What are the main causes of elevated liver enzymes. How do medications, diseases, and lifestyle factors contribute to high liver enzyme levels. What steps can be taken to lower elevated liver enzymes and improve liver health.

Understanding Liver Enzymes and Their Function

Liver enzymes are specialized proteins that catalyze important chemical reactions within liver cells. When these enzymes are found at higher-than-normal levels in the bloodstream, it often indicates some form of liver cell damage or dysfunction. But what exactly are these enzymes, and what do they do?

Key Liver Enzymes and Their Roles

• Alkaline Phosphatase (ALP): Involved in breaking down proteins
• Alanine Transaminase (ALT): Helps convert proteins into energy for liver cells
• Aspartate Transaminase (AST): Assists in metabolizing amino acids
• Gamma-glutamyl Transferase (GGT): Aids in metabolizing drugs and other toxins

When liver cells are damaged or die, these enzymes leak into the bloodstream, resulting in elevated levels that can be detected through blood tests. While temporary elevations can occur due to various factors, persistently high levels may indicate underlying liver problems that require medical attention.

The Impact of Medications on Liver Enzyme Levels

Many common medications can affect liver enzyme levels, either through direct toxicity or by altering liver metabolism. Understanding these effects is crucial for both patients and healthcare providers.

Over-the-Counter Pain Medications

Acetaminophen, a widely used pain reliever, is generally safe when taken as directed. However, excessive use can lead to liver damage. How much is too much? For most adults, the maximum recommended daily dose is 4,000 mg. Exceeding this limit, especially when combined with alcohol consumption, can result in toxic buildup and elevated liver enzymes.

Prescription Cholesterol Medications

Statins, commonly prescribed to lower cholesterol levels, can cause mild elevations in liver enzymes. While this effect is usually not harmful, it’s important for patients taking statins to have their liver function monitored regularly. Are statins dangerous for the liver? In most cases, no. The benefits of statins in preventing cardiovascular disease typically outweigh the risk of liver problems. However, if enzyme levels rise significantly, your doctor may adjust your dosage or switch to an alternative medication.

Viral Hepatitis and Its Effect on Liver Enzymes

Viral hepatitis is a significant cause of elevated liver enzymes worldwide. Let’s examine how different types of hepatitis affect liver function.

Hepatitis A: Acute but Self-Limiting

Hepatitis A typically causes a sudden increase in liver enzymes, particularly ALT and AST. This acute infection usually resolves on its own within a few weeks to months. How is Hepatitis A transmitted? It’s primarily spread through contaminated food or water, or close contact with an infected person. Vaccination is an effective preventive measure.

Hepatitis B: Potential for Chronic Infection

Hepatitis B can cause both acute and chronic liver inflammation. In chronic cases, ongoing liver cell damage leads to persistent elevation of enzymes. Can Hepatitis B be cured? While there’s no cure for chronic Hepatitis B, antiviral medications can effectively manage the infection and prevent further liver damage.

Hepatitis C: Silent but Serious

Often called a “silent” disease, Hepatitis C can cause liver enzyme elevations for years before symptoms appear. The virus directly damages liver cells, causing enzyme leakage into the bloodstream. What’s the prognosis for Hepatitis C? With modern antiviral treatments, many people can be cured of Hepatitis C, but early detection is key to preventing long-term liver damage.

Non-Alcoholic Fatty Liver Disease: A Growing Concern

Non-alcoholic fatty liver disease (NAFLD) has become increasingly common, paralleling rising rates of obesity and diabetes. This condition occurs when excess fat accumulates in liver cells, leading to inflammation and potential scarring.

The Spectrum of NAFLD

1. Simple fatty liver: Excess fat without significant inflammation
2. Non-alcoholic steatohepatitis (NASH): Fat accumulation with inflammation
3. Advanced fibrosis: Scarring of liver tissue
4. Cirrhosis: Severe scarring and impaired liver function

How does NAFLD affect liver enzymes? In NAFLD, ALT and AST levels are often mildly to moderately elevated. These elevations can fluctuate over time but tend to persist if the underlying condition is not addressed.

