Maybe you’ve recently received a routine blood work test as part of your annual physical and found out your liver enzymes are elevated. If you’ve never had elevated liver enzymes, you may be wondering what this means and what you can do about it. There are a number of common causes for high levels of liver enzymes, and in many cases, there are ways to help liver enzyme levels return to normal.
Enzymes on Liver Function Test
What exactly does a liver function test show? A liver function test evaluates the levels of liver enzymes and byproducts – like albumin and bilirubin – present in the blood. These levels indicate how well your liver is working.
Though numerous enzymes can be included on liver tests, these are the three main liver enzymes that doctors use to detect issues with the liver:
- Alanine transaminase (ALT): This enzyme belongs to a group of enzymes called transaminases, also known as aminotransferases. These enzymes facilitate amino acid synthesis. ALT is only found in small amounts in other tissues, making it an accurate sign of liver problems. (1)
- Aspartate transaminase (AST): This enzyme is also classified as a transaminase, and may also be called aspartate aminotransferase. AST, in addition to being found in the liver, can also be found in muscle tissue.
- Alkaline phosphatase (ALP): This enzyme is essential for protein metabolism and can be found in the liver, bone, and other tissues.
- Gamma-glutamyl transferase (GGT): GGT is found in the liver as well as other organs like the pancreas and intestine.
What Causes Elevated Liver Enzymes?
Your doctor will interpret your liver enzyme levels and other blood test results and symptoms to determine the cause of elevated liver enzymes. For example, elevated transaminases, as well as high GGT, generally indicate liver injury and damage to liver cells. On the other hand, elevated ALP alone doesn’t necessarily point to liver damage directly, and may instead suggest cholestasis, which means the flow of bile out of the liver is blocked. (2)
When high liver enzymes are detected, nonalcoholic fatty liver disease and alcohol-induced liver damage are commonly the culprits. These conditions, if left untreated, can lead to a more severe form of fatty liver disease called steatohepatitis. Years of untreated liver disease can scar your liver, cause fibrosis and cirrhosis, and ultimately result in liver failure.
Other causes may include: (3)
- Medications and supplements: Certain antibiotics and anti-seizure drugs may cause abnormalities in liver enzyme levels. Statins, which are used to manage metabolic syndrome, may cause liver enzyme levels to increase above the normal range. Even over-the-counter pain relievers like NSAIDs or those containing acetaminophen could cause elevated liver enzyme levels.
- Viral infections like hepatitis A, hepatitis B, and hepatitis C: Hepatitis A is spread by consuming food and drinks. Hepatitis B and C are usually spread through contact with blood and other bodily fluids; for example, unknowingly using contaminated needles or sexual contact. All forms of viral hepatitis cause liver inflammation and damage and can result in high liver enzymes.
- Autoimmune hepatitis: Autoimmune hepatitis is a noncommunicable disease that occurs when your immune system malfunctions and begins to attack your own liver cells, causing inflammation and damage.
- Hemochromatosis: Hemochromatosis is a hereditary disease that results in excessive iron accumulation in the blood, which can eventually damage the liver.
- Wilson’s disease: Wilson’s disease is a rare hereditary disorder that results in high blood copper levels, which can damage the liver and cause high liver enzymes.
Treating the cause of high liver enzymes will yield the most sustainable results. Your doctor can help determine the cause of elevated liver enzymes and advise you on medical adjustments for decreasing your liver enzymes. For example, if your medication is the cause, your doctor may want to change your medication to an alternative that effectively treats your condition without elevating liver enzymes.
Some Causes May Be Normal and Temporary
Your liver enzymes may rise as a natural and temporary biochemical response to certain circumstances. For example, ALP levels may increase during pregnancy, especially during second and third trimesters, and fall back down after delivery. Extremely vigorous exercise may cause also cause a temporary rise in liver enzymes. (3) A study in the British Journal of Clinical Pharmacology found that intense weightlifting elevated liver enzymes for up to a week in healthy men. (4) Levels should return to normal a couple weeks after excessive exercise has stopped.
Causes May Be Non-Liver Related
Keep in mind that those proteins traditionally referred to as “liver enzymes” are also found in other tissues and may indicate vitamin deficiency, heart disease, or issues with your bones or digestive system. Your doctor will be able to assess the specific configuration of your liver enzyme levels to determine what may be causing elevated levels. In this article, we focus primarily on liver health and liver-related causes of elevated liver enzymes.
Elevated Liver Enzymes Symptoms
In other cases, having elevated liver enzymes on a liver function test is a sign that your liver is not working as well as it should. An otherwise healthy individual who has elevated liver enzymes may not experience any symptoms at all. Even liver disease may go undetected until later stages.
In other cases, individuals with liver damage and disease may experience the following symptoms:
- Abdominal pain, especially in the upper right-hand quadrant
- Jaundice, or yellowing of the skin
- Fluid retention in the abdomen
- Unexplained weight loss
Nutrition to Lower Liver Enzymes
What you eat can have a major impact on liver health. Here are a few diet tips to help lower your liver enzymes.
Eat a Balanced Diet with Lots of Vegetables
Consuming a balanced diet based on whole foods can stave off risk factors for nonalcoholic fatty liver disease, including high cholesterol, diabetes, and other indicators of metabolic syndrome.
To support normal liver enzyme levels, incorporate macronutrients like high-quality protein, healthy fats, complex carbohydrates and micronutrients like vitamins and minerals into your diet. Try to avoid processed and packaged foods, and instead choose whole grains, fruits, vegetables, legumes, low-fat dairy, and lean meats and fish.
