Abnormal Liver Enzymes

Abnormal Liver EnzymesAbnormal liver enzymes can be a sign of chronic and acute alcohol use, chronic hepatitis B and hepatitis C and possibly liver cancer.

The liver is one of the most important organs in the body, and is responsible for a number of functions that keep the body working as it is designed. The liver detoxifies your blood, produces proteins that help with clotting, handles cellular waste, processes nutrients, stores vitamins, and helps your body make glucose. Liver Enzymes are proteins within the liver that help to speed up certain chemical reactions. If any of these processes are inhibited it could lead to serious complications. Elevated liver enzymes may indicate inflammation or damage to cells in the liver. Inflamed or injured liver cells leak higher than normal amounts of certain chemicals, including liver enzymes.

Abnormal Liver Enzymes Symptoms

Symptoms of mild to moderate elevation of liver enzymes may vary from no symptoms to the following:

  • Fatigue
  • Fever
  • Nausea and Vomiting
  • Upper right quadrant abdominal pain and tenderness
  • Mental changes
  • Itching

Elevated liver enzymes most commonly found:

  • Alanine Transaminase (ALT): In most types of liver disease, the ALT level is higher than AST and the AST/ALT ratio will be low (less than 1). There are a few exceptions; the AST/ALT ratio is usually increased in Alcoholic Hepatitis, Cirrhosis, and in the first day or two of Acute Hepatitis or injury from bile duct obstruction. With heart or muscle injury, AST is often much higher than ALT (often 3-5 times as high) and levels tend to stay higher than ALT for longer than with liver injury. AST is often performed together with the ALT test or as part of a liver panel.
  • Aspartate Transaminase (AST): Very high levels of AST (more than 10 times normal) are usually due to Acute Hepatitis, sometimes due to a viral infection. With acute Hepatitis, AST levels usually stay high for about 1-2 months but can take as long as 3-6 months to return to normal. Levels of AST may also be markedly elevated (often over 100 times normal) as a result of exposure to drugs or other substances that are toxic to the liver as well as in conditions that cause decreased blood flow (ischemia) to the liver. With Chronic Hepatitis, AST levels are usually not as high, often less than 4 times normal, and are more likely to be normal than are ALT levels. AST often varies between normal and slightly increased with Chronic Hepatitis, so the test may be ordered frequently to determine the pattern. Such moderate increases may also be seen in other diseases of the liver, especially when the bile ducts are blocked, or with cirrhosis or certain cancers of the liver. AST may also increase after heart attacks and with muscle injury, usually to a much greater degree than ALT.


The human liver contains thousands of enzymes, which are special types of protein cells that help necessary chemical reactions to take place. Liver enzymes trigger activity in the body’s cells, speeding up and facilitating naturally occurring biochemical reactions, and maintaining various metabolic processes within the liver. A wide range of health problems can lead to elevated liver enzymes:

Statin drugs for cholesterolCeliac DiseaseHypothyroidism
AcetaminophenCirrhosis of the LiverLiver Cancer
Heart FailureCytomegalovirus (CMV) InfectionMononucleosis
Hepatitis A, B, CDermatomyositisPancreatitis
Fatty Liver DiseaseEpstein-Barr VirusPolymyositis
ObesityGallbladder InflammationToxic Hepatitis
 Alcoholic HepatitisHeart AttackWilson’s Disease
Autoimmune HepatitisHemochromatosis

Diagnostic Testing

When the liver is damaged, cells release higher levels of the two major enzymes, Alanine Transaminase (ALT) and Aspartate Transaminase (AST), into the bloodstream. To determine if your liver is damaged, several blood tests will be conducted to check the type and amount of Liver Enzymes in the blood. If elevated abnormal liver enzymes are present, it could indicate liver damage, as these enzymes are normally only found within the liver. In most cases, liver enzyme levels are only mildly or temporarily elevated and don’t signal a serious liver problem.

  • Physical Examination
  • Ultrasound
  • CAT scan (computed axial tomography)
  • Liver Biopsy
  • Liver Blood tests – Alanine Transaminase (ALT) and Aspartate Transaminase (AST)

Dietary Guidelines

The liver helps maintain good health and is important for many body functions including digestion, metabolism, detoxification and blood clotting. Liver Enzymes are proteins that help to speed up reactions, and elevated levels are signs of a liver impairment that must be treated. While a variety of conditions and some medications can cause enzyme imbalances in the liver, diet also plays a crucial role.

Lifestyle ChangesFood to AddFood to Avoid
Stop drinking alcoholGarlicSugar
Limit caffeineEggsWhite bread
No non-prescription drugsBroccoliPasta
No fast foodSpinachPastries
Take fish oilsBrown RiceDesserts
Increase fiber intakeMustard GreensFried food
Eat whole foodsFruitProcessed food

Board-Certified physicians Dr. Ranvir SinghDr. Stephen RashbaumDr. Nitin J. ParikhDr. Long B. Nguyen, Dr. Ruth Montalvo, Dr. Jae Kim, and providers Tammi D’Elena, PA-C and Vanessa T. Bridgeman, MSN, APRN, FNP-BC; care for patients in the North Atlanta, GA; area including Johns Creek, GA, Cumming, GA, Lawrenceville, GA,  Alpharetta, GA, and Dawsonville, GA. The in-house endoscopy suite at Digestive Care Physicians is a certified facility which has achieved the highest level of accreditation by the Association for Ambulatory Health Care (AAAHC). If you suffer from gastrointestinal problems, abdominal pain, or need a colorectal cancer screening, contact us at (770) 227-2222 to schedule an appointment.

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Dr. Ranvir Singh, Dr. Stephen Rashbaum, Dr. Long Nguyen, Dr. Nitin Parikh, Dr. Ruth Montalvo, Dr. Jae Kim, Tammi D’Elena, PA-C, and Vanessa Bridgeman, MSN, FNP-BC

For clinical questions, please contact our office: 770-227-2222

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