Can Stress Cause Elevated Liver Enzymes?

The short answer is yes — stress and anxiety can possibly cause elevated levels of liver-produced enzymes. There’s some evidence of liver injury in times of stress, so it’s important to understand how liver enzymes work. 

What exactly are liver enzymes? What do they do, and how can we ensure they stay within healthy ranges?

What are liver enzymes?

Liver enzymes are enzymes that your liver produces to help catalyze (or “help along”) biochemical reactions and processes that your body needs to operate normally.

The liver itself is responsible for multiple activities, namely detoxifying the blood of metabolites, creating proteins, and producing enzymes to help with digestion. 

Liver enzymes play a crucial role in your metabolism. They regulate your red blood cells, create glucose (sugar), and store energy as glycogen (another type of sugar). Liver enzymes also help control the levels of other chemicals your body produces and absorbs, as well as facilitate the excretion of waste products.

Your liver makes many different enzymes and ”helper molecules.” The most important liver enzymes are:

• Aspartate transaminase (AST) (SGOT)

• Alkaline phosphatase (ALP) (SGPT)

• Alanine transaminase (ALT)

• Gamma-glutamyl transferase (GGT)

Measuring the levels of these enzymes in your body can give your doctor an idea of how well your liver is functioning and can help determine the cause behind a number of different medical conditions. Blood tests often include testing of these liver enzymes to help them understand the state of your body.

Symptoms of elevated liver enzymes

The enzymes your liver creates help many different biological processes in your liver to operate normally, so when enzyme levels are abnormal, you may notice a range of different symptoms. The most common symptoms associated with abnormal enzyme levels are:

• Abdominal pain

• Dark urine

• Light-colored stools 

• Yellowing of the eyes and skin (jaundice)

• Loss of appetite

• Inexplicable or unjustifiable fatigue 

Causes of elevated liver enzymes

Liver function is a complicated system with many different enzymes and metabolites playing a role, each affecting others in different ways. As such, the cause of elevated liver enzymes can be one or more conditions. 

Liver enzymes in the blood originate from living cells in your liver that have died, meaning elevated liver enzyme levels are a reflection of your liver health.

Some of the more common causes of elevated liver enzymes include:

• Excessive alcohol consumption or substance abuse

• Metabolic disorders such as stroke, heart failure, or heart attack

• Autoimmune diseases like autoimmune hepatitis 

• Liver cancer

• Significant inflammation of the muscles

• Side effects of taking some medications

• Celiac disease

• Viral hepatitis, such as hepatitis B or C

• COVID-19

• Fatty liver disease

• Cirrhosis

Tests for elevated liver enzymes

Your doctor can test your liver function by taking a sample of your blood and sending it off to the lab. In the lab, scientists will test the levels of liver enzymes found in your blood.

Liver function tests mainly look at AST, ALT, ALP, and GGT. The normal levels of these enzymes vary from person to person but should fall within a standardized range. Normal levels of these enzymes are:

• AST: under 36 U/L

• ALT: between 7 U/L and 56 U/L

• ALP: between 20 U/L and 140 U/L

• GGT: between 0-30 IU/L

Your doctor may also ask the lab to test your levels of albumin and bilirubin. These two proteins are involved in liver function and can provide good information about how well your liver is operating.

How to treat and manage stress?

Stress is pretty unavoidable if you have work, children, or a partner, but there are many things you can do to help keep stress under control. Here are some of the best ways to control stress and, by doing so, support healthy liver function:

• Take breaks from work or family when you need to. It doesn’t mean you don’t love them if you need some time away — interacting with others can be quite tiring. Take a few minutes or hours to center yourself and make some time to relax.

• Take care of your body by exercising when you can. Aim to get your heart rate up. The American Heart Association recommends at least 150 minutes of exercise per week.¹

• Practice meditation or other mind-relaxing activities like reading a book. These short breaks from the hustle and bustle of everyday life can be a great way to manage stress. 

• Connect with others in your community by attending events such as potlucks or block parties. Interacting with others can be draining, but it can also be energizing if they are kind people who care about you.

• Avoid alcohol or drugs, as they can promote a depressed state of mind and make it hard to keep calm when you’re stressed.

• Make a routine to follow that encourages a calm and healthy mind. This can be simply having a few moments to enjoy your coffee in the morning or going for a short walk before bed.

What can you do to normalize elevated liver enzymes?

Normalizing your liver enzyme levels when they are already elevated may not be easy, but it can be as simple as changing your diet and getting a bit more exercise. By getting your body sweating and your heart beating, you can help your body to recover from elevated liver enzyme levels.

Here are some ideas for changes to make when your liver enzyme levels are too high:

• Exercise regularly: There is a wealth of evidence supporting regular exercise as a way to support healthy liver enzyme levels. Regular exercise can also help you feel more energetic, have a better mood, and feel more capable of dealing with stress and anxiety.

• Eat more vegetables and less meat: While meat may be a tasty treat, it's never a bad idea to boost the amount of vegetables in your diet. Leafy greens, crunchy carrots, and various fruits can all help a healthy body to flourish.²

• Avoid processed and fast foods: Processed foods are made to last a long time without going bad, and while the excessive sugar and salt make the food taste good, these additives increase your chances of numerous diseases. 

• Drink coffee: You read that right — drinking coffee can help your liver stay healthy. 

The lowdown

Stress and anxiety may cause your liver enzyme levels to get out of balance, but that’s not a reason to get too worried. A healthy diet of fruits and vegetables combined with good stress management can support healthy levels of liver enzymes. 

If you are concerned about your liver enzyme levels, speak to your doctor.

Frequently asked questions

What are liver enzymes?

Liver enzymes are proteins that your liver produces to help your body operate normally. They help digestion, regulate your blood and fat storage, and even help eliminate toxins from your body.

Can stress cause elevated liver enzymes?

Possibly. Eating a healthy diet rich in vegetables and fruits, as well as managing stress, can help you maintain healthy levels of liver enzymes.

What are the symptoms of elevated liver enzymes?

The more common symptoms associated with elevated liver enzymes are abdominal pain, dark urine, light-colored stools, jaundice, loss of appetite, and excessive fatigue. 

Why does a healthcare provider check liver enzymes?

Your healthcare provider may check your liver enzyme levels to get an understanding of how well your liver is operating. As your liver is responsible for removing toxins from your body, liver problems can contribute to a number of health conditions.

What are the risk factors for elevated liver enzymes?

Common risk factors for elevated liver enzyme levels include viral hepatitis  (i.e., hepatitis B and C), heart failure, and drinking excess alcohol.