What Does It Mean When My Liver Enzymes Are High?

Your liver plays a major role in digestion, metabolism, and detoxification (eliminating harmful substances from your body). Liver enzymes help the liver perform these functions by speeding up chemical reactions.

Elevated liver enzymes happen when there are higher-than-normal levels of liver enzymes in your blood. This increase can be temporary or last a long time.

Regular monitoring of liver enzymes, early diagnosis of the underlying causes, and lifestyle or medical treatments can help protect your liver health and prevent complications.

Enzymes are proteins that speed up chemical reactions. Liver enzymes are essential for processing nutrients, removing harmful substances, and helping digestion. The most common liver enzymes include:

These enzymes usually stay in your liver but can enter the bloodstream due to liver injury or inflammation. This leads to higher levels in your blood, which may show up on a liver function blood test.

High liver enzyme levels do not always signal a liver problem. However, if your liver enzymes remain high over time, it may be a sign of an underlying liver condition.

Without proper treatment, these conditions may progress to cirrhosis, causing permanent liver damage or liver cancer.

Certain medications or infections may temporarily cause high liver enzyme levels. Increased liver enzymes may also be a sign of liver inflammation, damage, and disease. Some causes of elevated liver enzymes include:

• Alcohol-associated liver disease: Drinking alcohol in excess can cause liver damage and raise your liver enzyme levels. Without proper treatment, alcohol-associated liver disease can progress to cirrhosis.
• Metabolic dysfunction-associated steatotic liver disease (MASLD): This condition is formerly known as nonalcoholic fatty liver disease (NAFLD). It is one of the most common causes of elevated liver enzymes. Metabolic dysfunction-associated steatohepatitis (MASH) is a more severe form, characterized by liver cell damage and inflammation. If left untreated, MASH can also progress to cirrhosis and liver cancer.
• Viral hepatitis: Hepatitis is any inflammation and damage to the liver. Hepatitis B and C are chronic (long-term) viral infections that can cause inflammation, leading to elevated liver enzymes. These infections may progress to cirrhosis.
• Drug-induced liver injury: Certain medications may damage your liver and lead to mild, moderate, or severe increases in liver enzyme levels. These drugs include Tylenol (acetaminophen), statins, macrolides, anticonvulsants, antituberculosis medications, and some herbal supplements.
• Hereditary hemochromatosis: This hereditary disease causes your body to absorb too much iron from your diet. This excess iron can eventually damage the liver tissues and organs, leading to elevated liver enzyme levels.
• Wilson’s disease: This rare genetic disorder causes a buildup of excess copper in your body, especially your liver, brain, and eyes. Too much copper can damage liver cells and tissues, leading to elevated liver enzymes.
• Alpha1-antitrypsin deficiency: This genetic condition is characterized by abnormal production of a protein called alpha-1 antitrypsin (AAT). AAT may build up in the liver and cause damage, leading to higher liver enzyme levels.

You may not notice symptoms if your liver enzyme levels are high, as many people with elevated liver enzymes don’t have symptoms. Symptoms tend to appear if you have more severe liver damage. These include:

• Swelling of your abdomen and legs
• Easy bruising
• Jaundice (yellowing of your skin and the whites of your eyes)
• Changes in the color of your stool or urine

About 30% of people with elevated liver enzymes will have normal levels after three weeks. Depending on the cause, these high levels sometimes resolve on their own.

Healthcare providers may also recommend lifestyle changes to help lower the enzyme levels and reduce liver inflammation. These changes may include:

• Weight loss, if appropriate
• Regular exercise
• A balanced diet 
• Limited alcohol use, if any

Your healthcare provider may also recommend additional testing to determine your diagnosis and treatment options. Treatment options for elevated liver enzymes depend on the specific cause. Your provider may prescribe medications to manage different liver conditions.

Early diagnosis and appropriate treatment are essential to prevent complications such as cirrhosis or long-term liver damage. Talk to your healthcare provider for their guidance.

A few strategies to help maintain your liver health include:

• Maintain a weight that you and your healthcare provider agree is healthy for you.
• Eat a balanced diet, and avoid diets high in saturated fats, refined carbohydrates, and refined sugars.
• Exercise regularly according to your healthcare provider’s recommendations.
• Limit how much alcohol you drink, or stop drinking altogether.
• Avoid or quit smoking.
• Use barrier protection during sex to decrease the risk of hepatitis infections.
• Avoid sharing personal hygiene items.
• Visit your healthcare provider for regular checkups and inform them of any symptoms.

Certain medications may temporarily affect liver enzyme levels. However, high levels for longer durations may be a sign of an underlying liver condition. Without proper treatment, these conditions may cause permanent liver damage. 

If you have symptoms of liver damage or engage in behaviors that may increase your risk, like heavy drinking, see your healthcare provider. They may recommend a liver function test to determine your liver enzyme levels.

Based on the results, they may recommend additional tests to diagnose your underlying condition. You must also follow specific lifestyle approaches to maintain your liver health and prevent complications.