What Are Liver Enzymes?

Liver Enzymes are made by cells throughout the body but are found in highest concentrations in liver cells. These enzymes are found inside liver cells, so when the concentration is elevated in the blood, usually indicates liver cells (hepatocytes) are inflamed, damaged for dying. Below is a list of the four common liver enzymes that are routinely tested on an annual basis or monitored due to certain medications, such as Statin drugs and acetaminophen.

Liver Enzymes: 

• Alanine transaminase (ALT) / Serum Glutamic-Pyruvic Transaminase (SGPT) 
• Aspartate transaminase (AST) / Serum Glutamic-Oxaloacetic Transaminase (SGOT) 
• Alkaline phosphatase (ALP)
• Gamma-glutamyl transpeptidase (GGT)

Liver Enzyme Reference Range: (Quest Diagnostics)

What Does Slightly Elevated Liver Enzymes Mean?

Something we have consistently observed with our patients over the past ten years is slightly elevated liver enzymes. Specifically, a slight elevation to AST and ALT.   

For example, on a routine Comprehensive Metabolic Panel (CMP), a woman will have an AST level of 54 U/L and an ALT level of 47 U/L. Both enzymes are slightly outside the normal range, but this often gets blown off by the primary care physician because the liver enzyme levels are not high enough to indicate major a concern. However, if the enzymes levels were in the hundreds, then the doctor would do some follow-up testing for some liver disease like Hepatitis.

Slightly elevated liver enzymes is an indication of having a fatty liver.  Most people do not even know they have a fatty liver. And it is found incidentally on an ultrasound. A typical scenario is having a gallbladder attack.  You wake up in the middle of the night with terrible stomach pain, radiating to the right side or even the right scapula. Many people have ended up in the emergency room in the middle of the night for a gallbladder attack.  In the emergency room, an ultrasound of the abdomen is done. The doctor will tell you that you have gallstones and schedule you for surgery. Then in passing they will remark that you have a fatty liver and that is the last you will hear of that.

Conventional Approach:
If your liver enzymes are slightly elevated, your doctor will most likely not even address it.  Below is a list of the conventional approaches that are taken when the liver enzymes are just outside the normal ranges.

• Watch and wait
• Looking for Hepatitis
• Levels are not high enough, so Dr typically don’t do anything
• Liver Ultrasound will confirm fatty liver disease

What is Non-Alcoholic Fatty Liver Disease (NAFLD)

If your liver enzymes are elevated, then you have, or you are on the way to having a fatty liver.  When the liver enzymes are found elevated on blood work, most doctors will ask how much are you drinking and tell you to cut down.  People with NAFLD have a fatty liver, but it is not due to alcohol intake. I have had many patients say their doctor will not believe they don’t drink.  This is called Non-Alcoholic Fatty Liver Disease, abbreviated as NAFLD (pronounced Na-Fold’).

One of the most significant contributors to fatty liver is high levels of insulin.  Having a diet high in sugar will raise insulin. Insulin is supposed to tell the body to store fat in adipocytes (fat cells).  When there is a lot of insulin, the liver will start storing the fat into the hepatocytes (liver cell). Over time the liver becomes fatty, and the liver enzymes will begin to rise.

The liver metabolizes fructose.  Having a lot of high fructose corn syrup is especially hard on the liver.  Because high fructose corn syrup will skyrocket insulin and the liver has to work extra hard at metabolizing it. NAFLD usually gets dismissed by doctors.  I think that is because there is no medication for fatty liver.  If there is not a medication for it, then most docs do not know how to treat it.  

People often ask me:

• Is fatty liver going to hurt me?
• Can I get liver cancer from fatty liver?
• Are elevated liver enzymes something I need to be concerned with?
• You’re telling me I have a fatty liver, but I feel just FINE! Should I even care?

One of the major consequences of fatty liver disease is liver cancer.  That is a clear indication that fatty liver and slightly elevated liver enzymes should be addressed.

Other issues that occur with a fatty liver:

• Weight gain and trouble losing weight
• Digestion issues such as GERD, dyspepsia, constipation, IBS, bloating
• Skin issues like acne, dry, itchy skin
• Upper right quadrant pain
• Fatigue
• Brain fog and low memory or staying focused
• Even your mood can be lower

The liver is an extremely powerful organ.  It has over 600 different functions such as detoxifying metabolites and making proteins important for our blood, role in hormone production, the list goes on.  If the liver is burdened and not able to function efficiently, this can impact our quality of life and our health.

As mentioned above, there is no medication to take for a fatty liver disease.  Because of this many conventional doctors do not treat fatty liver. And most people are dismissed to watch and wait.  Fatty liver is very treatable. But it is a multifactorial process.

Treatment Approach for Fatty Liver Disease (NAFLD): 

• Lifestyle changes: Lowering stress and improving sleep
• Dietary changes: Reducing sugar (especially fructose).  
• Reducing and balancing insulin and cortisol.
  
• Exercise: Less cardio and more weight-bearing exercise.
• Supplementation: nutrients, vitamins, amino acids, herbs that are helpful to the liver.
• Hormone balancing: Treating the thyroid, reproductive hormones and adrenals.
  

The process takes time and effort.  But the effort is worth it. By healing fatty liver, people reduce the risk of liver cancer and live healthier and more energetic lives. If you have any questions, feel free to leave a comment below or send an email to [email protected].