Gastrointestinal Health
What Causes High Liver Enzymes? Understanding Your Labs
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High liver enzymes can have many possible causes, including metabolic changes such as fatty liver, alcohol use, medications or supplements, infections, inflammation, bile duct problems, and even strenuous exercise. What an elevated result means depends on which markers are high, the degree and pattern of elevation, whether it persists, and the rest of your health picture.
At Health For Life Naturopathic Medicine, our collaborative medical team looks at liver-related labs alongside your symptoms, medical history, medications and supplements, metabolic health, and other test results. The goal is to understand what the pattern may be pointing to, rather than reacting to a single flagged value in isolation.
What does it mean when liver enzymes are high?
When certain cells are stressed or injured, more liver-produced enzymes can enter the bloodstream. A blood test may then show a value above the reference range used by that lab.
An elevated result indicates that something warrants interpretation, but it does not identify the cause on its own. The meaning can change considerably depending on which enzyme is elevated, how far outside the expected range it is, whether other markers are abnormal, whether the result is new or persistent, and what else is happening with your health.
Which liver enzymes are usually checked?
A routine blood test, such as a comprehensive metabolic panel requested by your medical provider, can include several liver-related markers:
ALT (alanine aminotransferase)
ALT is the enzyme most closely associated with liver cells, so a rise in ALT tends to prompt a provider to look more closely into liver health.
AST (aspartate aminotransferase)
AST is found in the liver as well as skeletal muscle, heart and other tissues. An elevated AST result can sometimes reflect something happening outside the liver, such as muscle injury and strenuous exercise.
ALP (alkaline phosphatase)
Alkaline phosphatase is different from ALT and AST because it can come from several parts of the body, including the liver, bile ducts and bone. When ALP is elevated, clinicians may need additional context to understand where that signal is coming from.
GGT and bilirubin
Your provider may also look at GGT (gamma-glutamyl transferase), an enzyme found in the liver and bile ducts, and bilirubin, a yellow pigment made when old red blood cells break down.
Bilirubin is not an enzyme. It is a pigment formed during the normal breakdown of red blood cells and processed by the liver. Its level can provide additional information about how the liver and bile system process and move bilirubin through the body.
What causes high liver enzymes?
There are many possible reasons for elevated liver enzymes, ranging from temporary changes to conditions that warrant further evaluation.
Metabolic factors and fatty liver changes
Metabolic disorders and fatty liver, now often called MASLD (metabolic dysfunction-associated steatotic liver disease), mean extra fat has built up in liver cells. It’s closely linked to blood sugar, insulin resistance, and cholesterol, and it’s one of the explanations providers most often consider.
Alcohol
The liver processes alcohol, and regular or heavy drinking can raise enzyme levels. Providers will routinely ask about alcohol consumption because it helps them read your results accurately.
Medications and supplements
Many common medications can affect liver enzymes, including some pain relievers, cholesterol medications, and antibiotics. Herbal products and supplements can too, even ones marketed as natural or liver-supportive. This is why it’s important to communicate all of your medications (including supplements) with your provider.
Infections and inflammation
Viral infections, including the hepatitis viruses, and autoimmune responses can inflame the liver.
Bile duct and gallbladder issues
When bile can’t flow freely, for example because of gallstones, certain markers (especially ALP) may rise. Gallstones, bile duct obstruction, and other biliary conditions are among the possibilities clinicians may consider if liver enzymes are high.
Muscle injury and hard exercise
Because AST is also found in muscle, a tough workout or muscle injury can push it up for a few days. If your blood was drawn the morning after a long Camelback hike or an intense training session, share that information with your provider.
Other medical conditions
Thyroid problems, celiac disease (an immune reaction to gluten that damages the small intestine), and inherited conditions that affect how the body handles iron or copper can all show up as abnormal liver labs. While these are less common, these conditions can still be worth considering or ruling out.
Keep track of patterns in elevated liver enzymes
A single high liver enzyme count could be due to a virus or strenuous workout. Depending on other risk factors, your provider may not have a cause for concern in these cases.
Additionally, providers will examine the relationships among ALT, AST, and ALP results because differing patterns can point the evaluation in different directions. For example, a pattern in which ALT and AST are more prominently elevated can suggest that the main signal is coming from liver cells. A pattern in which alkaline phosphatase is more prominent raises different questions, including whether bile flow or the bile ducts may be involved.
The levels, and their relationship to one another, will tell your provider where to investigate further to ensure you have a complete picture of your health.
Can elevated liver enzymes cause symptoms?
Elevated liver enzymes frequently cause no noticeable symptoms, and many people learn about them only through routine bloodwork. There’s no single set of elevated liver enzymes symptoms, because the enzyme level is a measurement of what’s happening rather than a condition of its own.
If symptoms are present, they usually come from the condition contributing to the abnormal labs rather than from the enzyme level itself. Fatigue, digestive changes or abdominal discomfort can occur with many different health conditions, so symptoms alone cannot tell you why a liver-related marker is elevated. In extreme elevations, patients may have a yellowing to their skin or eyes, this is an emergency situation and patients should report to ER immediately for evaluation.