Risk Factors and Prevention

Who is at risk for NAFLD? Key risk factors include obesity, insulin resistance, high blood sugar, and high triglycerides. Can NAFLD be reversed? In its early stages, lifestyle changes such as weight loss, improved diet, and increased physical activity can significantly improve liver health and normalize enzyme levels.

The Role of Obesity in Liver Enzyme Elevation

Obesity is closely linked to liver dysfunction and elevated enzyme levels. The relationship between excess body weight and liver health is complex and multifaceted.

Mechanisms of Liver Damage in Obesity

• Insulin resistance leading to fat accumulation in liver cells
• Chronic low-grade inflammation affecting liver tissue
• Oxidative stress causing cellular damage
• Alterations in gut microbiota influencing liver metabolism

Why do obese individuals have higher rates of elevated liver enzymes? Excess body fat, especially visceral fat, releases inflammatory substances and free fatty acids that can directly damage liver cells. Additionally, obesity often coexists with conditions like diabetes and metabolic syndrome, which further stress the liver.

Weight Loss and Liver Health

Can weight loss improve liver enzyme levels? Yes, studies have consistently shown that even modest weight loss (5-10% of body weight) can lead to significant improvements in liver enzyme levels and overall liver health. This highlights the importance of maintaining a healthy weight for liver function.

Alcoholic Liver Disease and Enzyme Elevations

Excessive alcohol consumption is a leading cause of liver disease and elevated enzyme levels worldwide. Understanding the progression of alcoholic liver disease is crucial for prevention and early intervention.

Stages of Alcoholic Liver Disease

1. Fatty liver: Reversible with abstinence
2. Alcoholic hepatitis: Inflammation and potential scarring
3. Cirrhosis: Severe scarring and impaired function

How does alcohol affect liver enzymes? Alcohol directly damages liver cells, causing enzymes to leak into the bloodstream. In alcoholic liver disease, AST levels often rise higher than ALT levels, creating a characteristic pattern that doctors recognize.

The Importance of Moderation

What constitutes “moderate” drinking? For liver health, guidelines suggest no more than one drink per day for women and up to two drinks per day for men. However, individual tolerance varies, and some people may need to abstain completely to maintain healthy liver function.

Autoimmune Hepatitis: When the Body Attacks the Liver

Autoimmune hepatitis is a chronic condition where the immune system mistakenly attacks liver cells, leading to inflammation and elevated enzyme levels. This rare but serious condition requires careful management.

Characteristics of Autoimmune Hepatitis

• Presence of specific autoantibodies in the blood
• Elevated transaminases (ALT and AST)
• Increased levels of immunoglobulins, especially IgG
• Liver biopsy showing characteristic inflammatory patterns

How is autoimmune hepatitis diagnosed? Diagnosis typically involves a combination of blood tests to detect autoantibodies and elevated liver enzymes, imaging studies, and often a liver biopsy to confirm the diagnosis and assess the extent of liver damage.

Treatment Approaches

Can autoimmune hepatitis be treated effectively? Yes, most patients respond well to immunosuppressive medications that reduce the immune system’s attack on the liver. Treatment usually involves corticosteroids, often in combination with other immunosuppressants. The goal is to reduce inflammation, normalize liver enzymes, and prevent progression to cirrhosis.

Heart Failure and Its Impact on Liver Function

The relationship between heart failure and liver dysfunction is complex and often overlooked. Chronic heart failure can lead to liver congestion and elevated enzyme levels through several mechanisms.

Mechanisms of Liver Dysfunction in Heart Failure

1. Reduced cardiac output leading to decreased liver blood flow
2. Increased central venous pressure causing liver congestion
3. Hypoxia (low oxygen) in liver tissue due to poor circulation
4. Activation of inflammatory pathways affecting both heart and liver

How does heart failure affect liver enzymes? In heart failure, both ALT and AST may be elevated, but often to a lesser degree than in primary liver diseases. Additionally, cholestatic enzymes like ALP may increase due to liver congestion.

Management Considerations

Can treating heart failure improve liver function? Yes, optimizing heart failure treatment often leads to improvements in liver enzyme levels and overall liver function. This may involve medications to improve heart function, reduce fluid retention, and in some cases, mechanical support devices or heart transplantation.

