Elevated liver values: causes and what you can do

Elevated liver values mean enzymes such as ALAT, ASAT or gamma-GT in your blood rise above the upper limit. That usually points to irritation or strain on your liver, not necessarily a serious disease. In the vast majority of cases there is a treatable cause behind it: alcohol, excess weight, a medication or a fatty liver.

Still, a raised result is understandably alarming. This article calmly explains what the numbers mean, which causes are most common, and when it is time to call your doctor.

What do elevated liver values mean?

Your liver cells are full of enzymes. When those cells are damaged or irritated, the enzymes leak into your blood and the value rises. So an elevation is a signal that something is affecting your liver, but on its own it does not yet tell you the cause or how serious it is.

Want to know what each value means first? Read our overview on understanding liver values, where we explain ALAT, ASAT, gamma-GT and alkaline phosphatase one by one.

What are the causes of elevated liver values?

Causes range from completely harmless to something that deserves attention. These are the most common:

• Fatty liver - the most common cause of a mildly elevated ALAT in the Western world (Younossi et al., 2016), often linked to excess weight, little exercise and a sugar-rich diet.
• Alcohol - regular or heavy drinking mainly raises gamma-GT, often the first liver value to rise.
• Medications - high-dose paracetamol, statins, some antibiotics and anti-epileptics can temporarily push values up.
• Intense exercise - after heavy strength training or a marathon, ASAT in particular can stay elevated for days due to muscle damage, not the liver (Pettersson et al., 2008).
• Viral hepatitis - infection with hepatitis A, B or C can raise liver values considerably.
• Gallstones or bile duct problems - here gamma-GT and alkaline phosphatase often rise together.

How do you know if elevated liver values are concerning?

A mild, one-time elevation is usually no cause for panic. It becomes more serious as the deviation gets larger, more persistent or broader. Three things help you judge: how high, how long and which pattern.

• How high - a value just above the limit is different from more than twice the upper limit.
• How long - does the value stay elevated on a repeat test after 4 to 6 weeks? Then it warrants further investigation.
• Which pattern - several values elevated at once weighs more heavily than a single mildly raised enzyme. The ASAT to ALAT ratio gives your doctor direction (Botros & Sikaris, 2013).

Always contact your doctor if, alongside elevated values, you have symptoms such as yellowing of the skin or eyes, dark urine, persistent fatigue or pain in the upper right of your abdomen.

What can you do to lower your liver values?

With lifestyle-related causes, the liver often recovers remarkably well once you remove the strain. These steps support your liver, but do not replace discussing the cause with your doctor.

• Less alcohol - often the most effective step for an elevated gamma-GT. A period without alcohol shows the effect clearly.
• Work towards a healthy weight - even 5 to 10% weight loss can substantially improve fatty liver.
• Exercise regularly - movement improves a fatty liver, independently of weight loss.
• Be critical of supplements - "natural" is not the same as liver-safe. Some herbal extracts actually strain the liver.
• Discuss your medications - never stop on your own, but ask your doctor whether a drug could affect your values.

How quickly do elevated liver values recover?

That depends on the cause. With alcohol, values often normalise within 2 to 4 weeks of stopping. With a medication it is a matter of waiting until the drug is adjusted. With fatty liver it is gradual: expect 3 to 6 months of consistent lifestyle change before you see it reflected in your blood.

Frequently asked questions

Are mildly elevated liver values dangerous?

Usually not immediately. A mild, one-time elevation is often temporary, for example after exercise, a heavy meal or an evening of alcohol. A repeat test after a few weeks shows whether it is persistent. Only then is further investigation useful.

Can stress raise my liver values?

Stress itself does not raise liver values directly, but stress-related behaviour does: more alcohol, poorer eating and less exercise. So indirectly, stress can play a role.

Do I need to fast before a liver value test?

For ALAT, ASAT and gamma-GT, strictly speaking no. If glucose and cholesterol are drawn at the same time, fasting is advised. In all cases, avoid alcohol for at least 48 hours before the draw.

Want to have your liver values checked? See the Vital Check liver function test: you measure ALAT, ASAT and gamma-GT, with a doctor who reviews your result.

References

• Younossi ZM, et al. Global epidemiology of nonalcoholic fatty liver disease - meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016. PubMed
• Botros M, Sikaris KA. The de Ritis ratio: the test of time. Clinical Biochemist Reviews. 2013. PubMed
• Pettersson J, et al. Muscular exercise can cause highly pathological liver function tests in healthy men. British Journal of Clinical Pharmacology. 2008. PubMed