What Your Liver Enzymes Are Trying to Tell You

The liver is an incredibly important organ. In fact, it is the second largest organ, following the skin. It’s a workhouse that’s responsible for hundreds of critical functions. Without a liver, human life would cease to exist. One of the major jobs of the liver is detoxification, however it also plays important roles in: 

• Digestion by producing bile
• Blood sugar stability
• Breakdown of fats
• Production of cholesterol
• Balancing hormone levels

Along with these important responsibilities, the liver also contains enzymes (a type of protein) that speed up certain chemical reactions. If any of these enzymatic processes are inhibited, it could lead to serious complications. When liver cells are injured or are inflamed, they leak higher than normal amounts of certain chemicals, including liver enzymes. This is where we see elevated liver enzymes on standard blood work.

The Complete Metabolic Panel (CMP) is a standard blood workup you receive from your doctor, typically during your annual visit. Within this panel, you’ll see markers such as aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP). These are standard liver enzymes your doctor is reviewing to understand your liver health. They may also order a marker called GGT, or gamma-glutamyl transferase. When your doctor is interpreting your results, they are looking to see if these markers are outside of the normal reference range. If the marker falls within that range, you’ll be told the “results are all normal.” It isn’t until the results end up outside of the typical reference range in which practitioners start to recommend interventions. In functional medicine, however, we look at the whole person and strive to create optimal health BEFORE things become harder to rebalance. We seek to find and create lab results that are optimal for each unique person.

Let’s look at the liver enzymes from a functional perspective. 

AST is a liver enzyme that is also found in all the major muscles of the body such as the kidneys, lungs and heart. You could think of the “S” in AST as meaning “somewhere” in the body.  When the liver is stressed, this enzyme goes up. If you have a sluggish liver or gallbladder, you may present with elevated AST levels. If AST is elevated over the normal levels and far above ALT and GGT, then it typically indicates the major area of damage is outside of the liver, most commonly in the heart or kidney. 

ALT is an enzyme present in the liver that spills out during times of increased liver stress. Like, AST, elevated ALT levels may indicate poor liver or gallbladder health. You can think of the “L” in ALT as local to liver.  If ALT is elevated above normal levels and far above AST and GGT, then it typically indicates a problem with the liver specifically.

ALT and AST need vitamin B6 to be created. If you see a lower level of AST and ALT you may have a B6 deficiency. For some, adding needed B6 can skyrocket ALT and AST, showing whata the body was unable to do in a deficient state. 

GGT is an enzyme in the liver, pancreas, and kidneys. It is elevated in all forms of liver disease and functionally increased due to alcoholism and/or sluggish gallbladder or gallstone obstruction. Levels that are high within the normal range can be evidence of the liver working to generate more glutathione, which is your most potent antioxidant, in response to current demands. This can inform us that there might be a lot of toxicity your body is dealing with. If you have levels lower than 16 IU/L, it can indicate a vitamin B6 or magnesium deficiency. 

ALP is another liver enzyme that’s made by the mucosal cells that line the liver, gallbladder and bile ducts. This trio is known as the biliary tract and is responsible for making, storing and secreting bile. High ALP is one of the most sensitive markers for sluggish gallbladder or gallstones. If this marker is elevated (over 95) along with high bilirubin and liver enzymes, then think of liver and gallbladder problems. ALP is dependent mainly on zinc for synthesis, but also vitamin B12 and magnesium. Levels below 50 often are an indicator of one or more deficiencies.

Please note that ALP can also be high where there is bone remodeling or gut dysfunction. We expect to see this value high in growing children, and it can also be used as an indicator of osteoporosis or gut issues. 

So, what can impact the liver and increase these enzymes? 

• Stress
• Processed food consumption
• Excess sugar and refined carbohydrate consumption
• Alcohol consumption
• Smoking
• Undiagnosed celiac disease
• Prescription and over the counter medications
• Heavy metal toxicity
• Constipation
• Environmental toxicity such as mold, pesticides, VOCs, and other chemicals
• Infections such as viral, bacterial, fungal infections, and
• Suppressed emotions (especially anger). 

In summary, your liver is one of your most vital organs and plays a critical role in numerous functions including regulating digestion, metabolizing fats, carbohydrates, and proteins, and removing harmful particles and chemicals from the body. When it becomes congested, sluggish, and compromised, your detoxification capacity is impacted, potentially leading to a variety of dis-ease states. Understanding your liver enzymes and looking at these markers from a functional perspective as relates to your symptoms will allow you to support your body in a targeted systematic approach. If you would like support with this, reach out, we are happy to help!