Lifestyle Modifications to Improve Liver Enzyme Levels

While medical treatments are often necessary for managing elevated liver enzymes, lifestyle changes can play a crucial role in improving liver health and preventing further damage.

Key Lifestyle Interventions

• Maintain a healthy weight through balanced diet and regular exercise
• Limit alcohol consumption or abstain completely if advised by a doctor
• Avoid unnecessary medications and follow dosage instructions carefully
• Manage underlying conditions such as diabetes and high cholesterol
• Stay hydrated and reduce intake of sugary and processed foods
• Consider liver-supportive nutrients like vitamin E and omega-3 fatty acids

How quickly can lifestyle changes affect liver enzyme levels? Some people may see improvements in liver enzyme levels within a few weeks of making significant lifestyle changes. However, for others, especially those with more advanced liver disease, it may take several months of consistent effort to see substantial improvements.

The Role of Exercise in Liver Health

What types of exercise are best for liver health? Both aerobic exercise and resistance training have shown benefits for liver function. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity activity per week, along with strength training exercises at least twice a week. Regular physical activity can help reduce liver fat, improve insulin sensitivity, and lower inflammation, all of which contribute to healthier liver enzyme levels.

In conclusion, elevated liver enzymes can result from various factors, ranging from medications and viral infections to chronic diseases and lifestyle choices. Understanding these causes is crucial for effective management and prevention of liver damage. By addressing underlying conditions, making lifestyle modifications, and working closely with healthcare providers, many individuals can successfully lower their liver enzyme levels and improve overall liver health. Regular monitoring and proactive health measures are key to maintaining optimal liver function and preventing long-term complications.

12 Causes of High Liver Enzymes | Updated 2023

The liver is a crucial part of our body. Therefore, it is necessary to take care of our internal organs. However, it has been noticed that sedentary lifestyles have increased the rate of liver diseases. Almost 257 million people are living with liver conditions worldwide. These numbers are huge to resolve the problem. Liver enzymes are a protein in the liver that speed up the reactions of some chemicals. Various conditions such as Liver issues, Chronic health issues, medications, and infections can cause Causes of High Liver Enzymes. In the case of an inhibitory process, this can result in severe problems. Therefore, it is essential to know the causes of high liver enzymes and what to do to prevent them.

If you are looking for a doctor’s advice, watch the video below.

Table of Contents

What are elevated liver enzymes?

Individuals with more liver enzymes in the blood may develop high liver enzymes. These increased levels of liver enzymes are not normal and may cause transient or indicative medical conditions such as hepatitis or liver disease.

Different types of liver enzymes are listed below: 

• Alkaline Phosphatase (ALP)
• Alanine Transaminase (ALT)
• Aspartate Transaminase (AST) 
• Gamma-glutamyl Transferase (GGT)

There is a copious cause that elevates the liver enzymes in the blood. Let’s glance at a few of them. 

Also read: Top 10 Cod Liver Oil Benefits

Causes of Elevated Liver Enzymes – 

High liver enzymes often occur due to harmless health conditions. These conditions are readily treated or resolved on their own. Among the most prevalent Causes of High Liver Enzymes are: 

1. Pain Medications – 

Though taking acetaminophen for pain has little effect on the liver, taking too much can disrupt the function of the liver. People who drink alcohol regularly should avoid taking acetaminophen, which may cause an accumulation of toxic substances in the body.

It can lead to death also if severe liver damage occurs with pain medications. 

2. The statins Drugs – 

Statins drugs are used to decrease cholesterol which shows milder liver damage. Therefore, liver enzymes should be monitored if a person takes statin drugs. Do not abruptly stop your medications if you see your enzymes raised due to cholesterol medicine. 

3. Heart failure –

Many cases have shown low cardiac output has resulted in a reduction of hepatic flow. This leads to acute hepatic failure, which causes scarring of the liver. It develops the liver enzymes’ elevation in the body. When hepatic congestion occurs, that increases central venous pressure and raises liver enzymes. 

