Every year, millions of people are affected by liver diseases regardless of their age, sex, region or race. The Global Burden of Disease project, a program formed by the WHO to estimate the mortalities and morbidities caused by specific diseases, shows that chronic liver diseases are among the top five chronic illnesses that cause death.
Liver enzymes are a group of biomarkers that usually forms part of a larger and more complete liver panel that includes proteins (albumin and globulin) and bile (conjugated and unconjugated). It is ordered as part of a general metabolic health screen, or when doctor suspects liver disease.
Liver enzymes play a critical role in detecting any damage to the liver cells. Enzymes are important proteins in our body that facilitate chemical reactions. Liver enzymes are specific for liver cells and are extremely useful biomarkers, because many liver disease processes are evident in the blood test long before symptoms occur, often when severe damage to the kidney already occurred (such as non-alcoholic fatty liver, liver cancer, alcoholic liver disease, hepatitis A and B virus infection).
When liver cells are damaged, these enzymes “leak” into the circulation causing elevated levels in the blood. The liver enzymes that are commonly tested include:
Alanine Aminotransferase (ALT) enzyme
ALT is mainly used in the liver to metabolize proteins, to provide energy. The normal range of ALT is 7 to 55U/L. A higher level can be a sign of liver damage caused by acute hepatitis, drug overdose, alcohol abuse, or heart damage.
Aspartate Aminotransferase (AST)
AST is found in several parts of the body, including the liver, heart, kidneys, and muscles where it helps in energy production. Normal levels of AST are between 8 and 40U/L. When elevated, it suggests liver damage, muscle damage, drug toxicity, excessive physical activity or a recent heart attack. Since AST is not only present in the liver, it cannot be used alone to make a diagnosis of liver disease. Doctors therefore use AST together with ALT to make clinical decisions.
Gamma-glutamyl transpeptidase (GGT)
GGT is usually the first liver enzyme to rise if there is an obstruction in the bile ducts, a condition in which bile cannot flow from the liver to the duodenum and other parts of the digestive system. It is thus the enzyme that is used to detect liver damage due to biliary obstruction. Also, GGT is usually higher (2 to 3 times more) in people who drink heavily, as compared to those who take less than three drinks per day. GGT is thus useful in detecting alcoholic liver damage.
Alkaline Phosphatase (ALP)
ALP is primarily found on the edges of the bile ducts and bones. An ALT test is typically ordered when the doctor suspects a bone disorder that is causing excessive bone formation or blocked bile ducts. The average levels are between 45 and 115 U/L.
The results of liver enzymes do not always tell the exact cause of liver damage, but they help the clinician to take the next steps. The physician will most likely take a comprehensive history, examine your body physically and order further testing and radiology studies to make a specific diagnosis.
What Can Cause Elevation of Liver Enzymes?
Globally, alcohol, viral hepatitis, and nonalcoholic fatty liver disease are the leading causes of these diseases.
Nonalcoholic fatty liver disease (NAFLD)
NAFLD describes an abnormal accumulation of fat in the liver which affects 20 to 40% of healthy adults. People who are obese, have type 2 diabetes, high blood pressure, smoke, or have high cholesterol are at an increased risk of NAFLD. Having high levels of fat in the liver also increases the risk of other problems including liver fibrosis and liver cancer. It is associated with the metabolic syndrome of high cholesterol and type 2 diabetes. So healthy lifestyle and dietary choices are so important in preventing and managing NAFLD.
The liver is a resilient organ that works very hard and regenerates itself when damaged. However, each time it filters alcohol, a chemical called acetaldehyde, which kills liver cells, is released. Continuous heavy drinking continues to damage the liver, and at the end, there is permanent damage. According to the WHO, alcohol accounts for 3.8% deaths globally and is among the leading causes of liver-related illnesses and fatalities.
The amount of alcohol that one consumes is the most critical risk factor for the development of alcoholic liver damage. 30 grams of daily alcohol for more than ten years can cause permanent damage, but for some people, a lesser percentage and duration is enough to cause damage.
Viral Hepatitis Infections
Hepatitis A, B, and C are the commonest contributors to chronic liver damage and cancer. About 3.2 million people are affected by Hepatitis C and 1.2 million by Hepatitis B in the US alone. For these two viruses, people who come in contact with infected body fluids through sharing of needles, tattooing instruments and sexual intercourse.
