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Making Sense of Medicine-Liver Enzymes: anything up?

Every cell of your liver can perform over 5000 chemical reactions! The liver has been called the biochemistry lab of the body because it is such a hub of essential metabolic activity. All the nourishment we put into our bodies has to be processed biochemically to meet our needs, and the liver is expert at that. That’s why everything that your digestive tract absorbs is taken directly to your liver. 


And your liver doesn’t just manage the good stuff coming in, it also sifts and manages all the stuff that we need to eliminate, including all the toxins we have absorbed. This keeps our bodies cleaner, less encumbered by a toxic load, and working better. 


You can think of your liver as the Grand Central Station of your body, managing inputs and outputs, 

every moment of your life.


There are four major liver enzymes, found hard at work in our liver cells. If liver cells are inflamed, those enzymes can leak out, and we then find them in greater amounts in our bloodstreams. You may have heard of “leaky gut”, well this is “leaky liver”. 


Liver enzymes should be in your liver, not your blood: 

the clue really is in the name!


Because the liver is such a vital organ, liver enzyme tests are frequently done as part of a routine screening panel. If those enzymes are high, they tell you that the liver is inflamed, but they don’t tell you the cause of that inflammation, so they indicate the need to look further. 


This inflammation could be due to:• an acute illness such as hepatitis• a chronic problem such as fatty liver 

• a heavy load on your liver such as excessive alcohol consumption, or exposure to significant environmental toxins 


Some of these conditions create symptoms that leave us in no doubt that something is amiss. In acute illness such as hepatitis, some test results can show up to 50 times the high normal level. Someone suffering from this would feel absolutely awful. 


But some liver problems cause little or no distressing symptoms to tell us there is something inflammatory going on. These are the conditions in which we may see one or more liver enzymes that are slightly elevated.


The four liver enzymes tested have very long names so they are abbreviated to acronyms. You may have seen these on your blood test results:

  • GGT - Gamma glutamyl transferase 

  • AST - Aspartate amino transferase 

  • ALT - Alanine transaminase

  • ALP - Alkaline phosphatase 

The transferase and transaminase parts of these names indicate that we use them to transfer amino acid building blocks from one molecule to another, to make our proteins. It’s rather like breaking down one Lego model to put the blocks together in a different order, to make something we need. 


The “<” sign before the “normal range” number, means that your test result should be less than or equal to that number. If it is higher, the normal value has been exceeded, and that enzyme is marked as elevated.

 Which of the four enzymes is elevated, or which combination, may offer some clues as to what is going on:

  • GGT - high levels are most commonly associated with excess alcohol consumption. It’s also associated with exposure to environmental toxins.

  • AST and ALT – high levels almost always indicate damage to or disease of the liver itself.

  • ALP - high levels usually indicate obstruction of bile ducts, which can be due to liver inflammation. However it can indicate disease in a different organ. 

We regularly hear “My liver is fine - my MD just tested it and the results were OK”. Whereas most MDs are usually screening for significant disease, naturopathic doctors look further, for minor problems or imbalances. We like to address them before they have a chance to become major problems. 


While we are happy to hear that there’s nothing indicating something is really wrong with your liver, results in the normal range don’t necessarily mean that it’s in fabulous form! As mentioned above, it just means liver cells are not so badly inflamed that they are starting to break down. If we see that liver enzyme results are in the high normal range, and especially if they have risen since previous tests, we are interested in why that is happening. 


If your liver enzymes are mildly elevated, don’t panic but do pay attention. They could be indicative of fatty liver, which affects about a quarter of the world's population these days. Fatty liver can be diagnosed by an ultrasound test and usually responds well to lifestyle changes. If fatty liver is not found, it is good to track down what’s causing any elevation, so you can address it. Because the liver deals with all your nutrition and all pharmacological, environmental, and toxic exposure, there are many things that could be causing an elevation. This calls for some detective work, which might take some time, brainstorming and further testing. 


The good news is that the liver has a huge regenerative capacity, and many liver problems can be reversed through finding the cause, and then treating with nutrition, lifestyle and other changes. For more on this topic, see our liver masterclass, or consult a naturopathic doctor.

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