What diet is recommended for individuals with elevated AST (SGOT) and ALT (SGPT) levels?

Diet Recommendations for Elevated AST (SGOT) and ALT (SGPT) Levels

The Mediterranean diet is strongly recommended for individuals with elevated liver enzymes (AST/ALT), as it has been shown to reduce liver fat and improve inflammation in non-alcoholic fatty liver disease, which is a common cause of elevated liver enzymes. 1

Understanding Elevated Liver Enzymes

Elevated AST (SGOT) and ALT (SGPT) levels typically indicate liver inflammation or injury. The most common causes include:

• Non-alcoholic fatty liver disease (NAFLD)
• Alcoholic liver disease
• Viral hepatitis
• Medication-induced liver injury
• Muscle injury (can also elevate these enzymes)

Dietary Recommendations

Core Dietary Pattern

1. Mediterranean Diet Components:

   • Emphasize plant-based foods: vegetables, fruits, legumes 1
   • Include whole grains rather than refined grains 1
   • Use extra virgin olive oil as the main added fat 1
   • Consume fish 2-3 times weekly, especially oily fish (salmon, sardines, trout) 1
   • Limit red meat consumption 1

2. Limit Fructose Intake:

   • Avoid processed foods and beverages with added fructose 1
   • Avoid sweetened beverages and foods with "high fructose corn syrup" 1
   • Limit added sugars to no more than 100-150 kcal/day (6-9 teaspoons) 1

3. Increase Fiber Intake:

   • Eat vegetables with all main meals 1
   • Choose whole grain varieties of breads and cereals 1
   • Include legumes 2-3 times weekly 1
   • Consume fresh fruit daily 1
   • Consume nuts and seeds as snacks 1

4. Healthy Fat Sources:

   • Replace saturated fats with polyunsaturated fatty acids (PUFAs) and monounsaturated fatty acids (MUFAs) 1
   • Use vegetable oils (olive, canola) instead of tropical oils 1
   • Include nuts and seeds daily 1

Weight Management

For overweight or obese individuals with elevated liver enzymes:

• Aim for 5-7% weight loss to reduce liver fat 1
• Target 7-10% weight loss to improve liver inflammation 1
• Aim for >10% weight loss to improve fibrosis 1
• Focus on sustained weight loss through dietary changes rather than rapid weight loss, which can temporarily worsen liver enzymes 2

Foods to Limit or Avoid

• Highly Processed Foods: Fast food, commercial bakery goods, sweets 1
• Alcohol: Reduce or eliminate alcohol consumption, especially with signs of advanced liver disease 1
• Added Sugars: Limit to 100 kcal (6 tsp)/day for women and 150 kcal (9 tsp)/day for men 1
• Sodium: Limit to 2300 mg/day 1
• Saturated Fat: Limit to 5-6% of total calories 1

Meal Planning Approach

Daily Meal Structure

• Consume 5-6 smaller meals throughout the day rather than 3 large meals 3
• Separate liquids from solids (drink 15 minutes before or 30 minutes after meals) 3

Portion Guidelines

• Fill half your plate with vegetables and fruits
• Fill one quarter with whole grains
• Fill one quarter with lean proteins
• Include small amounts of healthy fats

Sample Daily Plan

1. Breakfast: Oatmeal with berries and nuts; or whole grain toast with avocado
2. Mid-morning snack: Fresh fruit with a small handful of unsalted nuts
3. Lunch: Large salad with olive oil dressing, lean protein (fish, chicken, or legumes), and a small portion of whole grains
4. Afternoon snack: Greek yogurt with fresh fruit or raw vegetables with hummus
5. Dinner: Grilled fish or lean poultry, steamed vegetables, and quinoa or brown rice
6. Evening snack: Small piece of fruit or a few nuts

Additional Lifestyle Recommendations

• Physical Activity: Engage in regular aerobic physical activity (at least 150 minutes of moderate-intensity exercise weekly) 1
• Hydration: Drink at least 1.5 liters of water daily 3
• Cooking Methods: Prefer baking, steaming, grilling, or boiling instead of frying 3
• Meal Tracking: Keep a food and symptom journal to identify individual food sensitivities 3

Monitoring Progress

• Regular monitoring of liver enzymes is recommended to assess improvement
• Track weight changes and adjust dietary intake accordingly
• Consider periodic assessment of nutritional status, particularly for vitamin and mineral deficiencies if dietary restrictions are significant

By following these dietary recommendations, most individuals with elevated liver enzymes can see improvement in their liver function tests over time, particularly when the underlying cause is related to metabolic factors such as fatty liver disease.