4. Hepatitis A –

Hepatitis A is a liver condition when a virus starts attacking the liver, which causes inflammation. This raised alanine aminotransferase and aspartate aminotransferase liver enzymes. Although it doesn’t affect in the long term, sudden functional loss of the liver results in the increase of enzymes in the bloodstream.  

5. Hepatitis B –

A person affected by hepatitis B might have a chance of liver cell damage from the virus. The inflammation of the liver results in scarring, which raises the liver enzymes and starts leaking into the bloodstream. This is due to the immune system starting to detect the virus and special cells fighting with them, which causes inflammation and high enzymes as a defense mechanism.

6. Hepatitis C –

Hepatitis C has also been shown to increase the viral load on the body and elevate the liver’s serum. Mainly, aminotransferase increased clinically. The cause of this is when parenchyma cells get damaged; alanine transferase starts leaking into the blood, which causes increased liver enzymes. 

7. Non-Alcoholic Fatty Liver Disease –

Excessive fat builds up in the liver, which causes damage to the liver cells. These diseases mainly occur in people who do not drink alcohol. It is also denoted by non-alcoholic steatohepatitis. The scarring of the liver means fibrosis is mostly in this type of disease condition. This is irreversible, making it impossible to bring back a healthy liver. ALT and AST are typically seen as elevated non-alcoholic fatty liver disease. 

8. Obesity –

This has been proven that the prevalence of increased liver enzymes is much higher in obese people with normal BMI. As obesity results in inflammation of liver diseases. Additionally, it also alters the metabolism that affects the liver.

9. Alcoholic Hepatitis –

Alcoholic hepatitis causes inflammation of the liver caused by heavy drinking. The alcohol starts producing a toxic substance that triggers liver damage. It leads to an increase in liver enzymes, mainly AST and ALT, causing cirrhosis over time, resulting in lifelong liver damage. 

10. Autoimmune Hepatitis –

Autoimmune hepatitis is related to chronic inflammatory conditions where liver transaminase is elevated in the presence of antibodies. Moreover, there is also an increase in gamma globulin levels. It is when a person’s immune system starts attacking viruses, bacteria, and other pathogens that cause chronic inflammation and severe liver dysfunction, which results in high liver enzymes.

11. Celiac Disease –

The liver enzymes should be checked regularly if a person is affected by celiac disease. This results in a high liver enzyme range which causes extraintestinal symptoms of celiac. However, it returns to normal when a person goes on a gluten-free diet. In addition, liver abnormalities are common if a person suffers from celiac disease. 

12. Cytomegalovirus –

The high liver enzyme is a characteristic feature of cytomegalovirus infection in humans. The cytomegalovirus inflamed the liver and caused high liver enzymes and liver failure. The associated organs also get affected by these conditions, such as the lungs, esophagus, stomach, brain, and sleep.

A few Additional causes of high Liver enzymes are –

• Sepsis
• Polymyositis
• Wilson’s Disease
• Thyroid

What are the high liver enzymes treatments?

You must consult a hepatologist(liver specialist) for immediate treatment if you are diagnosed with a high-level liver enzymes issue.  

High liver enzyme treatment options may vary depending on the causes of high levels of liver enzymes.  

Your doctor may recommend additional tests (Blood, liver function, etc.)and treatments to identify what is causing your increased liver enzymes.

How can you prevent elevated liver enzymes?

There are a couple of ways to decrease the level of enzymes in your body and make your liver healthier. 

• Reduce alcohol intake
• Consume more caffeine
• Taking an organic and natural diet
• Eat fruits and vegetables
• Increase intake of dietary fiber
• Exercise regularly
• Weight reduction
• Quit smoking
• Avoid medication unless prescribed 

Frequently Asked Questions –

Which liver enzymes indicate liver damage? 

The ALP shows the main liver enzymes, which indicate damage. The high ALP damaged hepatic function and may have also blocked the bile duct.  

What are the signs of fatty liver? 

There are a few signs that can indicate fatty liver are: Ascites, Enlarged spleen, Red palms, Yellowing of the skin and eyes.

Can stress cause High liver enzymes?

Yes, excessive stress & anxiety can cause high levels of liver enzymes. 

