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The liver is the body's primary detoxifier, converting one compound to another. Liver enzymes are proteins that speed up chemical reactions in the body. Elevated liver enzymes may be caused by liver disease, medication, or muscle damage. Intense exercise can cause muscle fibres to tear, resulting in the release of enzymes and potentially leading to elevated liver enzymes. Certain medications, such as cholesterol-lowering drugs, can also cause elevated liver enzymes. Factors such as alcohol consumption, unhealthy lifestyles, and specific medications can cause GGT levels to rise, indicating general liver health issues. Elevated liver enzymes may be temporary, but they can also be a sign of a medical condition like hepatitis or liver disease.
| Characteristics | Values |
|---|---|
| Types of exercise that cause muscle damage | Resistance training, ultra-endurance events with elevation changes, weightlifting |
| Susceptible sports | Trail running, road cycling, mountain biking |
| Muscle enzymes | Creatine kinase (CK), alanine transaminase (ALT), aspartate transaminase (AST) |
| Liver enzymes | ALT, AST, GGT (Gamma-glutamyl transpeptidase) |
| Liver function tests | Liver function test (LFT), liver panel, blood test |
| Liver disease symptoms | Abdominal pain, dark urine, fatigue, jaundice, light-colored stools, loss of appetite, nausea, vomiting |
| Medications causing elevated liver enzymes | Riluzole, methotrexate, statins, acetaminophen, herbal and vitamin supplements |
| Liver diseases | Fatty liver disease, hepatitis, hemochromatosis, celiac disease, cirrhosis, metabolic syndrome |
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What You'll Learn
Intense exercise and muscle damage
The liver is the body's primary site for compound conversion and detoxification. Liver enzymes are proteins that catalyse chemical reactions in the body. Elevated liver enzymes may indicate liver damage, but they can also be temporary. Intense exercise can cause elevated liver enzymes due to muscle damage. When you push yourself hard during a workout, your muscle fibres can experience microscopic tears, causing them to release enzymes. This is particularly common in resistance training and ultra-endurance sports, such as trail running and cycling.
Creatine kinase (CK), an enzyme found in muscles, is a marker of muscle damage. After strenuous exercise, CK levels can rise, along with aspartate transaminase (AST) and alanine transaminase (ALT). ALT is found in the liver, heart, muscles, and kidneys, while AST is present in a broader range of organs, including the liver, heart, muscles, kidneys, brain, pancreas, spleen, and lungs.
Elevated levels of these enzymes can be misleading. Doctors must determine whether the source of the elevated enzymes is the liver or the muscles. GGT (gamma-glutamyl transpeptidase) is an enzyme found in the liver but not in muscles. Elevated GGT levels are typically not linked to muscle damage from exercise and are more indicative of general liver health. If GGT levels are normal, it suggests that the liver is not the source of the elevated enzymes. However, if GGT levels are high, it indicates potential liver injury.
In some cases, both the liver and muscles may be affected. Additional enzyme tests can help differentiate between liver and muscle damage. For example, a normal CK level with elevated ALT and AST enzymes suggests a potential liver problem, whereas high CK levels along with high ALT and AST levels indicate muscle involvement.
It is important to note that elevated enzyme levels due to muscle damage are typically not harmful in themselves. However, they can be alarming and may require further investigation to determine the underlying cause.
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ALT and AST levels
ALT and AST are enzymes that are usually found in the liver, heart, muscles, and kidneys. ALT stands for alanine transaminase, while AST stands for aspartate aminotransferase or aspartate transaminase. ALT and AST levels are often measured through blood tests, which are sometimes ordered as part of a routine checkup or to monitor the treatment of a liver problem.
High levels of ALT and AST in the blood may indicate liver damage. When the liver is damaged, it releases these enzymes into the bloodstream. However, ALT and AST can also be released into the blood when muscles are damaged. Intense exercise or muscle conditions can cause muscle fibres to tear slightly, leading to elevated levels of these enzymes.
If you have elevated ALT and AST levels, your doctor may perform additional tests to determine whether the enzymes are coming from your liver or your muscles. A normal level of GGT, an enzyme found in the liver but not in muscles, can indicate that the ALT and AST are coming from the muscles. On the other hand, high levels of CK (creatine kinase), an enzyme found in the heart, skeletal muscles, and brain, in combination with elevated ALT and AST, suggest that something is happening in the muscles.
It is important to note that elevated ALT and AST levels do not always indicate a medical condition requiring treatment. Factors such as pregnancy, exercise, certain medications, age, and sex can affect enzyme levels.
