53yo female on medifast diet. Their food contains iron. Yearly lipid, A1c CMP, CBC, CK, Tsh all perfect except for ALT of 39and BUN/creatine ratio of 24 Is more testing recommended? Or could it be iron related? My Alt last year was 19.

Retest in 1-2 months. Low grade elevations in transaminases (ALT/AST <5x upper limit of normal) are common, and there are many things that can cause them to go up. It's probably not related to dietary iron. I would suggest having your LFT's checked again in 1-2 months. If it is still elevated your PCP can do a workup for the most common causes of elevated Transaminases.