Elevated liver enzymes may mean a person’s liver is not working properly. Common causes include fatty liver disease and cirrhosis. Managing these conditions will help treat high enzyme levels.

Doctors test people for elevated liver enzymes if they have symptoms of conditions that typically cause liver damage.

In this article, learn about the causes of elevated liver enzymes, as well as the symptoms and treatment of each of these conditions.

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Liver enzymes is an umbrella term for a collection of proteins that support specific chemical reactions. These proteins include:

  • alanine transaminase (ALT)
  • aspartate transaminase (AST)
  • alkaline phosphatase (ALP)
  • gamma-glutamyl transferase (GGT)
  • serum bilirubin

Liver enzyme testing typically focuses on ALT and AST levels.

If a person’s blood test results show elevated liver enzymes, a doctor will investigate possible underlying causes. They may do further tests in addition to asking about a person’s lifestyle and dietary habits.

There are many different causes of elevated liver enzyme levels.

Below are the common causes of elevated liver enzymes, as well as their symptoms:

Fatty liver disease

The most common cause of elevated liver enzymes is fatty liver disease. Research suggests that 25–51% of people with elevated liver enzymes have this condition.

Fatty liver disease occurs when fats build up in the liver. If this buildup is due to alcohol consumption, it is called alcoholic fatty liver disease. When alcohol is not a causative factor, the buildup of fat in the liver is called nonalcoholic fatty liver disease (NAFLD). People with metabolic syndrome are at a higher risk of NAFLD.

Fatty liver disease may sometimes cause tiredness and pain on the right side of the abdomen, but it often causes no symptoms.

Learn about what to eat to help manage fatty liver disease here.

Metabolic syndrome

Metabolic syndrome is a group of symptoms that increase the risk of heart disease. These symptoms include:

The doctor may test people with one or more of these symptoms for elevated liver enzymes.


Hepatitis is a virus that leads to liver inflammation and damage. There are several different strains of hepatitis, which are called A, B, C, D, and E. The symptoms of all of the strains are similar.

Common hepatitis symptoms include:

The doctor may test a person with symptoms of hepatitis for elevated liver enzymes.

Alcohol or drug use disorder

Drinking too much alcohol or using illegal drugs may lead to liver inflammation or damage.

Liver inflammation due to alcohol consumption is called alcoholic hepatitis. When drugs are the underlying cause, doctors call it toxic hepatitis.

The symptoms of alcoholic and toxic hepatitis are similar to those of other strains of hepatitis.


Cirrhosis is a type of liver damage. A person with cirrhosis has permanent scarring of the liver, which can prevent it from working properly. Cirrhosis may eventually lead to liver failure.

Cirrhosis symptoms include fatigue and skin itching. People are at risk of cirrhosis if they do not receive treatment for hepatitis or fatty liver disease.

If a person has cirrhosis symptoms, the doctor may check their liver enzyme levels.

Other conditions

Other conditions that less commonly cause elevated liver enzymes include:

Elevated liver enzymes are a symptom of many different conditions rather than a condition themselves. People should seek help if they exhibit symptoms of fatty liver disease, cirrhosis, or other conditions listed above.

Liver enzyme levels may return to normal quickly if a person follows the doctor’s recommended treatment plan for the underlying condition.

Testing for elevated liver enzymes

A blood test can show elevated liver enzymes. The blood test checks for raised levels of AST and ALT, which are enzymes that the liver releases when it becomes inflamed or damaged.

If a doctor finds that a person has raised AST or ALT levels, they are likely to carry out further tests to determine the underlying cause.

The treatment for elevated liver enzymes will focus on managing the underlying condition causing the increased levels.

The treatments for some common causes of raised AST or ALT levels include:

Fatty liver disease

People can work with their doctor to treat NAFLD with weight loss. The doctor may advise a person to make lifestyle changes to lose weight, such as:

Speaking with a nutritionist or even a personal trainer can help someone stay on track with their weight loss plan.

If a person has fatty liver disease due to alcohol consumption, the doctor will support them in reducing their alcohol intake.

Metabolic syndrome

Treatments for metabolic syndrome include:

  • losing weight
  • exercising more
  • eating a healthful, balanced diet
  • managing blood sugar levels

Lifestyle changes that may help a person manage stress include:


Treatments for hepatitis depend on whether it is acute or long-term. A doctor may recommend the following treatments for acute hepatitis:

  • bed rest
  • plenty of fluids
  • avoiding alcohol

Treatment for long-term hepatitis usually includes antiviral medication to manage the condition’s symptoms and progression.

Alcohol or drug misuse disorder

Treatments for alcohol or drug use disorder include:

  • behavioral therapies
  • medications
  • support groups

Anyone who feels as though their alcohol or drug use is causing health problems or interfering with their everyday life should speak to their doctor.


Cirrhosis is permanent liver damage, so it is not always treatable. However, the underlying cause of liver damage is usually responsive to treatment. The conditions that we discussed above may all lead to cirrhosis.

Treatments such as a modified diet, weight loss, and reduced alcohol consumption can all reduce the risk of further liver damage. The prompt diagnosis and treatment of conditions that affect the liver can help prevent cirrhosis.

Elevated liver enzyme levels are a symptom of an underlying condition, and as such, prevention will focus on these causes rather than enzyme levels themselves. Following an active, healthy lifestyle can help support liver health and function and can reduce the risk of several conditions, such as fatty liver diseases and metabolic syndromes.

This may include eating a balanced diet rich in fruits, vegetables, whole grains, and healthy fats while limiting saturated fat, salt, and alcohol intake.

Elevated liver enzymes are themselves asymptomatic, but the underlying conditions responsible for them may cause symptoms.