Elevated liver enzymes are a common medical issue that requires normalizing liver function through lifestyle changes and/or medical treatment. The liver plays a vital role in many body processes, so monitoring liver health via enzyme levels is important. When liver enzymes become elevated, it means the liver is stressed and damaged in some capacity. Some key questions related to normalizing liver enzymes include:
What are the main liver enzymes?
The two main liver enzymes that are tested to assess liver function include:
– Alanine aminotransferase (ALT) – an enzyme found mostly in the liver
– Aspartate aminotransferase (AST) – an enzyme found in the liver and other body tissues
If ALT and AST levels are elevated, it typically means the liver is inflamed or damaged in some way. Other enzymes like alkaline phosphatase (ALP) and bilirubin may also be tested to evaluate liver health.
What causes elevated liver enzymes?
Some common causes of elevated liver enzymes include:
– Fatty liver disease – caused by obesity, diabetes, high cholesterol
– Viral infections like hepatitis or mono
– Alcohol abuse
– Autoimmune diseases
– Medications and supplements
– Gallstones
– Genetic liver conditions
Why is it important to lower liver enzyme levels?
It’s important to lower liver enzyme levels because:
– Ongoing inflammation can lead to permanent liver damage and scarring (cirrhosis)
– Cirrhosis increases the risk of liver failure and liver cancer
– High liver enzymes indicate an underlying condition needing treatment
– Normal enzyme levels are a sign of overall good liver health
How long does it take to lower liver enzyme levels?
How long it takes to get liver enzymes back to normal depends on the underlying cause and severity. Here is an overview:
– Mild elevations (less than 3 times the upper limit of normal) -Levels may return to normal within 1-2 months with lifestyle changes like diet, exercise, reducing alcohol intake.
– Moderate elevations (3-10 times the upper limit of normal) – Levels may return to normal within 3-6 months with treatment of underlying conditions, medication changes, frequent monitoring.
– Severe elevations (over 10 times the upper limit of normal) – Can take over 6 months to return to normal range even with aggressive treatment. This indicates significant liver injury.
– Chronic liver disease – May take much longer (up to 1-2 years) for enzymes to normalize, and some damage may be irreversible. Lifestyle changes and medications are still important.
– Liver transplant – Enzyme levels should return to normal within 1-3 months after liver transplant surgery, once the new liver is fully functioning.
The rate of improvement depends on how quickly the underlying cause of liver injury is addressed. Regular blood work helps monitor progress. Enzymes returning to normal is a good sign the liver is healing.
Main Causes of Elevated Liver Enzymes
Here is more detail on some of the most common medical conditions that can raise liver enzymes:
1. Non-alcoholic fatty liver disease (NAFLD)
NAFLD is an umbrella term for a range of liver conditions caused by a buildup of extra fat in liver cells. It is tied to insulin resistance and the metabolic dysfunction that occurs in obesity and type 2 diabetes. NAFLD can cause inflammation that raises liver enzyme levels. Weight loss, diabetes management, and modifying diet and exercise helps lower enzyme levels in NAFLD. Medications may also be used.
2. Alcoholic liver disease
Drinking excessive alcohol can allow fat to accumulate in the liver. This fat buildup causes inflammation and elevated enzymes. Abstaining from alcohol is key to allowing liver inflammation to heal and enzymes to lower. Alcoholic hepatitis is a severe form of liver inflammation caused by alcohol abuse that sharply raises enzyme levels.
3. Viral hepatitis
Hepatitis A, B, and C viruses cause liver inflammation and significantly elevated liver enzymes. The body fights the virus and attacks infected liver cells. Antiviral medications are used to control viral replication and allow liver enzymes to improve. Vaccinations help prevent hepatitis A and B.
4. Autoimmune liver disease
Autoimmune conditions like autoimmune hepatitis involve the body’s immune system mistakenly attacking liver cells, raising liver enzymes as a result. Autoimmune diseases require medications to suppress the immune system attacks and subsequent inflammation.