Outlook – 

Many diseases can severely damage the liver. However, it is crucial to have a health check of your liver function test from time to time. I have listed some causes which everyone should know. There are good doctors who you can visit if you get any abnormalities in your body. The liver is a crucial organ like the heart and brain. Therefore, it is mandatory to follow healthy routines to alleviate the critical liver enzyme value. The high liver enzyme can be resolved in an early stage which is why visiting a liver doctor or a hepatologist can be good for your good health. 

Hepatitis and elevated liver enzymes explained

July 28 is World Hepatitis Day, an occasion to raise awareness about the World Health Organization’s goal to eliminate hepatitis.

But first, we need to understand what triggers the condition. When a doctor uses the term “hepatitis,” it means that there is inflammation in the liver leading to an elevation in liver enzymes. Hepatitis ranges from limited, benign elevations to significant diseases that need to be evaluated and treated. Reshi Kanuru, MD, PPG – Gastroenterology, helps us better understand the disease and its causes.

alcohol and medications as the cause.
Most commonly, elevated liver enzymes are related to excessive alcohol use or the use of certain medications. While it’s likely that a few alcoholic drinks per week won’t cause an elevation in liver enzymes, the amount of alcohol that can cause liver damage varies from person to person. Alcohol consumption in any form can put a strain on the liver, and your doctor can help determine if it’s the cause of your hepatitis. Additionally, numerous medications, such as antibiotics, blood pressure medications, and cholesterol medications can also put a strain on the liver and cause elevations in the enzymes. The good news is that stopping the use of these medications, or stopping the consumption of alcohol, will allow the hepatitis to resolve over time and your enzymes will eventually return to normal.

viral hepatitis.
The next most common cause of liver enzyme elevations is viral hepatitis, such as hepatitis A, B, or C. Of these three types, hepatitis A, which is contracted through contaminated food, is the only one that does not cause long term liver injury. Hepatitis B and C can both lead to long term liver injury and eventually cirrhosis, which is severe scarring of the liver. Currently, hepatitis C is behind most needed liver transplants in the United States. Because hepatitis C is so common and can cause such severe damage, it’s recommended that anyone born between 1945 and 1965 be screened for the disease. It’s important to understand that both hepatitis B and C are treatable.

In the past, hepatitis C was difficult to treat and had poor cure rates partly because of medications that had many intolerable side effects. Recently, however, new medications for hepatitis C have been developed that have few side effects, and boast cure rates above 95 percent after a single course of treatment. Treating everyone for hepatitis C will prevent cirrhosis in millions of Americans and help to significantly reduce healthcare costs in the future.

fatty liver disease.
The epidemic of obesity and the availability of fried foods have led to dramatic health consequences.  Instances of both heart disease and fatty liver disease have been increasing over the last few decades, primarily because of our poor eating habits and overall weight gain.

Fatty liver disease is when fat deposits in the liver and leads to inflammation, which can cause an elevation in liver enzymes. Typically, fatty liver disease occurs in those dealing with obesity who may also have diabetes; however, the disease can also occur in thin individuals who may have genetics that predispose them to liver issues. It’s important to catch fatty liver disease as early as possible, not only because it will soon beat hepatitis C as the most common cause for liver transplantation in the United States, but also because fatty liver disease significantly increases the risk of death due to heart attack and stroke. It can lead to cirrhosis of the liver.

The treatment of fatty liver disease entails eating healthy and committing to 30 minutes of cardiovascular exercise every day with the goal of losing 10 percent of your body weight. Losing weight will cause the amount of fat deposited in the liver to significantly decrease and your risk of heart attack, stroke, and cirrhosis will greatly improve.

autoimmune hepatitis, PBC, PSC and other liver disorders.
Though most people will develop hepatitis related to alcohol, medications, fatty liver and viruses, there are many other diseases that cause elevations in liver enzymes.  Our immune system plays a large role in our health, but unfortunately, the immune system can also cause diseases.

