Know your AST/ALT. Know your health.
Test your De Ritis Ratio (AST/ALT) and 100+ other biomarkers in a single blood draw.
Normal range: 0 – 1 (lower is better)
The De Ritis ratio divides AST by ALT, two liver enzymes released when liver cells are stressed or damaged. The pattern between them, not just their individual levels, hints at what kind of liver issue may be present. In early fatty liver disease, ALT tends to run higher than AST, producing a ratio below 1. As liver damage advances toward fibrosis or cirrhosis, AST rises relative to ALT and the ratio climbs above 1. A ratio above 2 is classically associated with alcohol-related liver injury.
AST/ALT isn't sold on its own. It comes in a comprehensive metabolic panel, about $40. A fuller workup adds Vitamin D ($75), hs-CRP ($69), ApoB ($50), and ApoA1 ($50). You can test AST/ALT and 100 other biomarkers for $190 as part of an Empirical membership.
Empirical is FSA/HSA eligible, so you can pay with pre-tax dollars. Fast for 8-12 hours beforehand for the most accurate lipid and metabolic results, and expect results in days rather than weeks.
A normal AST/ALT is 0 – 1. Lower is better.
A low ratio (ALT higher than AST) is typical of early non-alcoholic fatty liver disease, which is driven by insulin resistance, excess weight, and a diet high in sugar and refined carbohydrates. A rising ratio can signal progression toward fibrosis as the liver sustains more damage.
A high ratio (AST higher than ALT) shifts the picture toward alcohol-related liver disease, advanced fibrosis, or cirrhosis. Because AST also comes from muscle, intense exercise or muscle injury can raise it and push the ratio up without reflecting the liver at all.
The ratio is most useful read together with the individual enzyme levels and other markers. Reducing alcohol, losing excess weight, cutting sugar and refined carbs, and exercising regularly all support liver health and improve the underlying enzymes the ratio is built from.
AST/ALT is drawn at 2,200+ Quest and BioReference patient service centers across the US, so there's usually one within a short drive. Browse the full directory to find the one closest to you.
Test your De Ritis Ratio (AST/ALT) and 100+ other biomarkers in a single blood draw.