a meta-analysis of 5 studies with 270 children participants .
In a study of 173 adolescents with a non-alcoholic fatty liver disease, daily supplementation with 800 IU of vitamin E for 96 weeks did not reduce ALT levels. However, the control group may have adhered to their protocol better than the treatment group .
- 500 mg daily for 12 weeks reduced ALT levels by 32% on average 
- 300 mg daily for 13 weeks reduced ALT levels by 18% on average 
Vitamin C (Alone and with Vitamin E)
Vitamin Chttps://selfhacked.com/blog/need-know-vitamin-c-32-science-based-health-benefits/ significantly reduced ALT levels in rats exposed to pesticides (neutralizing free radicals) .
In a study of 15 patients receiving nutrition through an IV (parenteral nutrition), choline reduced ALT levels after 6 weeks .
Choline supplements also lowered ALT levels in rats .
However, a study of 60 men, choline supplements (550 mg/day) did not reduce ALT levels but prevented ALT from rising .
Rutin, an antioxidant found in citrus fruits, reduced ALT levels in rats after they had increased due to a high-calorie diet and daily alcohol consumption .
Daily supplementation with rutin protected rats from high ALT levels when they were fed a high-cholesterol diet (by reducing the damage caused by free radicals) .
5) Drink More Coffee
In a study of 376 patients with hepatitis C over 12 months, those who drank coffee regularly were more likely to see a decrease in their ALT levels, or preserve their normal ALT levels .
However, in a study of 177 patients with scar tissue on their livers (liver fibrosis), daily coffee consumption did not lower ALT levels. However, the participants who drank at least 2 cups of coffee a day had lower levels of scarring (as measured by liver biopsy), suggesting that coffee was still improving liver health .
It is unclear if the beneficial effects of coffee are due to its antioxidant properties or by another mechanism. Caffeine is unlikely to be involved because green tea does not consistently reduce ALT levels [41, 40, 38, 42].
6) Try Iron Reduction Therapy
A 3-month regimen of iron reduction therapy reduced ALT levels by an average of 38% in a study with 33 patients with chronic hepatitis C .
7) Supplement with Plant Extracts
Artichoke Leaf Extract
Taking 2700 mg of artichoke leaf extract per day for 2 months reduced ALT levels by an average of 47% in a study of 60 patients with non-alcoholic liver disease .
Extract of Hammada Scoparia Leaf
The Hammada scoparia leaf is a traditional medicine from North Africa used to treat cancer, hepatitis, and obesity .
Daily supplementation with this extract protected rats from increased ALT due to alcohol consumption .
Extract of Piliostigma thonningii Plant
The Piliostigma thonningii plant is native to the tropical forests of Africa, where it is used to treat stomach aches, coughs, colds, inflammation, and snake bites .
Daily supplementation with this plant extract significantly lowered ALT levels in rats, possibly by decreasing insulin resistance .
8) Drink Alcohol in Moderation
Small amounts of alcohol may reduce ALT levels by increasing insulin sensitivity, reducing free radical damage, and/or reducing blood levels of uric acid .
In a study of 9,703 healthy Japanese men, moderate alcohol consumption (4 to 14 drinks per week) was associated with lower ALT levels .
Minimal alcohol consumption (1% of their water) significantly reduced ALT levels in rats fed a high-fat diet. Doubling the alcohol consumption to 2% weakened the effect .
To put this in perspective, it is equivalent to about 11 grams of pure alcohol per day for a human. A standard drink has 14 grams of alcohol.
9) Probably Not Omega-3
Due to the beneficial effects of omega-3 fatty acids on a non-alcoholic liver disease, many researchers suspected that they would also decrease ALT levels. However, the evidence does not support this claim [51, 52].
Want to Learn More?
This post is part of a series about ALT.
- Find out more about the causes of high ALT levels in this post.
- Learn more about the functions of ALT and why doctors order the test here.
- If your ALT levels are abnormally low, read this post.
Irregular ALT Levels?
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You can lower your ALT levels naturally by engaging in moderate exercise, eating an antioxidant- and nutrient-rich diet low in carbs, drinking more coffee, and supplementing with herbs such as artichoke. You should also lose extra weight and avoid drinking too much alcohol.