Diseases like autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cholangitis are all autoimmune disorders that affect the liver. It is important to be evaluated for these diseases because they can cause severe liver injury. Beyond autoimmune issues, there are liver diseases that cause abnormal deposition of copper and iron in the liver.  These deposition diseases not only cause liver injury, but can cause damage to multiple organs throughout the body.

causes, symptoms, diagnosis and treatment

Gilbert’s syndrome is a common, harmless liver disease in which the liver does not process bilirubin properly. This is a hereditary genetic disorder. You may not know you have Gilbert’s syndrome until it is discovered by chance, such as when a blood test shows elevated levels of bilirubin. Gilbert’s syndrome does not require treatment.

What is bilirubin?

Definition

Bilirubin is a yellow substance found naturally in the blood. It is formed as a byproduct of the breakdown of old red blood cells. Usually, when red blood cells come to an end (after about 120 days), hemoglobin, the red pigment that carries oxygen in the blood, breaks down into bilirubin. Bilirubin travels through your bloodstream to your liver, where an enzyme breaks down the pigment and removes it from your bloodstream. Bilirubin is also found in bile, a digestive fluid produced by the liver that helps the body metabolize fat. Your liver is part of the digestive system. It filters toxins from the blood, digests fats, and stores glucose as glycogen to use as energy. The liver converts bilirubin to a water-soluble form, which is converted to bile (a fluid produced by the liver to aid digestion) and eventually excreted from the body.

Source: NHS

In Gilbert’s syndrome, bilirubin accumulates in the blood and is slightly higher than normal.

How common is Gilbert’s syndrome?

The modified gene that causes Gilbert’s syndrome is fairly common. Many people carry one copy of this gene. In most cases, Gilbert’s syndrome requires two modified copies to occur.

It is difficult to say exactly how many people are carriers because the syndrome does not always cause obvious symptoms.

3-7% White people

It is difficult to say exactly how many people are carriers because the syndrome does not always cause obvious symptoms. According to various estimates, from 3% to 7% of white people suffer from Gilbert’s syndrome. This type of liver disease is more common in men than women. It affects all ages, races and ethnic groups. Usually the syndrome is diagnosed in a person in late adolescence.

Who can have Gilbert’s syndrome?

Gilbert’s syndrome is genetic, which means that it is passed from parent to child through a change or mutation in the UGT1A1 gene. A healthy gene produces liver enzymes that break down bilirubin and remove it from the body.

UGT1A1

Description

This gene codes for UDP-glucuronosyltransferase, an enzyme in the glucuronidation pathway that converts small lipophilic molecules such as steroids, bilirubin, hormones, and drugs into water-soluble, excreted metabolites. This gene is part of a complex locus encoding several UDP-glucuronosyltransferases. The locus contains thirteen unique alternate first exons followed by four common exons. Four of the alternating first exons are considered pseudogenes. Each of the remaining nine 5′ exons can be spliced ​​to four common exons, resulting in nine proteins with different N-terminals and identical C-terminals. Each first exon encodes a substrate binding site and is regulated by its own promoter. The preferred substrate for this enzyme is bilirubin, although it also has moderate activity against simple phenols, flavones, and C18 steroids. Mutations in this gene result in Crigler-Najjar syndromes types I and II and Gilbert’s syndrome.

Source: RefSeq

When you have the modified gene, your blood contains an excess amount of bilirubin because your body does not produce enough of this enzyme.

Other than inheriting the defective gene, there are no known risk factors for developing Gilbert’s syndrome. It is not related to lifestyle habits, environmental factors, or serious liver problems such as cirrhosis or hepatitis C.

Symptoms of Gilbert’s syndrome

The most common symptom of Gilbert’s syndrome is an occasional yellowish tinge to the skin and whites of the eyes as a result of slightly higher levels of bilirubin in the blood. In people with Gilbert’s syndrome, bilirubin levels may be elevated due to:

Symptom triggers:

1. Illness such as a cold or flu
2. Fasting or very low calorie diet
3. Dehydration
4. Menstruation
5. Strenuous exercise
6. Stress

Most people with Gilbert’s syndrome have occasional and brief episodes of yellowing of the skin and whites of the eyes (jaundice). It is caused by the accumulation of bilirubin in the blood. Jaundice may be less noticeable if you have brown or black skin, but you may notice that the whites of your eyes look yellow.

