High ALT (alanine aminotransferase) levels usually mean there is inflammation or damage to liver cells, because ALT is an enzyme released into the blood when the liver is stressed or injured. Common causes include fatty liver disease, viral hepatitis, alcohol use, obesity, diabetes, certain medications (like painkillers or antibiotics), and sometimes muscle injury or other liver disorders. Mild elevations may be temporary, but persistently high or very elevated ALT levels can indicate more serious liver disease. Medical evaluation is important if ALT remains high, rises significantly, or is accompanied by symptoms like jaundice, fatigue, abdominal pain, nausea, or dark urine, as further tests or treatment may be needed to identify the cause and prevent liver damage.