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CK levels
Creatine kinase (CK), also called creatine phosphokinase (CPK), is an enzyme found in the heart, skeletal muscles, and brain. CK is a marker of muscle damage and can be specifically measured when a doctor suspects a muscle problem. CK levels can be elevated due to strenuous exercise, causing muscle fibers to tear and release enzymes. This can lead to a false indication of liver damage, as elevated CK levels can be associated with both muscle and liver issues.
To differentiate between muscle and liver CK elevation, doctors may perform additional enzyme tests. A normal CK level with elevated ALT and AST enzymes suggests a liver problem, while high CK levels accompanied by high ALT and AST levels indicate muscle involvement. The CK/ALT ratio is also significant, as a higher ratio has been associated with lower mortality in patients with rhabdomyolysis.
In summary, CK levels are markers of muscle damage and can be elevated due to strenuous exercise or muscle disorders. Elevated CK levels can be indicative of muscle or liver issues, and additional enzyme tests are often necessary to determine the source of the elevation. CK levels play a crucial role in assessing muscle health and can provide valuable insights into potential liver involvement.
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GGT levels
GGT, or gamma-glutamyl transferase, is an enzyme found in high levels in the liver, kidney, pancreas, heart, and brain. It is also found in lesser amounts in other tissues. GGT levels are a more specific indicator of general liver health. Unlike AST and ALT, GGT is not found in muscle tissue. Therefore, elevated GGT levels in blood tests are typically not linked to muscle damage from regular exercise routines.
Elevated GGT levels in the blood are usually indicative of liver damage or disease. GGT is usually the first liver enzyme to rise in the blood when any of the bile ducts that carry bile from the liver to the intestine become obstructed, for example, by tumors or stones. This makes GGT the most sensitive liver enzyme test for detecting bile duct problems. However, it is not very specific or useful in differentiating between various causes of liver damage. It can be elevated with many types of liver diseases, such as liver cancer and viral hepatitis, as well as other non-hepatic conditions, such as acute coronary syndrome.
GGT testing uses a sample of blood to test for elevated GGT levels. A GGT test is usually ordered in conjunction with or as a follow-up to other liver tests such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), ALP, and bilirubin. While both GGT and ALP may be elevated in liver diseases, only ALP will be elevated in bone disease. Therefore, GGT can be used as a follow-up to an elevated ALP to help determine if the result is due to liver or bone disease.
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Medication and liver damage
Medication can cause elevated liver enzymes and liver damage, known as drug-induced liver injury (DILI). DILI is a side effect of taking certain medications. The liver breaks down medicines, usually stopping them from continuing to work and helping to remove them from the body. However, sometimes parts of the medicine will still be active after being broken down, or they can change into a more harmful form, which can build up in the liver and cause damage.
DILI is more common in females, although it is not known exactly why. People who already have another liver condition may have an increased risk of DILI. Being overweight can put a strain on the liver and lead to a liver condition called NAFLD. There is some evidence that obesity and diabetes could also increase the risk of DILI.
The most common medication that can damage the liver is acetaminophen (also known as Tylenol), which is widely available without a prescription and is present in many cold and flu remedies, as well as in prescribed pain medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac, and naproxen, may also cause DILI. People who drink alcohol regularly are at a higher risk of developing severe liver damage from acetaminophen, as alcohol use leads to the accumulation of a toxic byproduct of acetaminophen in the liver that can kill liver cells.
Other medications that can cause liver damage include cholesterol-lowering drugs (statins), herbal supplements such as comfrey tea, and vitamin supplements like vitamin A. The medications riluzole, used to treat amyotrophic lateral sclerosis, and methotrexate, used to treat inflammatory myopathies and myasthenia gravis, are also among the many drugs with liver-damaging potential.
If you have symptoms of DILI, you will probably have blood tests to check your liver function. Liver enzyme levels will be high if you have the condition. You may also have an ultrasound scan, which uses sound waves to make a picture of your liver to help doctors see any possible damage. If you have taken a high dose of acetaminophen, you should seek treatment in an emergency department or acute treatment setting as soon as possible, as there is an antidote for acetaminophen poisoning. In most cases, DILI goes away within days or weeks after you stop taking the drug that caused it.
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Frequently asked questions
Liver enzymes are proteins that speed up chemical reactions in the body.
Elevated liver enzymes can be caused by liver disease, medication, strenuous exercise, or muscle damage.
Symptoms of elevated liver enzymes include abdominal pain, dark urine, fatigue, jaundice, light-coloured stools, loss of appetite, and nausea or vomiting. However, most people with elevated liver enzymes do not experience any symptoms.
You should consult a healthcare professional, who may perform a liver function test (LFT) or liver panel to check your liver enzyme levels.
