Preventing liver enzyme abnormalities - what is it worth knowing?

Liver enzyme abnormalities are often asymptomatic, and in many cases are detected during a routine laboratory test. Although the name may be a cause for concern, it is important to understand that elevated liver enzyme levels are not a disease in themselves, but are a sign of some kind of damage or inflammation to liver cells. Knowing these values can be key to identifying the underlying causes and starting appropriate treatment. This article details the possible causes of liver enzyme abnormalities, the diagnostic process and, most importantly, prevention strategies to help keep your liver healthy.

What does liver enzyme mismatch mean?

Liver enzymes are proteins found in liver cells that catalyse vital biochemical processes. When liver cells become damaged or inflamed, these enzymes are released into the bloodstream in higher amounts. The liver enzymes most commonly measured in laboratory tests are:

• Alanine aminotransferase (ALT): This enzyme is found almost exclusively in liver cells, so elevated levels of it specifically indicate liver damage.
• Aspartate aminotransferase (AST): Although it is present in high amounts in the liver, it is also found in the heart and skeletal muscles, as well as other organs. Elevated AST is therefore not exclusively a sign of liver problems.
• Gamma-glutamyl transferase (GGT): This enzyme is concentrated mainly in the cells of the bile ducts. Elevated levels often indicate bile duct obstruction, biliary stricture (cholestasis) or excessive alcohol consumption.
• Alkaline phosphatase (ALP): ALP is also found in the cells of the bile ducts and in bones. Elevated levels may also indicate biliary problems or bone disease.

Liver enzyme abnormalities therefore mean that the level of one or more of these enzymes in the blood is above the normal range. It is important to know that mild, transient elevations are not always abnormal, but persistently high levels definitely require careful investigation.

Possible causes of liver enzyme abnormalities

Damage to liver cells and elevated levels of enzymes can be caused by a number of factors. These can be grouped into several main categories.

Lifestyle factors and nutrition

• Alcohol consumption: Excessive and regular alcohol consumption is one of the most common causes of liver damage. Alcohol is directly toxic to liver cells, causing inflammation and fatty degeneration, leading to the development of alcoholic fatty liver. This can lead to long-term liver cirrhosis and liver failure.
• Non-alcoholic fatty liver disease (NAFLD): This condition is a consequence of overweight, obesity, type 2 diabetes and metabolic syndrome. Excess fat is deposited in the liver cells, causing inflammation (NASH - non-alcoholic steatohepatitis) and scarring, which can also lead to cirrhosis. A polymorphism in the PNPLA3 gene is a genetic predisposition to the development of NAFLD.
• Improper nutrition: A diet high in processed sugars, saturated fats and calories contributes to the development of fatty liver and elevated liver enzyme levels.

Infections

• Viral inflammation of the liver (hepatitis): Hepatitis A, B, C, D and E viruses can cause liver inflammation of varying severity. In particular, chronic hepatitis B and C infection can lead to permanent liver damage, cirrhosis and liver cancer. Infections can be spread through sex, blood or contaminated food and water.
• Other infections: Certain systemic infections, such as Epstein-Barr virus (EBV) or cytomegalovirus (CMV), which cause mononucleosis, can also cause a temporary liver enzyme elevation.

Medicines and toxins

• Drug-induced liver injury (DILI): Many prescription and over-the-counter medicines, herbal products and supplements can put a strain on the liver. Common examples include paracetamol (in case of overdose), certain antibiotics, cholesterol-lowering drugs (statins) and methotrexate.
• Toxins: Industrial chemicals, fungal poisons (e.g. killer gallstones) can cause serious, even fatal liver damage.

Autoimmune and genetic diseases

• Autoimmune hepatitis: In this case, the immune system mistakenly attacks your own liver cells, causing chronic inflammation.
• Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC): These autoimmune diseases attack the bile ducts inside and outside the liver, leading to biliary strictures and liver damage.
• Genetic and metabolic diseases: Examples include haemochromatosis (iron accumulation), Wilson's disease (copper accumulation) or alpha-1-antitrypsin deficiency, all of which can damage the liver.

How can liver enzyme abnormalities be prevented?

The key to prevention is a healthy lifestyle and minimising risk factors. The liver has an extraordinary regenerative capacity, so lifestyle changes can do a lot for your health.

1. A balanced diet

Eat foods rich in fibre, vitamins and antioxidants. A Mediterranean-style diet rich in vegetables, fruit, whole grains, fish and olive oil is particularly beneficial. Avoid processed foods high in sugar, saturated fat and salt.

2. Weight control and regular exercise

Maintaining a healthy weight is the most important means of preventing non-alcoholic fatty liver. Regular physical activity - at least 150 minutes a week of moderate-intensity exercise (e.g. brisk walking, cycling) - helps to reduce weight, improve insulin sensitivity and reduce liver fat.

3. Reducing alcohol consumption

To keep your liver healthy, it is best to avoid alcohol. If you do drink, do so in moderation. Men should drink no more than two units of alcohol a day and women no more than one unit of alcohol a day, but it is important to have alcohol-free days. Complete abstinence is essential if you already have liver disease.

4. Prevention of infections

• Vaccinations: Vaccination against hepatitis A and B is available. These are particularly recommended if you are in a risk group (e.g. a healthcare worker) or travelling to an endemic area.
• Safe practices: To prevent hepatitis B and C infection, avoid sharing needles and shavers and practice safe sexual behaviour. When getting a tattoo or piercing, make sure the salon uses sterile equipment.

5. Prudent use of medicines

Take only the medicines prescribed by your doctor, in the dosage indicated. Do not exceed the recommended daily dose of any non-prescription medicines, especially paracetamol. If you are taking more than one medicine, tell your doctor to avoid adverse drug interactions.

When should you see a doctor?

If a laboratory test shows elevated liver enzyme levels, you should always consult your GP or a specialist gastroenterologist. Although symptoms are often absent, the following signs may indicate a liver problem:

• Persistent fatigue, weakness
• Pain or discomfort under the right rib cage
• Loss of appetite, nausea
• Jaundice (yellowish discoloration of the skin and whites of the eyes)
• Dark urine, light stools
• Skin itching

From Endomedix Gastroenterology Centre specialists are available with the most modern diagnostic techniques to help uncover the background of liver enzyme abnormalities. The examination includes a detailed history and physical examination, which may be followed by further laboratory tests (viral serology, autoimmune markers, genetic tests) and imaging (abdominal ultrasound, CT, MRI). If necessary, a liver biopsy may also be performed, which involves microscopic examination of liver tissue to determine the exact extent and cause of the damage.

The next steps

A liver enzyme abnormality is an important signal that should be taken seriously. It is also an opportunity to review your lifestyle and take proactive steps to improve your liver health. Prevention is a simple but effective set of steps: a balanced diet, regular exercise, weight control and avoiding or reducing alcohol consumption all help to reduce the risk of liver damage.

If you have been found to have elevated liver enzymes, do not hesitate to seek professional advice. Early and accurate diagnosis and a personalised treatment plan are essential to prevent more serious complications such as cirrhosis or liver failure. Visit Endomedix Gastroenterology Centre experienced team will help you navigate the diagnostic maze and find the best solution to restore your health.