Since Gilbert’s syndrome usually causes only a slight increase in bilirubin levels, yellowing in jaundice is often mild. The eyes are usually the most affected.

1 in 3

About 1 in 3 people with Gilbert’s syndrome have no symptoms at all. You may not realize you have Gilbert’s syndrome until tests are done for an unrelated problem.

Get tested

See a geneticist if you have had an attack of jaundice for the first time. Jaundice in Gilbert’s syndrome is usually mild, but jaundice may be associated with more serious liver problems such as cirrhosis or hepatitis C.

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If you have been diagnosed with Gilbert’s syndrome, you usually do not need to seek medical attention during an episode of jaundice unless you have additional or unusual symptoms.

Risk factors

Although Gilbert’s syndrome is present from birth, it is usually not noticed until puberty or later because bilirubin production increases during puberty. You are at increased risk of developing Gilbert’s syndrome if:

Factors

1. Both of your parents carry the modified gene that causes this disorder
2. you are a man
3. You have complications
4. You have low levels of the enzyme that converts bilirubin, which causes Gilbert’s syndrome

Diagnosis of Gilbert’s syndrome

Gilbert’s syndrome can be diagnosed with a blood test to measure the level of bilirubin in the blood, a liver function test, and a genetic test.

Bilirubin metabolism

When the liver is damaged, it releases enzymes into the blood. At the same time, the levels of proteins that the liver produces to keep the body healthy begin to decline. By measuring the levels of these enzymes and proteins, one can get a fairly accurate picture of how well the liver is functioning.

If your blood test results show that you have high levels of bilirubin in your blood, but your liver is otherwise functioning normally, we recommend that you have a genetic test to confirm the syndrome.

Living with Gilbert’s syndrome

Gilbert’s syndrome is a lifelong disease. But it does not require treatment because it does not pose a health risk and does not cause complications or an increased risk of liver disease. Episodes of jaundice and any associated symptoms are usually brief and eventually resolve.

Changing your diet or the amount of exercise you do will not change whether you have this disease. But it’s still important to make sure you’re eating a healthy, balanced diet and getting plenty of exercise. You may also find it helpful to avoid things that you know cause jaundice episodes, such as dehydration and stress.

If you have Gilbert’s syndrome, problems with your liver may also mean that you are at risk of developing jaundice or other side effects after taking certain medications, such as high cholesterol medications such as statins.

You should check with your doctor before taking any new medicine. Be sure to tell any doctor treating you for the first time that you have Gilbert’s syndrome.

Gilbert’s syndrome: symptoms, treatment, diagnosis

⁠Hereditary benign liver dysfunction, which leads to an increase in the level of free bilirubin in the blood, is called Gilbert’s syndrome. Many authors of scientific papers do not consider this pathology a disease, characterizing it as a constitutional feature transmitted by heredity. In varying degrees, it occurs in at least 3% of the population, and among the inhabitants of Africa, its prevalence reaches 10%. In men, Gilbert’s syndrome occurs several times more often than in women – according to various estimates, from three to seven times.

General

The main external sign of Gilbert’s syndrome is the characteristic yellowing of the skin, ocular sclera and mucous membranes of the oral cavity. Pathology does not cause structural changes in the liver tissues and is periodic. As a rule, metabolic defects do not manifest themselves before reaching adolescence and are discovered by chance, during an examination conducted for another reason.

A congenital inherited pathology is a decrease in the production of the enzyme glucuronyl transferase in the liver tissues, due to which a certain amount of unbound bilirubin, a breakdown product of hemoglobin, remains in the blood. Exacerbation is usually due to:

• viral or bacterial infection with fever;
• injury or surgery;
• in women – the onset of menstruation;
• violations of the recommended diet, eating foods that create an additional burden on the liver;
• malnutrition or starvation;
• excessive sun exposure;
• lack of sleep;
• severe fluid loss;
• high physical or psychological stress, stress;
• taking certain medications, which include some antibiotics, hormonal drugs, caffeine, etc. ;
• alcohol intoxication.

A distinction is made between the congenital form of Gilbert’s syndrome, which is caused by a defect in the gene of the second chromosome, and the acquired form, which develops after acute hepatitis of viral etiology.