Fruits and vegetables, in particular, are filled with vitamins, minerals, antioxidants, and anti-inflammatory agents that promote liver health. Research has determined numerous plant-based foods that help repair liver damage, reduce fat accumulation in the liver, and prevent liver cancer. (5) Additionally, a study in Tehran, Iran revealed a direct association between increased intake of vegetables and lower ALT enzymes. (6)
Protect Gut Health with Probiotics
Scientific evidence suggests there may be a crucial link between gut health and liver function. Bacteria are key to creating a healthy gut microbiome that supports digestive health. Not all bacteria are bad. In fact, lots of bacteria strains are beneficial for gut health and even liver health.
These bacteria are called probiotics and help your digestive system process and break down the foods you eat. A pilot study conducted at the Northern State Medical University in Arkhangelsk, Russia, showed that probiotic supplementation may be a promising intervention to lower liver enzymes in individuals with alcoholic liver damage. (7)
These healthy microorganisms can be found in foods that have been fermented, including yogurt, sauerkraut, kimchi, tempeh, and miso. It may be difficult to include these foods in your diet on a regular basis, so you may choose to take high-quality supplements to make sure you get a consistent supply of probiotics.
Having a cup of coffee in the morning – or two – has the dual benefit of helping you wake up and supporting liver health. Interestingly, a number of studies have shown coffee consumption to be associated with lower AST, GGT, ALP, and ALT levels. (8)
It was once hypothesized that caffeine may be the therapeutic element in coffee. However, research suggests that there is a specific property in coffee that supports liver health, because both decaffeinated and caffeinated coffee seem to be associated with a lower risk of high liver enzymes. (9)
Coffee consumption, in addition to being associated with lower liver enzymes, seems to also inhibit liver disease progression. A wealth of research demonstrates that drinking coffee is connected to a lower risk of liver damage and mortality as a result of nonalcoholic liver disease, alcoholic liver disease, hepatic fibrosis, cirrhosis, viral infections, and liver cancer. (8)
Other Lifestyle Tips to Lower Liver Enzymes
In addition to the foods you eat, here are tips for making lifestyle changes that promote liver health.
Decrease Your Stress Levels
Traditional Chinese medicine has always asserted the critical connection between psychological state and physical health. For example, Chinese medicine describes how an emotional state of rage inhibits normal liver function.
Research supports the connection between the body and mind. In a study conducted on rats and published in the Lipids in Health and Disease journal, distress altered the healthy metabolism of fat in the liver. (10) Moreover, another study published in Gastroenterology found that psychological stress was associated with more negative outcomes in liver disease. (11)
As we deal with difficult circumstances in our lives, it is important to find an outlet for stress. Try different activities to determine what stress reliever works best for you. Exercise, meditation, or yoga may provide stress relief for some. For others, reading, journaling, or spending time outdoors is the best way to find peace. Whatever your go-to stress reliever is, making it a part of your daily routine in some way can help manage psychological stress.
Exercise decreases systemic inflammation, promotes weight loss, encourages muscle growth and fat loss, and eliminates risk factors associated with nonalcoholic fatty liver disease. Begin with moderate exercise, combining both aerobic activity and strength training. Gradually increase your exercise as your body adjusts to your activity level.
Reduce or Eliminate Alcohol in Your Diet
If elevated levels of liver enzymes are the results of alcoholic fatty liver disease or alcohol-induced cirrhosis, cutting alcohol out of your diet is the way to go. Alcohol is a stressor for your liver, and liver cells have to work hard to break down alcohol. As a result, alcohol can cause oxidative damage and inflammation in your liver that leads to alcoholic fatty liver disease, fibrosis, and cirrhosis. If you are physically dependent on alcohol, there are ways to detox from alcohol, so you can protect your liver.
Even if you’re not a chronic drinker, binge drinking can have immediate impacts on your liver enzyme levels. A recent study published in the Journal of the American Medical Association evaluated lipid profiles and liver function tests for individuals who identified as high-intensity binge drinkers. (12) Binge drinking is defined as consuming four drinks on a single occasion for women, and five drinks for men. (13) High-intensity binge drinking is any level of drinking that reaches at least double that number on a single occasion. Results of the study revealed that the dangerously high consumption of alcohol at one time can elevate ALT, AST, and GGT.
How Long Does It Take to Lower Liver Enzymes?
In most cases, elevated liver enzymes will not go down overnight. However, commitment to lifestyle changes can bring down your liver enzymes in a shorter time frame than you may think.
Research shows it may not take long at all to bring down elevated liver enzymes. A team of researchers University of Sydney and Westmead Hospital in Sydney, Australia evaluated the impact of exercise regimens on patients with elevated liver enzymes and signs of metabolic syndrome. Results showed that within just a few months, the risk of high alanine aminotransferase decreased by 70% in comparison to controls. (14)
Things to Keep in Mind
Remember that your body is a finely tuned machine than works hard to maintain balanced levels of enzymes, hormones, and other compounds. Elevations in liver enzymes may be reflective of the health of your other organs. Make sure to review your results with your doctor and follow his or her guidelines to best treat underlying causes.
Elevated liver enzymes don’t occur in isolation and are often a sign of liver illness or inflammation in connection with lifestyle habits and co-occurring illness. In some cases, high liver enzymes are temporary and will resolve on their own. Most of the time, there is no quick fix for lowering liver enzymes. Making sustained lifestyle changes is the best way to normalize your liver enzyme levels and support overall health and wellness.