Elevated liver enzymes signal that the liver is experiencing cellular stress or injury. The two most commonly measured enzymes are Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST). These enzymes normally reside within liver cells, assisting in amino acid metabolism. Their increased presence in the bloodstream suggests that damaged liver cells have leaked their contents. The goal of lowering these levels is to address the underlying cause of the liver cell damage, not just to achieve a better number on a blood test. This article provides actionable strategies to help reduce elevated ALT and AST levels.
Context of Elevated Liver Enzymes
ALT and AST are fundamental components of a standard liver function test, often ordered during routine physicals or when symptoms like fatigue or jaundice are present. ALT is primarily concentrated in the liver, making it a more specific marker for liver injury than AST. AST is also found in other organs, including the heart and muscles, meaning its elevation can sometimes have non-liver related causes.
When liver cells are inflamed or damaged, they release higher concentrations of these enzymes into the blood. Common causes for elevation range from fatty liver disease and excessive alcohol consumption to certain medications or chronic viral infections like hepatitis. Identifying the precise cause is the first step toward effective management and reduction of the enzyme levels.
Primary Lifestyle and Dietary Strategies
For many individuals, especially those with Non-Alcoholic Fatty Liver Disease (NAFLD), reducing elevated liver enzymes requires specific adjustments to daily habits. Gradual weight loss is a powerful tool; losing just 5% to 10% of body weight significantly reduces liver fat and improves enzyme levels. This modest reduction substantially impacts reversing steatosis, the fat build-up within liver cells that drives enzyme elevation.
Dietary modifications should focus on reducing processed sugars, particularly fructose, and refined carbohydrates, which contribute to liver fat accumulation. Adopting a Mediterranean-style diet, rich in healthy fats, whole grains, and fresh produce, is highly recommended. Incorporating regular physical activity, including both aerobic and resistance training, is also beneficial. Exercise improves insulin sensitivity, which helps reduce fat within the liver, even before significant weight loss occurs.
Limiting or stopping alcohol consumption is often the most immediate action to lower liver enzymes, as alcohol is a direct source of liver damage. Even moderate alcohol use can cause liver inflammation, making abstinence a priority in cases of elevated levels. Furthermore, certain foods, such as coffee, have been associated with a protective effect and may help lower abnormal liver enzymes in individuals with NAFLD.
Addressing Underlying Medical Conditions
While lifestyle changes are important, they may not be sufficient if the enzyme elevation is caused by an underlying medical condition requiring specific treatment. Persistent or significantly elevated levels necessitate a full medical evaluation to determine the precise root cause. This could include chronic viral hepatitis (B or C), hemochromatosis, or autoimmune disorders. Treating these specific conditions directly is the only way to achieve a sustained reduction in liver enzymes.
A thorough review of all medications is also important, as many prescription and over-the-counter drugs can cause drug-induced liver injury, leading to enzyme elevation. Common culprits include certain antibiotics, anti-seizure medications, statins, or high doses of acetaminophen. A healthcare provider may need to adjust the dosage, substitute the medication, or implement close monitoring, but patients should never stop prescribed medication without medical guidance.
For conditions like chronic Hepatitis C, antiviral therapy can eliminate the virus, resolving the cause of ongoing liver cell damage and normalizing enzyme levels. For hemochromatosis, a genetic disorder causing excessive iron storage, therapeutic phlebotomy (blood removal) is the standard treatment that prevents further iron-related liver damage. Treating the diagnosed condition is the definitive action that will ultimately resolve the enzyme elevation.
Navigating Supplements and Herbal Support
Many individuals seek supplements like Milk Thistle (Silymarin) or Vitamin E for their potential hepatoprotective effects. Silymarin, the active component of milk thistle, has shown some promise in clinical trials, suggesting it may help reduce ALT levels in people with fatty liver disease due to its antioxidant properties. Vitamin E, a powerful antioxidant, is also sometimes used, and studies indicate it may improve certain liver parameters.
However, the scientific evidence supporting the widespread use of these supplements for lowering liver enzymes remains limited and inconsistent. A significant concern is the lack of regulation in the supplement industry, meaning purity and active ingredient dosage can vary widely. Some herbal supplements, such as kava or chaparral, have been linked to liver injury and can actually cause enzyme levels to rise. It is prudent to consult with a physician before starting any supplement regimen, especially since certain compounds, including milk thistle, can interact with prescription medications like Warfarin or certain immunosuppressants.