The liver is the largest glandular organ in the human body and holds an estimated 13% of the body’s blood supply. As one of our vital organs, the liver plays a major role in detoxification and metabolic and immune system processes. Located mainly in the top right area of the abdomen, this organ receives all the blood leaving the stomach and intestines. In the liver, chemical levels in the blood are regulated, and waste products are removed.
Another unique feature of the liver is its ability to regenerate. It has been shown that following the removal of up to two-thirds of the liver, it has the potential to regenerate to near its original size within just 7 days of surgery.1 There are a variety of well-known health conditions known to have a negative impact on liver function, but what effect does stress have on our liver?
About liver enzymes
What is the role of liver enzymes?
Liver enzymes play a vital role in the daily functioning of the liver. They are functional proteins that speed up the rate of chemical reactions. These chemical reactions are involved in liver functions such as; bile production, creating blood clotting factors, breaking down food and toxins, and helping to fight off different infections.
Some of the most common liver enzymes include:
Types of liver enzymes
- Aspartate transaminase (AST)
- Alanine transaminase (ALT)
- Alkaline phosphatase (ALP)
- Gamma-glutamyl transferase (GGT)
What effect does stress have on liver enzymes?
In a study published in the Journal of Gastroenterology and Hepatology, it was found that during periods of stress, natural killer cells in the liver contributed to exacerbated liver cell death and worsened the progression of liver disease. It was also found that blood flow to the area of the brain controlling the liver experiences weakened blood flow during stress.3
Chronic stress has been shown to amplify and exacerbate inflammation, which negatively impacts chronic liver diseases. It has also been noted that immune function in patients with hepatitis B is affected by psychological stress, which consequently affects the liver.4
A study investigating people with chronic hepatitis B saw a significant correlation between the degree of depression and ALT levels in the blood.5 It is further noted by people with hepatitis C that a stressful period of time in their lives is often followed by a flare-up of symptoms.
Although research has identified stress as an exacerbating factor in deteriorating liver health, further investigation is required to determine a definite causal link.
What are the causes of stress?
Everyone experiences stress at some point in their life, and it can be the result of a multitude of different factors. Often, stress affects how you feel physically and mentally, and a lot of negative stress can lead to a variety of different health problems.2 Stress can be caused by:
- A big change in your life
- Feeling like you are under a lot of pressure
- Feeling like you don't have control over a situation
- Struggling with a period of uncertainty
- Problems at work
- Chronic illness
Mental symptoms of stress include; becoming easily frustrated or feeling overwhelmed, difficulty relaxing and low self-esteem. Some of the physical symptoms associated with stress are; headaches, low energy, digestive problems, rapid heart rate and a dry mouth.
What does it mean when liver enzymes are elevated?
High levels of liver enzymes in the blood can indicate inflammation or damage to the liver. Whilst liver enzymes are often only mildly and temporarily elevated (and not usually a major reason for concern), they may also be a sign of a health condition such as liver disease or hepatitis.
A blood test requested by your healthcare provider may include a Liver Function Test (LFT), Liver Panel, or tests for individual levels of liver enzymes. These tests check for raised levels of the enzymes that are produced when the liver becomes damaged or inflamed.
When liver cells are either injured or inflamed, they leak a higher amount of chemicals, including liver enzymes, into the bloodstream, which is reflected in the findings of a blood test. AST and ALT levels are common indicators of liver health.
What causes elevated liver enzymes?
There is a range of different medical conditions, liver diseases, medications and infections that may cause elevated liver enzymes. A few of the most common are listed below:
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Alcoholic hepatitis - where excessive consumption of alcohol causes severe liver inflammation
- Alcohol and drug abuse
- Non-alcoholic fatty liver disease - a condition where an excess of fat builds up in the liver causing damage and inflammation
- Cirrhosis of the liver - a type of liver damage where the tissue is permanently scarred and therefore prevented from working properly
Some other less common factors known to cause elevated liver enzymes are:
- Autoimmune hepatitis
- Liver cancer
- Coeliac disease
- Metabolic syndrome
- Wilson’s disease
Certain medications such as prescription statin drugs and certain over-the-counter pain relief medications also affect liver enzyme levels.
Your doctor may request a blood test to check your liver enzyme levels if you are exhibiting symptoms of these types of health conditions that are associated with liver damage.
Symptoms of elevated liver enzymes
Elevated liver enzymes are asymptomatic alone; however, the underlying health condition that causes these raised enzyme levels often lead to symptoms. There are a variety of common symptoms associated with high liver enzyme levels, such as:
- Abdominal pain
- Dark urine
- Nausea and vomiting
- Loss of appetite
- Pale stools
- Itching skin
Similar symptoms are known to be associated with hepatitis, including fatigue, muscle soreness, painful joints, nausea, fever, jaundice and a general sense of feeling unwell. Chronic hepatitis may also not have any noticeable symptoms until the liver begins to fail and may only be identified in the results of a blood test.
What are the risk factors?
The general risk of developing liver damage and consequently elevated liver enzymes is increased by alcohol and drug abuse, having diabetes, certain medications, a family history of liver disease and exposure to hepatitis.
Treatment and prevention
Treatments for elevated liver enzymes focus largely on targeting the underlying cause. For example, treatment for fatty liver disease is directed towards exercising more, eating a healthy and balanced diet and encouraging weight loss. Working with a nutritionist or personal trainer may be helpful in supporting these lifestyle changes.
If alcohol consumption is having a negative effect on a person's liver health they would be encouraged to reduce their alcohol intake and seek support in controlling their drinking habits. Support groups, medications and therapy are common treatments for alcohol or drug use.
Hepatitis treatment differs between acute and long-term diagnoses. Acute hepatitis is managed by resting, focusing on fluid intake and avoiding alcohol. Chronic or long-term hepatitis is often treated with an antiviral medication. People at risk of contracting hepatitis may be advised to have a vaccination against hepatitis.
In general, avoiding excessive alcohol consumption, maintaining a healthy lifestyle with balanced eating and exercise habits can help you to maintain the health of your liver.
Part of maintaining a healthy lifestyle involves managing stress. Regular and enjoyable exercise, spending time with friends and family, making time for hobbies you enjoy, and having a balanced diet, are all effective ways of managing stress.
It is a good idea to seek help from your doctor if you cannot manage the stress in your life or if you are unsure that stress is the cause of the symptoms you are experiencing.
In conclusion, liver enzymes play a vital role in regulating physiological processes in the liver and can be used as a significant indicator of liver dysfunction. Whilst elevated liver enzymes may only be temporary, they may also be a sign of a serious health condition like liver disease or hepatitis. Making some important lifestyle changes, including taking active steps to reduce your stress levels, will positively benefit the health of your liver.
- Kholodenko IV, Yarygin KN. Cellular Mechanisms of Liver Regeneration and Cell-Based Therapies of Liver Diseases. Biomed Res Int. 2017;2017:8910821.
- American Psychological Association: "Mind/Body Health: Stress." 2011, (accessed on 20/05/2022).
- Chida Y, Sudo N, Kubo C. Does stress exacerbate liver diseases?. J Gastroenterol Hepatol. 2006;21(1 Pt 2):202-208. doi:10.1111/j.1440-1746.2006.04110.x
- Block PD, Shinn B, Kim JH, Hann HW. Hepatitis B-related hepatocellular carcinoma and stress: untangling the host immune response from clinical outcomes. Hepat Oncol. 2020 Dec 29;8(1):HEP35.
- ‘Stress and the liver’, HCPS fact sheet. HCV advocate. HCSP • VERSION 4.1 • November 2013 (accessed on 20/05/2022).