Other causes include:
- Medication-associated liver damage the commonest being acetaminophen, antibiotics and anti-tuberculosis medications
- Excessive deposition of iron in the liver, an inherited condition known as hemochromatosis
- Wilson’s disease, a condition characterized by abnormal copper metabolism
- Liver cancer
Lifestyle and Dietary Modifications to Improve Liver Enzyme Levels
Most liver diseases are preventable since only 5% of the cases are attributed to unmodifiable genetic and autoimmune causes, while over 90% are due to alcohol, viral hepatitis, obesity, and other lifestyle causes all preventable by dietary and lifestyle decisions.
Here are some of the ways to improve liver function and prevent long term consequences:
1. Eating and everything nutrition
By eating a clean, healthy diet and limiting your food portions, you can prevent liver damage. If you already have liver damage, your doctor together with a dietitian may suggest a specific diet to follow. Generally, you should:
- Limit your intake of foods high in fats to prevent accumulation of fat in the liver. Replace saturated fats from meat and dairy products, cookies and cakes, fries, and candies with unsaturated fats from peanuts, canola, olive, vegetable oils, fish, seed oils, and corn.
- Select your carbs from complex carbohydrate sources such as whole grains, sweet potatoes, wholemeal bread, beans, and vegetables.
- Avoid refined sugars found in sweetened tea, coffee, juices, sports drinks and soft drinks
- Eat your fruits whole and if you prefer fruit juices, limit to one serving daily
- Cut down on proteins to 1 gram per kilogram of body weight to avoid build-up of waste products.
- Limit salt intake
- Take liver friendly foods like moderate instant espresso coffee, berries, grapes, beetroot, broccoli, brussels, nuts, fish, turmeric, garlic and other vegetables.
2. Control your alcohol intake
The Australian National Health and Medical Research Council recommends that both men and women should drink no more than two standard drinks per day and no more than four drinks on a single occasion. Abstaining from alcohol altogether is even better. A standard drink contains 10 grams of pure alcohol. Once alcoholic liver damage has set in (abnormal liver enzymes), the British Liver Trust recommends complete abstinence from alcohol.
If you are on the journey of cutting back or quitting alcohol, you can do it on your own or with medical and social support. The option that you choose depends on how advanced your alcoholism is, the duration of the problem and how stable you are to deal with it. Whatever decision you choose, consider some of these strategies:
- Set a goal with timelines
- Keep track of how much you drink using a journal, calendar, or phone tracker
- Count and measure the level of alcohol in your choice of drinks
- Select drinks with a low percentage of alcohol
- Sip your drinks slowly and have breaks in between, if you must take more than one drink
- Find alternatives of engaging activities to replace your drinking times
- Avoid people and situations that trigger you to drink
- Know how to decline drinking offers politely
3. Weight loss
Weight loss helps to burn the fats that have accumulated around internal organs, including the liver. Losing weight is a slow process that takes resilience, patience, and discipline. The secret for keeping the extra kilos lost is through food portion control, eating a clean diet and exercise. Your daily aim should be to burn more calories than you consume. Moreover, base your diet on good sources of complex carbohydrates, proteins, healthy fats and vegetables.
4. Be active
Vigorous physical activity helps to reduce the damage to the liver by the accumulation of fats and to fight insulin resistance. The American Heart Association recommends 150 minutes of moderate physical activity every week. This can be divided into 30-40 minute sessions, for 3 to 4 days in a week. If you are not used to exercising regularly, build up from simple activities like walking and jogging as you build up to higher-intensity exercises.
5. Stay hydrated
Water makes up 70% of the human body, and besides preventing dehydration, it helps the liver in removing toxic substances from the body. Do not let thirst guide your daily intake but aim at maintaining a steady intake of 8 glasses per day. If you already have liver (or heart) disease that is causing swelling, your doctor may recommend a different approach to prevent fluid overload.
6. Take medications as prescribed
Unnecessary medications put stress on the liver, and if you already have liver damage, it becomes difficult to process drugs. For this reason, always ask your doctor before taking any drugs including over-the-counter medications, carefully follow instructions and avoid illicit drugs.
7. Get your vaccinations
Getting the full courses of Hepatitis B and A vaccines gives you protection that lasts more than ten years. Avoiding contact with other people’s body fluids will also help you in the prevention of these viruses.
Finally, when it comes to liver damage, prevention is better than cure. You need to maintain a healthy disciplined lifestyle. If the damage has set in, the prevention strategies discussed will help to reverse the damage or slow down the progression of the disease. Work together with your doctor to treat the underlying cause.
If you’re interested in learning more about liver enzymes and how they are essential, read on more about it in our biomarker post here!
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