Do mildly elevated liver enzymes always mean something serious?
A mildly elevated liver enzyme result should be reviewed by a healthcare provider without automatically assuming either the best- or worst-case explanation.
How far above the range the value is, whether it shows up again on repeat testing, how it compares with past results, which medications and supplements you take, your symptoms, and your other lab findings will all contribute to your provider’s prescribed next steps.
What happens after a high liver enzyme result?
After a high liver enzyme result, a provider will gather more information before making a diagnosis. They may compare the result with previous bloodwork, review the pattern across ALT, AST, ALP, bilirubin, and other relevant markers, discuss medications and supplements, ask about alcohol use and metabolic risk factors, and review symptoms and medical history.
Depending on what that initial evaluation shows, repeat bloodwork may be appropriate. Some patients may also need additional laboratory testing or imaging such as an abdominal ultrasound. More extensive testing is generally guided by the degree and pattern of the abnormality and the clinical picture.
Understanding the bigger picture behind your labs
Abnormal labs don’t exist in isolation, and at Health for Life Naturopathic Medicine in Phoenix, we don’t read them that way. Our medical team looks at your liver markers alongside your symptoms, history, digestive health, and lifestyle to understand what may be contributing to them.
If you’ve been told your labs are “a little off” without a clear explanation, that frustration makes sense. Here, you’re supported by our entire collaborative medical team, so you can see any of our doctors and receive the same quality of care. Recommendations are built around you and what’s driving your results, never a one-size-fits-all protocol.
What can you do about elevated liver enzymes?
What you can do depends on what’s behind the result, so understanding the cause comes first. If you’re looking for information on nutrition, metabolic health, and other supportive strategies, read our article on 5 natural ways to lower liver enzymes and support detox.
Get help making sense of your liver labs in Scottsdale or Phoenix
If your liver enzymes came back elevated and you are still unsure what the results mean, Health For Life Naturopathic Medicine can help you look beyond the flagged number.
Our medical team works with patients in Phoenix, Scottsdale, and throughout the Valley to evaluate lab results alongside symptoms, history, and the larger health picture to determine appropriate next steps.
Become a patient at Health For Life Naturopathic Medicine or call 602-368-9211 to get started.
Frequently asked questions
Why would liver enzymes be high if I feel fine?
Liver enzymes can be high in people who feel completely well. Fatty liver changes, medications, supplements, a recent hard workout and other factors can raise enzyme levels without causing noticeable symptoms. That’s why these results so often turn up on routine bloodwork. Feeling well is good news, but the result still deserves follow-up with your provider.
What does “high liver enzymes” mean on a lab report?
It means one or more liver-related enzymes measured above the reference range that particular lab uses. The flag shows a value is outside the typical range, but it doesn’t identify a cause or tell you how significant the result is. Your provider interprets it alongside your other results, past labs, medications and health history.
Can supplements or medications raise liver enzymes?
Yes. Some prescription medications, over-the-counter pain relievers, herbal products and supplements can affect liver enzymes. When patients wonder what causes high liver enzyme count results that seem to come out of nowhere, reviewing everything they take is often one of the first steps. Bring a complete list, including natural products, to your appointment.
Can exercise raise liver enzymes?
Yes, strenuous exercise can temporarily raise AST and sometimes ALT, because these enzymes are also found in muscle. If you had a hard workout, a long hike or a day of physical labor before your blood draw, let your provider know. That context can change how a result is interpreted and whether repeat testing makes sense.
When should elevated liver enzymes be evaluated?
Any elevated liver enzyme result is worth discussing with the provider who ordered it, even if you feel fine. Seek prompt medical care if you notice yellowing of the skin or eyes, dark urine, pale stools, severe abdominal pain, unusual confusion or easy bruising, since these can signal something that needs attention quickly.
Where can I get help understanding liver labs in Scottsdale?
Health for Life Naturopathic Medicine works with patients from Scottsdale and across the Phoenix area who want a clearer understanding of abnormal labs. Our collaborative medical team reviews your results in the context of your symptoms, history and overall health, then builds a care plan around what’s actually behind your results.
Disclaimer: The information in this blog is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. All recommendations related to liver health, elevated liver enzymes, or metabolic conditions are based on individual evaluation by a licensed healthcare provider. Health for Life Naturopathic Medicine does not offer one-size-fits-all treatment plans, and care is provided only under appropriate clinical supervision and based on medical necessity. Always consult with your healthcare provider before beginning any new treatment or wellness program.
(2023). Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis. Indian Health Service. https://www.ihs.gov/diabetes/clinician-resources/soc/masld-mash/
(n.d.). Liver Test Interpretation – Approach to the Patient with Liver Disease: A Guide to Commonly Used Liver Tests. Cleveland Clinic. https://my.clevelandclinic.org/departments/digestive/medical-professionals/hepatology/liver-tests
Malakouti, M., Kataria, A., Ali, S. K. & Schenker, S. (2017). Elevated Liver Enzymes in Asymptomatic Patients – What Should I Do?. Journal of Clinical and Translational Hepatology 5(4), pp. 394-403. https://doi.org/10.14218/JCTH.2017.00027
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