In general, the disease proceeds without serious complications and with a favorable prognosis, although it is accompanied by a decrease in the detoxification function of the liver.

Manifestations of pathology

The latent course is typical for about a third of all cases of the disease. Most often, pathology is detected between the ages of 13 and 30 during an examination conducted for another reason – for example, during a medical examination of young men of military age. With exacerbations of Gilbert’s syndrome, the symptoms depend on the form of the pathology:

• with dyspepsia – with nausea, heartburn, flatulence, metallic taste in the mouth and pain in the right hypochondrium;
• with asthenovegetative – with weakness, headaches, increased sweating, palpitations, sleep disturbances, anxiety, muscle pain;
• with icteric – with a bright icteric coloration of the skin and sclera without changing the color of the discharge;
• with latent – with no external manifestations.

In some patients, there are disorders of the emotional sphere – depressive states, irritability, causeless fears and panic attacks, and in some cases, the tendency to acts of an asocial nature increases. Doctors explain these disorders by self-hypnosis associated with mental stress due to the need to visit doctors, take tests and undergo examinations.

How disease is determined

The most important methods for diagnosing Gilbert’s syndrome are laboratory tests, including:

• general blood and urine tests – increased number of immature erythrocytes and slightly reduced hemoglobin in the blood, bilirubin may be present in the urine;
• biochemical blood test – sugar level may be slightly reduced, protein content is within normal limits, ALT and AST are within normal limits, a negative thymol test result;
• blood test for bilirubin – the total content is increased due to the growth of indirect bilirubin;
• blood clotting test – no deviations;
• analysis for markers of viral hepatitis – negative.
• Serum iron tests and other tests related to blood iron are possible.

In addition, the patient is required to undergo an ultrasound of the liver in order to exclude the possibility of other hepatic pathologies. The size of the liver may increase slightly during periods of exacerbations. Molecular genetic analysis of venous blood is rarely performed due to its high cost, but it allows you to identify defective DNA, which is the cause of Gilbert’s syndrome.

To confirm the diagnosis, stress tests are performed:

• with fasting – with complete starvation or with calorie restriction, the level of free bilirubin increases by 2-3 times;
• with phenobarbital – after a five-day intake, the level of free bilirubin decreases;
• with nicotinic acid – intravenous injection of the drug increases the level of free bilirubin by 2-3 times;
• with rifampicin – the introduction of the drug leads to an increase in the amount of bilirubin.

To exclude chronic hepatitis or cirrhosis, a liver puncture may be prescribed.

How to lower bilirubin?

Since the pathology does not lead to a sharp deterioration in the patient’s condition, the treatment of Gilbert’s syndrome usually comes down to the formation of a lifestyle in which the risk of exacerbation and an increase in the level of bilirubin will be minimized. To do this, the patient should avoid:

• excessive physical activity – sports, heavy physical labor;
• starvation and lack of fluids;
• prolonged sun exposure;
• drinking alcohol;
• taking drugs with toxic side effects on the liver.

Of paramount importance is a special diet for Gilbert’s syndrome, which must be followed throughout life, but most carefully during periods of exacerbations. The diet should be dominated by cereals, mainly buckwheat and oatmeal, vegetable dishes, low-fat or low-fat dairy products, lean meats, poultry and fish. It is advisable to exclude sweets, pastries, chocolate, fatty and spicy dishes from the menu. Portions should be small, the intervals between meals should be reduced.

During exacerbations, courses of vitamin B6 and digestive enzymes may be prescribed, as well as short courses of phenobarbital, a substance that binds free bilirubin.

Frequently Asked Questions

What is the danger of Gilbert’s syndrome?

By itself, Gilbert’s syndrome does not pose a danger to health and well-being. However, with an increase in the level of free bilirubin, bile secretion may gradually decrease, cholelithiasis, cholecystitis or duodenitis may develop.

Why is it impossible to sunbathe with Gilbert’s syndrome?

Due to the negative effect of solar ultraviolet radiation on liver function, sunbathing with Gilbert’s syndrome is undesirable either in the open sun or in a solarium. There is no direct prohibition, but prolonged insolation can activate an increase in unbound bilirubin.