5. Medications and supplements
Certain prescription medications like statins, antibiotics, anti-seizure drugs and over the counter supplements can, in some cases, cause drug-induced liver injury that raises enzymes. Switching medications and avoiding supplements under medical supervision can help enzymes recover.
6. Inherited genetic disorders
Genetic conditions like hemochromatosis, Wilson’s disease, alpha-1-antitrypsin deficiency, and others can disrupt normal liver function and lead to elevated liver enzymes. Treatment is aimed at managing the symptoms and complications of the underlying genetic disorder.
Lifestyle Changes to Help Improve Liver Enzyme Levels
Making certain lifestyle adjustments can go a long way towards helping normalize liver enzymes along with medical treatment. Some helpful tips include:
Lose weight if overweight
Excess body fat, especially centered around the abdomen, contributes to fat accumulation in the liver. Losing weight through diet and exercise helps reduce liver fat and inflammation.
Follow an anti-inflammatory diet
Eat plenty of antioxidants, foods high in omega-3 fatty acids, plant-based proteins like nuts and seeds, fruits, vegetables, and whole grains. Limit saturated fats, refined carbs, sweets, and red or processed meats.
Increase physical activity
Aim for 150 minutes per week of moderate cardio and 2 sessions of strength training to help improve fatty liver disease. Always check with your doctor before significantly increasing exercise.
Limit alcohol intake
Drinking large amounts of alcohol regularly contributes to liver inflammation. Follow doctor guidelines for appropriate alcohol limits or abstaining completely if liver disease is present.
Manage metabolic conditions
Get high blood pressure, high cholesterol, and diabetes under control to help avoid compounding liver problems. Follow prescribed treatment plans.
Treat sleep apnea
Sleep apnea has been linked to worsening NAFLD. Using CPAP therapy to treat sleep apnea helps improve the condition.
Medical Treatments for Elevated Liver Enzymes
If lifestyle measures are not sufficient, doctors may prescribe medications to help get liver enzymes back to normal ranges. Some examples include:
Corticosteroids
Prednisone and other corticosteroids help reduce liver inflammation in autoimmune hepatitis and alcoholic hepatitis. They are usually tapered once enzymes start improving.
Immunosuppressants
Azathioprine, cyclosporine, and other immunosuppressants may be used in cases of autoimmune liver disease to prevent the immune system from attacking the liver.
Ursodeoxycholic acid (UDCA)
UDCA is a medication that can help improve liver enzyme levels in certain cases of autoimmune or genetic liver disease.
Statins
In some cases, statin medications may help decrease enzymes elevated due to non-alcoholic fatty liver disease. They help reduce excess fat accumulation in the liver.
ACE inhibitors
Angiotensin converting enzyme inhibitors like lisinopril can also help lower liver enzymes in NAFLD patients by decreasing insulin resistance and oxidative stress.
Antiviral medications
Medications that fight hepatitis B and C infection work to control viral replication so the body can resolve liver inflammation and normalize enzymes.
Antibiotics
Antibiotics may be used short-term to treat any bacterial infections contributing to high liver enzymes.
Doctors may periodically recheck liver enzymes and make medication adjustments based on how enzyme levels respond to treatment. Along with medications, addressing any underlying medical conditions is key.
When to See a Doctor
Make an appointment with your healthcare provider if you have any symptoms or conditions that could indicate liver problems. Seek prompt medical care if you experience:
– Fatigue, nausea, loss of appetite
– Itchy skin or rashes
– Jaundice (yellowing skin/eyes)
– Upper right abdominal pain
– Swelling in legs or abdomen
– Dark urine color
– Pale stool color
– Unexplained weight loss
Your doctor will examine you and may order blood tests to check liver enzymes as well as other liver function markers. They can help determine if any liver damage is present and what is causing enzyme levels to be elevated.
