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The most common causes of high liver enzymes 

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Even if you feel fine, elevated liver enzyme levels aren’t something to ignore. Here’s what the numbers mean — and how to lower them. 

Rosemary Black

By Rosemary Black

You go for routine bloodwork as part of your annual physical. And when your doctor calls with the results, you learn that your liver enzymes are high. 

This news can be unnerving. Even if you feel perfectly healthy, you might jump to worst-case scenarios. But know this: Elevated liver enzymes are a common health problem, and they can be high for several reasons.  

“There’s no reason to panic, but ignoring it is not a good option,” says Anurag Maheshwari, MD. Dr. Maheshwari is affiliated with the Institute for Digestive Health & Liver Disease at Mercy Medical Center in Baltimore. “If your liver enzymes are elevated, you need to be monitored to find out the cause.”  

Here’s the scoop on what liver enzymes are and the most common culprits that could raise your levels. 

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What are liver enzymes and what do they do? 

Your liver has many important functions. It helps filter blood and remove toxins. It also produces bile, which breaks down fats during digestion. So it’s normal for doctors to order a liver function test, explains Sanjaya K. Satapathy, MD, medical director of liver transplantation at Northwell Health in Manhasset, New York.  

This blood test checks the overall health of your liver. It measures the levels of important liver chemicals in your blood. These include liver enzymes and other proteins, as well as the compound bilirubin.   

Liver enzymes, or proteins, play many roles in the body. In general, they regulate chemical reactions that keep you healthy. For example, they influence how fast substances that help you fight infection or help your blood clot are made. And they help your body break down food and toxins in a timely manner. 

The most common liver enzymes that these tests monitor are: 

  • Alkaline phosphatase (ALP) 
  • Alanine transaminase (ALT) 
  • Aspartate transaminase (AST) 
  • Gamma-glutamyl transferase (GGT) 

According to the Cleveland Clinic, your liver releases enzymes into your blood when it’s hurt. So higher blood levels of liver enzymes could indicate a problem. 

Common causes of high liver enzymes  

There are many possible causes behind elevated liver enzyme levels. Here are some of the most common culprits:  

#1: Dietary supplements and vitamins 

Those herbal supplements, or “liver detox” vitamins, may not do as much for your health as the label touts. In fact, they could do more harm than good. “I tell my patients that any supplement you take in the hopes of boosting your health can cause liver problems,” says Dr. Maheshwari.  

Your liver filters everything that you consume. That includes food, medications and over-the-counter (OTC) supplements. It processes nutrients that are absorbed from the small intestine. And it removes things that could be toxic to your body.  

If your liver is overworked or is asked to filter harmful ingredients, it can cause liver damage over time. Supplements aren’t regulated as prescription medications are. So they can have impure ingredients. Even high-dose vitamins or certain herbs can cause harm. That’s why it’s so important to tell your doctor about any supplements you take. 

#2: Non-alcoholic fatty liver disease 

The most common cause of mildly high liver enzymes is non-alcoholic fatty liver disease (NAFLD). It’s a condition caused by having too much fat buildup in your liver. And it’s a silent disease with few to no symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases. 

For many people, NAFLD doesn’t cause serious health problems. But for some, it can lead to liver damage and even cirrhosis, or scarring of the liver.  

#3: Certain medications 

Some medications can cause your liver enzymes to become elevated, says Nadia M. Khan, MD, an internist at Northwestern Medicine Central DuPage Hospital in Winfield, Illinois. And that includes both OTC and prescription medications.  

“The most common ones to cause this are statins,” she says. They are cholesterol-lowering medications, such as atorvastatin (Lipitor®) and simvastatin (Zocor®.) That said, the risk of liver damage is low. And it usually doesn’t outweigh the heart-health benefits. It seems to be more of a concern at higher doses or when interacting medications and other substances are taken at the same time. These may include acetaminophen (Tylenol®), alcohol and niacin. 

Other medications that can raise liver enzymes include: 

  • Non-steroidal anti-inflammatory drugs (NSAIDs) 
  • Certain antibiotics 
  • Some epilepsy medications 

Recommended reading: Can’t take NSAIDs? There are other ways to find relief.  

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#4: Hepatitis 

When you stub your toe or hit your head, the area swells. That swelling is inflammation, or your body’s response to injury. And the same thing can happen to your liver. 

When your liver is injured and gets inflamed, it’s called hepatitis. It can be caused by heavy alcohol use or certain toxins. But it’s most often caused by a virus. The top 3 in the U.S. are hepatitis A, hepatitis B and hepatitis C

Some people with hepatitis don’t have any symptoms. Talk to your doctor about your risk and whether you should be screened if you haven’t been already. Thankfully, effective vaccines are available to help prevent hepatitis A and B. And there are effective treatments for hepatitis C, too.

#5: Bone disorders 

The enzyme ALP is also made in your bones. If you break a bone, it can raise the ALP enzyme levels in your blood, Dr. Satapathy says. Once the bone heals, though, those numbers should go back to normal. 

Other bone disorders, such as Paget’s disease of bone, can raise your ALP levels, too. 

#6: Celiac disease 

Celiac disease is an autoimmune condition that’s triggered when someone eats gluten. It’s a protein found in wheat, rye and barley. The gluten causes an immune response and damages the small intestine.  

About 5% to 10% of people with high liver enzymes end up having celiac disease, according to a review in the Journal of Clinical and Translational Hepatology. And many of them had none of the telltale gastrointestinal symptoms.  

Experts aren’t sure why celiac disease is linked with high liver enzymes. But the inflammation can allow more substances to pass through the small intestine. So toxins and other chemicals may enter your bloodstream, reaching the liver and causing damage over time. 

#7: Heart failure 

When you have heart failure, your body can have a hard time meeting the needs of your organs. And your liver is no exception. Over time, low blood flow can starve the liver of oxygen. In some cases, blood has trouble pumping back up to the heart. So fluid can build up at the liver, which can cause damage, too. 

Here are the 6 surprising signs of heart failure. And if you’re on medication for heart failure, here are some easy ways to save

What to do if you have high liver enzymes 

Again, there’s no reason to panic. It may be a temporary bump-up. Or it could be a sign that something isn’t quite right.  

“If the person is healthy, this elevation is usually reversible,” Dr. Khan says. “However, it does need to be followed and investigated if it persists,” she adds. Part of this deeper dive could include seeing a specialist and doing more tests to find out the cause. 

It’s a good idea to review the medications and supplements you take with your doctor, adds Dr. Maheshwari. “You may be told to stop taking certain medications or supplements and then repeat the liver enzyme tests in 12 weeks,” he says.  

If you’ve caught the culprit, your numbers should be back to normal in no time. And if you need to switch or start a prescription medication, we want to help you save. Download our mobile prescription discount app to find, save and share coupons.  

 

Additional sources
Liver function tests: Cleveland Clinic 
Background on NAFLD: National Institute of Diabetes and Digestive and Kidney Diseases 
Review covering the link between celiac disease and elevated liver enzymes: Journal of Clinical and Translational Hepatology (2017). “Elevated liver enzymes in asymptomatic patients—what should I do?” 

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