Based on the suspected cause, your doctor may recommend:
– Repeat blood work over several months to monitor enzyme trends
– Imaging tests like an abdominal ultrasound or CT scan
– Referral to a hepatologist (liver specialist)
– Liver biopsy for definitive diagnosis
– Appropriate medications or treatments
Follow all your provider’s advice about lifestyle changes, medications, and ongoing monitoring to help resolve the problem leading to elevated liver enzymes. Report any concerning new symptoms immediately. With proper treatment, many people with elevated liver enzymes recover and avoid serious liver damage.
When Are Liver Enzyme Levels Considered Dangerous?
Doctors look at ALT, AST, and ALP enzyme levels compared to the standard reference range to determine the degree of elevation. Typically:
Mild elevations:
– 1-2 times the upper limit of normal ALT – less than 150 IU/L
– 1-2.5 times the upper limit of normal AST – less than 150 IU/L
– 1-2 times the upper limit of normal ALP – less than 150 IU/L
Mild elevations may still require monitoring and addressing underlying causes, but generally reflect less liver damage.
Moderate elevations:
– 2-5 times the upper limit of normal ALT – 150 to 500 IU/L
– 2.5-10 times the upper limit of normal AST – 150 to 500 IU/L
– 2-3 times the upper limit of normal ALP 150 to 450 IU/L
Moderate enzyme elevations often mean there is substantial inflammation and liver injury occurring.
Severe elevations:
– Over 5 times the upper limit of normal for ALT – higher than 500 IU/L
– Over 10 times the upper limit of normal for AST – higher than 500 IU/L
– Over 3 times the upper limit of normal for ALP – higher than 450 IU/L
Very high elevations over a prolonged period can indicate acute liver failure or life-threatening chronic liver disease. Immediate treatment is needed to prevent permanent damage.
Doctors also look at bilirubin levels as they can reflect severity. High bilirubin along with very elevated ALT/AST show severe inflammation and increased risk of permanent liver damage. The pattern of different enzyme elevations can help identify the type of liver injury. A gastroenterologist or hepatologist should be involved for high enzyme levels.
When to Consider a Liver Transplant
For chronic severe liver disease, a liver transplant may eventually be necessary if enzymes and liver function does not improve and complications develop. Doctors may recommend an evaluation for liver transplant if:
– Liver enzymes remain very elevated despite lifestyle changes and medication treatment
– Signs of liver failure are present – fluid retention, hepatic encephalopathy, etc.
– A liver biopsy shows significant cirrhosis and scarring
– Liver cancer or life-threatening liver-related complications develop
– Liver function continues to deteriorate
Timing of liver transplant depends on multiple factors including the rate of liver disease progression, presence of complications, and overall health of the patient. People with chronic liver disease are monitored very closely to determine when a transplant evaluation is warranted.
After a liver transplant, enzyme levels typically normalize within 1-3 months if the new liver is functioning well and not rejected. Doctors follow enzyme trends to ensure the transplanted liver is working properly without any problems. With successful transplantation, liver enzymes remain within normal ranges for the long-term.
Can You Live with Elevated Liver Enzymes?
It’s possible for some people with chronic liver disease to live for years with moderately elevated liver enzymes. However, there are risks if enzymes remain elevated long-term without definitive treatment:
– Ongoing liver inflammation leading to scarring/cirrhosis
– Higher likelihood of developing liver cancer
– Increased complications of portal hypertension – fluid retention, varices, etc.
– Higher risk of progressing to liver failure
– Poorer quality of life from chronic fatigue, itching, nausea
Prognosis depends on the specific liver condition causing enzyme elevation. For example, viral hepatitis can be cured with antivirals while genetic diseases have no cure.
Even if a chronic liver problem itself is not life-threatening, living with elevated enzymes is not ideal for long-term health. That’s why following doctor advice is crucial – this includes taking prescribed medications, frequent lab monitoring, abstaining from alcohol, addressing associated conditions, and reporting any symptoms of liver disease progression.
While not everyone returns fully to normal, through comprehensive management most people can achieve some improvement or stability in their enzyme levels. This helps slow progression and complications.
Can Liver Enzymes Go Back to Normal Without Treatment?
In some cases, mild to moderate elevations in liver enzymes may resolve spontaneously without treatment. However, this is not guaranteed and depends on the underlying cause:
– Acute viral hepatitis – enzymes may improve on their own as the infection resolves
– Medication induced injury – stopping the causative medication may reverse enzyme elevation
– Mild fatty liver disease – lifestyle changes may normalize enzymes
– Gallstone obstruction – treatment of gallstones may resolve enzymes
However, in most chronic liver diseases, some form of treatment is necessary to lower liver enzyme levels back to normal. Untreated, enzymes are less likely to improve on their own.
– Autoimmune liver disease requires immunosuppressive treatment
– Chronic viral hepatitis necessitates antiviral medications
– Severe fatty liver disease worsens without treatment
– Alcoholic liver disease needs alcohol abstinence and therapy
Without addressing the root problem through medical treatment, even mild elevations can progress to chronic enzyme elevation and eventual liver damage.
When Are Follow-Up Tests Needed?
Doctors typically recommend follow-up blood work about every 3-6 months for people with elevated liver enzymes. This helps monitor enzyme trends to see if levels are responding to treatment and improving, remaining stable, or worsening.
More frequent repeat testing may be advised if:
– Initial liver enzyme levels were very high
– The underlying liver condition is known to be rapidly progressive
– New concerning symptoms develop
– Medication dosing is being adjusted
Follow-up testing may include:
– ALT, AST, ALP enzyme levels
– Bilirubin level
– Complete blood count
– Electrolyte panel
– Prothrombin time (PT/INR)
– Albumin
– Viral hepatitis panels
Additional imaging tests like ultrasound, CT, or MRI may also be warranted to evaluate liver changes over time. Doctors can determine if enzymes are trending the right direction based on follow-up results.
For liver transplant patients, very frequent enzyme level monitoring is done initially after transplant surgery to quickly detect any signs of liver rejection or dysfunction requiring intervention. Over time, as enzyme levels stabilize, follow-up tests are needed only annually.
Consistent follow-up testing allows doctors to gauge the effectiveness of treatment and determine if any medication or care plan adjustments are required to help normalize liver enzymes.
Tips for Lowering Liver Enzyme Levels
Here are some proactive steps you can take to help improve elevated liver enzymes:
Take medications religiously:
Carefully follow your doctor’s instructions regarding prescribed medications to treat the underlying liver problem. Never adjust dosing or stop medications without medical guidance.
Follow up on tests:
Get repeat blood work and imaging tests as scheduled to monitor your progress. Report any new symptoms in between visits.
Make diet and exercise changes:
Eat a nutritious diet low in sugar and saturated fats. Get regular exercise appropriate for your condition. Losing excess weight helps.
Limit toxins:
Avoid alcohol, unnecessary medications/supplements, inhalants, and anything that could further stress the liver.
Reduce stress:
Find healthy ways to manage psychological stress like yoga, meditation, counseling, and good sleep habits. High stress is linked to poorer liver healing.
Treat associated conditions:
Work to get any high blood pressure, high cholesterol, or diabetes under control to support liver health.
Staying compliant with your treatment regimen gives your liver the best chance of healing so your enzymes can normalize. But some degree of elevation may persist. The goal is to keep enzymes as low as possible within your range.
Conclusion
Elevated liver enzymes signal that damage or inflammation is present and that the liver needs help to heal. How long it takes for enzyme levels to normalize depends greatly on the underlying cause, but significant improvement can usually be seen within 1-6 months with appropriate lifestyle changes and medical treatment.
Getting regular blood work to monitor enzyme trends is very important during treatment as is carefully following doctor recommendations regarding medications, diet, exercise, and controlling related medical conditions. Consistent follow-up and self-care gives the liver the best opportunity to repair itself and for enzyme levels to return to their healthy normal range.